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Joined: 14 Dec 2010
Posts: 50
Posted: Mon Aug 22, 2011 11:11 pm
Post subject:
Cowboy Trouble
by Joanne Kennedy. AWFUL. Questionable plot; ill defined characters; amateurish writing. All her good stars seem to come from her fellow writer's club members. There can't be too many members in Cheyenne, Wyoming without them being your friends as well.
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Joined: 22 Mar 2007
Posts: 1175
Location: Elsewhere
Posted: Tue Aug 23, 2011 1:08 am
Post subject:
JamiSings wrote:
I only saw a couple of the latter episodes, admittedly, but she was too tough. Only Buffy I like is the whiny cheerleader from the comedy movie version.
I can't stand the movie version; Buffy is just ridiculous in it. The later seasons did have a darker vibe and a tougher Buffy, which is understandable considering all that the character goes through.
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Joined: 08 Nov 2009
Posts: 202
Location: United States
Posted: Tue Aug 23, 2011 8:15 am
Post subject:
I forget the name of this book. I still have in a storage bin.
Anyway, it was a harlequin presents from the early 80's. The first three chapters gave me the ideal the herione was Mirianne. The chapters, while not in first person, described Miranne's observations of her cousin, Caro, and Miranne's feelings. I honestly thought Miranne was the herione.
Sometime in the first 3 chapters, Miranne and Caro meet two cousins. Earlier, Caro said all she needed was a rich man. Caro's family was going to loose their home if they didn't get some money fast.
From the first 3 chapters, I thought Miranne was the herione, and the book was going to be about Mirannan's romance with one of the cousins. Then the book shifted to Caro. I wish I had the notes I made on this book. It was so bad. I had no sympathy for Caro. I hated her. I saw her as scheming and basically taking away Miranne's only chance at happiness. Miranne had fallen in love with the 'hero' and Caro knew. But yet, when Miranne went away for teachers conference, Caro sneaks into her room and 'borrows' some of Miranne's perfume to impress the hero. The whole time Miranne is away, Caro tries to make the hero more interested in her. Caro has also been portrayed as not very responsible.
The last page is Miranne's inner thoughts. Miranne has decided to go away to France. She thinks what a 'good' aunt she'll be to Caro and the hero's children. Ugh.
I hated that book.
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Joined: 28 Dec 2010
Posts: 94
Location: Costa Mesa, CA
Posted: Tue Aug 23, 2011 3:53 pm
Post subject:
Yulie wrote:
JamiSings wrote:
I only saw a couple of the latter episodes, admittedly, but she was too tough. Only Buffy I like is the whiny cheerleader from the comedy movie version.
I can't stand the movie version; Buffy is just ridiculous in it. The later seasons did have a darker vibe and a tougher Buffy, which is understandable considering all that the character goes through.
Well, I prefer the movie version to the tv version. To each their own.
In the meantime does anyone know the name of the worse romance novel I ever read?
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Joined: 26 Jan 2009
Posts: 812
Posted: Wed Aug 24, 2011 5:53 am
Post subject:
Yulie wrote:
Also, I loved Spike, who may be love's bitch but is man enough to admit it. I just wanted to add that.
This cannot be said enough.
I nominate any book that features rape cream as a prop.
I just read To Love a Princess by Patricia Grasso after seeing it mentioned here and thought it was pretty pitiful. The plot is crazy over the top (and I can be really forgiving of this if a book has other things going for it.) The hero was a self-pitying mope and the heroine was one of those fey, too good beautiful and forgiving to be true types. It was all tell and no show and quite repetitive with the added detraction of ridiculous and too convenient plot devices. As just one example the heroine is hurt because the hero has three former mistresses who somehow without consulting each other all write to the hero and then come to see him on the same day in one hour increments like ghosts of harlots past, present and future. There was lots more like this but it's quickly fading from my memory and I'm not willing to revisit it to make this post more complete. I can't believe it got 4 stars on Amazon.
Justin managed to look superior and bored and disbelieving all at once. No mean feat for a man who'd just fallen from a tree.
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Susanna Kearsley
Joined: 03 Nov 2008
Posts: 87
Location: Canada
Posted: Wed Aug 24, 2011 11:26 am
Post subject:
JamiSings wrote:
In the meantime does anyone know the name of the worse romance novel I ever read?
It wasn't
, by Fern Michaels, by any chance? That takes place in Russia, and the heroine gets raped right at the beginning by the hero, who's a Mongol prince...
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Vol Fan
Joined: 30 Dec 2008
Posts: 309
Location: Tennessee
Posted: Wed Aug 24, 2011 11:44 am
Post subject:
I can't add too much to this thread, because I won't finish a book if it's bad. However, I can add a couple.
"He's No Prince" by LuAnn McLane. Occasional pratfalls and silliness can be funny. Over and over and over, it becomes stupid. This book was filled with stupid scenes and silliness, repeating the same format again and again a few pages later, plus dreadfully boring characters too. I was totally unimpressed with her previous book "Redneck Cinderella" also. But as I had really enjoyed her earlier books, and hoping that RC was a fluke, I decided to give her the benefit of the doubt, hoping she would return to form so I read "He's No Prince". "Prince" was the worst I've read and finished anyway.
I read the "Twilight" books too and while I didn't think they were the worst, they certainly were the worst in examples for teenage girls. Could Bella have been anymore dependant? I thought the fact she had no life or existance without Edward was sick.
Last edited by Vol Fan on Wed Aug 24, 2011 11:49 am; edited 1 time in total
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Joined: 28 Dec 2010
Posts: 94
Location: Costa Mesa, CA
Posted: Wed Aug 24, 2011 11:45 am
Post subject:
Susanna Kearsley wrote:
JamiSings wrote:
In the meantime does anyone know the name of the worse romance novel I ever read?
It wasn't
, by Fern Michaels, by any chance? That takes place in Russia, and the heroine gets raped right at the beginning by the hero, who's a Mongol prince...
Yep, that's it! After googling I finally found a picture of the cover. Truly awful book.
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Susanna Kearsley
Joined: 03 Nov 2008
Posts: 87
Location: Canada
Posted: Wed Aug 24, 2011 12:05 pm
Post subject:
JamiSings wrote:
Yep, that's it!
Glad to be of service...I think...
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Joined: 20 Aug 2007
Posts: 11
Location: New Jersey
Posted: Wed Aug 24, 2011 11:02 pm
Post subject:
Almost Perfect by Susan Mallery
The so called hero was the pride and joy and family member of the the town's founding family.
The heroine was from the wrong side of the track, while in high school the H convinces the h to date him in secret, she worked at the diner where all the kids hung out and he would come in with the in crowd and ignore her while there.
She gets pregnant by him and goes to tell him and finds him in bed with the "beauty queen" she leaves town, writes to him telling him she is pregnant by this time the hero has married the 'beauty queen" because she was pregnant and she intercepts the letter reads it and sends a reply stating that he wants nothing to do with the kid or her.
When she does come back to town because her brother is in jail and she needs to care for her nieces the hero finds out, the heroine thought he knew and was finally coming to see his son, when he does finds out he is livid and blames the heroine.
She shows him the letter in which his now dead wife was the author of and he still blames her and threatens to take his son from her.
His mother (what a bitch) encourages him on his quest to sue for custody, oh yeah the heroine is a quite famous author now, while he just owns and runs the family business.
All the town folks stare daggers at the heroine and makes snarky comments to her about keeping the hero's son away from him.
Both the h and H were unlikeable, nothing about that story screamed of a happy ending.
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Lea Hensley
Site Admin
Joined: 11 Apr 2007
Posts: 417
Location: Oklahoma
Posted: Wed Aug 24, 2011 11:34 pm
Post subject:
Due to the number of posts within this thread, it's time to close this one and start another. If you want to keep the discussion going, please start a new thread. Anyone can start the thread.
Once the new thread is started, this thread will be locked to new posts but will still be available for viewing.
Lea Hensley
Audiobooks Bookshelf at Goodreads
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Joined: 27 Oct 2011
Posts: 3
Posted: Fri Oct 28, 2011 8:27 am
Post subject:
Hi I'm new and I hope you dont mind me jumping into this great thread.
Ok the worst books I have read? Well they arent as bad as some of the ones you people have posted about, but given that they were from best selling authors, they should have been better!
Ok first one that comes to mind. Lacy by Nora Hess: I read this a long time ago.
Utter crap! Set somewhere in the west I think. Girl (Lacy)lives selling snake oil with her old father. Father dies and of course girl is alone. I cant think of the Heros name at all, it could have been Colt, or Buck, or Blaze, or something of the kind. Anywho, he comes upon the girl and thinks Ohhh a whore, Ill marry her to piss off my old man. <~~~~ not sure where the logic was in this.
So Lacy agrees because she doesnt want to be alone. After a rape for a wedding night he takes her and drops her off at some dead guys farm. Leaves her there for months only going to see her so that he can lift her skirt a few times. All the while he is seeing another woman on the side.
So then somehow he moves her in with him. His girl on the side starts sleeping with his dad and then he drops her. Lacy of corse is prego so now everything is ok with her husband because he loves her now?
It ended with the dad and the side girl being trampled by cattle in the end.
It just never got around to a plot at all. It was just tacked together.
To tell the truth Im shocked no one else has posted about Nora Hess. Maybe you all were just old enough to know a bad book when you seen one?
The next I want to talk about was a Diana Palmer book. Now I have to say as far as an easy read I like her books. I cut my teeth on her books. And in a way they are comfortable for me to read.
But even I have to say she has not wrote anything in the last 10 years worth reading.
One book by her is, True Colors.
This book had some good makings. This girl was taken advantage buy incredibly sexy and more experienced guy. She is engaged to the guy but his meddling mother with only a few lies gets him to believe the girl is a thief and sleeping with another guy. So he quickly drops the girl not knowing she is with child. The girl runs to NY where she is hit by a car and the owner (Henry) is a very nice, handsome, wealthy guy, who loves her on sight. Takes her home, takes care of her every need, and marries her. He doesnt ask her anything in return. He even puts her through school and treats her kid like his own. She says at that time that she fell in love with him. And how much she grew up and became an independent woman
But Henry dies in a crash and so she takes over his huge business. She then decides to take over the business of her boys father as a way to get revenge. But as soon as she sees him she loses all spine and ohhh suddenly she is in bed again with him. Then he finds out about the boy and wants to make amends.
In short the guy never really owned up to the fact that he had been a huge ass. Though he did admit that he got engaged to her just to sleep with her. As if that would win him any brownie points in my BOOK! She then while they were having sex told him Ohhh you are my only love. WTH about Henry?! She had clearly said that she loved him while he was with her. So she only loves the guy she is having sex with?
The book made me so mad because in my mind it could have been so much better to show that the nice guy is a better choice by far! Who needs a jerk when you can have a guy who loves you no matter what. And one that helps you better yourself.
In real life this girl would have been so over the daddy of her baby she wouldnt have even given him the time of day.
I have more but thats all for now.
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Lea Hensley
Site Admin
Joined: 11 Apr 2007
Posts: 417
Location: Oklahoma
Posted: Fri Oct 28, 2011 9:07 am
Post subject:
It looks like I didn't lock this thread as planned.
I wanted others to have the opportunity to respond to CryingRaven. I'll be locking it in a few days. In the meantime, can someone else start a new thread on this subject if you want the discussion to continue?
Lea Hensley
Audiobooks Bookshelf at Goodreads
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Joined: 07 May 2012
Posts: 6
Posted: Tue May 08, 2012 8:14 pm
Post subject: Re: Worsr romances I've read
styles31 wrote:
As someone who was born in the late 70's, I must confess on not having read many of the romances that were published in the 80's. (Judging from some of your comments, it sounds like I didn't miss much)
Anyway, some of the books that stand out in my mind as books that I will NEVER read again are:
"A Knight in Shining Armor" by Jude Deveraux. I hated, hated, HATED the ending except for the part where the heroine finally stands up for herself. Also, I found her constant weepiness to be a bit annoying.
"To love again" by Beatrice Small. I liked the time period and the main characters were decent. I couldn't handle the graphic love scenes, though, and the one where she had just had a baby and was still nursing when the villian shuts her up in a tower or something and drinks some of her breast milk.
THAT pretty much killed it for me right then and there.
"Devil's Embrace" by Catherine Coulter.I was curious about it, so I decided to read the reissue version in Borders. I am very glad I didn't buy it as I thought the hero was a jerk and I could NOT get past the infamous gang-rape scene, and then her losing her baby b/c of it. That scene alone burned in my memory for many days afterward.
"Ride the fire" by Pamela Clare. At first, I really liked it and liked Nicholas, the hero of the story. But, then I read it again several months later, and while I still like Nicholas, I now think that it is a book that is pretty dark and depressing in many places; a little TOO dark and depressing for me.
"Delacey's Angel" by Monique Ellis. Too many secondary characters, including the hero's best friend who had a major chip on his shoulder and a nasty attitude to go with it. I could never figure out what was up with him. And too many big words in it. I spent so much time tying to understand what she was trying to say that it pretty much killed it for me.
I adore A knight in shining armor... it's my first Romance novel ever, this book got me hooked on romance novels.
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Joined: 02 Apr 2010
Posts: 63
Location: Germany
Posted: Wed May 09, 2012 12:20 pm
Post subject:
I think I would name Christina Dodd´s "Rules of Surrender" as worst romance novel.
I liked the premise and the first pages were quite wonderful, but I have never, never disliked a romance "hero" as much as the guy in that novel. He bullies the heroine, is arrogant and a total jerk. He also tells her what´s right for her and what she likes and there is also the issue of forced seduction. I remember how appalled I was that this was considered to be "romantic". The worst thing was that it put me in a historical romance funk for a long time.
I think I read a couple of books that were worse written and had a sillier plot, but I doubt I´ve ever been so angry with a hero (and the heroine for sticking with such a jerk)
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How to Stop Nuclear Terror
Journal Article, Foreign Affairs, volume vol. 83, issue no. 1
January/February 2004
Author: Graham Allison, Director, Belfer Center for Science and International Affairs, Harvard Kennedy School
For more information about this publication please contact the Belfer Center at 617-495-1400.
Full text of this publication is available at:
For Academic Citation:

subset: commoncrawl


text:
Does Quad core make use of the threading option?
Does Quad core make use of the threading option?
Yes it does mate. It's been spoke about on here before, I've seen PaulC and another SI member confirm this.
ok cheers, that is good news
Well, so they say, but i'm not sure. It might make use of it, but it's not very effective in that case. Well, for me that is
Q6700 OC'd to 3,4GHz (normally 2.66GHz, which i have been playing with)
GeForce GTX 260 896MB
Home Premium
It goes kinda slow here, compared to FM2008 on a worse computer. And that was a dual-core.
what is threading?
http://en.wikipedia.org/wiki/Thread_(computer_science)#Multithreading:_Advantag es.2FUses
the lates test i did was run 10 nations' with top 2 divisions so thats 20 leagues etc. running in holiday mode it took 2hrs 10 mins to complete 1 year exactly, thats 2.5 minutes per week on average..
i don't really want to overlclock any higher and am trying to find the fastest setting's for my own requirments really
Yeah, i know Wayne. I was expecting it to fly with that kind of setup.
I don't know why, but it just seems to fly for a while, then it slows down. Then i get the UI lag and everything. Haven't really figured it out.
It's not like i expect it to fly 1 week in 5 seconds when i click continue, but you know when you have that feeling that something is off?
I normally don't have much running either. Normally FM is the only application running (apart from important services), apart from now
Could you pm your in-game settings and which leagues you are running? Would like to take that test myself, with everything being exactly the same as yours - in the game that is
I did follow a few advice on the forums, and it seemed to help a little bit, but i was a bit surprised when i turned off Aero. The game started to stutter. When i turned Aero back on the game was fine.
i'm using large data base with the threading option ticked..
Nations, Argentina top division, Brazil top division, English top 4 divisions, Italian top 2 divisions, Holland top 2 divisions, France top 2 divisions, spain top 2 divisions, scotland top 2 divisions, german top 2 divisions and portugal top 2 divisions
I set my choosen club to forest, i dont change any detail level, soon as i chose my club i just set the holiday option and click july 15th 2009 and then leave it to run, while running i dont do any thing else on pc.
Alright. Will try to do that. Won't happen today though, but probably within this week. Will let you know how long it takes.
Thanks Wayne\'o
I just have a feeling that the game can go faster on my system, i just can't get the grasp on what can be changed
obviously if it's not that quick, then we just need to take alook at other programs that may be slowing your pc down, i do run virus checks alot to keep my system clean.
Do you know the game date when it starts slowing down? It could be The Winter Freeze
Game date is random. First time i was playing the game it started already in August-September, and then the computer was brand new. But there's no specific date or period.
Sometimes it's fast, sometimes it's slow. I'm not considering the match-day lag or the job search screen lag.
I did a few tweaks to my computer, and it has become more stable, but not necessarily faster; or, as fast as it feels like it could go. It did help with the 9.2.0 patch, but still some "problems"
There is a thread in the bugs-forum, i think, that was started by Wakers. My final post there (again, i think ) i just figured i'll wait for 9.3.0 and see what happens.
But the interesting things i found out was that if i don't have Aero activated i will suffer from the game stuttering.
Also the game is actually more stable (smoother when processing between fixtures) when i run more applications at the same time. That doesn't make it go any faster, but it runs smoother.
I've also, recently, turned off the processor idle powersaving setting to see if that helps. Time will tell.
But i will come back with it after i try the test. If you look at my posts (somewhere), then i will have a dxdiag report in one of them, if that would help you at all. You probably know how to read that one better than me
just to let you know rokela, im only running vista basic, and i have turned off unwanted programs running, when desiding on what i use my pc for, i didnt see the need to buy any better than basic because it had what i need and i thought it would leave more memory for FM...
I think unticking my threading option did make my processing seem slower.
I'll keep that in mind Wayne. I've disabled services i don't need as a well, and turned off unwanted programs running too. They didn't have basic as an option when i ordered my computer. What a bummer
I tried unticking threading once and that really slowed it down.
TheRealMagpies - I know i have an Intel X38 Express chipset, but after that i'm stuck. I simply just don't understand that language. But i've seen someone else mention the same thing - not that it really tells me much. I definitely help to understand that one. I know your post was to Wayne, but i couldn't help butting in. Sorry :o
i ordered the hardware for my pc and built it my self, kinda wish i had spend a bit extra and got 64 bit and a tad better processor..
i guess my next challenge will be to build an ip7 as soon as i built mine i now feel it;s out of date already lol..
i wonder if Si get commision on pc hardware, so many people have updated or bought a new pc just to run FM2009.. playing the game long term with only limited leagues makes my experiance poor, i like to see alot of international teams keep full squads and have alot more player nationality's to choose from.
At it's simplest (but not totally accurate)
Think roads ..
1 thread = 1 lane, so you only have 1 lot of traffic
so with 1 core with 1 thread you have a single lane 'b' road
1 core with 2-4 threads means you have an 'a' road through to a motorway
1 core = a cpu
2/4 cores means 2-4 cpu's welded together as 1 chip
An "Intel's X38 chipset" is just a collective term for a large list of motherboard hardware and will be similar in nature to other chipsets by Intel/VIA etc.
Wayno\'0 I'm pretty sure "threading" can only be ticked/unticked if your PC has multiple cpu's anyway and is detected by the game, leave it ticked for improved performance. (you can check in Windows task Manager on the performance tab - CPU Usage History there will be 1-4 graphs on the top-right section)
yeh took a look at the task manager, i have 4 windows with the output moving up and down
as the game runs on holiday the CPU usgae % indicator moves up and down, havnt seen it raise above 54% yet


text:
How was your hallmark holiday everyone?
How was your hallmark holiday everyone?
Well, I open my eyes and I see things. I've seen spirits moving through the walls. I've seen a vortex coming through the wall. I've seen amorphous little balls of light bouncing all around in the front yard through the window. I've seen giant bugs on the floor. I was in a hotel room in Amarillo, Texas, and all I remember is standing on the bed and seeing the whole wall in front of me filled with lights that were [makes popping sound] popping like popcorn out of the wall. Then I'll wake up and I go "Wow, I was standing on my bed and staring at this wall."
Same. But I also have been diagnosed with Bipolar, Anxiety, OCD, and heart issues.
I had dinner at some French wine bar and got a massage then smoked. It was nice.
Okay. I've been pondering what's happened to me today and where I'm going to go with it. After the appointment, it took me a while to even remember why I had bothered to get a professional opinion in the first place, because I was never going to take anti-depressants (even if they were prescribed to be); I'd be terrified of the general potential side-effects; having my creativity impaired; having my personality altered or just (as I've seen happen to some friends of mine struggling with depression) becoming a zombie.
I suppose it was two reasons. One, I needed closure for my erratic behaviour over the last eighteen months. A lot if if is conveniently explained by a serotonin deficiency, which is a much better hypothesis for acting out socially than just me losing it completely (although to be fair I'm pretty sure I had a nervous breakdown midway through 2013). The diagnosis feels a lot more surprising than I think it should, considering I sort of already knew I suffered from depression. The only good thing that's come from this in the immediate aftershock is the second reason: my novel. I mentioned in the other thread that it deals with social isolationism in the advent of the technological age, which is true, but it also touches on the world as viewed by one of its depressed inhabitants... who doesn't know he's depressed. The problem with the story was it ended on its tenth chapter with no real resolution, a rather French ending. I love those types of tales, but I don't think an approach like this would do it justice. Truth be told, I simply hadn't lived long enough to write the eleventh, final chapter. I know how the novel ends now.
I'm dealing with another social crisis. Namely who I should tell I have depression. My best friends - the ones who had to look after me during my worst moments - probably deserve to know, as well as all of my various love interests whose hearts I've broken over the last few years (and vice versa). But I don't know if I should tell anyone. I don't want to be labelled 'that guy'. I've always had depression, it's only official now - I don't want people treating me differently, you know?
Your night sounds lovely though.
I work part-time now, and I'm worried it's doing more harm for me than good. Last week I convinced my friend to go to the university bar with me. We had a few pints and I suggested we go back to his house with a shoulder of vodka in tow. We downed it in about twenty minutes and headed back to the bar to meet up with some friends. Everything is a blur after that.
The night after, I went to a girl's nineteenth birthday party (I've had sexual relations with her before). We had been snap chatting during the week leading up to it (she's attending university in another part of the country so we couldn't get together when we got together) and I assumed I was in, but when I went, I just got twisted and pulled her best friend instead, presumably breaking her heart. I really need to hit her up and apologise. Her best friend is in my college course; she texted me to apologise the following morning. I didn't even bother responding, haha.
It's not easy being slightly above average in the looks department guys.
Its hilarious to think that officially the only thing wrong with me is a slight learning disability.
Anyway, I say this with all ignorance, but is there perhaps an underlying reason for your depression? I don't know if I was clinically depressed, but I was 'sad' for a long ass time and it was only once I embraced my trans-ness that I felt better and like I was starting to get control of my life.
Is there perhaps something you keep on purposely pushing into the depths of your mind Lord that is eating you up inside?
I don't think you understand how depression works Kirby.
Well to be honest Lotd, you've always seemed to be a bit if a pompous ass and I'm sure the depression only serves to excacerbate the most negative aspects. Just do what the rest if the world does. Your a smart guy and can figure out when it's socially expected to act a certain way so just fake it. Just push down all your unhappy thoughts, bury em deep like the British and keep up appearances. People have been doing it for hundreds if years why stop now? Oh but look in to doing something about your rampant alcoholism. I know you're Irish but damn man.
Oh yeah since you love the sex and who doesn't? Look into cosplay. Professional cosplay era are mega hot and it'll give you yet another creative outlet.
Yeah dude maybe it's time to get off the bottle for a little while
I currently take 100mg of Zoloft for my OCD/anxiety/depression/etc., and while it's helped me at least a little bit, I still have a long ways to go before I get to a position where it isn't totally affecting my life. I actually went to see a psychiatrist because my mom thought he'd help me out like that other psychiatrist did at Sloan-Kettering, but he ended up recommending me to see a psychologist instead because what I have wasn't very serious, especially considering I've been taking Zoloft since last September.
i'm depressed and they've given me 100 mg of sertraline. it prevents my body from absorbing serotonin too quickly, thus having it in my system longer throughout the day. i've also been given Prazosin for my nightmares. it lowers my blood pressure and lowers anxiety (which could be causing my nightmares) it's been helping but the Prazosin prescribed at 1 MG cap. i was suppose to take 3 every night, but shit was way too strong.
now i take 1 capsule a night, but doesn't work well with my nightmares.... it keeps me in a nightmare and i don't feel that rested... oh well.
Leo 3DS friend Code: 0344 - 9299 - 0936
See, the problem with that advice is I don't think I can function in social situations without being slightly tipsy.
And then when you enter a state of tipsiness you determine you should get even more inebriated.
well, you should see how you actually are on medication and then tell your psychologist what you don't like about it. s/he should be able to find another drug to prescribe that would work better for you.
Leo 3DS friend Code: 0344 - 9299 - 0936
It's 100% true.
Alcohlism at it's finest, ladies and gentlemen
<3 cheer up.
Also I've learned alcohol does not help. I used to drink myself to sleep. I'm not even legally allowed to buy alcohol yet lol. But seriously it causes more harm then good unfortunately. It caused me to lose friends and lose my virginity to some pig and I don't even remember losing my virginity. I drink on occasion now and smoke for my nerves. Also I take sertaline and hydroXizine (tranquilizer/anti anxiety) for my panic attacks and it's wonderful
Like I said Altmaster, you're a smart guy. If you can do the no fap challenge you can do the no booze one, and Leo's right. It make take a couple of tries to get a medication that doesn't fuck you over. We went through about 6 different things before we got the right thing for aloras ADHD
True dat. Common cultural conception that "proper" sexual intercourse somehow requires a romantic connection (or in movies, sex=true love) ignores the fact that sex is a very primal, physical urge, and choice of partner, time/place, or acts involved should not affect judgment on a person's character.


text:
Have you ever been pressured to drink more water than feels natural? Do you follow the recommended 8 to 10 glass of water a day, or are you constantly coming up short?
If so you will probably like this article! I am going to examine a few studies that question the comin logic of drinking 8 to 10 glasses or water per day. Studies that have been conducted lately are showing that you should be following your senses on how much water to drink, instead of sticking to some rigid drinking routine.


text:
Chapter 34: Chronic Pain Management
Billing & Payment Policies for Healthcare Services provided to Injured Workers and Crime Victims
Return to Billing & Payment Policies
Effective July 1, 2013
|Complete Chapter for printing
Link to updates & corrections
Look for possible updates and corrections to these payment policies
Note: Portions of these policies are supported by WAC 296-20-12055 through WAC 296-20-12095.
Table of contents
Payment policies:
Structured, intensive, multidisciplinary program (SIMP)
Vocational services for SIMP claimants
More info:
Related topics
Lumbar surgery candidate:
An injured worker who is considering having a lumbar fusion or lumbar intervertebral artificial disc replacement due to uncomplicated degenerative disc disease.
Important associated conditions:
Medical or psychological conditions (often referred to as co-morbid conditions) that hinder functional recovery from chronic pain.
SIMP (structured intensive multidisciplinary program):
A chronic pain management program with the following four components:
- Structured means care is delivered through regular scheduled modules of assessment, education, treatment, and follow up evaluation where workers interact directly with licensed healthcare practitioners. Workers follow a treatment plan designed specifically to meet their needs, and
- Intensive means the Treatment Phase is delivered on a daily basis, six to eight hours per day, five days per week, for up to four consecutive weeks. Slight variations can be allowed if necessary to meet the worker's needs, and
- Multidisciplinary (interdisciplinary) means that structured care is delivered and directed by licensed healthcare professionals with expertise in pain management in at least the areas of medicine, psychology, and physical therapy or occupational therapy. The SIMP may add vocational, nursing, and additional health services depending on the worker's needs and covered benefits, and
- Program means an interdisciplinary pain rehabilitation program that provides outcome focused, coordinated, goal oriented team services. Care coordination is included within and across each service area. The program benefits workers who have impairments associated with pain that impact their participation in daily activities and their ability to work. This program measures and improves the functioning of persons with pain and encourages their appropriate use of healthcare systems and services.
Treatment plan:
An individualized plan of action and care developed by licensed healthcare professionals that addresses the worker's identified needs and goals. It describes the intensity, duration, frequency, setting, and timeline for treatment and addresses the elements described in the Treatment Phase. It is established during the Evaluation Phase and may be revised during the Treatment Phase.
Uncomplicated Degenerative Disc Disease (UDDD):
Chronic low back pain of discogenic origin without objective clinical evidence of any of the following conditions:
- Radiculopathy,
- Functional neurologic deficits,
- Spondyloisthesis (> Grade 1),
- Isthmic spondylolysis,
- Primary neurogenic claudication associated with stenosis,
- Fracture, tumor, infection, inflammatory disease, or
- Degenerative disease associated with significant deformity.
Valid tests and instruments:
Those that have been shown to be scientifically accurate and reliable for tracking functional progress over time.
Payment policy: Structured, intensive, multidisciplinary program (SIMP)
(See definition of SIMP in "Definitions" at the beginning of this chapter.)
Coverage decision
Injured workers eligible for benefits under RCW Title 51 may be evaluated for and enrolled in a comprehensive treatment program for chronic noncancer pain if it meets the definition of a SIMP.
Prior authorization is required for all workers to participate in a SIMP for functional recovery from chronic pain. (See details about "Prior authorization" requirements later in this "Payment policy" section).
The goals for this program are to help workers recover their function, reduce or eliminate disability, and improve the quality of their lives by helping them cope effectively with chronic, noncancer pain.
Note: Special conditions and requirements apply to workers who are considering having a lumbar fusion or lumbar intervertebral artificial disc replacement due to uncomplicated degenerative disc disease (referred to as "lumbar surgery candidates" as defined in WAC 296-20-12065 ). These conditions and requirements are noted throughout this policy. (See definitions of uncomplicated degenerative disc disease and lumbar surgery candidates in "Definitions" at the beginning of this chapter.)
Links: See more information in RCW Title 51 and WAC 296-20-12065 .
Program design: Phases of an approved SIMP
An approved SIMP has three phases:
- Evaluation Phase,
- Treatment Phase, and
- Follow up Phase.
See below for details about each of these three phases.
Note: For information about how and when each phase may be prior authorized by the claim manager, see "Prior authorization" (below).
1. Evaluation Phase
The Evaluation Phase occurs before the Treatment Phase and includes treatment plan development and a report. Only one evaluation is allowed per authorization but it can be conducted over one to two days (see definition of treatment plan in "Definitions" at the beginning of this chapter).
The Evaluation Phase includes all of the following components:
- A history and physical exam along with a medical evaluation by a physician. Advanced registered nurse practitioners and certified physician assistants can perform those medical portions of the pretreatment evaluation that are allowed by the Commission on Accreditation of Rehabilitation Facilities (CARF), and
- Review of medical records and reports, including diagnostic tests and previous efforts at pain management, and
- Assessment of any important associated conditions that may hinder recovery, such as opioid dependence and other substance use disorders, smoking, significant mental health disorders, and unmanaged chronic disease (see definition of important associated conditions in "Definitions" at the beginning of this chapter), and
Note: If such conditions exist, also see the information in "Prior authorization," "Provider requirements," and "Worker requirements" (below).
- Assessment of past and current use of all pain management medications, including over the counter, prescription, scheduled, and illicit drugs, and
- Psychological and social assessment by a licensed clinical psychologist using valid tests and instruments (see definition of valid tests and instruments in "Definitions" at the beginning of this chapter), and
- Identification of the worker's family and support resources, and
- Identification of the worker's reasons and motivation for participation and improvement, and
- Identification of factors that may affect participation in the program, and
- Assessment of pain and function using valid tests and instruments; it should include the current levels, future goals, and the estimated treatment time to achieve them for each of the following areas:
- Activities of Daily Living (ADLs),
- Range of Motion (ROM),
- Strength,
- Stamina, and
- Capacity for and interest in returning to work, and
- If the claim manager has assigned a vocational counselor, the SIMP vocational provider must coordinate with the vocational counselor to assess the likelihood of the worker's ability to return to work and in what capacity (see "Vocational services for SIMP claimants" section of this chapter), and
- A summary report of the evaluation and a preliminary recommended treatment plan. If there are any barriers preventing the worker from moving on to the Treatment Phase, the report should explain the circumstances, and
- For lumbar surgery candidates, the report should address their expectation and interest in having surgery (see definition of lumbar surgery candidate in "Definitions" at the beginning of this chapter).
2. Treatment Phase
Treatment Phase services may be provided for up to 20 consecutive days (excluding weekends and holidays) depending on individual needs and progress toward treatment goals. Each treatment day lasts six to eight hours. Services are coordinated and provided by an interdisciplinary team of physicians, psychologists, physical or occupational therapists, and may include nurses, vocational counselors, and care coordinators. Treatment must include all the following elements:
- Graded exercise: Progressive physical activities guided by a physical or occupational therapist that promote flexibility, strength, and endurance to improve function and independence, and
- Cognitive behavioral therapy: Individual or group cognitive behavioral therapy with the psychologist, psychiatrist, or psychiatric advanced registered nurse practitioner, and
- Coordination of health services: Coordination and communication with the attending provider, claim manager, family, employer, and community resources as needed to accomplish the goals set forth in the treatment plan, and
Note: For lumbar surgery candidates, communication and consultation with the spine surgeon is recommended.
- Education and skill development on the factors that contribute to pain, responses to pain, and effective pain management, and
Note: For lumbar surgery candidates, this includes provision and review of a patient education aid, provided by the insurer, describing the risks associated with lumbar fusion.
- Tracking of Pain and Function: Individual medical assessment of pain and function levels using valid tests and instruments, and
- Ongoing assessment of important associated conditions, medication tapering, and clinical assessment of progress toward goals; opioid and mental health issues can be treated concomitantly with pain management treatment, and
- Performance of real or simulated work or daily functional tasks, and
- SIMP vocational services may include instruction regarding workers' compensation requirements. Vocational services with return to work goals are needed in accordance with the Return to Work Action Plan when a vocational referral has been made, and
- A discharge care plan for the worker to continue exercises, cognitive and behavioral techniques and other skills learned during the Treatment Phase, and
- A report at the conclusion of the Treatment Phase that addresses all the following questions:
- To what extent did the worker meet his or her treatment goals?
- What changes if any, have occurred in the worker's medical and psychosocial conditions, including dependence on opioids and other medications?
- What changes if any, have occurred in the worker's pain level and functional capacity as measured by valid tests and instruments?
- What changes if any, have occurred in the worker's ability to manage pain?
- What is the status of the worker's readiness to return to work or daily activities?
- What is the status of progress in achieving the goals listed in the Return to Work Action Plan if applicable?
- How much and what kind of follow up care does the worker need?
- For lumbar surgery candidates, what is the worker's current expectation and interest in having surgery?
3. Follow up Phase
So long as the claim remains open, a Follow up Phase may occur within six months after the Treatment Phase has concluded. This phase isn't a substitute for and can't serve as an extended Treatment Phase.
The goals of the Follow up Phase are to:
- Improve and reinforce the pain management gains made during the Treatment Phase;
- Help the worker integrate the knowledge and skills gained during the Treatment Phase into his or her job, daily activities, and family and community life;
- Evaluate the degree of improvement in the worker's condition at regular intervals and produce a written report describing the evaluation results.
- Address the goals listed in the Return to Work Action Plan if one was developed.
Follow up Phase site
The activities of the Follow up Phase may occur at the:
- Original multidisciplinary clinic (clinic based), or
- Worker's home, workplace, or healthcare provider's office (community based).
This approach permits maximum flexibility for workers whose needs may range from intensive, focused follow up care at the clinic, to more independent episodes of care closer to home. It also enables workers to establish relationships with providers in their communities so they have increased access to healthcare resources.
Follow up Phase services: Face to face vs. non face to face
Follow up services are payable as "face to face" and "non face to face" services.
Face to face services are when the provider interacts directly with the worker, the worker's family, employer, or other healthcare providers.
Non face to face services are when the SIMP provider uses the telephone or other electronic media to communicate with the worker, worker's family, employer, or other healthcare providers to coordinate care in the worker's home community.
Both are subject to the following limits:
- Face to face services: up to 24 hours are allowed with a maximum of 4 hours per day, and
- Non face to face services: up to 40 hours are allowed.
Follow up Phase reporting requirements
If a worker has been receiving follow up services, a summary report must be submitted to the insurer that provides the following information:
- The worker's status, including whether the worker returned to work, how pain is being managed, medication use, whether the worker is getting services in his or her community, activity levels, and support systems,
- What was done during the Follow up Phase,
- What resulted from the follow up care, and
- Measures of pain and function using valid tests and instruments.
This summary report must be submitted at the following intervals:
- For non lumbar surgery candidates: at one and three months, and
- For lumbar surgery candidates (regardless of whether they had lumbar surgery after successfully completing SIMP treatment): at one, three, and six months.
Follow up Phase activities
According to the worker's identified needs and goals, the Follow up Phase should include the following kinds of activities listed below, and may be done either:
- Face to face at the clinic or in the community, or
- As non face to face coordination of community based services:
Evaluation and assessment activities include:
- Assessing pain and function with valid tests and instruments, and
- Evaluating whether the worker is complying with his or her home and work program that was developed at the conclusion of the Treatment Phase, and
- Evaluating the worker's dependence, if any, on opioids and other medications for pain, and
- Assessing important associated conditions and psychological status especially as related to reintegration in the workplace, home, and community, and
- Assessing what kind of support the worker has in the work place, home, and community, and
- Assessing the worker's current activity levels, limitations, mood, and attitude toward functional recovery.
Treatment activities include:
- Providing brief treatment by a psychologist, physician, nurse, vocational counselor, or physical or occupational therapist, and
- Adjusting the worker's home and work program for management of chronic pain and reactivation of activities of daily living and work, and
- Reinforcing goals to improve or maintain progress made during or since the Treatment Phase, and
- Teaching new techniques or skills that were not part of the original Treatment Phase, and
- Addressing the goals listed in the Return to Work Action Plan if one was developed.
Community care coordination includes:
- Communicating with the attending provider, surgeon, other providers, the claim manager, insurer assigned vocational counselor, employer, or family and community members to support the worker's continued management of chronic pain, and
- Making recommendations for assistance in the work place, home, or community that will help the worker maintain or improve functional recovery.
Support activities include:
- Contacting or visiting the worker in his or her community to learn about the worker's current status and needs and help him/her find the needed resources, and
- Holding case conferences with the:
- Interdisciplinary team of clinicians, and/or
- Worker's attending provider, and/or
- Other individuals closely involved with the worker's care and functional recovery.
Follow up Phase special considerations
When determining what follow up services the worker needs, SIMP providers should consider the following:
- Meeting with the worker, the worker's family, employer, or other healthcare providers who are treating the worker is subject to the 24 hour limit on face to face services, and
- If a SIMP provider plans to travel to the worker's community to deliver face to face services, travel time isn't included in the 24 hour time limit and the trip must be prior authorized for mileage to be reimbursed, and
- The required follow up evaluations must be done face to face with the worker and are subject to the 24 hour limit on face to face services, and
- When the SIMP provider either meets with treating providers or coordinates services with treating providers, the treating providers bill their services separately, and
- Authorized follow up services can be provided, even if the worker has lumbar surgery during the follow up period, and
- If a SIMP provider wishes to coordinate the delivery of physical or occupational therapy services in the worker's home community, they should be aware that these therapies are often subject to prior authorization and utilization review for workers covered by the State Fund.
Links: For more information about "Helping Workers Get Back to Work," see www.Lni.wa.gov/ClaimsIns/Providers/TreatingPatients/RTW/.
Prior authorization
General referral and prior authorization requirements
All SIMP services require:
- Prior authorization by the claim manager, and
- A referral from the worker's attending provider.
Note: An occupational nurse consultant, claim manager, or insurer assigned vocational counselor may recommend a SIMP for the worker, but this can't substitute for a referral from the attending provider.
SIMP referral
SIMP services are authorized on an individual basis. If there are extenuating circumstances that warrant additional treatment or a restart of the program, providers must submit this request along with supporting documentation to the claim manager.
When the attending provider refers a worker to a SIMP, the claim manager may authorize an evaluation if the worker:
- Has had unresolved chronic pain for longer than 3 months despite conservative care, and
- Has one or more of the following conditions:
- Is unable to return to work due to the chronic pain, or
- Has returned to work but needs help with chronic pain management, or
- Has significant pain medication dependence, tolerance, abuse, or addiction, or
- Is a lumbar surgery candidate.
Note: It is recommended that lumbar surgery candidates be evaluated by a SIMP prior to requesting the surgery.
Evaluation Phase
Prior authorization for the Evaluation Phase occurs first and includes only one evaluation. Once authorized, the SIMP provider verifies the worker meets the requirements described in the "Worker requirements" in this "Payment policy" section (see below), and can fully participate in the program.
If the worker:
- Meets the requirements and the SIMP provider recommends the worker move on to the Treatment Phase, the SIMP provider must provide the insurer with a report and treatment plan as described under the Evaluation Phase, or if the worker
- Doesn't meet the requirements, the SIMP provider must provide the insurer with a report explaining:
- What requirements aren't met, and
- The goals the worker must meet before he or she can return and participate in the program, also
Treatment Phase and Follow up Phase
The Treatment Phase must be prior authorized separately from the Evaluation Phase. Treatment Phase authorization includes authorization for the Follow up Phase.
Lumbar surgery candidates
Lumbar surgery candidates must successfully complete a SIMP to obtain authorization for a lumbar fusion or a lumbar intervertebral artificial disc replacement. Also:
- If a lumbar surgery candidate previously participated in a SIMP as a lumbar surgery candidate but didn't successfully complete treatment, one additional SIMP may be authorized only if:
- The worker obtains an additional surgical recommendation noting clinical changes one year or more after the date first referred to a SIMP, or
- The reason the worker didn't participate fully or successfully complete a SIMP the first time was important associated conditions that are now fully resolved.
- If a lumbar surgery candidate successfully completed a SIMP and didn't have the surgery, and in the future becomes a lumbar surgery candidate again, another SIMP may be authorized, but isn't required.
- If a worker's treatment is interrupted due to significant family or life circumstances such as a death in the family, the claim manager may authorize resuming or restarting the SIMP if recommended by the SIMP provider.
- If a SIMP provider plans to travel to the worker's community to deliver face to face services, mileage may be reimbursed, but only if it is prior authorized. Also:
- Lodging and meals (per diem expenses) aren't reimbursable, and
- Actual travel time isn't included in the 24 hour limit, and
- When requesting prior authorization for mileage, the SIMP provider must explain both the reason for the visit and how it will benefit the worker.
SIMP provider requirements
To provide chronic pain management program services to eligible workers, SIMP service providers must meet all these requirements:
- Meet the definition of a Structured Intensive Multidisciplinary Program (see "Definitions" at the beginning of this chapter), and
- Be accredited as an interdisciplinary pain rehabilitation program by the Commission on Accreditation of Rehabilitation Facilities (CARF; also see "Note" below this list), and
- Provide the services described in each phase, and
- Communicate with providers who are involved with the worker's care, and
- Ensure care is coordinated with the worker's attending provider, and
- Inform the claim manager if the worker:
- Stops services prematurely,
- Has unexpected adverse occurrences, or
- Doesn't meet the worker requirements, and
- Communicate with the worker during treatment to ensure he or she understands and follows the prescribed treatment, and
- Act as a resource for the worker, insurer, and providers to ensure treatment is progressing as planned and any gaps in care are addressed, and
- Coordinate the worker's transition and reintegration back to his or her home, community, and place of employment.
Note: Providers must maintain CARF accreditation and provide the Department of Labor & Industries (L&I) with documentation of satisfactory recertification. A provider's account will be inactivated if CARF accreditation expires. It is the provider's responsibility to notify L&I when an accreditation visit is delayed.
Worker requirements
An injured worker must make a good faith effort to participate and comply with the treatment plan prescribed for him or her by the SIMP provider. To complete a SIMP successfully, the worker must meet all these requirements:
- Be medically and physically stable enough to safely tolerate and participate in all physical activities and treatments that are part of his or her treatment plan, and
- Be psychologically stable enough to understand and follow instructions and to put forth an effort to work toward the goals that are part of his or her treatment plan, and
- Agree to be evaluated and comply with treatment prescribed for any important associated conditions that hinder progress or recovery (for example, opioid dependence and other substance use disorders, smoking, significant mental health disorders, and other unmanaged chronic disease), and
- Attend each day and each session that is part of his or her treatment plan. Sessions may be made up if, in the opinion of the provider, they don't interfere with the worker's progress toward treatment plan goals, and
- Cooperate and comply with his or her treatment plan, and
- Not pose a threat or risk to himself or herself, to staff, or to others, and
- Review and sign a participation agreement with the provider, and
- Participate with coordination efforts at the end of the Treatment Phase to help him or her transition back to his or her home, community, and workplace.
Services that can be billed
SIMP fee schedule
The fee schedule and procedure codes for Evaluation, Treatment, and Follow up Phases are listed in the following table.
The fee schedule applies to injured workers only in an outpatient program:
|Local code
|Duration/ limits
|Units of service
|Maximum fee
|SIMP Evaluation Services
|One evaluation per authorization, which may be conducted over one to two days.
|Bill only 1 unit for evaluation even if conducted over 2 days
|SIMP Treatment Services, each 6-8 hour day
|Not to exceed 20 treatment days (6-8 hours per day).
|1 day equals 1 unit of service
|$720.21 per day
|SIMP Follow up Services: Face to face services with the worker, the worker's family, employer, or healthcare providers, either in the clinic or in the worker's community
|Not to exceed four hours per day and not to exceed 24 hours total (time must be billed in one minute units).
|1 minute equals 1 unit of service
|$1.50 per minute
($90.00 per hour)
|SIMP Follow up Services: Non face-to-face coordination of services with the worker, the worker's family, employer, or healthcare providers in the worker's community
|Not to exceed 40 hours (time must be billed in 1 minute units).
|1 minute equals 1 unit of service
|$1.19 per minute
($71.40 per hour)
|Mileage for traveling to and from the worker's community
|Mileage requires a separate prior authorization. Travel time isn't included in the 24 hours allotted for face-to-face services.
|1 mile equals 1 unit of service
|Current Washington State mileage rate
Requirements for billing
Outpatient chronic pain management programs must bill using the local codes listed in the fee schedule (see above) on a CMS-1500 form.
Billing for partial days for the treatment phase
Clinics can bill only for that percent of an eight-hour day that has been provided, (even if the patient was scheduled for less than eight hours). Example:
- The worker has an unforeseen emergency and has to leave the clinic after two hours (25% of the treatment day). The clinic would bill $720.21 x 25% = $180.05.
Payment limits
SIMP evaluation services
Only one evaluation per authorization is allowed, which may be conducted over the course of one to two days. If the evaluation is conducted over a two day period, billonly one unit and span the dates.
SIMP treatment services
These services can't exceed 20 treatment days (6-8 hours per day).
SIMP follow up services
Non face to face services (local code 2015M) can't exceed 40 hours.
Face to face services (local code 2014M) can't:
- Exceed four hours per day, and
- 24 hours total.
Note: Mileage for travelling to and from the worker's community isn't included in the 24 hour limit (see more information in the "SIMP fee schedule," above).
Payment policy: Vocational services for SIMP claimants
Prior authorization
Vocational referrals
Prior to authorizing participation in a SIMP, the claim manager will determine, based on the facts of each case, whether to make a vocational referral.
The claim manager may assign a vocational counselor if the worker needs assistance in returning to work or becoming employable.
The claim manager won't make a vocational referral when the worker:
- Is working, or
- Is scheduled to return to work, or
- Has been found employable or not likely to benefit from vocational services.
Requirements for a Return to Work Action Plan
A Return to Work Action Plan is required when vocational services are needed in conjunction with SIMP treatment and the claim manager assigns a vocational counselor. The Return to Work Action Plan:
- Provides the focus for vocational services during a worker's participation in a chronic pain management program, and
- May be modified or adjusted during the Treatment or Follow up Phase as needed.
Note: At the end of the program, the outcomes listed in the Return to Work Action Plan must be included with the Treatment Phase summary report.
If a vocational counselor is assigned, he or she will work with the SIMP vocational counselor to agree upon a Return to Work Action Plan with a return to work goal.
Return to Work Action Plan roles and responsibilities
In the development and implementation of the Return to Work Action Plan, the insurer assigned vocational counselor, the SIMP vocational counselor, the attending provider, and the worker are involved.
The specific roles and responsibilities of each are as follows:
- The SIMP vocational counselor will:
- Co-develop the Return to Work Action Plan with the insurer assigned vocational counselor, and
- Present the Return to Work Action Plan to the claim manager at the completion of the Evaluation Phase if the SIMP recommends the worker move on to the Treatment Phase and needs assistance with a return to work goal, and
- Communicate with the insurer assigned vocational counselor during the Treatment and Follow up Phases to resolve any problems in implementing the Return to Work Action Plan.
- The insurer assigned vocational counselor will:
- Co-develop the Return to Work Action Plan with the SIMP vocational counselor, and
- Attend the chronic pain management program discharge conference and other conferences as needed either in person or by phone, and
- Negotiate with the attending provider when the initial Return to Work Action Plan isn't approved in order to resolve the attending provider's concerns, and
- Obtain the worker's signature on the Return to Work Action Plan, and
- Communicate with the SIMP vocational counselor during the Treatment and Follow up Phases to resolve any problems in implementing the Return to Work Action Plan, and
- Implement the Return to Work Action Plan following the conclusion of the Treatment Phase.
- The attending provider will:
- Review and approve or disapprove the initial Return to Work Action Plan within 15 days of receipt, and
- Review and sign the final Return to Work Action Plan at the conclusion of the Treatment Phase within 15 days of receipt, and
- Communicate with the insurer assigned vocational counselor during the Treatment and Follow up Phases to resolve any issues affecting the return to work goal.
- The worker will:
- Participate in the selection of a return to work goal, and
- Review and sign the final Return to Work Action Plan, and
- Cooperate with all reasonable requests in developing and implementing the Return to Work Action Plan.
Note: If the worker fails to be cooperative, the sanctions as set out in RCW 51.32.110 will be applied.
Link: For more information about what can happen if the worker refuses to cooperate, see RCW 51.32.110 .
Links: Related topics
|If you're looking for more information about…
|Then go here:
|Administrative rules
supporting SIMP payment policies
|Washington Administrative Code
(WAC) 296-20-12055 through WAC 296-20-12095:
|Becoming an L&I provider
|L&I's website:
|Billing instructions and forms
|Chapter 2:
Information for All Providers
|Crime Victims
Compensation Program
contact information
|Phone: 1-800-762-3716 (toll free)
Fax: 1-360-902-5333
L&I's website:
|Fee schedules for all
healthcare services
|L&I's website:
|Return to work: "Helping
Workers Get Back to Work"
|L&I's website:
|Self-insured claims authorization
from the self-insured employer (SIE)
or their third party administrator (TPA)
|Contact list of SIE/TPAs on L&I's website:
|Worker refuses to cooperate
with care plan: Legal issues
defined in Washington state laws
|Revised Code of Washington (RCW) 51.32.11:
Need more help? Call L&I's Provider Hotline at 1-800-848-0811.
CPT® codes and descriptions only are © 2012 American Medical Association


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Resources on the requirement that teachers be highly qualified who teach a core academic subject.
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Motorola MAX Locate: Best-in-class GPS implementation enables a signal lock in challenging areas where signals are typically weak, such as urban canyons and indoors, providing more users with location-based services in more areas; supports Assisted and Autonomous GPS with SUPL compliance
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2 bedroom apartment in Las Palmas
Size90 m²
Floor No.1(with elevator)
- Kitchen
- Lockable room
- Elevator in building
- Washer/dryer
- Smoking allowed
- Parking available
|35010 Las Palmas, Canary Islands, Spain
|Property type
|Property ID
|Acceptance rate
|Response time
|A few hours
|Calendar updated
Apartment block. 1 km from the centre of Las Palmas, 50 m from the sea. In the house: lift. Grocers, restaurant, bus stop, sandy beach 50 m. The Alfredo Kraus auditorium, 500 m. Old town, 1 km. The builing is situated in the 2nd row from the sea and from "Las Canteras" beach, which is the largest beach in Las Palmas.
|Check-in After
|On arrangement
|Check-in before
|On arrangement
|Check-out Before
|On arrangement
|Cancellation Policy
|View Details
Perfect weekend. The apartment is located in a great location, 50 meters from the Paseo de Las Canteras. And 'big, clean and with two bathrooms, making it very convenient. Kitchen well stocked. In addition to our arrival we rented a spot for 3 days and being the apartment with parking we never had problems in finding a parking place on the way back from our excursions. Stra recommended.
Week-end perfetto. L'appartamento è sito in una posizione ottima, a 50 metri dal paseo de Las Canteras. E' grande, pulito e con due bagni, il che lo rende comodissimo. Cucina molto fornita. In aggiunta al nostro arrivo abbiamo affittato una macchia per 3 giorni ed essendo l'appartamento dotato di parcheggio non abbiamo mai avuto problemi nel ricercare un posteggio al ritorno dalle nostre escursioni. Stra consigliato.
Apartamento bastante bueno,muy bien situado,amplio,propietarios muy amables y agradables,limpio,bastante tranquilo.lastima que no tenga wi-fi y una mampana de aspiración en la cocina, pero son detalles.Muy contento de haber pasado allí unos días .
Nice clean well equipped apartment. Very friendly hoists. Would recommend to all my friends.
The Oasis is a wonderful and great accomodation. The house is surrounded by Lemon trees and offers a great view to the sea. It is well equipped, clean and very comfortable for Groups/families up to ten. Highly recommanded.
The place shown on the pictures has an open swimming pool. However if you 're in to reading all the small letters in the massive paper work of Inter Home you Will Read That the pool is open from the 15th of June. What à dissapointment for my daughter. Furthermore we had to pay for the bedlinen on top of the cleaning which was counted pro person. And of course because it was cold we had to pay for the heating although in the living room was no heating system, only in the bath and bedroom. The owners were. Ice although when people arrive in the middle of the night due to their flight it would be nice if there would be something to drink. The garden is large and nice decorated so I think in summer when the pool is open it will be a paradise. For myself I think it is deceive that Wimdu puts this booking through a link connecting to another website. In this way you pay a lot more and you don,'t get what is shown on the pictures. I will never book in this manner again because in the end you pay a lot more.
Wonderful place with great hosts. The apartment is spacious and very clean, the beds are big and comfortable, the kitchen is very well equipped and the balcony offers a superb view of Eiger. We will certainly come back again.
nice sunny apartment, close to mountains, ideal for active holidays close to innsbruck and germany.
a bit 90's furnishing but everything clean and usefull.
Thanks a lot
We had a great time. The accommodation was good, room was clean and complete. It had a nice parking garage, a bit small but fine.
It was no problem that we arrived late in the evening (car trouble). The breakfast service was convenient and good. We had a great view of the mountains and we got some great advice about the area from the landlord.
We would recommend this accommodation to everyone who loves nature. But you do have to travel a bit (25min) for the first big supermarket.
Convenient to 3 metro lines; furnished; pictures of small rooms accurate; elevator. Shelves and dishes grimy; very noisy street (major road to airport) during week; no trash cans; smelly towels poorly laundered; some musty smells throughout; no Internet (borrowed from neighbor, though).
First of all, I was a little nervous because I had plenty of doubts and the agency didn't answer me, in that point very bad customer service I can't believe they take like one week to answer a customer email... Anyway one week before our arrival our host finally could contact me and I talked to her. Luckly Montse was a Spanish woman and we could understand each other very good. Despite we had problems in our arrival, she was very kind and understood everything, made everything very easy and was very flexible about the arriving time. She really cared about us, offering herself for any help we could need (finding supermakets, places to eat, and useful information) we are really grateful about that:)
About the house, 10-15 min walk from Piazza San Marco, good location, very close to important places and easy to find (difficult in Venice..) the house is exactly as described in the pictures, one big sofa-bed (very comfortable) one bedroom, the kitchen, bathroom and a small terrace. Despite was a little bit small apartment was very nice, comfortable and charming.
Against: it wasn't very cleaned, some dirty in the corners and under the sofa and furniture. I don't understand why we had to pay 20€ per person for cleaning taxes and other taxes when they left us the apartment not as cleaned as they could...
The oven didn't work (or we didn't know how to turn it on... Neither our host) and half of the stoves didn't work, and the ones who did was very low fire and we took ages to cook and to get the water to boil.
The other think I didn't like (but this isn't problem of the house) is that even is well located, it's pretty far from the train station, like 40 min walking, 1hour if you are taking luggage, so the best thing is to take the vaporetto and its 40 min more or less and 7,50€ each trip. It's not a really big deal but a think to take on count if money is a struggle for you. You'll do it if you are going to Treviso airport.
Anyway, we had a very nice time then, if I go back to Venice, I would repeat for sure! :)
- Quality assured accommodation
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«Zwerm» is a public performance. In analogy to a swarm of birds or fishes, a group of people clusters together for a few minutes in order to run through the city as though it were one collective body. On the basis of local interaction the swarm moves void of any hierarchy, seemingly without destination and often unpredictable. By play of internal friction and cohesion it changes form dynamically, breaks into pieces, melts together again and suddenly disintegrates.
Swarms are both tantelizing and disturbing, giving them the capacity to create a new enchantement, to put people beyond their boundary. «Zwerm» has no identity, is a hybrid, is impure. It consists of individuals united only on the basis of the common destiny related to the performance. «Zwerm» takes shape on the basis of a continuous coproduction, without master plan, without director. «Zwerm» disintegrates to reappear in another time, on another place and with another constitution.
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De Kleine Academie 2008-2009 Publicado 22 de enero de 2010


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Sed rate, or erythrocyte sedimentation rate (ESR), is a blood test that can reveal inflammatory activity in your body. A sed rate test isn't a stand-alone diagnostic tool, but it may help your doctor diagnose or monitor the progress of an inflammatory disease.
When your blood is placed in a tall, thin tube, red blood cells (erythrocytes) gradually settle to the bottom. Inflammation can cause the cells to clump together. Because these clumps of cells are denser than individual cells, they settle to the bottom more quickly.
The sed rate test measures the distance red blood cells fall in a test tube in one hour. The farther the red blood cells have descended, the greater the inflammatory response of your immune system.
Sed rate tests were used more frequently in the past than they are today because more-specific measures of inflammatory activity are now available. Today, the test is most often used if your doctor suspects you have:
A sed rate test can also help determine the severity of your inflammatory response and monitor the effect of treatment.
Because a sed rate test can't pinpoint the problem that's causing inflammation in your body, it's usually accompanied by other blood tests, such as the C-reactive protein (CRP) test.
The sed rate is a simple blood test. You don't need to fast before the test.
A nurse or medical assistant will use a needle to draw blood from a vein, most likely a vein in your arm. The site on your arm may be tender for a few hours, but you'll be able to resume most normal activities.
Results from your sed rate test will be reported in the distance in millimeters (mm) red blood cells have descended in one hour (hr). The normal range is 0-22 mm/hr for men and 0-29 mm/hr for women. The upper threshold for a normal sed rate value may vary somewhat from one medical practice to another.
The results of your sed rate test are one piece of information to help your doctor check your health. Talk to your doctor about what your sed rate results mean in light of the symptoms you're experiencing and the results of other diagnostic tests.
A number of conditions can affect the properties of blood, thereby affecting how quickly red blood cells sink in a sample of blood. So information about inflammatory disease — what your doctor intends to learn from the sed rate test — may be obscured by the influence of other conditions. These complicating factors include:
Your doctor will take into account possible complicating factors when interpreting the results of your sed rate test.
Original article: http://www.mayoclinic.org/tests-procedures/sed-rate/basics/why-its-done/PRC-20013502
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Calendar of Events:
2012 Past Event: Cancelled-Calendar Standing Committee Meeting
- Date & Time:
- Thursday, December 13, 12:00 p.m. - 1:00 p.m.
- Location:
- C217 (PCC Campus maps and directions)
- Open To:
- Public
- Description:
The Calendar Standing Committee shall recommend to the College Council annual college calendars that support the pedagogical and operational needs of students, faculty, and staff within the framework of the negotiated agreements between the collective bargaining units and the District.
- Contact:
Kathy Barnes, Interim Admin. Assistant
Phone: 626-585-7072
- Download this event


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Rated 3 out of 5 by 4 reviewers.
Rated 4 out of 5 by bbkitty Unique Features I read the other reviews, but decided to take a chance on ordering this lamp anyway. I'm so glad I did. It's a beautiful lamp with distinctive features that set it aside from most other lamps. I haven't had any trouble with it at all, however, I have to say that the switch is delicate. I handle it with great care. The manufacturer should be notified, if they haven't been already, so this one bad feature can be resolved. I've discovered that there is a matching table lamp, and am thinking about purchasing that as well. They will make a dynamite pair! April 6, 2013
Rated 4 out of 5 by libby's mom Beautiful, but lightbulb is too big This is a very beautiful lamp, with a very heavy base so that it doesn't tip. The shade appears to be real glass, too. My only problem with it is that the torchiere shade was designed for a traditional style/size lightbulb, which is getting harder and harder to find. It comes with a CFL (curly) bulb, which sticks up over the top of the shade, so that you are looking at the bright tip of the naked lightbulb when it is lit. I am hoping to find a smaller CFL bulb. December 15, 2011
Rated 3 out of 5 by Lawrence Beautiful, but a bit cheap This is a very nice lamp and blends in well with finer furnishings. However, it is a bit low-end in terms of quality. The first one we ordered was slightly warped and we had to return it. The replacement though was in good shape and looks so nice we are ordering another one. We're hoping it will be a good one! Also, we hate the old school styrofoam packaging. FYI, you cannot return this in a store. December 26, 2012
Rated 1 out of 5 by Kim Switch Broken After 3 Months The lamp looks nice but the switch broke after normal use and could not be repaired. May 14, 2012
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Compared to earlier satellites in the Insat series, Edusat used several new technologies. The spacecraft was built around the I-2K standardised spacecraft bus. It had a multiple spot beam antenna with a 1.2 m reflector to direct Ku band spot beams, a dual core bent heat pipe for thermal control, high efficiency multi-junction solar cells and an improved thruster configuration for optimised propellant use for orbit and orientation maintenance. The satellite used radiatively cooled Ku-band Travelling Wave Tube Amplifiers and a dielectrically loaded C-band demultiplexer for its communication payloads. Edusat carried five Ku-band transponders providing spot beams, one Ku-band transponder providing a national beam and six Extended C-band transponders with a national coverage beam. It was to join the Insat system that already provided more than 130 transponders in C-band, Extended C-band and Ku-band for a variety of telecommunication and television services.
First operational flight of launch vehicle. Launch delayed from July, August and September 10. Dry mass 820 kg. As of 2007 Mar 9 located at 73.92E drifting at 0.006W degrees per day.


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Thanks to support from the Mayor's Fund Holiday Meal mini-grant and other generous donations, Catholic Charities provided 1,000 meals, warmth and support throughout the holiday season to those struggling in the Staten Island Hurricane Sandy Recovery Zone.
Catholic Charities served dinner to 682 people including victims of Hurricane Sandy, day laborers and their families, and low-income residents and gave toys to children at the CYO Center at Anderson Avenue in Staten Island on the Friday before Christmas, December 21, 2012.
Then, on Christmas Day, Catholic Charities hosted a sit-down dinner for more 300 people including day laborers and their families at the same location. The multi-course meal included everything from turkey to apple pie and was donated and served by Young Israel and Temple Emmanuel. After the meal, guests received gifts of clothing and toys.
On New Year's eve and day, Catholic Charities delivered 6,000 meals to families in the Hurricane-ravaged Midland Beach neighborhood to reach those hardest hit by the super storm.
To top off the holiday, Catholic Charities celebrated Three Kings Day – El Dia de Los Reyes – by serving up a light traditional Mexican meal to 316 people on January 3 at the CYO Center. After the meal, three "kings" distributed toys and books to the children as well as clothing and toiletries to those in need.
The holidays have come to a close but need continues.
Would you like to help? Donate today, or sign up to volunteer.


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Learn More About SAC
Learn More About SAC Students
More Information for New Students
Learn More about Academics
Learn More About SAC School of Continuing Education
More Information About Faculty and Staff
Learn More About SAC Foundation
Learn More About Accreditation
We take great pride in offering comprehensive programs and services to ensure that students receive the learning and resources he/she needs to achieve his/her educational and career goals. Though I have served as President of Santa Ana College since March 2005, I am still in awe of the student-focused efforts that are evident throughout every facet of the campus.
The accomplishments of our students affirm our commitment to providing access to higher educational opportunities for all. Students who have received their training and education from Santa Ana College have achieved great success in areas including business, science, technology, public service, athletics and entertainment. Whether you desire to earn a degree or certificate, transfer to a four-year college or university, or obtain workforce training, we look forward to working with you to achieve your goals. Thank you for choosing Santa Ana College to pursue your education.
Best regards!
Click here for a biography on Dr. Erlinda J. Martinez
President's OfficeErlinda J. Martinez, Ed.D.
Assistant to the PresidentKennethia VegaEmail: firstname.lastname@example.com: (714) 564-6975Fax: (714) 564-6977
Vice President of Academic AffairsCarlos L. Lopez
Vice President of Administrative ServicesMichael Collins, Ed.D.
Vice President of Continuing EducationJames Kennedy
Vice President of Student ServicesSara Lundquist, Ph.D.


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Arts & French Language - Institut Catholique de Paris -Institut Catholique de Paris
This is a unique five-week opportunity to discover Paris through the arts and language. The program is a perfect match for one who seeks a study abroad experience with arts courses taught in English. French language courses are also available.
While French courses take place in the classrooms at the Institut Catholique de Paris, arts courses step out into the city, as professors lead students through museums and monuments of interest, relating foundations of art to the students' own work. For those moments when classroom time is needed, arts courses are held in the ISA Paris Office's classroom.
French courses are available at all language levels. All students taking a French language course must complete a two-part French language placement exam, one portion before departure for the program and the other upon arrival in Paris. The exam will indicate each student's language proficiency level, and will determine the courses in which the student is eligible to enroll.
Please use the following only as a guideline to determine what each student's language level may be. Each semester/quarter is of COLLEGE-LEVEL French or the equivalent of:
True Beginning (A1-1)
Please note that a student's French language level in France may be lower than his/her level in the U.S.
During the program, students may choose one of two options:
Option A: Students focus solely on art by taking two arts classes, 45 contact hours each.
Option B: Students combine one arts course of 45 contact hours and one French course of 60 contact hours.
Art classes, designed specifically for the Arts & French Language program, are taken with other students participating in the program. French classes are taken with other international students.
The Institut Catholique de Paris issues the transcripts for this program.
Gap students, 18 years old and older, are also eligible for this program.
French language courses are taught by host university faculty at the Institut Catholique de Paris in the Institut de Langue et de Culture Française (ILFC). Arts courses are taught by visiting faculty at the ISA office and/or at various sites throughout the city of Paris.
Minimum GPA
Students must have a minimum grade point average of 2.50.
Minimum Admissions Prerequisites
There is no language prerequisite for this program.
To participate in this program, students must be 18 years of age or older.
Course Information
Course Disclaimer
Course placement is organized in a first-come, first-serve fashion and is based on scheduling and availability; therefore, no course can be guaranteed.
Click on a session to view details!
Currently Accepting Applications!
Currently Accepting Applications!
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He was born Nov. 25, 1948 to Audie and Inez (Nichols) Prine. He was a Decorated U.S. Army Vietnam Veteran. He was preceded in death by his parents, three brothers; Jack Prine, Ronnie Prine and Bill Barnett. His survivors are his wife; Donna (Steinmetz) Prine, one son; Michael Prine, seven grandchildren, fifteen great grandchildren, one brother; Deyvon Prine of Newport and one half sister; Betty Fisher of Newport. Funeral service were 1 p.m. Saturday, March 9, at Dillinger Funeral Home Chapel. Burial was in Watson Cemetery. Visitation was 11 a.m. untill service time. Arrangements by Dillinger Funeral Home. www.dillingerfuneralhome.com
Location, ST | website.com


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Rated 5 out of 5 by 2 reviewers.
Rated 5 out of 5 by Jeff59 This Candy has a great flavor and it is great This candy is indeed very chocolately and very delightful to the palate is has a wonderful flavor and it just absolutely melts in your mouth and it does really have a great flavor and it is also a great candy to enjoy and have a great chocolate moment with when you taste it. June 6, 2013
Rated 5 out of 5 by MB Nick It's hard!! It's hard to put the bag down!! yum!! June 27, 2008
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Now that the political dust has finally settled (it even made the news on the BBC) in my fair Commonwealth (for some reason, we're not a State), I can now get back to fully focusing on scouring the webosphere to see what people are saying about enterprise mobility. I was sent a link yesterday by a friend and colleague that I found quite interesting.
The author of the blog entry is someone whom I respect and find to be highly knowledgeable in the world of enterprise mobility. That said, I simply can not agree with his hypothesis.
Continue reading "Mobile Network and Device Performance: Whose Responsibility Is It?" »


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Robert Earle has held senior positions in the U.S. foreign affairs and intelligence communities for 25 years, including serving as Ambassador John Negroponte's senior adviser in Iraq and later as his counselor when Mr. Negroponte was appointed deputy secretary of state. The recipient of the Christian A. Herter Award for outstanding contributions to American diplomacy, Mr. Earle is author of the Naval Institute Press book, Nights in the Pink Motel: An American Strategist's Pursuit of Peace in Iraq.
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Career Accolades: Three-time Ivy
League champion (2009, 2010, 2012) ... Played in all 30 games over his final three seasons ... Finished with 1,110 career rush yards on 270 carries (4.1 yards per carry) ... Ten career touchdowns (eight rush, two receiving) ... Had 22 career receptions for 216 yards ... Also had 70 kick return yards and finished with 1,396 career all-purpose yards ... Added 21 career tackles.
2011: Played in all 10 games and started one ... Third on the team in rushing with 165 yards ... Fourth on the team in total offense ... Rushed for a touchdown against Villanova (Sept. 24) and in the win over Princeton (Nov. 5) ... Season-high 55 rush yards and 87 all-purpose yards in the win over Fordham (Oct. 8) ... Finished the year with 64 receiving yards on six catches ... Also had five tackles as a member of Penn's special teams units.
2010: Started all 10 games at running back ... Finished third on the team with 466 rushing yards and fourth in scoring with two touchdowns rushing and two receiving ... Averaged 4.5 yards per carry ... Had four catches for 44 yards ... Had touchdown runs against Bucknell (Oct. 9) and Columbia (Oct. 16) ... Had a 25-yard touchdown reception against Harvard (Nov. 13) and a 17-yard touchdown catch at Yale (Oct. 23) ... Tallied a career-high 95 rushing yards in win over Dartmouth (Oct. 2) ... Also appeared on special teams and recorded four tackles.
2009: Appeared in seven games, mostly on special teams ... Had five tackles on the year with one each at Dartmouth (Oct. 3), vs. Bucknell (Oct. 10) and vs. Yale (Oct. 24), and two vs. Princeton (Nov. 7) ... Finished the season with 66 yards on 17 carries ... Ran nine times for 41 yards in win over Princeton (Nov. 7) and seven times for 25 yards in season finale against Cornell (Nov. 21) ... Also had a kickoff return for 21 yards against the Big Red.
High School: Three-sport athlete competing in football, wrestling and baseball ... Member of 2005 and 2006 Washington State 1A championship teams ... Two-time 1A Player of the Year ... Holds Washington's all-time state scoring record ... Two-time team captain at Royal High School ... Attended Salisbury School (Conn.) in 2007 where he was a team captain on the New England Prep Class A champions ... 2007 New England Prep Player of the Year ... His teams went a combined 37-0 between 2005-07.
Personal: Son of Steve and Janet Jack ... Sister Audrey Jack played Rugby at BYU (Class of 2009) ... Served a two-year LDS Church Mission in Madagascar ... Enrolled in Wharton.
Career Stats:


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Pine Trail principal inspired many
Published: Wednesday, April 3, 2013 at 6:20 p.m.
Last Modified: Wednesday, April 3, 2013 at 10:22 p.m.
Twenty-five years after he sat in Barbara Paranzino's sixth-grade classroom, John Steigner still remembers "it always felt like she really cared about the answers you gave to her questions."
Paranzino, who died Tuesday, had the same kind of effect on the teachers and other adults with whom she worked as principal of Pine Trail Elementary School in Ormond Beach from 1992 until she retired in 2010.
"She was a mother figure with that persona of someone who cared about people," said Stan Whitted, a retired area superintendent of Volusia County schools who was Paranzino's boss before her retirement.
Paranzino, 67, died Tuesday at Florida Hospital Memorial Medical Center. Her husband, Bob, said she was diagnosed a few years ago with myelodysplastic syndrome, the same blood disorder that "Good Morning America" anchor Robin Roberts has battled recently.
A Pittsburgh native, Paranzino started teaching at Port Orange Elementary in 1982 shortly after she and her husband moved to Volusia County. She went on to teach at Port Orange's Horizon Elementary before being appointed assistant principal of George Marks Elementary in 1991.
"She always thought first and foremost about other people and how she could help them," said Diane LeJeune, a third-grade teacher at Pine Trail Elementary who was hired by Paranzino in 1994. "She cared so much about children and teachers and made sure the school had an environment where everybody could collaborate."
"She truly motivated and inspired people to be even better than they thought they could be," said Sandy Russell, principal of Cypress Creek in Port Orange. Paranzino was Russell's supervising teacher her first year in the classroom and had remained a professional and personal mentor ever since.
Besides her husband, Paranzino's survivors include two brothers, Tom Joseph, New Castle, Pa., and John Joseph, St. Petersburg; and two sisters, Carole Wierzbicki, Harrisburg, Pa., and Irene Bauer, Venice. Her funeral will be at 10 a.m. Saturday at Epiphany Catholic Church, 201 Lafayette St., Port Orange. Volusia Memorial Funeral Home, Port Orange, is in charge.
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