text:
|Home > RNJ > 2008 > July/August > Predicting Posthospital Recovery of Physical Function Among Older Adults After Lower Extremity Surgery in a Short-Stay Skilled Nursing Facility
Predicting Posthospital Recovery of Physical Function Among Older Adults After Lower Extremity Surgery in a Short-Stay Skilled Nursing Facility
This study describes the posthospital recovery of physical function among 131 older adults after lower extremity surgery in a short-stay skilled nursing facility (SNF), and identifies admission factors predicting physical function at discharge. Multiple regression analyses found that older adults with low baseline physical function, pressure ulcer, malnutrition, memory loss upon admission, and not enough physical therapy had poor physical function at the time of discharge from the facility. This study generated the following recommendations for nurses working in short-stay SNFs: (1) screen all posthospital residents at admission with predictors to identify people at risk for physical functional decline, (2) design and implement targeted nursing and rehabilitation interventions to improve physical function, and (3) develop discharge plans that provide ongoing monitoring and interventions for community or nursing home nurses.
The number of elderly Americans with physical impairments is significantly increasing. Fifty-seven percent of elderly people have a condition that limits their physical mobility (AARP, 2003). Physical functional decline is a major concern for older adults, especially those who are discharged from acute care hospitals. Typically, postsurgical elders transfer from acute care hospitals to short-stay skilled nursing facilities (SNFs) or rehabilitation centers for intensive rehabilitation therapy; they subsequently are discharged home or to long-term care (LTC) facilities. This immediate posthospital period represents a crucial window during which older adults are challenged to regain functional independence. But postsurgical older adults who have lower extremity surgery demonstrate a pattern of persistent physical functional decline. Consequently, it is important to understand the factors that influence posthospital recovery of physical function and ways to improve or maintain physical function with targeted interventions.
This study was conducted to identify the pattern of change in physical function among posthospital elderly patients after lower extremity surgery who may have admission factors that predict physical function at discharge in a short-stay SNF. Identifying risk factors early may help to develop targeted interventions for older adults at risk of losing physical function during the posthospital recovery period.
Conceptual Model
Previous studies were reviewed using combinations of the following key words from CINAHL, MEDLINE, PubMed, and PsycINFO: change in physical function, elderly, factors, function, functional decline, hospital, nursing home, older adults, physical function, predicting, predictors, recovery, and skilled nursing facility. In total, 56 studies were collected; after analyzing abstracts, the review was narrowed to 20 relevant studies. The literature review identified nine predictive variables: poor baseline physical function, pressure ulcer, urinary incontinence, malnutrition, pain, history of falls, cognitive impairment, negative mood state, and rehabilitation therapy (Figure 1). The dependent variable was physical function at discharge from the SNF. Age and comorbidity were controlled as covariates.
Admission Factors
Baseline physical function was the strongest predictor of future physical function in elderly patients, particularly after acute medical illness such as respiratory tract infection or hip fracture (Binder et al., 2003; Lee, 2006; Marottoli, Berkman, & Cooney, 1992; Sager et al., 1996).
Approximately 23% of patients living in skilled care facilities or nursing homes developed pressure ulcers, which are predictive of declines in activities of daily living (ADLs) or delayed recovery of premorbid function (Binder et al., 2003; Johnson, Kramer, Lin, Kowalsky, & Steiner, 2000). Urinary incontinence affects more than 50% of elders in hospitals and LTC facilities (AHCPR, 1996; Mezey & Fulmer, 1999). ADL scores are strongly associated with incontinence (Burgio, Ives, Locher, Arena, & Kuller, 1994). Malnutrition affects 40%–62% of patients in hospitals, and 40%–80% of those in nursing homes (Abbasi & Rudman, 1993; Constans et al., 1992; Guigoz, Vellas, & Garry, 1996; Morley & Kraenzle, 1994; Saletti, Johansson, & Cederholm, 1999). Deteriorating functional status is associated with albumin levels, subscapular skinfold thickness, and decreasing body cell mass in nursing home residents (Zuliani et al., 2001).
Pain is a common problem that can influence the physical function of elderly people (Ferrell, 1991). Pain of severe-or-greater intensity was significantly associated with physical disability in 885 community-dwelling older adults (Scudds & Robertson, 2000). One of three older adults falls each year (Hausdorff, Rios, & Edelber, 2001). Among those with a history of falls, 20%–30% sustain moderate-to-severe injuries that reduce mobility and independence and increase the risk of premature death (Alexander, Rivara, & Wolf, 1992; Fox et al., 2000; Karlsson et al., 1996).
Cognitive impairment is relatively common in the elderly, with an estimated 4–5 million older adults experiencing cognitive disorders such as acute confusion, delirium, and dementia (Mezey & Fulmer, 1999). Poor cognitive capacity was one of the most consistent and significant predictors of functional impairment, particularly the ability to perform instrumental activities of daily living (IADLs; Laukkanen, Kauppinen, Era, & Heikkinen, 1993). (IADLs are daily tasks such as grocery shopping that enable patients to live independently in the community.) Negative mood state is defined as feelings of depression, anxiety, and sadness (Gowans et al., 2001). In a prospective cohort study of 120 community-dwelling older adults who had a hip fracture during a 6-year study period, depression was a significant factor in functional recovery (Marottoli et al., 1992).
Rehabilitation Therapy
In posthospital intensive rehabilitation, older adults who have had lower extremity surgery benefit from the comprehensive, integrated efforts of a number of professional disciplines working to increase patients' extremity strength and endurance and improve standing balance and ADL tolerance (Brummel-Smith, 1993). Physical therapists primarily work toward improving patients' range of motion, strength, endurance, balance, and mobility (Clark & Bray, 1984). Occupational therapists work to improve patients' upper extremity function and self-care abilities to perform ADLs (Clark & Bray).
Physical functional decline becomes more prevalent with age (Binder et al., 2003). Twenty percent of people over age 65 require assistance with ADLs, and 45% of people older than age 85 require such assistance; difficulty with IADLs also increases with age (Mezey & Fulmer, 1999). Age may not directly influence physical functional decline; however, it may accelerate the effects of other risk factors on change in physical function.
Severe comorbid conditions decrease functional autonomy (Di Libero, Fargnoli, Pittiglio, Mascio, & Giaquinto, 2001). A prospective cohort study of 367 older people with hip fracture found that higher levels of comorbidity were associated with increased risk of functional dependence (Cree, Carriere, Soskolne, & Suarez-Almazor, 2001). Comorbidity may affect study outcomes, either independently or by confounding the effect of treatment or primary disease (Nitz, 1997).
This study employed a retrospective cohort design with a series of admissions to a short-stay SNF from an acute care hospital. All subjects were admitted after having lower extremity surgery, and data were abstracted from patients' medical records and the Minimum Data Set (MDS) 2.0.
Setting and Participants
The study was approved by the institutional review board at the university hospital system in an urban Midwest area. The medical records of all residents admitted to a short-stay SNF were reviewed to identify study subjects. The nursing facility had a 100-bed subacute care unit and administrative and rehabilitation areas. Most residents living in this facility had transferred from acute care hospitals.
The sample size of 131 elderly patients was determined by a power of .80, alpha level of .05, moderate effect size of R2 = .13, and 11 independent variables for multiple regression (Cohen, West, Cohen, & Aiken, 2003). No previously published research examining physical function in short-stay SNFs existed using the proposed predictive variables; to calculate the sample size, the moderate effect size of R2 = .13 was used for the multiple regression test.
Medical records of consecutive posthospital elderly patients were reviewed from a short-stay SNF at an urban academic medical center in the Midwest between January 2000 and December 2002. Sample inclusion criteria were appropriate age (65 or older) and admission from an acute care hospital immediately after lower extremity surgery (total hip replacement, total knee replacement, or open reduction and internal fixation of hip). The exclusion criterion was severe cognitive impairment, indicated by an MDS Cognitive Performance Scale (CPS) score of 5 or higher (Morris et al., 1994). The CPS measures consist of memory impairment and levels of consciousness and executive function, with scores ranging from 0 (intact) to 6 (very severe impairment). It demonstrates substantial agreement with the Mini-Mental Status Exam (MMSE) in identifying cognitive impairment; the sensitivity was .94 (95% CI, .87, .96) and the specificity was .94 (95% CI, .88, 1.0; Hartmaier et al., 1995).
Baseline Physical Function
Because the MDS-ADL assessment was done only on facility admission, motor subtotal scores of the Functional Independence Measure (motor-FIM) from rehabilitation notes were used to measure physical function on admission and at discharge to determine the degree of recovery during the facility stay. The facility used recoded scores of the original motor-FIM. If function improves in the original tool, motor-FIM scores go up. But if function improves in the facility, motor-FIM scores go down. For analysis, the facility's recoded motor-FIM scores were again recoded. In this study, if there was an improvement in function, motor-FIM scores would go up as the original FIM scoring system. The 13-item motor-FIM consists of six items for self-care, two items for sphincter control, three items for mobility, and two items for locomotion, and ratings range from 1 (total assist) to 7 (complete independence). The intraclass correlation coefficient was .92 in 73 stroke survivors (Daving, Andren, Nordholm, & Grimby, 2001).
Pressure ulcer was measured with the MDS Skin Condition Scale, which tallies the number of ulcers at each ulcer stage and types of ulcers. The total score was summed after multiplying the number of ulcers by the staging scores of each (Berlowitz et al., 2001). In a comparison study, the MDS predicted 62 of 66 pressure ulcers, while the Braden Scale predicted only 46 pressure ulcers accurately (Vap & Dunaye, 2000). Urinary incontinence was evaluated with the MDS Bladder Continence Scale, which assesses control of urinary bladder function with appliances (e.g., a Foley catheter) or continence programs. Malnutrition was measured using the two MDS nutrition items: weight loss (≥5% during the previous 30 days, or ≥10% during the previous 180 days) or weight gain (≥5% in the last 30 days, or ≥10% in the last 180 days). Pain was measured with the MDS Pain Scale and was coded from "mild" to "horrible." In a study of 95 postacute nursing home residents, there was agreement (93%) between the MDS and the visual analogue scale measures of pain (Fries, Simon, Morris, Flodstrom, & Bookstein, 2001). History of falls was measured with the 2-item MDS Health Conditions-Accidents Scale, which assesses for falls in the past 30 days or falls in the past 31–180 days.
Cognitive impairment was measured using the MDS Cognitive Scale, which measures long- and short-term memory loss and memory recall ability. The criterion-related validity (construct validity) of the scale showed strong correlations with the MMSE (r = .75, p < .001) in a study of 290 nursing home residents (Cohen-Mansfield, Taylor, McConnell, & Horton, 1999). Negative mood state was measured by the 16 MDS mood items, which were found to have good agreement with the Geriatric Depression Scale Short Form (Kappa = .60, p < .01; Schnelle, Wood, Schnelle, & Simmons, 2001).
Demographic data included admission diagnoses, age, gender, race, length of stay, comorbidity, and type of surgery. Comorbidity was measured by the Charlson Comorbidity Index (CCI; Charlson, Pompei, Ales, & MacKenzie, 1987). The CCI is widely used to capture the number and severity of health problems present and is easily completed using medical records in acute units and in LTC settings (Bravo, Dubois, Hebert, De Wals, & Messier, 2002; Charlson et al.). The CCI consists of 45 items corresponding to four levels of disease conditions. Based on previous findings, age and comorbidity were controlled as covariates (Administration on Aging, 2004; Bravo et al.; Di Libero et al., 2001; Kempen, Brilman, Ranchor, & Ormel, 1999). Rehabilitation therapy included physical therapy (PT) and occupational therapy (OT). This cohort received 6 days of PT and 5 days of OT every week. The amount of rehabilitation therapy for analysis was the mean of total minutes of rehabilitation therapy per day that a patient received while in the facility. Researchers counted total minutes of PT or OT and divided them by actual days patients received PT or OT.
Characteristics and Patterns of Change in Physical Function
Older adults ranged in age from 66 to 95 years, with a mean of 77.1 years (SD = 6.9; see Table 1). The majority of subjects were women (n = 98, 75%), unmarried (n = 82, 64%), and White (n = 92, 70%). The mean length of stay was 18.7 days (SD = 4.4, range = 15–44). Among this sample, 108 subjects (82%) were discharged to home and 23 (18%) went to a nursing home. Residents discharged to nursing homes were significantly older, had more pressure ulcer episodes and cognitive impairment, and were more depressed at the time of facility admission. The mean physical function score on admission was 46.4 (SD = 8.3, range = 19–69) in the motor-FIM. The motor-FIM on admission and at discharge had high Cronbach's alpha reliability (a = .81, and a = .87, respectively). Physical function significantly improved during the facility stay, increasing from 46.4 to 71.4 (p < .0001) in the motor-FIM.
Overwhelmingly (99%, n = 130), older adults reported pain on admission that was mild (n = 8), moderate (n = 84), and severe (n = 38; Figure 2). Thirty-one percent of residents (n = 42) had a history of falls on admission. Among those who had fallen (n = 11), 26% had surgery resulting from fall fractures: hip fractures were the most common (n = 6), followed by femoral fractures (n = 3), pelvic fracture (n = 1), and tibia fracture (n = 1). No subject fell during his or her facility stay.
Thirty-four older adults (26%) had pressure ulcers, including eight residents with multiple-stage ulcers and 20 residents with multiple lesions at stage I (n = 9), stage II (n = 29), stage III (n = 1), and stage IV (n = 4). Twenty percent (n = 25) of subjects reported urinary incontinence on admission as occasional (n = 12), frequent (n = 10), or always incontinent (n = 3). Sixteen percent (n = 21) experienced memory loss characterized as short term (n = 17), long term (n = 1), or both (n = 3), while 90% (n = 117) reported no problems with recall ability. Consequently, memory loss was used only in analysis. Twelve percent (n = 16) had weight fluctuations or weight gain (n = 10) or weight loss (n = 6). Mood problems were reported in 44% (n = 58) of cases, but items checked were limited to 1 or 2 of the 16 criteria, such as insomnia/change in usual sleep pattern or sad, pained, worried facial expressions.
Predicting Physical Function at Discharge
Hierarchical multiple regression examined two models (Table 2). One model used only the co- variates of age, comorbidity, and baseline physical function because it was expected they would have the strongest impact on physical function at discharge. The multiple R2 for this model was 0.42, with baseline physical function as a strongest predictor (B = .58, p < .0001). Age or comorbidity was not significant in predicting physical function at discharge. The second model included other admission factors of interest and rehabilitation therapy as described above. In this case, the multiple R2 increased to 0.55. Among the independent variables, pressure ulcer, malnutrition, memory loss, and rehabilitation therapy all had coefficients that were significantly different from 0. Because the coefficients of the admission variables all were negative, this would correspond to lower motor-FIM scores and worse outcomes. The sign of the coefficient for rehabilitation therapy is positive, meaning that more rehabilitation therapy is predicted to result in better physical function at discharge among posthospital older adults after lower extremity surgery.
The study described the pattern of posthospital recovery of physical function and its admission predictors among older adults after lower extremity surgery in a short-stay SNF. Residents receiving intensive rehabilitation therapy experienced improved physical function after an average stay of 19 days at the facility. Approximately 80% of the subjects returned home and 20% were transferred to an LTC facility. The leading primary causes of falls are gait and balance disturbances related to decline in physical function and environmental hazards (American Geriatrics Society Panel on Falls Prevention, 2001). Greater emphasis on fall prevention for residents with histories of falls or for those at risk for falls will reduce LTC admissions.
The older adults who participated in this study and had poor physical function, pressure ulcer, malnutrition, and memory loss upon admission to a short-stay SNF had poor physical function at SNF discharge. Older adults with these problems need targeted interventions to improve their physical function. Consistent with previous studies (Marottoli et al., 1992; Sager et al., 1996), baseline physical function on admission was the strongest predictor of physical function at discharge in this cohort. Alternative types or greater intensity of rehabilitation therapies may be necessary for those experiencing the lowest levels of physical function upon SNF admission to help them prepare more adequately for discharge.
Among this study's participants, 26% had pressure ulcers at the time of admission to the short-stay SNF. The more severe the ulcers, the more likely the residents would be dependent in physical function at discharge. This finding is consistent with previous studies that found an inverse relationship between pressure ulcer at rehabilitation admission and physical function at discharge or recovery of premorbid function (Binder et al., 2003; Johnson et al., 2000).
Malnutrition was associated with dependence in physical function at discharge. Interestingly, weight gain as well as weight loss was highly predictive of dependence in physical function at discharge. Although the data in the MDS do not detail the cause of weight fluctuation, 10 residents had congestive heart failure as an admission diagnosis. Weight fluctuation may be an important indicator of patient health that requires further assessment to understand its underlying causes.
Elderly patients with memory loss at admission reported relatively lower physical function at discharge. These results are congruent with previous studies (Chiodo, Kanten, Gerety, & Mulrow, 1994; Sager et al., 1996) and are notable because the inclusion criteria for this study excluded older adults with severe cognitive impairment.
This study's findings generated several clinical practice recommendations for nurses working in short-stay SNFs. First, nurses should screen all posthospital residents at admission with predictors that help identify people at risk of physical functional decline. Nurses also should design and implement targeted nursing interventions and rehabilitation interventions to improve physical function.
If nurses can identify a person with pressure ulcer, urinary incontinence, and cognitive impairment at admission, for example, they can expect this resident will have a longer stay because of their increased potential for physical functional decline or delayed recovery. Nurses should compose a plan for these patients' long-term care and provide targeted interventions based on prioritized assessments of indicators of physical functional decline. Nurses also should develop discharge plans that provide ongoing monitoring and interventions for community-based or LTC nurses. They must develop standard discharge plans and protocols of institutional communication among facilities to provide consistent, ongoing care to patients who receive care from short-term SNFs, home care agencies, or LTC facilities.
This study has several methodological weaknesses. Regional variations could not be addressed because the study was conducted at one particular facility (an academic medical center). Measures of this study's variables relied on the accuracy of MDS data collection. Although a trained clinician conducted this multidimensional assessment and many of the items use objective criteria, the assessment also includes a more subjective appraisal of client health, such as mood and behavior patterns. In addition, memory loss from the MDS cognition items (memory loss and memory recall ability) was used for the analysis because 90% of this study sample reported no problems with recall ability. However, memory represents only a small portion of cognition, and participants might have retained other aspects of cognition. Lastly, this was a retrospective study that relied on limited data contained in medical records.
Despite its methodological weaknesses, this study shows that admission factors can predict post- hospital recovery of physical function in short-stay SNFs. As shortened hospital stays increase the likelihood of discharge complications including physical functional decline in vulnerable older adults, patterns of posthospital recovery of physical function need to be investigated. The study's findings will contribute to more effective nursing care planning and further research on posthospital recovery of physical function.
About the Authors
Jia Lee, PhD RN, is an assistant professor at Kyung Hee University in Seoul, South Korea. Address correspondence to her at firstname.lastname@example.com.
Patricia A. Higgins, PhD RN, is an associate professor at Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, OH.
AARP. (2003). Beyond 50.03: A report to the nation on independent living and disability. Washington, DC: Author.
American Association of Colleges of Nursing & John A. Hartford Foundation Institute for Geriatric Nursing. (2000). Older adults: Recommended baccalaureate competencies and curricular guidelines for geriatric nursing care. Retrieved May 21, 2008, from http://www.aacn.nche.edu/Education/pdf/Gercomp.pdf.
Abbasi, A. A., & Rudman, D. (1993). Observations on the prevalence of protein-calorie undernutrition in VA nursing homes. Journal of the American Geriatrics Society, 41, 117–121.
Administration on Aging. A profile of older Americans: 2004. Retrieved March 31, 2008, from www.aoa.gov/prof/Statistics/profile/2004/3.asp.
AHCPR (1996). Urinary incontinence in adults: Acute and chronic management, clinical practice guideline No. 2. Rockville, MD: AHCPR.
American Geriatrics Society Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons: American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Journal of the American Geriatric Society, 49, 664–672.
Alexander, B. H., Rivara, F. P., & Wolf, M. E. (1992). The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health, 82, 1020–1023.
Berlowitz, D. R., Brandeis, G. H., Anderson, J. J., Ash, A. S., Kader, B., Morris, J. N., et al. (2001). Evaluation of a risk-adjustment model for pressure ulcer development using the minimum data set. Journal of the American Geriatrics Society, 49, 872–876.
Binder, E. F., Kruse, R. L., Sherman, A. K., Madsen, R., Zweig, S. C., D'Agostino, R., et al. (2003). Predictors of short-term functional decline in survivors of nursing home-acquired lower respiratory tract infection. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(1), 60–67.
Bravo, G., Dubois, M. F., Hebert, R., De Wals, P., & Messier, L. (2002). A prospective evaluation of the Charlson Comorbidity Index for use in long-term care patients. Journal of the American Geriatrics Society, 50, 740–745.
Brummel-Smith, K. (1993). Research in rehabilitation. Clinics in Geriatric Medicine, 9, 895–904.
Burgio, K. L., Ives, D. G., Locher, J. L., Arena, V. C., & Kuller, L. H. (1994). Treatment seeking for urinary incontinence in older adults. Journal of the American Geriatric Society, 42, 208–212.
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Disease, 40, 373–383.
Chiodo, L. K., Kanten, D. N., Gerety, M. B., & Mulrow, C. D. (1994). Functional status of Mexican American nursing home residents. Journal of the American Geriatrics Society, 42, 293–296.
Clark, G. S., & Bray, G. P. (1984). Development of a rehabilitation plan. In T. F. Williams (Ed.), Rehabilitation in the aging (pp. 125–143). New York: Raven Press.
Cohen, J., West, S. G., Cohen, P., & Aiken, L. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Cohen-Mansfield, J., Taylor, L., McConnell, D., & Horton, D. (1999). Estimating the cognitive ability of nursing home residents from the Minimum Data Set. Outcomes Management for Nursing Practice, 3, 43–46.
Constans, T., Bacq, Y., Brechot, J. F., Guilmot, J. L., Choutet, P., & Lamisse, F. (1992). Protein-energy malnutrition in elderly medical patients. Journal of the American Geriatrics Society, 40, 263–268.
Cree, M., Carriere, K. C., Soskolne, C. L., & Suarez-Almazor, M. (2001). Functional dependence after hip fracture. American Journal of Physical Medicine and Rehabilitation, 80, 736–743.
Daving, Y., Andren, E., Nordholm, L., & Grimby, G. (2001). Reliability of an interview approach to the Functional Independence Measure. Clinical Rehabilitation, 15, 301–310.
Di Libero, F., Fargnoli, M., Pittiglio, S., Mascio, M., & Giaquinto, S. (2001). Comorbidity and rehabilitation. Archives of Gerontology and Geriatrics, 32, 15–22.
Ferrell, B. A. (1991). Pain management in elderly people. Journal of the American Geriatrics Society, 39, 64–73.
Fox, K. M., Magaziner, J., Hawkes, W. G., Yu-Yahiro, J., Hebel, J. R., Zimmerman, S. I. et al. (2000). Loss of bone density and lean body mass after hip fracture. Osteoporosis International, 11, 31–35.
Fries, B. E., Simon, S. E., Morris, J. N., Flodstrom, C., & Bookstein, F. L. (2001). Pain in U.S. nursing homes: Validating a pain scale for the minimum data set. Gerontologist, 41, 173–179.
Gowans, S. E., deHueck, A., Voss, S., Silaj, A., Abbey, S. E., & Reynolds, W. J. (2001). Effect of a randomized controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis and Rheumatism, 46, 519–529.
Guigoz, Y., Vellas, B., & Garry, P. J. (1996). Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutrition Reviews, 54, S59–S65.
Hartmaier, S. L., Sloane, P. D., Guess, H. A., Koch, G. G., Mitchell, C. M., & Phillips, C. D. (1995). Validation of the Minimum Data Set Cognitive Performance Scale: Agreement with the Mini-Mental State Examination. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 50, M128–M133.
Hausdorff, J. M., Rios, D. A., & Edelber, H. K. (2001). Gait variability and fall risk in community-living older adults: A 1-year prospective study. Archives of Physical Medicine and Rehabilitation, 82, 1050–1056.
Johnson, M. F., Kramer, A. M., Lin, M. K., Kowalsky, J. C., & Steiner, J. F. (2000). Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke. Journal of the American Geriatrics Society, 48, 1389–1397.
Karlsson, M., Nilsson, J. A., Sernbo, I., Redlund-Johnell, I., Johnell, O., & Obrant, K. J. (1996). Changes of bone mineral mass and soft tissue composition after hip fracture. Bone, 18, 19–22.
Kempen, G. I., Brilman, E. I., Ranchor, A. V., & Ormel, J. (1999). Morbidity and quality of life and the moderating effects of level of education in the elderly. Social Science & Medicine, 49, 143–149.
Laukkanen, P., Kauppinen, M., Era, P., & Heikkinen, E. (1993). Factors related to coping with physical and instrumental activities of daily living among people born in 1904–1923. International Journal of Geriatric Psychiatry, 8, 287–296.
Lee, J. (2006). An imperative to improve discharge planning: Predictors of physical function among residents of a Medicare skilled nursing facility. Nursing Administration Quarterly, 30, 38–47.
Marottoli, R. A., Berkman, L. F., & Cooney, L. M., Jr. (1992). Decline in physical function following hip fracture. Journal of the American Geriatrics Society, 40, 861–866.
Morley, J. E., & Kraenzle, D. (1994). Causes of weight loss in a community nursing home. Journal of the American Geriatrics Society, 42, 583–585.
Morris, J. N., Fries, B., Mehr, D. R., Hawes, C., Phillips, C., Mor, V., et al. (1994). MDS Cognitive Performance Scale. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 49, M174–M182.
Nitz, N. M. (1997). Comorbidity. In R. L. Kane (Ed.), Understanding health care outcomes research (pp. 153–174). Gaithersburg, MA: Aspen.
Sager, M. A., Rudberg, M. A., Jalaluddin, M., Franke, T., Inouye, S. K., Landefeld, C. S. et al. (1996). Hospital admission risk profile (HARP): Identifying older patients at risk for functional decline following acute medical illness and hospitalization. Journal of the American Geriatrics Society, 44, 251–257.
Saletti, A., Johansson, L., & Cederholm, T. (1999). Mini Nutritional Assessment in elderly subjects receiving home nursing care. Journal of Human Nutrition and Dietetics, 12, 381–387.
Schnelle, J. F., Wood, S., Schnelle, E. R., & Simmons, S. F. (2001). Measurement sensitivity and the Minimum Data Set depression quality indicator. Gerontologist, 41, 401–405.
Scudds, R. J., & Robertson, J. M. (2000). Pain factors associated with physical disability in a sample of community-dwelling senior citizens. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55A, M393–M399.
Vap, P. W., & Dunaye, T. (2000). Pressure ulcer risk assessment in long-term care nursing. Journal of Gerontological Nursing, 26, 37–45.
Zuliani, G., Romagnoni, F., Volpato, S., Soattin, L., Leoci, V., Bollini, M. C., et al. (2001). Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56, M212–M216.


text:
I love sewing , painting , jewellery making / any art work that is useful and NOT purely decorative. Reusing materials is the main focus. I love gardening and cooking in addition to sewing and crafts . I also conduct cooking classes at my home .
Take Craftsy with you!
Craftsy Apps for iOS and Android. Read more »

subset: commoncrawl


text:
Star Wars: Warriors of the Force
View Single Post
.Devil's Trap.//
Join Date
: Jan 2006
: 1,156
"Damn.." He said to himself, tucking his arm behind him and using his other arm to put his blade on the ground and prop himself up. He managed to grab the sword and sheath it in the knotted sheath on his back before a sniper shot tore through the tree and struck him in the small of the back. It was a weak shot due to the decreased force of the tree, but it still knocked him down.
He landed roughly and rolled to the left, behind that same rock as two other shots flew past. He could hear cursing and a few clicking sounds. Bingo. He spun away from the rock and sprinted towards him. The speed of his sprint was faster than normal, and it was needed for the difficulty of this bout. He leapt into the air as the man loaded his rifle and aimed it at him. He managed to land on his head with his right foot, balancing for a few seconds before the force of the landing knocked the man to his feet. Ty backflipped off and landed on the ground gracefully, snatching up his rifle and walking towards him, the butt of the rifle under his right armpit. He kicked the man over to face upwards as the man coughed a little.
He brought the sniper's barrel to the man's forehead and pulled the trigger. He turned his head as the shot burnt a rather large hole in the man's forehead and left a scorch mark on the ground behind it, killing the man instantly. He slid the rifle around his shoulder and lifted his left arm, the feeling in it starting to come back.
you may:
quote & reply
View Public Profile
Visit Xbx_Inthusiast's homepage!
Find More Posts by Xbx_Inthusiast


text:
According to Digitimes, Acer will leverage its large economies of scale to build and distribute a UMPC similar to Eee PC.
The device is said to be 8.9" long, and fits the "low-cost PC" profile. Asustek will launch its second generation Eee PC at around the same time, but supposedly there will not be a price war between the two giants of the PC world. They speculate that Asustek may launch their Eee PC product earlier to gain an advantage.
The report mentions that the Acer mobile will be cheaper by as much as $50 USD, with an average selling price (ASP) of $350-400 USD.
Read more over here.


text:
The Gender Studies BA Program | Academic Requirements | Student Learning Outcomes | Minor in Gender Studies | The Senior Project | Courses | Faculty
Students majoring in any discipline may pursue a minor in gender studies, which offers a variety of courses drawn from across the college. Students have the opportunity to study gender in a variety of historical periods and geographical areas using different academic, political, and feminist perspectives.
Students interested in this minor must submit a completed Application for a Program of Minor Study and should plan their program of study in consultation with the gender studies faculty in their major field or with the coordinator of the gender studies program.
Academic Requirements for the Minor in Gender Studies
Five courses, as follows:
Updated Mar. 24, 2016
Please direct updates for this page to the managing editor in the Office of the Provost and Academic Affairs. Eight-semester plan updates or questions should be directed to the associate provost.
– For curricular revisions, please refer to the Faculty Handbook.


text:
Images and words to delight the senses. Inhale, be, let go. A piece of art using words and images- perfect for the sensitive, curious and aspiring souls.
I am currently a college student studying Humanities and Science. I grew up in Brooklyn, I mention this because I have an inner attitude that I can only attribute to growing up in NY. I was raised by a single mom, making me a tough cookie yet there are some things that make me gentle and in love and this is travel, writing and poetry. Because to gather your things and move thru the sky to another life is an adventure. I've always come back a more courageous person. Pictures and Words have both grounded and inspired me. Who hasn't seen a picture and instantly been touched or read some words and have been soothe. I want to give back. This is my first go.
Comment posted.
jjcharles says from what i've read, this is a gorgeous piece of art. thank you for sharing. your light-hearted lines just cleared up my day
posted at 07:40PM Sep 16 PST
danierod says It was fun. I hope many others will enjoy.
posted at 09:53AM Sep 11 PST
Log in or create an account to post a comment.


text:
Click to download high res image
Doug McNeel Sons of Maverick Press Kit (pdf)
Texas songwriter, Doug McNeel, has been writing, recording and performing songs that are upbeat, funny, thought-provoking and inspiring. His brand of soul-nourishing Texas-Americana music is a rich brew of folk, country, gospel and blues spiced with a Texas flavor.
In October of 2009 Doug released his premier CD, The Great Awakening. Since then three of Doug's songs on the album have won Honorable Mention awards in the 17th Annual (2009) Billboard World Songwriting Contest: "Blues Universe" (R&B, Blues Category); "Doctor Jesus" (Contemporary Christian/Gospel Category); and "The Great Awakening" (Country Category), with Doug's musical associate Owen Duggan participating as co-songwriter on "Blues Universe" and "Doctor Jesus."
Recorded at state of the art recording studio, Salmon Peak, under the guidance of Mark Sinko and technical wizardry of RB Blackstone, the album features excellent musicianship by Kenny Grohman on steel guitar and rhythm, Hank Harrison of Tennessee Valley Authority on fiddle and mandolin, Richard DeLeon on lead guitar, Barry Brake on piano, Adam Booker on upright bass and Darren Kuper on drums. A number of the tracks include pleasing harmony vocals by Gary Birdwell and co-producer Owen Duggan (the creator, performer and producer of an award winning children's CD, An Elephant Never Forgets).
Truly a son of Maverick, Doug is the great-great grandson of Samuel A. Maverick, the Texas pioneer who never branded his cattle and so gave rise to the term "maverick" to describe independent minded individuals. Challenged by his grandmother at the age of 16 to start writing his own music, Doug accepted the challenge and since then has been writing songs shaped by the folk, country and gospel influences from his early years. Songwriters he admires include Bob Dylan, Lyle Lovett, Willie Nelson, Don McLean, John Denver, Johnny Cash, Arlo Guthrie, Gordon Lightfoot, Nitty Gritty Dirt Band, Jerry Jeff Walker, John Prine, Thomas Michael Riley, Josh Turner, Delbert McClinton and Mary Chapin Carpenter.
Doug and the current members of The Sons of Maverick are headquartered in and around San Antonio and are available to perform throughout the Texas Hill Country and beyond.
Great Awakening Productions
P.O. Box 1025
Helotes, Texas 78023
Phone: (210) 695-9263
Email: firstname.lastname@example.com


text:
The latest market share and phone shipment numbers from research firm IDC don't show a promising future for Microsoft's (NASDAQ:MSFT) Windows Phone platform.
It the second quarter, Microsoft's smartphone shipments dropped to 7.4 million units from 8.2 million in the same period of 2013. At the same time, the Windows Phone global market share fell from 3.4% to to 2.5%.
To overcome this, Microsoft appears bent on tackling the low-end market, which makes some sense but could prove problematic. Microsoft should take a page out of Samsung's (NASDAQOTH:SSNLF) playbook instead and hit all price points fast and hard.
Taking the low road, again
In an letter to employees last month, Microsoft devices and services chief Stephen Elop said, "In the near term, we plan to drive Windows Phone volume by targeting the more affordable smartphone segments, which are the fastest growing segments of the market, with Lumia."
Microsoft launched the new $99 off-contract Lumia 530 this month in India, and will bring the phone to the U.K. market next month. The company is trying to repeat the success it has had with the phone's predecessor, the Lumia 520. That device garnered 10% market share in some parts of Europe and makes up 30% of all Windows Phones sales.
But there's no guarantee the 530 can replicate the 520's success, especially with -- as IDC noted -- the low-end market cooling toward Windows Phone.
This is where Microsoft needs to take the broad approach Samsung has taken for its handset business.
Just see what sticks
Samsung has long been praised --and chided -- for its shotgun style of product releases. High-end devices like the Galaxy S5 and Note 3 are some of the best in the world, but the South Korean company taps into the low-end market as well with its Galaxy Young and Galaxy Core lines. The devices hit nearly every spectrum of size, quality, and price.
Overall, that strategy has helped push Samsung to the No. 1 vendor spot, even if it means dropping phones that don't sell well or having a bad quarter here and there, like it did in the second quarter of this year.
Oddly enough, Nokia's device business -- which Microsoft just bought -- had the exact opposite of Samsung's strategy for quite a while. Dan Rowinski, former editor for ReadWrite, wrote in 2012: "In many ways, Nokia is the direct inverse of Samsung. Where Samsung can develop and deploy a long list of devices in a short time, Nokia is sluggish."
Microsoft was notably sluggish in mobile for a while too, but now that it owns Nokia's devices and services unit, the company can finally move forward at its own speed. The question of its handset success rests on whether it can introduce devices to market fast enough to create real momentum.
That's no easy task. It's not as if Microsoft can launch a new high-end phone and expect consumers to open their wallets (just ask Amazon). But flooding the market with many devices in a myriad of price ranges would be a good place to start. It's not a perfect strategy, but it's better than targeting just the low end -- which seemingly is Microsoft's only strategy right now.
Microsoft will eventually run out of time with its handsets if it can't turn this around. No mobile platform can stay between 2% to 3% market share and be a success. If Windows Phone and the Lumia line are to succeed, it's going to take an all-out blitz on the handset market. Anything else will leave Windows Phone where BlackBerry is today -- minus all the good years on top.
Leaked: Apple's next smart device (warning, it may shock you)
Apple recently recruited a secret-development "dream team" to guarantee its newest smart device was kept hidden from the public for as long as possible. But the secret is out, and some early viewers are claiming its everyday impact could trump the iPod, iPhone, and the iPad. In fact, ABI Research predicts 485 million of this type of device will be sold per year. But one small company makes Apple's gadget possible. And its stock price has nearly unlimited room to run for early in-the-know investors. To be one of them, and see Apple's newest smart gizmo, just click here!
Chris Neiger has no position in any stocks mentioned. The Motley Fool recommends Apple. The Motley Fool owns shares of Apple and Microsoft. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.


text:
Petunia Pickle Bottom Sojourn Sling Review, Tutorial and Giveaway!!
Drum roll, please! I am very excited to announce our latest giveaway!
The Sojourn Sling from Petunia Pickle Bottom!! I am giving away the one above, in the picture, the fabric is called Moment in Morocco. Isn't is stunning?! It's a size medium and will fit a Mama with a shirt size of m-l. It has a bit of stretch in the fabric, so even if you are the larger end, it will fit. I wear a size 40E bra and wear a M to L shirt and it fits fine and has room for Penelope to grow. If you are smaller, you can very easily take it in and hem the seam to make the sling shorter in length to fit.
To enter, go to Petunia Pickle Bottom's website and browse around then leave a comment below telling me what you love! You can win additional entries by posting on Facebook or Twitter, or on your blog, or become a Fan on the Mama and Baby Love Facebook page. For each entry leave a separate comment. A winner will be randomly selected on October 27th.
They also sent one for me to try out and review. Let me tell you, I am pretty in love with my Maya Wrap, Ella Roo Wrap and my New Native sling, so the Sojourn Sling had stiff competition going up against my other beloved carriers-carriers that I have been using for 5 plus years ( I was nanny before I became a mother).
The Sojourn Sling takes the cake, hands down in the style department. I mean, look at these other fabric options!!! This one, Dancing in Dublin, or this one, Frockling in Fez, make my heart go pitter-patter! And we all know how much I like things to be matchy-matchy, so with these slings, you have the option of get any kid of Petunia Pickle Bottom diaper bag to match!
In the function department, its neck and neck with my Maya Wrap. The Maya Wrap has a slight edge over the Sojourn Sling, because I am able to sort of hog tie Penelope very tightly, in the Maya Wrap. So when I am cooking I put her arms in side the sling and tighten it up and it keeps her little arms safe inside while I cook. Other than that, I like the Sojourn Sling just as much, if not better, because you don't have to adjust anything!! You just throw it on and off you go.
The New Native sling I have is similar in cut to the Sojourn Sling, except the Sojourn Sling has a bit of stretch to it. So you can get a better, snugger fit with the Sojourn Sling.
And last, but not least, its ORGANIC COTTON! The fabric that is touching your little ones skin all day, not only looks beautiful, its good for their health and the earth. Ah, you couldn't ask for a better sling than this one!
Seriously, if you are pregnant and trying to figure out what kind of sling to get, get this one in your collection, no question about it. If you are new to babywearing and not sure where to start, START HERE (and be sure to check out my tutorial below!) If you are an old pro, (ahem, like me) and want to try something new and fabulous, buy one!
I am starting to feel like I sound like raving lunatic, so I will end my rave review here, but I am just so impressed with this sling. It hard to find one that is this gorgeous and actually functions they way you need it to.
Now on to the picture and video tutorial!
here and here for more tutorials.
Check out the same tutorial in video, below. Let me know if you have any questions!
And P.S. this is the kind of Pentunia Pickle Bottom diaper bag I have and I LOVE it. It makes my tired, frumpy ass feel very glamorous. I have both the Cosmopolitan Carry All and the Cameo Clutch.
P.S.S.If you are local, there is no one in town selling these slings, so you have to buy them online. If you do, please purchase one from one of the links below and send a few pennys my way to add to Penelope's Ivy League College Fund! Thanks!
Labels: attachment parenting, babywearing, slings


text:
Tell Care2.com to change their butterfly rewards credit system to make it fair. So far, you only receive 2 credits for receiving green stars but you don't receive any credit for sending them? Why can't we show our appreciation and get credit at the same time so we can reach out and motivate more members?
Sign the petition if you feel that we should receive rewards credit for sending green stars as well!
Problem on this page? Briefly let us know what isn't working for you and we'll try to make it right!


text:
Sun Tong Luck is a little known gem in Columbus on Bethel Rd. The restaurant boasts "Best in Town" on their menu, and they definitely live up to that.
They are known for quality, fast and delicious Chinese food, but also are committed to cooking up a healthier alternative than their competitors. They do not sure hydrogenated oils or high fructose corn syrup and offer vegetarian and vegan options on top of the traditional menu.
Their General Tso's and Sesame Chicken are what they are most known for, but they offer many delicious options.
You can dine in and then hit up the movie theatre in the same parking lot, or carryout for a quiet date night at home.
Sun Tong Luck's hours are Tuesday-Saturday 11:30am-9:30pm and are located at 2500 Bethel Road, Columbus.


text:
The Xen Project community today announced it will be a founding project in the CentOS Project's new virtualization special interest group (Virt SIG).
Tizen has created an opportunity for app developers to expand into wearable technologies, says Marmalade Technologies CEO, Harvey Elliott.
Game developer Josh Parnell has released the latest development update on his open-world space simulation and strategy game, Limit Theory.
Get ready for an entertaining – and possibly infuriating – examination of Linux desktop distributions from the perspective of community insider, writer and commentator, Bryan Lunduke.
In his annual "Linux Sucks" presentation at LinuxFest Northwest last Saturday in Bellingham, Washington, Lunduke unabashedly took aim at some controversial targets – Ubuntu, Fedora, Gnome, Wayland and X, to name a few – while simultaneously praising their accomplishments.
When electrical engineer Manjinder Bains learned in January that his employer's planned restructuring would put his job at risk, he wasn't sure what to do.
From left, developers Lennart Poettering, David Strauss, Linux Foundation Fellow Greg Kroah-Hartman, and Kay Sievers were spotted on Google+ wearing silly hats at a recent Systemd hackfest.
When LG acquired the WebOS project from HP early last year, it was a stripped down Linux-based mobile operating system hardly fit to run on any hardware.
Enterprises today are facing the industrialization of IT, in which infrastructure is commoditized and innovation is happening much faster at the application level, said Red Hat President and CEO Jim Whitehurst in his 2014 Red Hat Summit keynote this week.


text:
The Maverick Music Festival returns for year number two in March and it has been expanded to two days. It is San Antonio's first and only indie live music alternative and it will be held at La Villita's Maverick Plaza in the heart of downtown.
The lineup for this music festival features national, international and Texas acts playing music that ranges from electronic, R&B, psychedelic, garage rock and more. The initial lineup includes:
- Psychedelic Furs
- Phantogram
- The Joy Formidable
- Roky Erickson
- Sza
- Twin Shadow
- Yacht
- The Black Angels
- The Gories
- Tamaryn
- Piῆata Protest
The Maverick Music Festival was created by music lovers who wanted to enrich the quality of live music in San Antonio. They varied in experience and backgrounds but they got together and organized a music festival worthy of the rich culture and artistic values of downtown. It started with Gary Clack Jr and Girl in a Coma and now includes more national acts.
Maverick Music Festival
La Villita Maverick Plaza
418 Villita St
San Antonio, TX 78205
(210) 207-8614
Friday March 21 and Saturday March 22
General admission two day passes are $79 and VIP two day passes are $119 and are available at Maverick Music Festival online. Single day tickets are also available.
Source: Courtney Knittel/Giant Noise


text:
The trendsetting, record-breaking creative minds at online retailer Amazon.com are at it again. On April 2, 2014, Amazon Founder and CEO, Jeff Bezos, announced the tiny "tv in a box" that responds to voice commands for searching. The box plugs into your HDTV and Bezos says:
It's the easiest way to enjoy Netflix, Prime Instant Video, Hulu Plus, WatchESPN, low-cost video rentals, and more. With instant access to over 200,000 TV episodes and movies, plus all your favorite subscriptions and streaming services, you can watch what you want, when you want.
At last, long overdue for faithful fans of television technology, viewers will be able to search freely for their favorite streaming shows without having to use the clunky and frustrating typical cable remote tuners where you have to tap endlessly to type in—letter-by-letter—the name of a program, movie or actor that you're searching for. Say an actor's name (Mark Harmon), say the title ("NCIS") you're looking for, or genre (drama)—and per Amazon claims, poof, the box starts searching.
Fire TV also has a brain; it's a little "Big-Brother-y" but once you get over that, Fire TV sports "ASAP" that guesses what you're going to want to watch next, whether TV episode or movie, and has them "ready to stream instantly." They're promise to reduce your "cuss and fuss" time waiting on videos to load or buffer, and for that reason alone, it's worth taking a chance.
The box retails right now on the site for $99 and from the photo you see they're ready to show you: Netflix, Amazon instant video, HuluPlus, WatchESPN, ShowtimeAnytime, Crackle, Bloomberg, Pandora, Vevo and iHeart Radio: they say "200,000 TV episodes and movies, plus all your favorite subscription and streaming services," so you'll keep up with your independent subscriptions but the box makes it so much faster to access them and upload to your television. They promise new games are available, for a nominal cost, plus there's enough free games to keep everyone busy.
In a way, it takes Google's Chromecast doodad and relegates it back into the toy box. But, never underestimate Google; hide and watch for what they'll come up with next.
Creative ideas—check; new technology—check; good competion to Apple and Google—check; advertising—fail.
On Amazon's site today, there's a preview of their new TV ad, which they say will be showing soon. So, be the first on your block to know, and before you use "1-click to buy" the new Amazon Fire TV and enjoy, you might want to watch the commercial first. Hint: The star of their ad is Gary Busey. Two guesses what and who he's searching for. This may be Busey's career bonanza bonus prize from when he was on "The Apprentice" and trying to sell Walgreen's ice cream that someone in Amazon's marketing firm thought of Busey as the ultimate pitch man. Or, it could have been a really bad April Fool's joke late by a day. Watch and see for yourself.
Personal message to Amazon: if you want to sell me your Fire TV, you have not won me over with Gary Busey. Really. You put Busey's face as the takeaway image one of your nicest technological advances ? What were you people thinking? Amazon might serve its customers better to call those creative guys who do the J.G. Wentworth commercials. Y'all need some serious help.
Kudos, though, to the engineering team at Amazon; they're forever thinking outside the box. The jury is now out on Fire TV. Just announce your product with anyone but Busey and I'll take a second look. Now it's time to search for an "NCIS" rerun in my presets. Click.
Suggested Links
- Gary Busey is instant 'Internet Gold' for Amazon Fire TV product launch
- CBS to air 'Intelligence' finale tonight: How to bring it back next season
- Abbyson Living showcased on TNT's 'Inside Job'
- USA Network offers 'Mark Madness' as alternative to 'March Madness'
- Clever advertisements make J.G. Wentworth name a household song


text:
|Our People | Our Land | Our Industry | Our Future | Our Association | Media & Info Centre | Our Partners
International Relationshipships
The Northern Territory cattle industry pioneered live exports in two Southeast Asia. The Northern Territory breeds tropically adapted, high-quality cattle adapted to south east asian conditions.
As part of this ongoing relationship the NTCA actively promotes and supports initiatives to build greater mutual understanding for growth and development.
In March 2013 the Northern Territory Cattlemen's Association (NTCA) signed an MOU with the Indonesian Society for Animal Science to establish a 3 year Indonesia Australia Pastoral Industry Student Program which builds on a very successful 2012 program. The 2013 program involves 16 students from 6 universities and will include stations in the NT and for the first time 1 station in WA.
Signing MOU - March 2013 (Alice Springs)
The 2012 program commenced after a memorandum of understanding (MOU) was signed between the NTCA and the Brawijaya University, Malang, East Java and the Padjadjaran University, Bandung, West Java28th Annual General Meeting and Northern Beef Forum .
The 2012 MOU set the foundations for a student initiative, that in 2012 piloting an 8 week program for 8 animal husbandry students to work in the northern beef industry. The program commenced with an intensive 6 day induction and training course to prepare the students for placement, initially with 2 NT Government research farms (Douglas Daly and Kidman Springs) and then on selected corporate and family run stations in the NT.
There ahs been a range of positive coverage of the program including an article in the age newspaper. click here.
ABC Landline ran a very good story featuring 1 of the students which can be viewed here.


text:
UK: T-Mobile Vivacity with Android 2.3, 3.5-inch screen, and 5 MP camera, now just £89.99 on PAYG
Back in November 2011, T-Mobile UK launched an affordable Android smartphone on Pay as you go – the Vivacity. This device is made by ZTE, and has an excellent price to features ratio. It's been sold by T-Mobile for £99.99 on PAYG ever since its release.
Up until today. The operator decided that even that price was too much to ask for this handset, so it kindly lowered that by a cool £10. Which makes this absolutely not the world's most extraordinary price cut, for sure, but do consider the base price here. This is in effect around 10% less, and for a phone that's only been selling for two months. That in itself is a feat.
Now think about how much bang you're getting for that buck (um, okay, pound) – Android 2.3 Gingerbread, 3.5-inch 800×480 touchscreen, 5 MP camera with LED flash, 3G, Wi-Fi, GPS, Bluetooth, 3.5 mm headset jack, and microSD card support (with a 2 GB card in the box).
If you're interested, T-Mobile is the place to go to now. Keep in mind though that as always with PAYG offers, you'll need to also purchase a mandatory £10 top-up when buying the phone.


text:
Scene of fatality at the Goldsbrough Mort apartment complex, Pyrmont. Photo: David Porter
Police are investigating the death of a man at an inner city apartment block after his body was found on a balcony on Saturday morning.
The body of the man, who has not been formally identified, was found on the second floor balcony in the Goldsbrough Mort building in Pyrmont Street, Pyrmont about 9.40am on Saturday.
There were reports the man had fallen six floors. He was dead when ambulance crews and police arrived.
The Goldsbrough Mort apartment complex, Pyrmont, where a body was found on Saturday. Photo: David Porter
A crime scene has been established and police have not confirmed the circumstances of the man's death.
Several people staying in the building, which has residents and hotel guests, reported hearing a woman screaming as she saw an object fall. They said she was not sure whether it was a piece of metal or a body.


text:
That's right, how's it going for dinner is another way of asking, "What are you doing for dinner?" When you are looking for something different, special, savory, and out of the ordinary just say, "How's it going for dinner?" When you do, you will reach for your phone and call Todd English's Ça Va in midtown Manhattan on West 44th Street for a reservation.
"Ça Va" is familiar French for "How's it going?" And when you go to Ça Va, you will be doing just fine. Ça Va is a true dining experience. It is a pleasure trip for your senses.
Located at the Intercontinental Hotel, the ambience is contemporary elegance and casually innovative. There is no pretense to this French inspired brassiere. It is open for breakfast, lunch and dinner, as well for a weekend brunch. Ça Va is a certified Green Restaurant and it is "A" rated by the city.
As you peruse the oversized one page paper menu, you will quickly notice the menu is in French (with English subtitles.) As you read each menu item you will sense that each one of the dishes seems to have been created with a wisp of genius by Chef de Cuisine Patrick Malone. It is hard to decide on what to order because everything looks so delicious.
The Chef also offers a pre fix menu that is a wonderful mix of his al a Carte menu and some specialties. As well, the Chef offers a Plats Du Jour. These "plates of the day" have a different entrée offering for each day of the week. These are different than the main menu entrée offerings. These daily specials look so good that they should be offered every day of the week.
Once you have decided upon your courses, you can sit back and enjoy that great cocktail or a glass of their many fine wines as you wait for that parade of food that is coming your way. You can nibble on French crusty bread and some house butter or smear delicious house grainy mustard spread onto that bread.
The Chef also pays homage to a flavor of the month. This month it is honey in tribute to National Honey Month. The Chef prepares an outrageous appetizer he calls BOULETTES DE POULET AU CITRON. This is a cup sized Mason jar filled with chicken meatballs, trued honey, and preserved lemon. The savory meatball against the honey and lemon was truly a match made in culinary heaven. Although it is a more than thoughtful portion size, you could definitely make this appetizer an entrée. For you seafood lovers, The GRILLED OCTOPUS with flageolet beans, olive tapenade and charred tomatoes is a clear winner as an appetizer. The octopus was succulent and not at all chewy, which is the true mark of a chef that knows how to prepare seafood. This is a must try.
And for your entree, if you are a meat eater you must try the CÔTE DE BOEUF BRAISÉE braised short rib of beef, truffled polenta and honey glazed baby root vegetables. The presentation is so incredible; you will just want to look at a bit before eating it. The meat is so tender and juicy that you know it has been braised for hours. The polenta is creamy and smooth. The demi-glaze is savory and not salty. The side of root veggies just compliments the dish so very well.
If chicken is what you like, the DEMI POULET RÔTI AU MIEL, honey roasted half chicken, smoked bacon Brussels sprout hash, butternut squash purée and sage brown butter is your entrée. The chicken is cooked to perfection--tender and juicy. The Brussels sprout hash was a taste treat. The layers of flavor going on in this dish is nothing short of amazing.
You cannot leave this restaurant without trying a side of TRUFFLED MAC 'n CHEESE. Seriously, DO NOT LEAVE without trying this to die for mac and cheese. It does not matter how many calories are in that side dish just eat it without remorse. It is one of the best mac and cheese dishes you will ever eat.
Hopefully, you now have a bit of room for dessert, so why not go with something chocolate. There is nothing better than chocolate following an amazing meal. Ça Va's WARM HAZELNUT CHOCOLATE TART chocolate gelato, chocolate streusel is the dessert of choice. Smooth, rich and satisfying, you will not want to share this with anyone. If you a bit more cosmopolitan and like something sweet, yet light, the FIG AND PEAR TART TATIN Puff pastry, vanilla gelato, caramelized honey is what you should order. You can see and taste the homemade goodness in this dessert. Simple and perfect!
Looking for something whimsical for dessert, ask for the PISTACHIO MADELEINES WITH CHOCOLATE DIPPING SAUCE. These lovely baked miniature cakes are uniquely French. They are a fine finish to an excellent meal that you can share between you. And, don't forget the espresso! Nothing finishes a great meal like a good cup of espresso coffee.
So, how is it going for dinner for you tonight?


text:
Today we had our second game.
BUT, we lost again. We did alot getter than before, we lost 4-1, so it wasn't that bad.
I screwed up quite a bit today, but I have improved greatly.
The biggest problem I had was kicking the ball in mid-air, where I barely tapped it, but didn't do enough to disrupt the opposing team's advances. Plus, I let a goal get away, but I guess we can't be perfect all the time.
But, I also took a couple of falls, I slipped and fell on my stomach, and when I finally made a good kick, a speck of dirt flew into my eye. I had to sit out for a while 'cuz it hurt really bad and I had to flush it out. Even afterwards my eye was still kinda red.
'Nuff said.
Anyways, look out for another episode that should be coming. I don't know what I'm going to do, but I also had another idea which I might try to develop sooner. IDK. I am in a bit of a mood today.
But finally (It's curfew now, so I'll try and wrap this up and pick up tommorow.), I am officially going on the offensive when it comes to Verny Vern.
I'm sick of talking about it, and I know you're sick of hearing it. So I am gonna go for broke (We had a little spat today, but I should'nt have been there anyways, so in a sense, it was my fault.) and I am just gonna come out with it.
I don't care if I get kicked out, I don't care if my uncle gets mad, I just need this buck to stop here!
*Turns red, black, and gray*
Good night, all.


text:
Black Tea Parties Ruin New Conservative Party Movement
The Tea Party is what the GOP used to be: patriotic, chaste, moral. When Barack Hussein Obama attempted to make us all pay for abortions, the Tea Party stepped up and demanded he rescind his dark ambitions. And he did.
When Obama dared try to make Islam our national religion by wooing crowds with deceptive speeches, the Tea Party threatened to show up and invoke the second amendment! Glory be!
Even now Obama plots to remove all of America's God ordained nuclear weapons. The 2nd Amendment gives us the rights to have nukes and strike whoever we see fit! It is in the Constitution and the Tea Party does not take its violation lightly! That is until now.
Obama is crafty and he has hired secret blacks to infiltrate the ranks of the pure Tea Party. Now don't try to label me racist!
This is not a race issue on our part but on Obamas. The proof of which is I like good men like Justice Clarance Thomas and Michael Steele, these are good men and would make great presidents. Let's not forget Colin Powell of the 90s.
What is horrible is that Obama is using these secret blacks to make the Tea Party all about racial issues. He is trying to use them to say, the Tea Party does not have enough black leadership so that becomes the talking point, instead of how we should all be concerned that Obama is letting Iran build nukes with Russia while just today he ordered America to get rid of all of our nukes so we are defenseless.
The Tea Party is the only party detached enough to counter this! Until Obama is out of office, I say we must make sure he does not let any more of his secret gules team onboard and therefore by executive order we should, put a halt on certain people getting to join up in any official leadership capacity. Then when in 2012 comes, we can run a proper candidate for US president.
- Excited
- Fascinated
- Amused
- Shocked
- Sad
- Angry


text:
By Todd Franko (Contact)
Published December 8, 2010
Burgers and football go pretty good together.
So I'm lumping these two below items together for your FYI.
• We're proud of our football legacy in the Valley. ESPN did a pretty good job last weekend showcasing the volume of top level coaches in college football who trace their X's and O's back to the Valley.
This has been passed around the Valley a few times this week, but if you missed it, here's the link to the ESPN piece.
• Awhile back, I did a feature on the Mahoning Valley Burger Review Board. They're a bunch of local guys -- all post office co-workers -- who've decided to celebrate the best burgers in the Valley. They've been on a quest and have built up quite a franchise with their effort. Read my story here, and go visit their website here.
Well, this Saturday at 7 p.m., they will crown their 2010 Burger of the Year recipient — Martini Brothers Bar & Grille.
The MVBRB, in their second year of reviewing burgers, has chosen them from a field of 16 establishments that they have visited this year. They join last year's winner, O'Donold's Irish Pub and Grille.
Finishing second and third this year are Cleats Club Seat Grille, Warren, and Station Square Ristorante Grill and Lounge, Liberty.
Martini Brothers, which recently moved from the Golf Dome in Girard to 36 Youngstown-Warren Road in Niles, will be hosting a "Burger Bash," including some great specials, to celebrate the occasion.
Well, I watched the video, and here we go again, as the Tressel Posse attempts to shove the Narduzzi family farther into obscurity. This was a tremendous slight to leave Pat Narduzzi (Defensive Coordinator, Michigan State) out of this discussion.
Pat grew up in the valley (Tressel, Dantonio, and Treadwell did not), was a standout at Ursuline HS, played for his Dad, Bill, at YSU, and has had a very successful college coaching career. Do we give him his due? No! Why?
Let's see, Carmine Cassese, who rattled off all of those names, not only wons the MVR, but is the Equipment Manager for YSU, and Tressel's good buddy. Joe Malmisur was brought to the AD job by then-trustee Mickey Monus, to get rid of Pat's Dad, but that had to wait, since Bill won Coach-of-the-Year honors in the Ohio Valley Conference.
It's about time somebody stands up for Bill's memory, and tells the true legacy of YSU.


text:
1st Net Connection connects you with your
First National Bank Bemidji accounts via your PC. You will get
instant information on your First National Bank checking,
savings, certificates of deposit, or loan accounts. You may
view check images and current statements and previous statements
issued within the last 18 months. It is quick and easy to verify
your balance and account activity.
1st Mobile
also allows you to use your mobile device (cell phone) to access
your First National Bank Bemidji account information. You will
have three ways to access your account information depending on
the capibilities of your mobile device.
1st Net Connection is available for First
National Bank Bemidji personal and business customers. It has
many of the same features that customers use and enjoy with 1st
Once enrolled in 1st Net Connection, you
may verify balances and transactions, view check images that
have cleared the bank, view current and previous statements,
transfer funds between accounts, make loan or Checking Reserve
payments from your accounts and much more.
View our
Frequently Asked Questions for details on security,
passwords, support and costs.
Click here to
Learn How to Enroll.
Log in
to First Net Connection on First National Bank Bemidji home


text:
Home Sports Tickets Football Serie B Andria
Andria Tickets
Find the Andria tickets you're looking for on viagogo, the world's largest ticket marketplace. Select a match from the Andria fixtures to view the range of tickets available. You can also sell your spare Andria tickets on viagogo, and listing tickets is free. All Andria tickets are covered by the viagogo Ticket guarantee!
Sign Up for Andria Ticket Alerts
Sign up for the latest information on upcoming Andria events. Be the first to know when Andria tickets go on sale!
The email address you entered is invalid


text:
College Hockey:After topsy-turvy season, Quinnipiac builds around goaltender
Last year
When Quinnipiac rocketed out to a 12-1-0 start, it looked as though the Bobcats could cruise their way right into the NCAA tournament.
Apparently, that sentiment was felt too deep in the locker room as well, as the Q-Cats dozed their way into a 1-11-2 slump and finished the year only two games over .500 … and an even 11-11-0 in ECAC Hockey.
That said, Quinnipiac did manage to dispatch with pesky Dartmouth in three games, and even took Game 1 of a second-round road series at Union — in quintuple-overtime, no less. The home-standing Dutchmen bounced back with great fortitude in 3-1 and 2-1 games to end QU's season.
The senior trifecta of Brandon Wong, Eric Lampe and Jean-Marc Beaudoin led the charge, each scoring more than a dozen goals and more than 34 points. (Wong's 19-22–41 set the pace.) Goalie Dan Clarke earned the lion's share of the netminding minutes, playing 34 games and maintaining respectable 2.52 goals-against average, .913 save percentage figures.
The assets
Long a tale of great woe in Bobcat Country, Quinnipiac may have finally found a worthy goalie in Clarke. The sophomore may have surrendered four-plus seven times last season, but he also held opponents to two goals or fewer in 20 outings … including a six-game string of such outstanding performances, all against ECAC opposition, to boot.
Coach Rand Pecknold declared it too early to tell how this edition of Hamden Hockey will shine, but early signs indicate that goaltending might finally be in capable hands.
Also of note, while the firepower lost to graduation is extreme, it could've been worse, according to an e-mail from Pecknold:
"Scott Zurevinski was offered the [rookie] maximum by the Vancouver Canucks and turned them down to return for his junior year. He will [most likely] sign next summer and not be back for his senior year. He had multiple other teams interested and prepared to offer, but he made it clear he wanted to do one more year at Quinnipiac. He will be our captain this year."
The weak links
Losing your top three scorers? That's a problem, especially when they're as prolific as Wong/Lampe/Beaudoin were. All were 100-point scorers in their respective QU careers, and adding Greg Holt, the Bobcats bid adieu to four of their five 10-goal scorers from last season (now-junior Zurevinski was the other, with 16).
So, yeah. Big, big shoes to fill there; theres really no other way to say it.
Quinnipiac has been a high-flying, fast-paced, run-and-gun kind of team ever since joining ECAC Hockey (though it probably was prior, too). It will be surreal to see the Bobcats without the likes of Wong, Lampe or Beaudoin, but such is life. Who will step up and score the big goals? Pecknold will coach his offense to play the same way it has always played, but the question isn't the strategy, it's the ability … and that's a tremendous question mark in central Connecticut today.
If the defense — which returns 100 percent intact — can support Clarke, and vice-versa, the Q should at least have a fighting chance of keeping its head above water until the snipers get comfortable. At first blush, I had foreseen a long, hard season for the Bobcats, culminating in a depressing first-round road series … but maybe I'm selling them short. Quinnipiac has never been anyone's idea of a defense-first program, but maybe this is its opportunity to evolve a bit.
The following is a self-policing forum for discussing views on this story. Comments that are derogatory, make personal attacks, are abusive, or contain profanity or racism will be removed at our discretion. USCHO.com is not responsible for comments posted by users. Please report any inappropriate or offensive comments by clicking the "Flag" link next to that comment in order to alert the moderator.
Please also keep "woofing," taunting, and otherwise unsportsmanlike behavior to a minimum. Your posts will more than likely be deleted, and worse yet, you reflect badly on yourself, your favorite team and your conference.


text:
My research explores questions of multilevel and networked governance through cooperative approaches. Using a multidisciplinary analytical approach that borrows from the sociological, urban studies, planning, anthropological and political/policy sciences' literatures, I examine new models of governing. My work probes these new, non-hierarchical models of governing through the analysis of a variety of case studies from the environmental field (specifically water, solid waste and hazardous/toxic waste). My major region of interest is North America (Canada, the United States and Mexico), and I have conducted field research in all three countries.
I am keenly motivated by a interest in cooperation amongst agents across multiple scales. Why do people cooperate to manage common pool resources and can we look at a wasted resource like wastewater) through the lenses of CPR theories? What drives firms to co-locate in the same geographical region even when they are potential competitors and how do clusters of allied (coupled/interconnected) industries respond to a multiplicity of stressors? What strategies do environmental non-governmental organizations (ENGOs) use to put pressure on governments to reduce their pollutant emissions and what are the underlying reasons why these ENGOs build transnational coalitions? Under what circumstances do business use cooperative approaches to pollution control and how effective are these in reducing pollutant releases?
My empirical research has shown, amongst other things, that:
River basin councils have proven innovative institutional reforms to govern water, yet they are ineffective in improving wastewater management at the municipal, provincial and federal levels.
Environmental non-governmental organizations (ENGOs) can successfully use coalition-building strategies to effectively put pressure on national governments to improve their pollution-control performance policy under specific circumstances that include campaigning for issues that have a direct effect on human health.
Small cities with mono-industry structures will engage in countervailing strategies if faced with multiple cross-scalar stressors, whereas cities where there is potential for industrial diversification will broaden their repertoire of industries.
My research is theoretically-grounded, policy-relevant, applied and empirically-informed. While I consider myself a comparative environmental policy specialist (with much of my fieldwork focused on Mexican environmental politics), I also analyze Canadian and US environmental problems within the context of a North American environmental policy regime. I use mixed-methods in my research. A keen interest in public policy evaluation and application to real life drives my scholarly research. While well-versed in qualitative approaches to research design, I am also conversant in quantitative analysis.
I have been strengthening my Geographical Information Systems (GIS) skills, and I have a keen interest in formal models and game theory. I have conducted extensive fieldwork and assembled my own datasets through archival research and structured/semi-structured interviewing. You can also check my Previous Projects, Current Projects and Research Output pages to learn more about my scholarship.


text: Rock out with your socks off in these stylish anti gravity bootie wedges! They are sure to turn heads in any occasion! They will look super hot paired with your favorite skinnies or dress. Make sure you add this collection to your closet, it definitely is a must have! The features include faux suede upper with faux leather platform wedge and trim, studded detailing, stitched detailing, side zipper closure, smooth lining, and cushioned footbed. Approximately 5 1/2 inch wedge heels and 2 inch platforms. Style: shoes-wedges-ttf-obsess-02blacksupu


text:
252 Schraalenbergh Rd. (High St.) Send to Phone
201-750-9966 | Make Restaurant Reservations | Menu
OpenLunch Tues.-Sat., Dinner Tues.-Sun., Brunch Sun.
Open late Thurs.-Sat.
- Valet parking
- Dress code: Dressy
- Entertainment: Live music Thurs.-Fri.
- Full bar
- Reservations suggested
* Click here for rating key
Harvest Restaurant Review: The flair is French but the food is mostly American --- modern and flavorful. Small plates are an option. Lobster bake is offered every Sunday night. French wines are featured, but the wine list overall is more international in its scope.
Sign up to receive the 2016 edition of GAYOT's Annual Restaurant Issue, which will feature the Top 40 Restaurants in the U.S. and more.


text:
Preheat oven to 350 degrees F.
Cook oatmeal with water, either in microwave or on the stove top.
In a medium sized mixing bowl, combine oatmeal, apples, butter, applesauce, and vanilla extract. Set aside.
In a large mixing bowl combine dry ingredients. Add oatmeal mixture until just mixed. Stir in eggs.
Use a loaf pan and cook for about 35-40 minutes. Use a toothpick to see when it's ready to eat.
Can also be made as muffins. If you are making these as muffins bake for 25 minutes.
Thank you for sharing this recipe!