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Benfield Business-Health Leadership
The Complete Leader: A Model for Effective Business-Health Leadership
by Chuck Reynolds
President, Employer Practice
The Benfield Group, LLC
I've long been an admirer of great leaders. As a kid, I remember being inspired by the leadership of heroes featured in old war movies. The books I remember most vividly were about historic leaders who answered the call in times of need, like Lincoln, Churchill, Kennedy, King and Lombardi…yes, in Wisconsin where I grew up, Vince Lombardi belongs on the list, just as sure as bratwurst is a food group unto its own.
I also remember admiring those rare adults—the teachers, coaches and parents—who were fully invested in what they were doing. They pushed and prodded and encouraged and inspired. When that wasn't working, they invented new ways to try to reach us, teach us and help us grow. At the time, I didn't have a framework to understand what set these adults apart, but I knew they were rare. And I knew I was blessed to be in their classroom, on their team or in their lives.
In the years since, I've continued to observe and admire great leadership. Over the past decade, Scott Thompson and I have deliberately focused much of our work at The Benfield Group on getting to know leaders and understanding leadership in the area of human capital health and productivity management. Through our research, observation and interaction, we've concluded:
- 1. Effective Leaders are Few and Far Between: One could argue that this is a self-fulfilling conclusion. If the objective is to identify standout leaders, then, of course, those leaders are going to be rare. We suspect, however, that the layer of effective leaders among the professions involved in human capital health and productivity management is thinner than in many other professions. Companies typically view human resources, benefits, safety, health and wellness as staff functions. Companies often seek to outsource as many of these 'non-core' responsibilities as possible and internal decision makers rely heavily on outside consultants for information and advice. This is a tough environment for leadership to thrive and, as such, leadership is rare.
- 2. Effective Business-Health Leadership Has Strategic Value: Organizations that have effective leaders strategically managing health and productivity-related benefits and programs have a competitive advantage. Strong leadership begets sound, value-driven strategy and effective execution, yielding lower costs, superior health and productivity outcomes and building momentum for a culture that promotes human capital asset growth. In other words, organizations that invest strategically in human capital health and productivity reap rewards that their non-strategic counterparts do not.
- 3. Effective Business-Health Leaders Share/Develop Common Capabilities and Attributes: Through repeated encounters with business-health leaders, we've identified the core capabilities and attributes that they share in common (Figure 1).
As one might expect, different leaders are naturally gifted with different capabilities, but they are not complacent about their situation. Rather, leaders continually invest in developing their strengths and finding ways to compensate for areas of weakness. The drive and ability to improve comes from the passion and humility common among leaders. They continually seek to improve what they're doing, and they are not too proud to learn lessons from multiple sources—peers, other departments, other industries, vendor partners and others.
Leaders are courageous enough to break the conventional expectations that often come with their jobs. As described above, most companies view staff functions as tactical and administrative baggage to be minimized and outsourced. It takes courage to risk challenging convention and to drive a strategy that redefines health as part of a broader human capital investment strategy.
This e-journal is for leaders and those who aspire to leadership in managing the health and productivity of human capital. With each issue, we will build on the framework in Figure 1 as we endeavor to provide information, insights and examples to equip and inspire professionals striving to improve their leadership capabilities. We will challenge you to look at old problems from new perspectives and to consider different types of solutions. We will tap into the wisdom of recognized leaders like Jack Mahoney, who we interviewed for this issue. We'll also rely on experts you're not likely to encounter in the normal flow of benefits, health and productivity information.
These are turbulent times, and much about the future is uncertain. However, it's a very good bet that in most industries, the winners on the other side of the economic trough will be the companies with the best and highest performing people. For now, organizations are being forced to rethink everything they do, including how they manage the health and productivity of their human capital. This is a time of need and organizations—perhaps even yours—need strong and effective leaders to answer the call.
Interview with Jack Mahoney
Value-Based Benefit Design: The Good, the Not So Bad and the Ugly
by Scott Thompson
President, Health Care Practice
The Benfield Group, LLC
VBBD Pioneer Jack Mahoney Shares His Leadership Observations on the Movement
During a distinguished career spanning government, medicine and several large employers, Jack Mahoney, M.D., has earned a reputation for thoughtful, innovative leadership. Jack solidified his reputation when he oversaw the design and implementation of Pitney Bowes' value-based benefit design (VBBD) as the company's Corporate Medical Director. After Pitney Bowes moved preferred and nonpreferred asthma, diabetes and hypertension drugs to the lowest level of its tiered formulary, total costs associated with those three conditions decreased.
Jack currently serves as Consultant for Strategic Health Initiatives at Pitney Bowes; Chief Medical Officer at the Florida Health Care Coalition; and Chief Medical Officer for the Center for Health Value Innovation.
Jack recently spoke with Scott Thompson of The Benfield Group about VBBD and business health leadership.
The Good
Scott: When did you realize that you and your team at Pitney Bowes had the opportunity to have an impact on the health and productivity of your employees?
Jack: The very first time I met CEO Michael Critelli when Pitney was recruiting me to work there. Like most employer executives, he cared about health care savings, but I could tell from our conversation that he cared more about the health of Pitney's population. Even back in the '90s, he understood the importance of and was dedicated to improving the health of our employees.
Scott: You rolled out the Pitney Bowes VBBD initiative in 2002. Looking back, what surprised you most about the discovery of value-based benefit design?
Jack: Our thinking stemmed from the RAND health insurance experiment which found that increasing an individual's cost share can cause him or her to decrease overall effective and noneffective utilization. What we struggled with at Pitney was how to increase effective utilization and still have a cost-efficient plan. In retrospect, it seems kind of obvious that the combination of disease management and removing financial barriers could give us what we were looking for.
Scott: What was your biggest leadership challenge in the early days of your new approach to remove towering financial barriers to care?
Jack: Changing the mindset of the people who worked in the area, whether it was the PBM or Pitney's administration folks. Internally, there was some skepticism if VBBD was really going to work, but we overcame that with scientific evidence from the predictive modeling we conducted. The biggest challenge was really the implementation. How do you get your vendors to go along with the new model? Frankly, the PBM was quite cooperative, but they had their doubts. We didn't have to deal with any of the managed care plans when Pitney rolled out VBBD because we had totally carved out our pharmacy.
Scott: What did you learn about organizational change and the C-suite when Pitney implemented VBBD?
Jack: One of the keys is to use the right language when you're presenting. We were talking about lowering trend rates and the chief operations officer said, 'Trend rates don't mean anything to business people, but if you talk about the compound annual growth rate (CAGR) they'll understand.' As soon as I started presenting the proposal in CAGRs, everybody said 'Oh yeah, we know what that is.'
A lot of people make the same mistake talking about savings. The C-suite is very skeptical about "savings," but they get "cost avoidance." They translate cost avoidance to additional dollars that flow to the bottom line.
An extension of using the right language is using a basic denominator that people understand quickly. For instance, if you translate everything into cost per share or potential upside per share for the finance people, then you know they're automatically playing with those numbers in their heads to figure out the impact on share price.
When you're proposing new ideas, the C-suite looks for the depth of your commitment to your idea. One of the things my team did early in the VBBD experiment was claim accountability for the project and own whatever impact the design had on the health care budget. And we used the impact on the budget as one of the metrics for our performance appraisal at the end of the year. While accountability doesn't guarantee success, it certainly shows that you are committed.
Scott: How did the external VBBD movement begin and did you have a sense of what Pitney Bowes had started at that point in time?
Jack: Not really. We knew what was going on, but never thought of it as anything all that noteworthy. The Wall Street Journal thought differently. After they published an article about the VBBD model in 2004, Mark Fendrick from the University of Michigan contacted us to say he had been writing about the value-based design concept for years. We shared information and the movement went from there.
Scott: Based on your observations, would you do anything differently if you had to roll out the Pitney value-based design all over again?
Jack: Several things. At the time, we thought we were solving a business problem and saw VBBD as a way to make our chronic disease management program work. The Achilles' heel of the Pitney model is no control group. It never occurred to us that the new model would be a health services experiment. Thinking it over again, I'd put in a control group, and I've encouraged others to do so as they start their programs.
I'd also keep better control of the information. A lot of people don't understand that VBBD didn't entail just looking at the claims reports and making a decision. The value-based design was really the result of a very rigorous application of predictive modeling.
Scott: What advice would you give other business health leaders about VBBD?
Jack: The first piece of advice is get your data together. Understand what's really happening in your population. The second piece is figure out what your intervention might be. Figure out how to measure your progress and maintain accountability.
Do the ground work first and then look at the change process. Change is a lot easier when you're moving in a direction that fits a need within the population. Then you're facilitating what people should do, not trying to induce something that's contrary to what people want to do.
The Not So Bad
Scott: No matter how great a plan you have as a leader, not everything goes as planned. What was your biggest surprise when Pitney went forward with VBBD?
Jack: One big surprise was the number of concerns about how the people who did not benefit from the value-based design would react to others receiving cheaper medication. Would they be outraged that the person at the next desk was enjoying an advantage? That outrage never materialized. I've talked to a lot of people who've implemented VBBD, and though there are allegations about lawsuits or controversy, I can't find any concrete evidence to verify those rumors.
Scott: What insider observations can you share about the biggest challenges you face in the early, middle and later stages of VBBD?
Jack: The biggest challenge at the beginning was coming face-to-face with the financial trade-offs in the model and trying to balance the loss of rebates, co-payments and co-payment revenue with the expected outcome of improved financial performance. What worked for us was relying on the predictive model.
In the middle stages, the challenge was just keeping a lid on the thing. There was an urge to tinker with the model. My approach has always been methodical. First, you identify a need and then move to fill it. Making changes to the model was not something we could rush into.
A common suggestion was to limit the discounts to the people who are compliant. So if people don't show up to a monthly disease management meeting, for instance, the drugs go back to the regular payment schedule. My thought is that VBBD has to be a public health model. It can't be discriminatory about eligibility other than diagnosis.
The challenge now is to validate VBBD. There are still many people who think VBBD is a lot of smoke and mirrors. I can understand the skepticism if you look at just one company's results. But as VBBD gets more mature and more companies implement designs, the data for what happens are consistent.
Scott: Why do you think there's so much skepticism about VBBD?
Jack: People may be used to research conducted by double-blind randomized controlled trials or pure health economic or cost-effectiveness research. But the employer world is more experiential and decisions have to be made very quickly. You also have to live with the rules of the road for dealing with employees; you can't really put people into randomized double-blind studies in the employer world.
Unfamiliarity with VBBD may be limiting its exposure outside the employer health care market. Frankly, the policymakers in Washington, D.C. haven't embraced the concept. I don't think they disbelieve VBBD. It's just outside of their normal experience.
Scott: What do you recommend business health leaders look out for when implementing VBBD?
Jack: Don't break a promise. Don't think you've got the silver bullet. Don't ignore other avenues to get to your goal. Think about what you want to achieve. It could be that you can reach your goal simply by communication, a disease management program or an education program. You may not have to go down the total value-based route.
The Personal Side of Dr. Mahoney
Scott: Clearly, the work you did to develop and pursue your ideas about health and health management didn't happen in a 40-hour work week. It was extracurricular work. What drove you to invest so heavily in pursuing your ideas?
Jack: Intellectual curiosity! I am very interested in what causes people to think they are sick and what they do to seek care for their condition. My curiosity is less about the mechanics of medicine and more about the behavior of health and the behavioral cause and effect. I find these issues to be very interesting problems to solve.
Scott: Are there people you credit for providing you with critical insights, direction or inspiration in your career?
Jack: My time at UCLA, during my Master of Public Health program, was just magical. My advisors and professors were very influential in developing my public health perspective. They restructured my view of medicine. I had been practicing the one-to-one model I learned in medical school, but they taught me what it takes to influence an entire population about health.
The Ugly
Scott: Are there any things related to VBBD that you wish hadn't happened? Is there a direction people may be heading that is not productive, maybe even dangerous?
Jack: Frankly, what surprises me is the number of people that have put in a value-based design simply based on what they've seen in presentations or studies. There's been a spiral of implementation. I chalk that up to people realizing VBBD isn't rocket science. When they think the concept through, they see it makes sense and begin to proceed down the pathway.
There is a significant downside to the spiral of VBBD. Many implementers don't base their decision on data or experience, but on what they have heard externally. I've seen some adoption that makes you wonder if the implementers will be able to demonstrate effectiveness. Poorly designed plans call into question the whole concept. VBBD is still in its infancy. It's still a fragile item and could easily be overwritten by health care reform. For all those reasons, VBBD needs to be treated very carefully in every single implementation to make sure that it's sensible.
I'm also very concerned about the tendency to dismiss disease management and say it's not effective. This trend may have a deleterious effect. VBBD doesn't occur in a vacuum. Pitney Bowes offered its VBBD plan in conjunction with disease management and wellness programs. By dismissing DM you may be dismissing VBBD too or dampening entities' enthusiasm to really attack chronic disease.
Scott: Do you have any commentary on the different type of VBBD plans employers and health plans have implemented?
Jack: The subject is really how so many people have interpreted the term "value-based" so differently. There are very different definitions out there. For some, value means generic only. For others, it's the cheapest possible formulary. Pitney Bowes' intent was a formulary that was going to synergize or promote an improved health experience.
Scott: As VBBD adoption increases, do you get a sense for what makes one organization more likely to succeed than another?
Jack: I think success is more likely when the people involved are clinically oriented and risk takers.
Scott: Any predictions for the future? Are there any ideas or thoughts in terms of where VBBD is heading?
Jack: There are some additional studies in the pipeline. Those will be released within the next year and hopefully that will begin to sway the discussion on the validity of VBBD.
Scott: Any final thoughts?
Jack: Don't forget that timing matters when you bring new ideas forward. In an economic down cycle, the C-suite is looking at expenses quite a bit more. You might have to frame your approach differently.
Benfield Minute
What do corporate medical, benefits and HR professionals see as their primary responsibilities—and what are they trying to achieve? Benfield's Employer Market Research Panel* recently answered those questions. The results reveal that panel members have the interest in expanding their roles to address broader health and productivity and human capital issues.
*The Employer Market Research Panel is comprised of health benefit managers or executives at self- or fully-insured employers with 5,000 or more employees and executives at employer-affiliated organizations, coalitions or employer-interest groups.
Worth Reading
Below is a collection of articles that leaders and aspiring leaders may consider worth reading. You'll note that the articles align nicely to the leadership model depicted in this issue's perspective. You may find that some of the articles come from sources not typically within the bounds of your discipline. That's not an accident, and although we regret that exploring new sources of information may require you to register on new sites or pay for access to full articles, we don't apologize for it.
Leadership in the human capital arena requires insight that spans traditional corporate silos. Time and money spent to access new information are sound investments. Our objective is to (1) identify truly insightful stuff that you may not otherwise encounter and (2) give you enough information about it and why it matters to enable you to quickly determine whether it's worth reading.
How to Design Smart Business Experiments
Source: Harvard Business Review, February, 2009
Synopsis: Now more than ever, widely available tools enable managers to design and test different options before making a consequential decision. Harvard Business Review explains how a variety of different companies have successfully used testing and when and why testing is appropriate.
So What? In the interview with Jack Mahoney in this issue, he states: "There is a significant downside to the spiral of VBBD. Many implementers don't base their decision on data or experience, but on what they have heard externally. I've seen some adoption that makes you wonder if the implementers will be able to demonstrate effectiveness." He also states: The Achilles' heel of the Pitney model is no control group. Thinking it over again, I'd put in a control group and I've encouraged others to do so as they start their programs."
"How to Design Smart Business Experiments" provides a rationale (and a number of examples) for implementation of experiments within a business. Not all the tools and lessons mentioned have direct applicability to things like benefit design (which has built-in complexities related to "experimentation"). But, if you think about the provision/marketing of programs and services to employees as consumers, the useful insights are bountiful!
This link will take you to a free copy of the article.
Health and Productivity as a Business Strategy: A Multiemployer Study
Source: Journal of Occupational and Environmental Medicine, Volume 51, Number 4, April 2009
Synopsis: This article explores refinements in the measurement of health-related lost productivity and assesses implications of a full-cost approach to managing health. Using data from 10 participating employers—including Health and Work Performance Questionnaires (over 50,000 respondents) and medical and pharmacy claims (over 1.1 million claims)—researchers applied a variety of models to explore the association between a range of health conditions and worker absence and presenteeism. Findings were consistent with prior research, estimating that health-related productivity costs are, on average, more than twice as great as medical and pharmacy costs.
Moving from the science of statistical analysis to the art of management, the article goes on to describe how employers who participated in the study used results of the analysis to impact their health management strategy. Further, the authors build on the analyses and managerial examples to provide eight insights for employers who are seeking to evolve their health management strategy.
So What? The notion that the full cost of health conditions does not begin and end with so-called "direct" medical and pharmacy costs is not new. And, there is nothing particularly surprising about the overarching conclusion that absence and productivity costs are—on average—more than twice these direct costs. What this article does for health management professionals is to (1) provide fresh conclusions based on sound analytic methods to fortify the health/productivity story, (2) provide condition-specific insights to help guide employers who lack integrated data in prioritizing their intervention targets and (3) reinforce the value of investing in integrated data and analytic support.
In our most recent syndicated research of employer health management trends, we found that during this time of economic uncertainty many employers have "pressed pause" on implementing interventions and benefit designs. However, we observed a continued increase in trend regarding development and use of integrated data to support health management strategic planning and decision-making. Equipped with information, these employers are simply in a better position to manage their investments in policies, programs and benefits to improve workforce health and productivity.
NOTE that I did not say "HEALTH policies, programs and benefits…" because as the next recommended item explains beautifully, there's more to managing health and productivity than health-focused intervention.
This link will take you to a free abstract of the article.
Make It Matter, Make It Possible, Make It Theirs: A New Strategy for Investing in Worker Human Capital
Source: Health as Human Capital Foundation, August 2008
Synopsis: This paper, and other research-based content from the Health as Human Capital Foundation, represents a sort of counter-balance to type of philosophy and research described in the above article: "Health and Productivity as a Business Strategy."The case presented in this paper is perhaps best captured by a question highlighted on its first page: "What if—by trying to convince employees to change health habits in hopes of improving business outcomes—we've gotten it backwards? What if there are strategies to improve human capital performance that also happen to encourage better health?"
Launching forward from those provocative questions, the paper proceeds to present a primer on human capital, and then suggests a strategy that strives to:
- 1) Make human capital matter by aligning policies and programs to reward employees for being productive.
- 2) Make human capital development possible by removing barriers that discourage personal growth and development.
- 3) Make it human capital theirs (the employees') by aligning policies and programs to reinforce personal ownership and accountability for human capital protection and development.
So What? This paper is required reading for health management professionals. If your philosophy and strategy for managing health and productivity has grown and matured on a diet of traditional health and productivity literature, you are missing key nutrients for well-rounded thinking about the relationship between health and human capital. I promise that reading this paper will make you uncomfortable, because it will challenge the notion that the path to health and productivity improvement runs straight through health-focused policies and programs.
This paper suggests that employers give their attention first to things like how people are paid, policies that govern absence and disability, and the culture around opportunities for personal/professional development and advancement. The fundamental premise is that employees will protect and nurture the health of their human capital if policies and practices are aligned to reward productivity and potential. That means things like pay for performance, absence and disability policies that don't reward being away from work more than being at work, and robust training programs and opportunities for advancement, among other things. With these policies and programs aligned, workers are more motivated to protect their health because it simply makes sense for them to do so; and as such, health-focused interventions are much more likely to gain traction and to have their desired impact.
This link will take you to a copy of the article.


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Healing Power of Music
Music therapy offers balm to the sick and may spark recovery for patients with severe impairment.
It was now or never. The patient, a 76-year-old laundress in the Dominican Republic, was scheduled for total bilateral knee replacements. But her blood pressure was so high—240/120—that her surgical team refused to operate. The patient's face was contorted with worry. She couldn't simply put off the procedure: The operation was part of a philanthropic program; her surgeons would not return to her hospital in Santo Domingo for a year at the earliest. And aggressive drug therapy was not bringing the pressure down.
The solution, it turned out, was song. In her room, the patient, a deeply religious woman, asked her nurses tentatively, "May I sing?" (She was worried about disturbing her three roommates.) After she'd crooned only two religious songs, her blood pressure dropped to 180/90. With her nurses' hearty endorsement, she sang softly through the night; the next morning she was cleared for surgery. She had successful total knee replacements, wrote the doctors who published her case history in Arthritis Care & Research (April 2011).
Why does old-fashioned music sometimes succeed when state-of-the-art medicine is at a loss? "In a very specific way, music can excite areas of the brain that have been dormant; it can turn on verbal or visual pathways that cannot be accessed by other therapies," notes Concetta Tomaino, D.A. (doctor of arts), a pioneer in the deployment of music to spark recovery in patients with severe disabilities. Dr. Tomaino is the co-founder, with noted neurologist Oliver Sacks, of the Institute for Music and Neurologic Function (IMNF) at Beth Abraham Family of Health Services in the Bronx. Its mission: to study "music's extraordinary power to awaken, stimulate and heal."
We've all seen music work its magic in our everyday lives. Recently I followed two professional guitarists and a soprano around a patient floor at Roosevelt Hospital—and saw singing bring patients instant ease and trigger deep emotion. These musicians were among the many professional players who volunteer to bring live performances to patients and caregivers in six New York City health-care facilities through Sing For Hope. "Do you care for a song?" the trio would ask, pausing in the patient's doorway; about half the time, they'd be invited in.
Our most enthusiastic welcome came from a jovial elderly woman who wanted to hear "A Bushel and a Peck." After the team launched into it, soprano Catherine Hancock began singing "Someone to Watch Over Me." As the soothing melody pervaded the room, the patient relaxed and lay back, transported; her eyes closed as she silently mouthed the words. When the song was over, she told us, in a choked voice, that its message had affected her deeply; it had brought back memories of how she had watched over her husband in his illness, and it made her hope that the next day, during her operation, "God will be watching over me."
What the Sing for Hope musicians were offering patients that day was "therapeutic music"—music that any laymen can provide to give moments of respite to those who are sick. But "music therapy," Dr. Tomaino points out, is a tool employed in a serious effort at rehabilitation, and those who practice it have undergone rigorous academic training. "Most people don't think of music therapy as a health-care field," Dr. Tomaino says. "But it is."
During the 16 years she has worked at the Institute for Music and Neurologic Function with patients suffering from stroke, traumatic brain injury, and chronic diseases like Parkinson's and multiple sclerosis, Dr. Tomaino has seen music stimulate the memory of patients suffering from dementia; help stroke patients recover their power of speech; aid physical therapists strengthen the muscles of patients and extend their flexibility; assist Parkinson's patients regain their ability to walk; and reduce severe anxiety in pre- and post-surgery patients. In a series of short, compelling videos, Dr. Sacks speaks eloquently of the transformations that he and Dr. Tomaino have witnessed over the years (see sidebar).
The New Science of Song
All of us can use music to bring pleasure to the sick; music therapists, however, know how to use music to treat patients. With guitar, keyboard, drums, or accordion (Dr. Tomaino's instrument of choice), these specialists work in hospitals, nursing homes, rehab centers, schools, and hospices—and their expertise is available to patients at home as well. (See "Harnessing Music's Restorative Power", next page.) They work with special-needs children, people suffering from depression or dementia, patients disabled by accident or brain injury, and the dying. And they have credentials: A music therapist must be a proficient musician and college graduate with a degree in music therapy; he or she must have spent at least 1,200 hours in clinical training, including a supervised internship; passed a national certifying examination, and, in New York State, be licensed.
"An ordinary musician can sing along with a patient with aphasia, but he won't know why she can sing, say, only the first and last words of "By the Light of the Silvery Moon," explains Dr. Tomaino. "A music therapist [MT] will alter the music, perhaps exaggerating the range of the note where a patient gets stuck, and then have the patient repeat the phrase over and over until the repetition disinhibits the block in her brain. Then the MT will prepare a treatment program and monitor the patient's progress.
"Parkinson's patients have trouble initiating steps, cadence, and balance," she continues. "People assume that if they play rhythmic music, a patient will follow it. But Parkinson's patients don't perceive the beat the way others do. MTs are trained to manipulate the beat until they see that the patient can feel it. And to help Parkinson's patients with their speech, MTs will initiate vocalization: Since a patients' vocal folds atrophy, one way to keep them soft is humming."
Dr. Tomaino's institute has CDs of "amazing" music that patients have created—therapists at IMNF urge patients to compose music and lyrics to help them deal with post-injury depression. "Music can be used in an in-depth, therapeutic way," Dr. Tomaino notes. "It helps the body break through some of the inhibitions that result from traumatic injury. Many times patients can't articulate what they are going through. Composing helps them do that." She cites a young man who had lost both of his arms as a result of gang violence. After months and months of therapy, he composed a song that declared, "Life isn't what you expect, but it's a brand-new day."
Today, advances in brain imaging enable researchers to chart the pathways that music follows in the brain. In her new book on the power of music, Elena Mannes, granddaughter of the founders of New York City's Mannes College of Music, calls this research "the new science of song" (see sidebar).
And research—the randomized, controlled trials that are the gold standard of scientific study—has begun to validate what we laymen "know" and what clinicians like Dr. Tomaino have long observed: Music therapy can improve the medical outcome of patients with many different afflictions. The field is young: Many of these trials involve only small numbers of patients, and authors of the studies stress the need for further research. Still, using rigorous research methods, these small trials have shown that music therapy can, among its other benefits, lower blood pressure preoperatively and relieve depression. It may help children with autistic spectrum disorder improve their communicative skills, and help people with schizophrenia improve their global state. On music therapy's effectiveness in pain relief, a 2006 review of 51 studies concluded, "Listening to music reduces pain intensity levels and [morphine and other opioids], but the magnitude of these benefits is small and, therefore, its clinical importance unclear."

subset: commoncrawl


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Who remembers going to Kings Dominion way back in the day? Rides, attractions and shows have come and gone over the past 40 years, and Kings Dominion is planning a reunion year with the return of some of those beloved park icons and attractions.
On Saturday, April 5, Kings Dominion opens for a season long celebration of 40 years. As a special treat, opening day will include special musical guest Brinn Black, performances by the VCU Peppas and other fun surprises. The first 4000 guests will receive a free souvenir KD40 wristband to commemorate the opening day and start of the 40th season.
Per the press release,
"I'm very enthusiastic to be opening for our thrilling 40th Celebration season. I grew up not only visiting Kings Dominion, but also started my career here as a seasonal associate," said Pat Jones, Kings Dominion's Vice President and General Manager. "When guests step through our gates onto International Street this year, they'll feel a fresh and exciting energy in the air. Just right for reviving old memories and making new ones."
The 2014 season at Kings Dominion will bring new things to see, do taste and share, along with the return of some of the old, though revamped, favorites. Guests can expect to see ...
- The Singing Mushrooms - four colorful 'shrooms and a friendly frog sing barbershop tunes.
- The Floral Clock has been rebuilt and returns to its original location a the end of Center Street, near the historic carousel.
- Candy Apple Grove, the park's original classic midway, returns with giant candy apples and lots of new surprises.
- The strolling Clown Band is back, roaming around the park and interacting with guests.
- Safari Village (formerly the Congo area of the park) has returned along with improvements to Anaconda and Volcano: The Blast Coaster.
- A new live musical show, KD40 on Stage, will hit the stage with tunes and memories from the 1970s to today.
- International Street is more energized with new lighting and enhancements to the fountain and new coasts of paint on the shops and buildings.
- The park has expanded food offerings and new restaurant concepts to offer more options for guests to enjoy.
- Pizza Parlor (formerly Tower Pizza) has been expanded for more room to cool off on hot days.
- Blue ice cream is back at Sweet Tooth Eatery, located near the Drop Tower in Candy Apple Grove.
- Retro merchandise and collectible pins featuring the Old Dominion Line train, the Safari Monorail and 40th anniversary logo. More limited edition pin designs will be available throughout the season. Some of the upcoming pins include the Skyride, Carousel and Rebel Yell. A
To start off this year of celebrating, Kings Dominion is debuting an inaugural Spring Bloom Festival on operating days April 5 through May 18. International Street has been transformed into a kaleidoscope of color with thousands of blooms, blossoms and sweet-smelling flowers. Guests will be able to taste unique spring foods and beverages, enjoy musical entertainment and participate in hands-on activities on Saturdays.
2014 Kings Dominion season passes are now available at KingsDominion.com. Check out some of the benefits of Kings Dominion season pass ownership by clicking right here.
Opening Day Entertainment at Kings Dominion
Nashville recording artist Brinn Black is from Chester, Virginia. In case you're not familiar with her, she opened for Darius Rucker last fall at Innsbrook, and she was awesome. This theme park and music Examiner can't wait to hear her again. Read all about her performance by clicking here or here.
According to the Huffington Post, the VCU Peppas Band is considered one of the most entertaining pep bands in college basketball. Opening day at Kings Dominion should be a blast!
Kings Dominion has been making memories for families since 1974. Why not come out and relive, or start some new ones, today?
For all of the latest information on this 40th anniversary season at Kings Dominion, please visit the park's website at KingsDominion.com/celebration. Guests can also share their memories of the park in a new photo mosaic at KingsDominionMemories.com.
To stay up-to-date on all of the latest and greatest theme park news and events, kindly click subscribe at the top of the page, follow on Facebook or connect on Twitter. Be sure to check out SomewhereInTheSand.com for even more travel tips, news, attractions and family fun.


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A Virginia woman owes her incredible 145-pound weight loss to a coupon. Torrie Creamer had struggled with weight her entire life and gave up trying to lose weight until a Living Social coupon arrived in the mail in 2011. The coupon offered her four weeks of boot-camp workouts for just $25.
Creamer immediately used the coupon to kick-start a workout regimen that has led to an astonishing 145-pound weight loss over the past two and a half years.
The 5-foot-11 Torrie, who once tipped the scales at 322 pounds, now weighs a fit 175 pounds and has never looked or felt better.
The mother of three said she left the first boot-camp workout in tears, but continued to go every day for four weeks, and promptly lost 15 pounds.
"I was always the last runner in, or in my case, the last walker in," she said. "I could not do push-ups. I could not finish a routine without feeling like I was dying and about to vomit. But somehow I made it there."
The boot-camp workouts were led by fitness trainer Ken Williams and involved running on the beach, body-weight exercises, and high-intensity interval training.
After four weeks had expired, Creamer abruptly got laid off from her job and told Williams she would no longer be able to take the exercise classes.
In a touching display of generosity, several of Torrie's new friends from boot camp banded together and paid her fees. The kind gesture moved Creamer deeply.
"I sat on my porch thinking to myself, 'These people don't know me,' " she said. "At that moment I made the promise to myself: If these people were not letting me fail, then how can I let myself fail?'"
Creamer then continued to show up for boot camp classes every day for the next 12 weeks, and lost even more weight. In the process, she also overhauled her diet and began following a low-carb, high-protein diet consisting of the following meals:
- Breakfast: Protein shake with oatmeal
- Morning snack: Mixed nuts
- Lunch: Turkey salad sandwich
- Afternoon snack:Yogurt with fruit
- Dinner: Chicken with vegetables
- Evening snack: Protein shake.
Looking back, Torrie is proud of her progress, and hopes her story can be an inspiration to others who feel hopeless. She now encourages other overweight women to embrace diet and exercise.
"I feel like this is what I truly was put here to do, and it [took] hitting rock-bottom before I could understand that," she said. "If I can do it, so can you."
Suggested Links
- Dr. Oz reveals inexpensive anti-aging wrinkle creams and weight loss secrets
- Vegan yoga fan Christie Brinkley wows at 62: I didn't get plastic surgery
- Ketogenic diet beats chemotherapy for almost all cancers says Thomas Seyfried
- Dr. Oz's two week rapid weight loss diet: Lose 9 pounds in 14 days
- Sexy Shania Twain, 50, reveals low-carb vegetarian diet and yoga workout tips


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Iam8bit, located on a gentrifying section of Sunset Boulevard, is easy to miss even if you're looking for it. But after a long week running around the E3 show floor, I decided to get away and check out the one LA art gallery I've always wanted to see. It was a good decision—the gallery is a kind of Mecca for anyone who believes in the power of video game imagery in our collective culture.
This image collection gathers some of my personal highlights from the gallery as well as my dive into a life-sized version of Uncle Scrooge's Duck Tales money bin (yes, really). Check out many more pieces (or buy one for yourself) at Iam8bit's website.
I loved the way this painting draws you in to a beautiful recreation of Mario's world. By Harlan / Darthpopstar
I loved the way this painting draws you in to a beautiful recreation of Mario's world. By Harlan / Darthpopstar
There was a contest going on to name as many of these characters as you could (I got roughly 90 percent). By Gabe Swarr
No, you didn't stumble upon the Incan art section of the gallery. By Michelle Valigura
It won't be long before Nintendo releases a game based on clay pot versions of the Mario brothers. By Michelle Valigura.
The walls of the bathroom were lined with pages from the Scott Pilgrim comics. Of course.
The big draw for the show was this mock-up of Scrooge's money bin, complete with plush gold coins. It was pretty shallow, so instead of jumping in, I had to kind of crouch and fall.
Life is good.
This green cheese tasted awful.
Note the little heart formed by the cord. By Kevin Stanton.
Senor Chips
A decidedly Mexican take on a familiar game. By Señor Chips.
Get it? It's a pun! Fun fact: The "Donkey" part of the name actually came from a bad translation for "stubborn" in a Japanese-English dictionary. By Mark Caballero.
The most dangerous turtle. By Darrick Maasen
I kind of guessed what this piece was going for before reading the lengthy title. By Hiroshi Yoshii
Much better than a singing Big Mount Billy Bass on your wall. By Derek Maasen.
This is just one of a series of rotating animated GIFs being projected on one of the gallery's empty walls. It was mesmerizing.
I have to admit, Sonic is a little imposing projected five feet high.
On a Game Boy screen, it's just pixels. Blow it up and put it on a gallery wall and it's high art.
Listing image by Senor Chips


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(Ivanhoe Newswire) – Researchers out of the University Medical Center Utrecht performed a multicenter, double-blind, randomized trial to determine the potential causal role of respiratory syncytial virus (RSV) infection in the pathogenesis of wheezing illness during the first year of life, using the commercial monoclonal antibody palivizumab against RSV.
Severe RSV bronchiolitis has been associated with an increase in multiple events of early wheezing, asthma, and possibly allergic sensitization later in life. The pathogenesis of recurrent wheeze after RSV infection is still not understood. To address this issue, researchers enrolled preterm infants in pediatric departments of one university and 15 regional hospitals in the Netherlands from April 2008 until December 2010. Researchers found that the administration of palivizumab for RSV prevention reduced the total number of wheezing days in the first year of life. The post-prophylaxis effect of RSV prevention on wheezing illness is evidence that RSV infection is an important mechanism in the pathogenesis of wheezing during the first year of life among late preterm infants.
For more information, go to: http://www.nejm.org/doi/full/10.1056/NEJMoa1211917
SOURCE: New England Journal of Medicine, May 2013
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August 7, 2014 | Volume 44, Number 31
Your July 31 edition has a front page story with the headline, "Senior tax break costing borough $300K."
That is incredibly offensive. Since when does anyone "owe" the borough for the right to live here? The borough's responsibility is...
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Integer-sided right triangles will fit into a square:
but how about integer-sided non-right triangles? Here's a near miss - they don't quite fit like this:
Is it possible?
I just used a hastily written electronic computer program:
Not very insightful but I suspect (and I'm sure someone can prove) that no solution exists which is only made of 4 triangle meeting at a single point in the middle. It also leaves behind the question of what the fewest number of triangles possible is.


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Ai She Er Hotel
- Location:
- Address: NO.143 Blue Caribbean Fang, North Kehua Road, Wuhou District, Chengdu
- Tel: 028-85220114 (Book this hotel, call 800-2682918)
- Hotel Name in Chinese: 成都爱舍儿酒店
- Lowest Price: On Request
Opened in 2007 and refurbished in 2009, the Ai She Er Hotel is an fashion style apartment, it is located close to the IT center and Sichuan University. The big market is just within walking distance. The hotel is 6km away from the city center, 8km away from the Chengdu North Railway Station and 20km away from the Shuangliu International Airport.
This Ai She Er Hotel boasts a total of 119 rooms, all the rooms are equipped with DDD phone, air conditioner, 24-hour hot water, free broadband internet access, slipper and 110V outlet. The restaurants and bars around the hotel can meet a variety of dining requets of guests.
- Prices not include 18% service fee and tax.
- Payment Method: pay using our secure online payment service or pay at the hotel at some hotels.
- Triple/quad occupancy may require an extra bed at extra cost.
Hotel Amenities
|Hotel Services
|Luggage service, Laundry service, Room service, Wake Up Call, 24hr Reception, Fax Service
|Room Amenities
|Air conditioning, Alarm clock, Color Television, Coffee/tea maker, Telephone, Bath and Shower, Free for Internet
Hotel Amenities: Elevator, Parking, Air-Conditioned Facilities, Deposit Box at Front Desk, Fire Detector
Dining Facilities:
Print the Taxi Directions
- Please drive me to Ai She Er Hotel, thank you!
- 请送我到成都爱舍儿酒店 ,谢谢
- Address: NO.143 Blue Caribbean Fang, North Kehua Road, Wuhou District, Chengdu
- 地址: 成都 武侯区 科华北路143号蓝色加勒比方
- Tel: 028-85220114
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Talent runs deep on 2013 roster
Game kicks off at noon PT on FOX.
Nine practices in six days
Offense looks good in two-minute drills
Utah vs. USC - USATSI Gallery
Utah takes on Cal
UTAH: One of the league's best nose tackles ... played in all 24 games in his two years with 14 starts.
2013-Second-team All-Pac-12 ... named first-team all-Pac-12 by Athlon Sports ... team captain ... played and started in all 12 games ... despite nearly constant double teams, he finished third on the team in tackles for loss (9.5) and sacks (4.5) ... 53 total tackles and one forced fumble ... career-high eight tackles against both Weber State (in one half) and Colorado ... seven tackles and an assisted TFL against UCLA ... six tackles and two tackles for loss against Arizona State.
2012-Played in all 12 games with two starts ... 21 total tackles with 3.0 tackles for loss (two sacks) ... season-high five tackles against Washington ... four tackles against Arizona.
PRIOR TO UTAH: 2011 NJCAA second-team All-American ... two-time all-conference (first-team WSFL in 2011) ... Snow College team captain ... 49 total tackles, 10 tackles for loss, two sacks and a fumble recovery in 2011 ... Snow won the Top of the Mountain Bowl in 2010 and 2011 and was the conference co-champion in 2010 ... first-team all-state in 2008 as a senior at Skyline High (Utah) and honorable mention all-state in 2007 ... all-region as a junior and senior ... 65 tackles and 10 sacks in 2008 ... Skyline team captain.
PERSONAL: Son of Tony and Tutaga Palepoi ... father played for the Samoan Rugby Team ... one of 14 children ... brother Anton Palepoi played at UNLV and had a five-year NFL career with the Seahawks, Broncos and Cardinals ... married (Delaney) with two children: Taytum and Liam ... last name is pronounced pah-lay-poy ... graduated in the fall of 2013 with a bachelor's degree in sociology ... born Dec. 19, 1990.


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By the time it was decommissioned, the original Woodrow Wilson Memorial Bridge connecting Maryland and Virginia to Washington, D.C., was carrying 167% more trips per day than it was designed to. Its $2.4 billion replacement has earned a different distinction: as the American Society of Civil Engineers' Outstanding Civil Engineering Achievement, awarded annually since 1960 to projects that contribute to both the civil engineering profession and the local community.
Soil conditions required the use of precast and post-tensioned V piers that support variable-depth plate girder spans, creating the arch appearance without the large horizontal thrusts of conventional arches. Sixty thousand tons of debris from the old bridge was used to create or enhance reefs in Chesapeake Bay, part of a massive environmental mitigation effort to restore 26 miles of fish spawning.
Selected from 26 entries, the merit finalists include:
Bridges and Culverts
Diversity in Engineering Matters, the new eLearning series from the Society of Women...
American Society of Civil...
After a cloud-based mapping program cut project costs 10%, one of the nation's largest...
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The commercial/institutional industry remained busy in the first quarter, but could...
Construction & Maintenance
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Roadway Design, Construction &...
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Make-A-Wish® grants the wishes of children with life-threatening medical conditions to enrich the human experience with hope, strength & joy.
Make-A-Wish is the legacy of Chris Greicius, a 7-year-old boy from Phoenix. Find out how his wish to be a police officer set in motion a phenomenon that would create an unprecedented kind of charity.
Since our Chapter's inception in 1983, Make-A-Wish® Ohio, Kentucky & Indiana has granted over 14,000 wishes to children with life-threatening medical conditions.
Learn more about working at Make-A-Wish®.
Help wish kids take flight. Donate your air miles now.
Sign up to receive emails from Make-A-Wish.


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View the links below to find out the types of jobs we have and how many are currently available within the Group.
Our staff culture is defined by our 'Vision and Values' and these are at the heart of everything we do. We are looking for individuals who will share our Vision and commit to demonstrating our Values in their role within WM Housing Group.
Creating places where people are proud to live and work


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Criminal Defense Resources
- Find Criminal Defense Lawyers, Criminal Law Attorney Finder
- The Changing Landscape of Drug Laws in the United State
- No Jail Time: Choosing the Right Plea Bargain Strategy
- The Rights of Immigrants Charged with Criminal Offenses
- When Misdemeanors Escalate Into Felonies
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- More Criminal Defense Articles
How To Handle A Grand Jury Investigation
The grand jury is among the most venerated traditions of our country. The United States is currently the only country that still uses grand juries in criminal indictments.
What Is A Grand Jury
A grand jury investigation is almost always preliminary to a serious felony charge. It consists of a group of 16-23 citizens who convene to decide if there is enough evidence to try the individual in question. This is just the first step before the trial. If the grand jury decides that there is not enough evidence, its judgment will prevent the trial from happening.
When the grand jury presents its case before a judge, the criminal defense attorney can present a legal defense, claiming that there isn't enough evidence of wrongdoing to bring the case to court. This is a lot like a standard criminal trial, except the grand jury takes the place of the prosecutor, and it only has to prove probable cause rather than "beyond a shadow of a doubt."
What Your Lawyer Will Attempt To Do
In its investigation, a grand jury may behave similarly to a police detective and call you in for questioning. Your lawyer will coach you for this questioning both to make sure that you answer questions properly and to coax out the grand jury's strategy. A criminal defense attorney will also:
- Help you collect, produce and submit the proper documents requested by the grand jury
- Analyze information collected by the grand jury to learn about the particulars of the case
- Develop a defense to counter the case being made by the grand jury
- Keep tabs on communications between the grand jury and other targets of the investigation
- Ensure that the grand jury does not overreach in its investigation
- Safeguard your legal privileges
- Work out deals with potential prosecutors who will handle the case if the grand jury decides to indict
What You Should Do
The answer to the question of how to handle the investigation can be expressed in two four-word sentences:
- Keep Your Head Down
- Let Your Lawyer Work
If you are facing a potential grand jury investigation, find a good criminal defense lawyer to help you handle the process today!


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"Bears for Belarus" Photographer Released by the KGB
Anton Suryapin, a photographer detained by agents from Belarus's state security agency (still referred to as the KGB), was released on August 17, according to Reporters Without Borders. He is being charged with "organizing illegal migration"; authorities accused him of helping the pilots who airdropped 800 teddy bears carrying pro-democratic messages throughout country on July 4. Amnesty International reports that Suryapin is a journalism student at Belarus State University and that he was arrested on July 13 after uploading images taken of the "Bears for Belarus" demonstration to the Belarusian News Photos Web site.
The event was engineered by the Swedish advertising firm Studio Total. It has created tension between the two European countries and resulted in president Aleksandr G. Lukashenko firing a number of officials, including the foreign minister and head of air defense, because the plane entered Belarusian airspace undetected and without permission.


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Singing blues has been getting old.Lana Del Rey Ride
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female - 04/10410 PhotosSan Martin Buenos Aires, Argentina
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One motorist was killed in a crash along Northlake Boulevard in Palm Beach Gardens.
Images: 1 hurt in Northlake Blvd. crash
The single-vehicle crash happened near Interstate 95 about 5 a.m. Saturday.
Authorities said a car crashed into some trees, and the man driving the vehicle was dead when rescuers arrived.
An investigation is underway.
Share breaking news photos on u local.
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Later this month at the Mobile World Congress, held annually in Barcelona, a new company will introduce a smartphone considered to be the most secure device ever for doing voice and text communication and Web browsing in complete privacy.
Blackphone, developed through a joint venture between Geeksphone, a Spanish smartphone maker, and Silent Circle, a maker of encryption software, will secure voice calls, texts and file transfers while its Web browser is built, by default, to block ad-tracking technology on Web sites.
While billed on some tech news Web sites as "NSA-proof," the Blackphone "is designed to let people decide whether companies that profile consumer behavior will be permitted to collect information about their Web browsing or physical movements," according to a February 7 article in MIT Technology Review.
The article was shared with me by Natalie Fonseca, head of the Privacy Identity Innovation group, which promotes privacy protection in our digital world and hosts tech forums on the subject. Thanks, Natalie.
"We are making a device that puts privacy first and tries to give control back to the end user to decide what information they share," said Javier Agüera, cofounder and chief technology officer of Geeksphone, in the article. "Maybe some people want to benefit from personalized advertisements, but we think you should have a choice."
This link to the Blackphone site includes a video telling the story of the product's design.
Blackphone will run on the Google Android mobile OS. Besides encrypting text and voice messages and blocking ad-tracking software in the browser, Blackphone will also block wi-fi beacons added to networks of late that collect information on how often customers visit and where they have accessed wi-fi previously. And besides blocking unwanted ads, the Blackphone browser also can block malware that can infect a device disguised as ads.
Existing smartphones and computers have settings that allow users to manage their own privacy settings, but the MIT article says opting out "is rarely easy."
"Efforts to develop a standard way for people to signal to all websites that they don't wish to be tracked have foundered, while opt-out schemes offered by ad industry groups and companies such as Google are clunky and little known," says the article by tech journalist Tom Simonite.
If you think it's ironic that a phone designed to thwart the ad revenue business model of companies like Google is running Google's own Android OS, another story about Blackphone on the site WomenCitizen.com, says it will run "a highly skinned fork of Android dubbed PrivatOS," so it's not the Android that runs on your typical Samsung or HTC device.
Pricing for Blackphone hasn't yet been revealed but it is network agnostic, which means you should be able to use it on any carrier in the U.S. or abroad.
I'm looking forward to seeing how it catches on.


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Intermec EasyCoder PF4i Barcode Label Printers
With the Intermec PF4i barcode printer, users can enjoy all the features and benefits of larger bar code label printers, including stand alone smart printing, without giving up valuable space. The flexible media handling of the Intermec PF4i label printer supports 6 or 8-inch OD label rolls, tear-off or label auto peel, and labels, tickets and tags in either roll or fan-folded format.
The PF4i is designed to excel where space is limited. Utilizing the latest technology, it features a strong and proven mechanical platform, and powerful newly developed electronics. The PF4i can act as a "smart client" executing user-de.ned programs. This means that your printer can eliminate the PC, operate additional hardware (e.g. scanners, other printers, conveyors), access information from the network, and has the ability to change with the application for additional functionality when needed. When using the wireless option, any attached peripheral devices also become part of the wireless infrastructure.
As an Authorized Honeywell Reseller, we only advertise MSRP (List Price) on Intermec EasyCoder PF4i Barcode Label Printers as part of their MAP (Minimum Advertised Price) policy. To get the actual price of an item, please call one of our product specialists at (714)922-1140.
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Printer command languages do not restrict the PF4i. The PF series printers can emulate and replace competitive and older Intermec printers without requiring any changes to the host programming or label formats. The PF series features optional integrated wired or wireless networking. The wireless interface uses an integrated standard 802.11b/g radio providing 128-bit WEP encryption of the information relayed through the network.
The magnetic QuickMount printhead eliminates hassles and downtime. The printhead is replaced quickly and easily with the magnet and u-brackets ensuring proper alignment. The double-clutching ribbon mechanism means that you are not restricted to ribbon types based on how they are wound. The handy, inexpensive and PC-compatible CompactFlash™ memory technology provides quick and easy memory expansion for extra storage of formats, graphics, fonts, and provides an easy way to update printer. The PF4i bar code printer is exceptionally fast in throughput and printing, reliable, and delivers very high print quality.
- Superior throughput eliminates wait time at the printer
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- Magnetic QuickMount printhead for easy printhead installation
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Activities Grants
Social and cultural activities, here at PVCC, are an important aspect of our learning centered philosophy. Our leadership is dedicated to promoting activites that advance student learning and increase the student's understanding of diversity and inclusiveness.
Grants are available for the faculty, administrators, and staff to support this effort.
We encourage you to design and implement one of these important projects. For more information, refer to the Frequently Asked Questions or contact Mike Ho at (602) 787-7308 firstname.lastname@example.com
Please provide 2-3 weeks advance notice from the date of your proposed event.


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Pandora's Box
My Pleasure
Connie Brockway
2004, European Historical Romance (Regency England)
Pocket, $6.99, 358 pages, Amazon ASIN 0743463234Part of a series
There is a staff review of this book as well
My Pleasure is the second book in a trilogy about three sisters who lost their father when he sacrificed his life to free a group of political prisoners. In return, the three men pledge to protect the sisters. Helena works as a lady's companion - and plays a dangerous game at night. Serving as a courier between two separated lovers, she attends a series of masked events. At one event, she meets fencing master Ramsey Munro, illegitimate grandson of a marquis. She recognizes him immediately as one of the men sworn to protect her family, but hopes that he won't realize who she is. What she doesn't know is that he has been watching her from afar for years. Now the two keep meeting as Ramsey watches over Helena. Meanwhile, Ramsey prepares for an international fencing competition that could bring him substantial wealth, and both characters face multiple threats to their happiness and well-being.
Blythe: Linda, it's kind of surprising that in all our time doing Pandora we've never discussed any of Connie Brockway's books before. She's written some classics that many romance readers love, and she continues to be very popular. I've read several of her books over the years (and of course, I have several more TBR), but it had been awhile since I'd read Brockway. On the whole, I thought My Pleasure was indeed a pleasure. I loved the characters - particularly the hero.
Linda: I too have some Brockway's both on my comfort reread shelf and in my TBR pile. I read both My Seduction (first book in the series) and My Pleasure and I liked the second book better. I loved the characters in both books, but the plot in My Seduction seemed to run out of gas in the middle of the book and then a whole lot happened too easily in the last few chapters. I loved My Pleasure's Ramsey and Helena and since I read this in one sitting it must not have dragged for me. <g>
Blythe: I haven't read MS, so I can't comment on that. But My Pleasure certainly didn't have a pacing problem. I thought it was a quick, engrossing read, and I didn't want to put it down. I think it was really Ramsey that made the book for me. I loved that he was a fencing master; it's an angle I hadn't seen before. And, even better, Brockway managed to make him have a group of friends (a group that swore an oath, no less) without making it cheesy and ridiculous. I am perhaps a little too critical of heroes with friend clubs at times, but it's one of my big pet peeves. So often, authors make them sound really juvenile.
Linda: Well, at least they didn't have silly 'secret' names, which I know you really hate. I liked Ramsey a lot because I love heroes who are drop-dead gorgeous, but aren't overly impressed by their own good looks. I too found this a quick read and once started I ended up reading till 2:30 AM (not unusual for me) as I was just totally engrossed. Perhaps the only problem I had with the book is that I always have trouble believing people won't recognize someone because that person is wearing a mask. At least they weren't husband and wife as in one of Quick's books, but the idea that someone thinks they won't be recognized because they were wearing a costume is ridiculous to me - I would know my hubby's voice if he disguised it and wore a King Kong costume!
Blythe: You've hit upon my single problem with the book. I too have a lot of trouble buying that scenario, and I thought it went on far too long. As soon as she showed up at his salle the jig should have been up. Anyway, I didn't think Ramsey would have any trouble recognizing her, and I was surprised she thought she could fool him. However, this plotline ended in the nick of time for me. Any longer and I would have been really annoyed. And I too have read a book where the hero and heroine were husband and wife - and he didn't recognize her after seeing her several times and even having a sexual encounter with her - because she'd had reconstructive surgery. Totally ridiculous, IMHO.
Linda: LOL, I remember a regency where the guy felt guilty because he loved a masked beauty (and had sex with her) instead of loving his wife - of course they were one and the same and it was totally ridiculous - a case of a couple being TSTL. Anyway, as you said the plot stopped just in time to avoid having Helena be annoying and I thought her anger was dumb too as she certainly could have told him that she was the 'masked beauty' instead of hoping he would never know. I too liked the fact that Ramsey had a profession and fencing master is unusual and enjoyable and made for some interesting scenes. It also made it easy to envision him as this handsome, graceful (and charming) man.
Blythe: I liked the fencing master angle but oddly enough I didn't care for the fencing term chapter headings. They just seemed awkward and contrived to me. But that's a really minor niggle. I should say too that while Helena's insistence at deception was a little annoying, over all I really liked her too. I tend to like poor relation/governess/companion type books. Helena is a companion to a real piece of work. Her employer, Lady Tilpot, is totally convincing and believable in her vanity and churlishness. Helena fulfills her job with dignity and spirit in spite of it all. I thought she made a good match for Ramsey.
Linda: I liked Flora, too, the slightly spacey niece and her love, Oswald...What a pair. I thought they made for a nice secondary romance and of course provided the impetus for Helena to dress in costume. Lady Tilpot was a real piece of work and rang quite true for me too. Her insistence on putting Helena in her place in public while obnoxious, is also true of this personality type that must be the center of attention. I did wonder what Ramsey's grandfather whispered to her that made her accept Ramsey as the true air to the Marquisate. It was never disclosed and I was curious.
Blythe: I liked the self-absorbed young couple too. What was nice is that Oswald was a total idiot, but he did actually love Flora. And Lady Tilpot had a definite Lady Catherine de Burgh vibe, didn't she? She liked to have the distinction of rank preserved. <g>
Linda: This book, My Seduction, and the third, My Surrender, also have a common plot and villain who remains in the background manipulating events to try to bring about the deaths of first Kit (from My Seduction) and then Ramsey. The villain betrayed Ramsey, Kit, Douglas and Andrew (Dand) when they were on a secret mission to France. I have a couple of theories about the identity of the villain, but we won't know who he is until book 3. I know I will be reading the next book very interested in seeing if my hunch is correct.
Blythe: I've heard from you and a couple of other people that the first book wasn't as good as this one, but I am interested enough to seek it out anyway (if I don't already have it somewhere. I need to get a handle on all my books). I was also very intrigued by Helena's younger sister Charlotte, who appears to run with a very fast set. I don't often bother to read the "previews" at the end of books -I figure I'll just catch the real thing later - but I did read this one and was quite intrigued by the set up.
Linda: Well, I hate previews that get me hooked on books that won't be available for ages - so I don't read any of them. It is frustrating to get hooked on a book that won't be out for a year! (Note from editor, My Surrender is due May 2005) I am intrigued by Charlotte - I love hoydens and she certainly seems to be one. I would recommend My Seduction although the pacing was slightly off for me. One thing that I really enjoyed in MS was the description of the rose garden and all of the wonderful things the four boys had built in it. Kate spends some time at the Monastery and gets to know more about the boys' background from the priests that helped to raise them. I would have like to have seen more of the monks in My Pleasure as I really enjoyed their interaction with Kate, especially the woman-hating Brother Martin.
Blythe: I'm glad to hear that those aspects are more fully explored in the earlier book. I think it's perfectly possible to get the gist of what's going on in the second book without having read the first , but I wouldn't mind having some additional information. It's always nice when you can get the whole picture. Nonetheless, I thought MP was a stand-alone read. And I'm glad we both enjoyed it.
Linda: Well, my hunch about the villain is based on a scene in the first book and a clue in the second book seems to confirm it, but it will be fun to see if I guessed right. The first book also goes into more detail about their awful captivity, which is also given fuller detail in book two. The conditions were horrific and the scene of Ramsey's branding is stomach-churning, at least for me who has a low 'squeamish' threshold.
Blythe: Not having read the first one, I only have a vague guess about the villain. But it's an interesting plot line. Do they explain in the first book why Kate and Helena's father sacrificed himself for the freedom of Ramsey and his friends?
Linda: No, it isn't really explained and I really liked the fact that Kate spends a lot of time being angry at him for his heroism and that of her husband Michael, who died in India. When her father died so did the annuity they lived on and her family is left destitute. Kate felt he had no right to do that to them. It becomes clear Kate's father traded himself for them, but he expected to have diplomatic immunity and never thought he would die. It is implied that he saw something or someone he shouldn't have and I think that is confirmed by the villain in this second book. I don't know that it is possible to do a spoiler when I am only guessing, but I hesitate to give my guess; if I'm right it could be a spoiler for others. I will say that I reread all scenes set during their captivity very carefully. I also thought it was interesting that the villain insists to himself that he is not a traitor.
Blythe: I don't think I caught that. But I did think it was very interesting that Ramsey honed his fencing skills in prison. He had to fight the guards - so they could practice - but he had to be very careful how he did it. He couldn't wound them at all, or he would have risked serious punishment.
Linda: I thought Ramsey was a wonderful hero and the memories from the dungeon were quite devastating. Ramsey seemed to me less embittered and distrustful then Kit was, even though he had plenty of reason to hate his grandfather, the betrayer and his captors. I will definitely be reading My Surrender. In general I have enjoyed series that are related with a common suspense line running through them, although some authors haven't been nearly as adept as Brockway in scattering clues throughout the books. I was shocked when the villain's disguise was revealed, which is unusual for me. But, I went back and realized that Brockway played fair - there were clues that something wasn't quite right if one had been paying more attention.
Blythe: I actually spotted that disguise early on, so I wasn't very shocked by that. He seemed the obvious choice. But since we didn't find out the "why" of it, or his true identity, it was still pretty suspenseful for me, and I'm sure that will carry over to the next book. In the interest of clarity, we should probably explain that when we talk about figuring out who the villain is in this book, we are talking about figuring out his current disguise. We still don't know who he is from Ramsey's past, or why he betrayed Ramsey and his friends.
Linda: I hate authors who don't play fair in a suspense plot, and just spring a villain on you. The clues are there but they are subtle (conversation) and overt (the convenient demise off-stage that allows the villain access to the main characters). Since the villain also used the same ploy in the first book, while taking care to avoid running into Kit - it looks as if his acting skills have improved by the second.
Blythe: I think you are right that the clues are there here (which is one reason I spotted him), but I know what you mean about authors who don't play fair. I've read a few books where the villain seems to be chosen at random and the reasoning doesn't make sense. But you know, I almost prefer that to when the author is trying to make the villain a secret, but the identity is so obvious it's embarrassing, or the clues are so heavy-handed that even a child would pick up on them.
Linda: I agree - the red-finger-nailed femme-fatale is not a favorite of mine either. I think that Brockway lived up to my expectations in My Pleasure, I was slightly disappointed with My Surrender, but the fault was certainly not with the hero and heroine - they were wonderful. I thought Kate's anger at their father for leaving his family in poverty was realistic and understood why it didn't diminish through 3 years of hardship and the loss of her mother. Brockway has a flair for creating characters one really loves that also have depth and she certainly doesn't disappoint in this series.
Blythe: I would also give this book a big thumb's up, even with the whole disguise plot. I think it's well worth reading, and I will be finding the other books as well. Next month, we'll be reading something completely different, however.
Linda: Next month we are reading The Shaughnessy Accord and The Samms Agenda by Alison Kent, second and third in her Smithson Group series. It will again be starting a series with a common thread from the first book, but they will be a change of pace as they are contemporaries from the Brava imprint, which is Kensington's hot and steamy line. I have enjoyed Kent's category books in the past and the one about phone sex, Call Me, is even on my keeper shelves.
Blythe: I don't think we've ever read a Brava before, so this will be something new for us. I too have read Kent before - I reviewed one of her Blazes and thought it was pretty fun (if a little over the top).
Linda: Yes, she has a great imagination and her characters have been very likable.
Well, that's it for this month - happy reading.
--Blythe Barnhill and Linda Hurst, for
-- Pandora's Box


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This book contains my personal recommendations to new dentists that I hire shared for the first and maybe last time. Frankly dentists get out of dental school as a danger to themselves as much as others. If you read this short book you'll dodge a few bullets and maybe even have an extra million in your account as they are shoveling dirt on you. Also check our 'tip of the day' in the dental student discussions section of Dentaltown.com for some cool ideas that didn't get into this edition.
After over 25 years in general dental practice it's time to share the good, the bad and the ugly. If you can't handle the tooth then don't read these books!
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The Bioethics of Shorter-term Orthodontics Publicado 02 de agosto de 2015
Toxic Root Canal Publicado 16 de marzo de 2014
The New Dentist Survival Manual- 2014 Publicado 13 de marzo de 2014
Affordable Dental Marketing Publicado 21 de enero de 2014
The Celebrity Tooth Collector Publicado 15 de enero de 2014
Dental Treatment in Mexico Publicado 14 de julio de 2013
High Speed INVISALIGN Publicado 11 de marzo de 2013
Teeth Shouldn't Hurt Publicado 17 de febrero de 2013


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Search Sports Card Radio
|2011 Tri-City Sports PL
Auto's & Rookies Football
Release Date: May 2011
3 Hits Per Box - 6 Per Hot Box
30 Total Cases In Production Run
All cards are graded by PSA or BGS
For a complete checklist of this product, please refer to the Tri-City Sports PL website. Here are the top 15 Blue Chip Graded Cards that are available in this product. Odds are 1:40 boxes. Cards pictured below are not the actual cards in the product.
2011 Tri-City Sports Auto's & Rookies Football
Graded Blue Chip Cards Checklist - Odds: 1:40 Boxes
-Check the current value on eBay below-
|2005 Playoff Contenders Football
Other Aaron Rodgers Blue Chip Cards:
|2000 Playoff Contenders Football
|1976 Topps Walter Payton PSA 9
|1984 Topps Dan Marino PSA 10
|1984 Topps John Elway PSA 9
|Additional Blue Chip Graded Hits in 2011 Tri-City Sports Football
|2011 Tri-City Presidential Cut Autographs
Limited to 1 Per President
Certified by PSA/DNA
|2011 Tri-City Game Used Helmets
Limited to 1 Per 20 Box Case
Redemption Card Inside Box
|2011 Tri-City Game Used Jerseys
Limited to 1 Per 20 Box Case
Redemption Card Inside Box
|2011 Tri-City Game Used Gloves
Limited to 1 Per 20 Box Case
Inserted Into Product
{module 65}


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Most filmmakers create crazy movie websites that look awesome, but do nothing to help sell their movies. Don't do that!
If you are promoting your movie online, you need to create a simple website. You should have a trailer, an about page, a buy now button, links to your social networks and an easy way for someone to sign up for your audience list. Additionally, adding a few dozen relevant blog articles will help you pick up organic traffic.
Anything else is egotistical movie marketing and bad business.


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My lonely trip to Scandinavian lands from Stockholm to Nord Cape. 4.144 km of roads through woods, lakes, wild places, small cities and friendly people.
see you soon
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you live only once Published April 07, 2012
Mosca 41° Published April 07, 2012
you live only once Published March 11, 2012
A parte l'anima, nulla mi appartiene Published March 05, 2012
VISIONI/VISIONS 2011 Published November 27, 2011
Raf b&n Published October 10, 2011


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Kung Fu Challenge! (1985)
October 31, 1985 from the World Wrestling Federation - Ricky Steamboat grapples with Mr. Fuji, who is accompanied by Don Murracco. Vince McMahon calls the action with Jesse Ventura. From the Saturday Night's Main Event broadcast on November 2, 1985.
To Embed this video, go to this link.
Back to the WWF Singles Matches Library
back to Uncle Earl's Classic TV Channel


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Need Help? Call 1.866.472.4001
Rule The World Crown Shelf
$169 Sale $129.99
- Overview
Give your space the royal treatment with a shelf that's befitting of your display-worthy treasures and favorite reads.
- 47" wide x 5" deep x 27.5" high
- This decorative shelf is expertly crafted of mild steel.
- Distressed Simply White finish is hand applied in a multistep process.
- Dimensions + Care
- Overall: 47" wide x 5" deep x 27.5" high
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- Dust with a soft, dry cloth.
- To protect the finish, do not apply abrasives or household cleaners.
- Shipping Info
Please allow 5-7 business days for delivery. Delivery estimate includes monogrammed and gift-wrapped items.


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Red Sea Nitrate Pro Test Kit is an accurate test kit with high quality reagents. Featuring a unique colorimetric comprator, this pro test kit comes with clear instructions for easy use. Tests in the range of .06 - 15 ppm with an accuracy of .06ppm.
Red Sea Nitrate Pro Test Kit includes reagents, analytic grade glass vials and the colorimetric comparator.


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Welcome to Winds West Elementary!
School Times
Start Time : 7:45 AM End Time : 2:45 PMStudent and Parent Handbook 2015-16
Check out Winds West's Calendar!
The following is the school supply list for Winds West Students, in PK - 4th Grade. If you have any questions, please contact the site, 350-3475.
Winds West
Teacher of the Year
Yeneer Oruru


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In June 2013, the Opening ceremony, III tour and Winners Gala of the XII Moscow
International Ballet Competition and contest of choreographers will be held
on the main stage of the country!
Grigorovich has been heading the juries of numerous international competitions in classical ballet. After the death of his wife, the great ballerina Natalia Bessmertnova, on February 19, 2008, he has been offered the opportunity to return to the Bolshoi again in the capacity of ballet master and choreographer.
Moscow International Ballet Competition has become a tradition, an integral and prolific aspect of the world ballet community. Founded in 1969 it quickly attained professional prestige as well as a reputation of a serious platform for young dancers. The magic of the Bolshoi Theatre has always attracted young dancers from all over the world, and success on its famous stage meant wonderful future possibilities.
All rights reserved, 2013 — 2014


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Tattoo Medical Supplies
Please choose a body region on the right for you to pin point the problem area of your body.
Shop by Condition
Shop by Brand
A variety of wipes, soaps and skincare products needed to maintain a clean healthy body, along with luxury products to enhance smooth, glowing skin. Proactive, preventive, and repair skin care products to keep you looking and feeling good.
The only one on the market that protects against chafing and friction, while also treating chafed areas and…
Soothes, Treats, and Prevents Rashes, Chapping, Burns, Saddle Sores, and Blisters. And treats all types of skin breakdown.…


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April 4, 2013
2013 UCLA Statistics | MPSF Release | 2013 MPSF Statistics
LOS ANGELES - The No. 4 UCLA women's water polo team (21-3, 3-1 MPSF) travels to Northern California to face No. 2 Stanford (22-1, 3-0) in a key MPSF game at 1:00 p.m. at Stanford's Avery Aquatic Center.
Sophomore attacker Emily Donohoe leads UCLA in scoring with 55 goals (2.29 goals per game), which ranks fifth in the MPSF. Freshman Rachel Fattal is second on team in scoring with 41 goals (1.71 goals per game), which ranks 13th in the MPSF. Freshman center Alexa Tielmann is third on the team in scoring with 23 goals while freshman defender Alys Williams is fourth on the squad with 21 goals. Senior attacker Gisselle Naranjo and sophomore attacker Danielle Ferraro are tied for fifth on the squad in scoring with 20 goals each.
Redshirt sophomore goalkeeper, Sami Hill is currently second in the MPSF in saves per game at 10.86. She is also fourth in the MPSF in goals against, giving up 5.84 per game. Hill is also second on the team with 25 assists and is fourth on the squad with 17 steals. Freshman Alex Musselman hasn't played enough games to qualify for MPSF rankings, but she has allowed just 5.80 goals per game and is averaging 6.92 saves per game.
True freshman Rachel Fattal leads the Bruins in steals (27), sprints won (31) and field blocks (17) and is second in scoring (41 goals) and is third in assists (23).
Freshman attacker Kodi Hill leads the team in assists with 26 on the year. Hill also has 10 goals, 13 steals and is tied for third on the squad with six field blocks on the year.
Brandon Brooks is in his fourth season as UCLA's head women's water polo coach in 2013. He was named the third head coach in program history on June 3, 2009, and has compiled a 92-22 (.807) record.
The No. 4 women's water polo team traveled to Northern California for a road double-header last week. The Bruins defeated No. 9 San Jose State, 15-8, in MPSF play on March 29 and then posted a 16-6 win at Santa Clara later that day in non-conference action.
UCLA sophomore attacker Emily Donohoe has captured MPSF/KAP7 Player of the Week acclaim for the week of Mar. 25-31, the Mountain Pacific Sports Federation (MPSF) announced Monday. This is the third player of the week award for Donohoe. She is the first player this season to earn MPSF Player of the Week honors three times.
Donohoe scored a career-high six goals (on six shots) to lead No. 4 UCLA to a 15-8 win at No. 9 San Jose State on Friday (March 29). She scored at least one goal in all four periods, including four in the second half. She also added one steal against the Spartans. The Bruins improved to 20-3 on the year and 3-1 in the MPSF with the win. Later that same day, she scored three goals (on four shots, all at full strength) in the Bruins' 16-6 win at Santa Clara. She also added an assist and one steal in the win over the Broncos. Shooting 90 percent in the two games (9 goals on 10 shots), she helped the Bruins go 2-0 on the week, improving to 21-3 overall and 3-1 in the MPSF.
Saturday's game is "Senior Day" for No. 2 Stanford, which will be honoring its five seniors (Kate Baldoni, Jillian Garton, Victoria Kennedy, Alexis Lee and Melissa Seidemann) prior to the game. Seidemann leads the Cardinal with 53 goals on the year, followed by freshman Maggie Steffens, who has 45 goals and scored 12 last week to capture her second straight KAP 7 MPSF Newcomer of the Week honor. In goal, Gabby Stone (4.26 goals-against average) and Kate Baldoni (4.56) are 1-2 in the MPSF rankings as the Cardinal boasts the top defense in the league with just 4.43 goals allowed per game.


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- ITV Report
Commuter strips off on the tube to protest about the heat
A commuter is staging a bizarre a heatwave protest by travelling to work dressed only in boxer shorts. Mungo Strachan has been turning heads and raising eyebrows among fellow travellers on the District Line.
Mr Strachan, a 23-year-old headhunter, complains his journey from Baron's Court to Monument is unbearable in hot weather. He says he's campaigning for all Underground trains to be fitted with air conditioning.
London Underground says 40% of tube trains will be air conditioned within two years but some lines present a technical challenge.
David Waboso, LU's Capital Programmes Director said: "New air condition trains are now operating on the Metropolitan, Circle, Hammersmith & City and are currently being rolled out on the Wimbledon to Edgware Road branch of the District Line.


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TC TO HENRIETTA MARIA STANLEY ; 31 May 1842; DOI: 10.1215/lt-18420531-TC-HMS-01; CL 14: 195
Chelsea, Tuesday Morng [31 May 1842]
Alas, my dear Mrs Stanley, I cannot come to you! I am so full of headaches, heartaches, idleness and consequent misery and contemptibility, I have had to decide on three weeks of total silence, and go out nowhither!
If virtue mean, as I have generally found it, the doing of something horribly disagreeable, and refusing to do something that seems the pleasantest thing in the world,—then I am from this moment on the road of virtue. Pray for me!—
Your unfortunate / T. Carlyle
Pray thank Mr Stanley again for his kindness to the poor Widow and me.1 I have written to Jeffrey, who approves, and will cooperate; I have thereupon written to Wilson:2 may the Fates be favourable.


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Go ahead, give it a try!...clear.
UPDATE: Uhoh! Looks like Paul isn't allowed to handle certain questions anymore! Can you find Pierre Poilievre?
Note: AskPaulCalandra.com currently uses flash and therefor may not be supported on your mobile device/tablet. We're working on it.
IMPORTANT NOTE: It is not unheard of for the CPC to capture emails and add them to their online database/email list without permission. In fact, it happened to me when I emailed my MP, Stella Ambler, to request a report. Depite requesting removal multiple times, I still receive unwanted CPC emails. So BE WARNED. It might be a better choice to call!
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Dress Modest Without Looking Like Laura Ingalls, Courtesy Of A New E-Shop
With so many fashion trends that run on the risqué side — sheer tops and lingerie as outerwear, anyone? — it's enough to make even the most confident women feel a bit like a prude. Thanks to the brand-new website Mode-sty, dressing conservatively no longer means having to take style advice from your grandma (although, she did set some pretty chic examples). Instead, the fashion flash-sale site curates a contemporary collection for people who want to dress on-trend ... without going against their tastes.
Mode-sty, which puts an "emphasis on mode," helps make beautiful clothing accessible from both big-name brands (think BCBG and Rachel Roy) and lesser-known designers, while still ensuring that all items on the site are palatable to their customers. Recognizing that all women have different comfort zones, the site has three levels of demure clothing based on the desired amount of coverage: tightness, sleeve length, and hemline and neckline.
Whether you're looking to dress conservatively due to personal, professional, or religious reasons, body coverage doesn't mean you have to hide in boring, oversized clothes. And, for extra-special attention, the site offers personalized styling services to make sure that your look and your morals never have to butt heads. In fact, gone are the days of struggling to find a cute, appropriate item that makes you feel great — Mode-sty has you covered, literally and figuratively. Sign up today and stay tuned for their next exciting flash sale.
Photo: Courtesy of Becca Sabot for Mode-sty
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