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Hotels near Bliss Mansion
Search hotels near Bliss Mansion in Carson City
Trending now in Carson City
Hotels within 0.5 miles of Bliss Mansion
- Most bookedRodeway Inn at Nevada State Capitol
169 people looked at this hotel in the last hour
Most recent review
"Stayed one night. Cheap rates. Staff was very friendly. Free breakfast. Room was clean but there was cigarette burn holes in the bedspread. Pool was super warm."
A Traveller, Jun 2016, US
68 people looked at this hotel in the last hour
Most recent review
"The staff was super friendly, the rooms were extremely clean."
R, Jul 2016, US
62 people looked at this hotel in the last hour
Most recent review
"Nice hotel in downtown - close to some nice restaurants and casinos."
A Traveller, Jul 2016, US
Hotels within 1 mile of Bliss Mansion
105 people looked at this hotel in the last hour
Most recent review
"Stayed two nights with my son on a mini vacation to ride the old V&T railroad. The hotel was great. The casino was a bit smoky add smoking is allowed, but the room was fresh smelling and smoke free. Great job! The Wi-Fi and TV left a little to be desired as both were laying, but that was not a bi..."
A Traveller, Jul 2016, US
53 people looked at this hotel in the last hour
Most recent review
"The staff are very nice and helpful. Not far to the Lake Tahoe with cheaper price. "
A Traveller, Jul 2016, US
Hotels within 2 miles of Bliss Mansion
131 people looked at this hotel in the last hour
Most recent review
"Accommodations were fairly standard, but I was very impressed with the immaculate room. Totally neutral smelling with a functioning microwave and mini-fridge added to my comfort. Minor inconveniences: Hot/Cold were reverse in the shower, and TV remote would not adjust volume or on/off."
A Traveller, Jul 2016, US
54 people looked at this hotel in the last hour
Most recent review
"Clean room and restrooms but needed to clean up back of motel were trash had blown in "
A Traveller, Jun 2016, US
41 people looked at this hotel in the last hour
Most recent review
"The room clean , feels like was remodeled, pleaseant to stay in . Room has everything you need. You have to have your own shampoo and hair dryer . Just because it's a low price hotel attracts some people that maybe not pleasant to be around . Overall was quiet and relaxing , close to shops and re..."
A Traveller, Jul 2016, US
37 people looked at this hotel in the last hour
Most recent review
"My girlfriend and I stayed here for one night and the employees were extremely friendly, they are painting so there's some crinsrructuon going on but not enough to interfere with our stay. They also have REALLY good tv channels. "
A Traveller, Jun 2016, US
29 people looked at this hotel in the last hour
Most recent review
"Family Reunion. 5 family members stayed in hotel. Nice clean rooms. Only problem was shower wouldn't drain properly. Called hotel service they quickly resolved problem.. Casino security wasn't helpful when my brother in laws wallet got stolen from casino. Should've been more helpful before.. Whe..."
A Traveller, Jul 2016, US
Map of hotels near Bliss Mansion
- Sand Harbor
- Topaz lake
- Topaz Lake Park
- Carson Nugget Casino
- UC Davis Tahoe Environmental Research Center
- Virginia and Truckee Railroad
- Jim Kelley's Tahoe Nugget Casino
- Crystal Bay Casino
- Mills Park
- Cal Neva Casino
- Sunridge Golf Club
- Saint Mary's in the Mountains Church
- Mark Twain Museum at the Territorial Enterprise
- Washoe Lake State Park
- Carson City Community Center
- Casino Fandango
- Spooner Lake Cross Country Ski Area
- Chollar Mine
- Incline Village Championship Golf Course
- Diamond Peak Ski Resort
Hotels in Carson City near Bliss Mansion
Are you looking for a cheap Bliss Mansion hotel, a 5 star Bliss Mansion hotel or a family friendly Bliss Mansion hotel? You just landed in the best site to find the best deals and offers on the most amazing accommodations for your stay.
When you search for hotels near Bliss Mansion with Hotels.com, you need to first check our online map and see the distance you will be from Bliss Mansion, Nevada.
Our maps are based on hotel search and display areas and neighborhoods of each hotel so you can see how close you are from Bliss Mansion and refine your search within Carson City or Nevada based on closest public transportation, restaurants and entertainment so you can easily get around the city. All the hotels details page show an option for free or paid onsite parking.
If you wish to see the hotels with the highest featuring discounts and deals near Bliss Mansion, simply filter by price/ average nightly rate. We recommend you filter by star rating and read our genuine guest reviews so you can get the best quality hotel with the best discount.
One of the new features on Hotels.com guest reviews is that also show reviews from Expedia for Bliss Mansion hotels and the TripAdvisor Bliss Mansion hotels reviews so you can make sure that you checking with a reliable source. See the review scores on our Carson City hotel information pages.
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manufacturing team member jobs
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Light Assembly - Mattress Assembler
Staff Management - Cedar Lake, IA
In addition, you may work with a team member or individually. Associates will be working per a daily production schedule and set manufacturing procedures....
Production Supervisor Sheet Metal
Twin City Fan Companies, Ltd. - Aberdeen, SD
Ability to work as a team member toward overall Company objectives. 5+ years in a manufacturing environment....
Pulaski, TN - Production Supervisor (1st or 2nd Shift)
Twin City Fan Companies, Ltd. - Lawrenceburg, TN
Ability to work as a team member toward overall Company objectives. 5+ years in a manufacturing environment....
Business Development Director - B2B
Precision Signs.Com, Inc. - Amityville, NY
Enjoy working in a collaborative, entrepreneurial environment and engaging team members throughout the organization -- Sales, Estimating, and Manufacturing,...
Maintenance Technician
Essentia Protein Solutions - Lytton, IA
Cooperate with all Essentia team members. Founded in 1975 and headquartered in Ankeny, Iowa, LGI is a global company including 50 manufacturing plants, 1500...
2nd Shift Production Supervisor
Smith & Vandiver Corp. - Watsonville, CA
Responsible for the day to day tasks associated with the manufacturing of liquid and semi liquid personal care products, including setting plans, monitoring...
Light Assembly / Material Handlers
Staff Management Serta - Clear Lake, IA
In addition, you may work with a team member or individually. Manufacturing Positions Available! Join Our Team today!...
Senior Manufacturing Technician
AirXpanders, Inc. - Palo Alto, CA
Identify out of calibration equipment and notify appropriate team member. Participate as a team member generating and maintaining complete documentation...
Senior Buyer
Omega, Inc. - Santa Ana, CA
Lean Manufacturing experience:. Provide leadership and training to buyers and supply chain team members. The buyer will be an integral part of the supply chain...
Powertrain Quality and Reliability Engineer and Field Vehicle Reliability Engineer
FCA - Kokomo, IN
Oversee and develop highly functioning work teams, comprised of Unit Leaders, Team Leaders and team members and practice the FCA Leadership Principles....

subset: commoncrawl


text:
Minky Monday: Take 20% off 1+ Yards of Minky fabric through 11:59 p.m. EDT July 25th.
Preview scale: 21.0 x 18.0 inches

Change DPI Base size is 150
Collection: toys
stripes (28030),
dots (27546),
whimsical (23502),
kawaii (3566),
toy (1213),
car (796)
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trcreative says:
Love the sketch and colors, cute
Posted over 5 years ago.
rhondadesigns says:
This reminds me of all the cardboard cars my kids made when they were little. I like the hand drawn look of this design.
Posted almost 6 years ago.
© 2008-2015 Spoonflower Inc


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By Sarah Courtauld, Illustrated by Adam Larkum
Cultivate art appreciation as you are introduced to 30 of the world's most beloved paintings! Each Usborne Famous Paintings Card has an image of a famous painting on one side and fun illustrated facts on the reverse, including the story behind the painting, when, where and by whom it was painted and interesting details. What are you waiting for? Dive into the world of art with Famous Paintings Cards from Usborne!
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A new young blonde bride calls her mother in tears. She sobs, "Robert doesn't appreciate what I do for him." "Now, now," her mother comforted, "I am sure it was all just a misunderstanding." "No, mother," you don't understand. "I bought a...
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Will The Lord Deliver From Bad Habits Of Tobacco, Rum, Liquor,
The Widow's Tree


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Crazy Substitute Teachers
Enjoy, NG4.03 / 5.00 2,526 Views
Vacuum Salesman
This dude and his Megazord vacuum cleaner4.01 / 5.00 2,806 Views
Markiplier Animated | Mark Of The Survey Corps
This took far too long to make...3.96 / 5.00 6,943 Views
Good animation, but it wasn't even funny...
it was okay i guess
not so gerat.
This flash was alright. the graphics and sound were realy good. maybe i'm just bias against people who buy a video for playing guitar instead of just playing a guitar. the same with paintball games whats the point when you could do it yourself.
I think you really need to try out Guitar Hero. But, if that's how you feel, how come you didn't enjoy the ending?
The bunny was kind of retarted
Listen man, I liked the music & headings but the story was kind of lame. I ain't sayin it sucks, but you should try harder if you want it to be funny. The guitar dude wasn't drawn so good, so you also might want to work on your art. Anyways man, it was ai'ght, rock on!
(see above)


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9 December 2012 10:10 AM, PST | Indiewire | See recent Indiewire news »
Focus Features' "Hyde Park on Hudson" led a generally slow weekend at the indie box office. The film -- directed by Roger Michell and starring Bill Murray as Franklin D. Roosevelt -- debuted on 4 screens to a $83,280 gross, giving it by far the best per-theater-average of any film in release ($20,820). Those are decent numbers and to be expected considering the lukewarm reviews that met the film. Though the presence of Murray and co-star Laura Linney, along with the fact that there's very little new competition in the specialty market right now, perhaps should have made for somewhat higher numbers. Either way, Focus appeared pleased with the performance thus far. "'Hyde' played well to older art house audiences this weekend," Focus Features said in a statement. "The top grossing theaters (Lincoln Square/NY, Landmark/La) traditionally attract adult audiences - particularly at matinee and early prime time shows - which is when. »
- Peter Knegt
Similar News ItemsBill Murray (I)
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- 'Indignation' Review: James Schamus' Philip Roth Adaptation, Starring Logan Lerman and Sarah Gadon, Resurrects the Focus Features Legacy (From Indiewire. 29 July 2016, 8:00 AM, PDT)
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- Casting News: Linney, Foy, Gillan, Mirchoff (From Dark Horizons. 27 July 2016, 8:04 PM, PDT)
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- TVLine Items: Laura Linney Joins Ozark, Spike's Late Night Talker and More (From TVLine.com. 27 July 2016, 2:47 PM, PDT)


text:
commercial lines producer jobs near Dallas, TX
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Insurance Sales Producer (Outside Sales Representative)
HUB International - Dallas, TX
Rewards for top Producers. This role is vital to our success in all our product lines – from personal, commercial, employee benefits, and other coverages....
Distribution and Marketing Manager, Commercial Insurance
Liberty Mutual - Richardson, TX
Distribution and Marketing Manager, Commercial Insurance. Ability to develop effective working relationships with peers and superiors across organizational...
Client Service Manager - Dallas
Arthur J. Gallagher & Co - Dallas, TX
Secures existing business and drives the sale of additional services and lines of coverage. The Branch Client Service Manager is accountable for delivering high...
Contracts Coordinator
Energy Transfer Partners - Dallas, TX
Create passwords and set up meters in Producer well data system. Correspond with producer regarding possible disconnect options and obligations for remaining...
Associate Customer Service Representative - Commercial Insurance
Liberty Mutual - Irving, TX
Commercial lines insurance experience is preferred (e.g. Associate Customer Service Representative - Commercial Insurance....
Technology Segment Underwriting Consultant
CNA - Dallas, TX
Prioritizes time and resources to effectively manage and optimize producer performance. Tech E&O, CNA NetProtect as well as CNA's traditional domestic property...
Insurance Customer Service Associate III - Commercial Lines
Regions Bank - Dallas, TX
Insurance Customer Service Associate III - Commercial Lines. At Regions the RIG Insurance Customer Service Associate III - Commercial Lines supports the...
Commercial Lines Property & Casulaty CSR
OrchestrateHR - Dallas, TX
Commercial Lines Property & Casualty CSR with Personal Lines Experience. Full Time Commercial Lines CSR Duties:....
Commercial Lines Account Executive
Jonus - Irving, TX
Commercial Lines Insurance Account Executive. Experience servicingmulti-line commercial mid/large market accounts....
Commercial Lines Producer
Jonus - Irving, TX
Commercial Lines Producer – Irving, TX. A Commercial Lines Producer is needed for our busy Independent Insurance Agency....


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This particular iteration of the venerable series had a pretty distinct musical style that I was certainly a fan of, though the game itself was definitely polarizing (just ask Rob his thoughts on the game, for example). That in mind, I was quite interested to hear what Bob Richardson had to say about this particular chunk of chipmixes. If you find yourself also wondering, then check out Bob's review below!
(And yes, the best Final Fantasy ever released is up next for chippy coverage. I wonder who will provide THAT particular review?)
Tales from the Borderlands July 31 • 9:00am PDT/12:00pm EDT
Sword Coast Legends Aug 7 • 9:00am PDT/12:00pm EDT
Breath of Fire IV Continues! Every Monday • 5:00pm PDT/8:00pm EDT
Star Wars: KotOR Continues! Coming soon...


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Category:Spanish civil engineers
From Wikipedia, the free encyclopedia
|Wikimedia Commons has media related to Civil engineers from Spain.
Classification: People: By occupation: Engineers: Civil engineers: By nationality: Spanish
Also: Spain: People: By occupation: Engineers : Civil engineers
Pages in category "Spanish civil engineers"
The following 13 pages are in this category, out of 13 total. This list may not reflect recent changes (learn more).


text:
Report: iPhone SDK pushed back to MarchDevelopers eager to write native applications for the iPhone and iPod touch will have to wait until March for the software developer kit, according to a reported insider.
Arik Hesseldahl of BusinessWeek is allegedly in touch with a source who says the SDK for the two touchscreen devices will slip from its intended February release window by one to three weeks.
No justification is given for the delay. However, the progress of the development kit is described as "fluid" and may see Apple release little or no information about the programming environment before the end of February.
"There are, apparently, a lot of moving parts to something this complex," the writer claims.
The report claims authority based on past tips obtained by the magazine staff. The publication successfully leaked news of the SDK just a day before Apple chief executive Steve Jobs revealed official plans to open development to third parties in October.
Despite the delay, rumors have surfaced that the iPhone maker has been eager to spur development as soon as possible and may have released an early SDK to select developers, including a social networking site.
On Topic: iPhone
- Apple rumored to launch 'iPhone 7' on week of Sept. 12
- Pokemon Go sets Apple App Store record for launch downloads, but US growth slowing
- 'Solid' forecast from Apple chipmaker Skyworks may bode well for 'iPhone 7' production
- New video from China compares rose gold finish in alleged 'iPhone 7' to iPhone 6s
- Pokemon Go comes home, launches in Japan with McDonald's sponsorship


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The Structure and Dynamics of the Plasma Sheet During the Galileo Earth-1 Flyby, G. D. Reeves, T. A. Fritz, R. D. Belian, R. W. Mcentire, D. J. Williams, E. C. Roelof, M. G. Kivelson and B. Wilken. DOI: 10.1029/GM084p0149
Complete the form below and we will send an e-mail message containing a link to the selected chapter on your behalf
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susandhakal2192089 commented on 7/2/16
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Preview my ONLINE REMIX Album entitled "EMIXES" 14 prescriptions for the Hiphop enthusiast" free download at http://www.metaprofessor.com/vice.htm
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Quote of the Day
an admirable concern to keep lines open to writing in Ireland, Scotland, Wales and America.
Seamus Heaney
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A Colour For Solitude (2e)
Sujata Bhatt
Categories: Black and Asian, Indian, Women
Imprint: Carcanet Poetry
Edition: 2nd
Published: April 2002
217 x 135 x 14 mm
112 pages
Publisher: Carcanet Press
Also available in: Hardback
Revolving around the public and private lives of the great modern painter Paula Modersohn-Becker, this collection explores the artist's relationship with her craft and her friendship with poet Rainer Maria Rilke and his wife, sculptor Clara Westhoff. Inspired by the artist's numerous self-portraits, Bhatt transports the image of Modersohn-Becker to present-day Germany. This book-length sequence of poems presents a rich and fully conceived history of the inner and outer worlds of one of the century's great modern painters.
Bhatt's style is refreshingly plain and direct, depending for its lyricism on moments of gentle repitition.
Alan Marshall, The Daily Telegraph.
You might also be interested in:
Collected Poems Sujata Bhatt
The Weather Wheel Mimi Khalvati
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text:
Gong Ho Restaurant
Today:11:30 am - 10:00 pm
Tomorrow:11:30 am - 10:00 pm
1338 75th St,
Downers Grove, IL 60516
(630) 968-5300
Business Details
in Business
- BBB Rating:
- Hours:
Regular Hours
- Extra Phones:
Phone: (630) 968-5310
Fax Number: (630) 968-5310
- Payment method:
- discover, diners club, mastercard, amex, visa
- Location:
- The Grove
- Other Link:
- Categories:
- Asian Restaurants, Take Out Restaurants, Caterers, Chinese Restaurants, Family Style Restaurants, Restaurants
- Other Information:
Parking: Lot, Private
Wi-Fi: No
Bike Parking: No
Attire: Casual
Good For Groups: Yes
Good for Kids: Yes
Wheelchair Accessible: Yes
Take Out: Yes
Cuisines: Asian, Family Style, Chinese, Pan Asian
Alcohol: Full Bar
Takes Reservations: No
Outdoor Seating: No
Price Range : Below Average
Posted: 6/27/2014
I live 45 mins away and I'll drive that far for this place. They have the best Chinese food I have ever had and the service and owner's are so friendly. I also have special orders that aren't on the menu and they are always accommodating to make what I ask.
Posted: 12/1/2007Provided by Citysearch -
the owner is really bitchy at times, snappy and inconvenienced, which could leave a bad impression. But the food is good and i love the eggrolls there. Go for the food.


text:
We also have part of the thread from the Lost season 2 finale. I think this one is actually more impressive because all of these posts take place within the span of about a minute. There are spoilers here too, so if you're a Sensitive Sally and you read them anyway it's your own plum fault!
That's all I can take for this week. Thanks to my forum friends Deg, Sombrerotron, moving shadow, Tahrajj, Gurney Halleck, kingcobweb, igloo house, Sexual Pushups, spatula, Archr5, WEAK and WILLING, Capt_Jim, screwy, kazoogirl, and Petey for being so kind.
Know of a terrible forum that should be featured in a future Weekend Web? Please send me a link!
I was betrayed by the bernio bros, the cougars, and this guy from back page I hired to keep me from jumping out a window at the DNC.
TOTAL WRECK - crazy-eyed hound is covered in cobwebs, has a vespiary on back, graffiti on side and savage thirst for boat fuel. Frankly, I'm in over my head. He's in room 115 at Motel 6, yours free. 555-2851
A dubious allegorical romp through a Fahey-filled world of Christly hackers and eyeliner tattoo!
Hillary Clinton has a new book! Here are some photo-shops of her, for you to enjoy.
Thirty games and a novel piece of hardware for sixty dollars? This is an insult to my honor.
There are hundreds of stories happening on the World Wide Web. Let me tell you, that's a very wide web. Our goal at Weekend Web is to bring you the latest headlines from around the Internet. We go into the very bowels of message boards everywhere and find out what millions of online citizens have to say.
Copyright ©2016 Rich "Lowtax" Kyanka & Something Awful LLC.


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high school jobs near Pittsburgh, PA
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PA-Pittsburgh Area-Unarmed Security Officers
Black Knight Security Inc. - Pittsburgh, PA
High school diploma or GED. The unarmed security officer is to guard, patrol, monitor, and protect clients property to prevent theft, violence, and any...
Customer Service Representative
Aaron's, Inc. - Pittsburgh, PA
High school diploma or equivalent. Personally and professionally, we hold ourselves to high standards and unwavering commitment to do what's right;...
PAID CNA Training!
Baptist Homes - Pittsburgh, PA
Baptist Homes in Mt. Lebanon is hiring for an upcoming CNA Training Class. Training time is paid! The class will run from September 8 to September 30. Upon...
INFANT TEACHERS AIDE (Professional Experience Required)
A Place to Grow Learning Center TOO - Pittsburgh, PA
High school or equivalent. PLEASE INCLUDE A COVER LETTER STATING YOUR CHILDCARE EXPERIENCE.*....
Restaurant Manager
Arby's - Pittsburgh, PA
High school or equivalent. Strong People Oriented Leadership skills• Ability to lead and develop a high performing restaurant team.• Excellent verbal and...
Landscape Worker
Harvest Lawn Care, Inc - Coraopolis, PA
High school or equivalent. Experienced and hardworking individuals needed for full time lawn care position....
School Bus Driver $18 - $20 PH
Krise Transportation, Inc. - Penn Hills, PA
High school or equivalent. Safety and attendance bonus $5.00 per school day. All drivers assigned to regular runs will be guaranteed 5.25 hours every school...
Full-time Teller Trainee
Dollar Bank - Pittsburgh, PA
High school diploma or GED required. Process transactions through the teller equipment on all retail and corporate accounts, including, but not limited to,...
Dishwasher/Food Prep
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Able to work Lunches and Dinners. Able to work Weekends. Willingness to learn. Should be able to work with the team. Should be local to Pgh area . NOT ON A...
Key Holder/Sales Lead
Five Below - Pleasant Hills, PA
Set the bar high for self and team and make sure to take risks. Assist the Store Manager and Assistant Manager to ensure the store is school and inventory...


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Latest News and Comment
Socialists admire that slogan "life, liberty and the pursuit of happiness" but assert that ONLY by carrying on the fight for socialism can it be achieved. It will ONLY be accomplished by the declaration of labour's independence and the proclamation of labour's coming emancipation. There is a multitude of reasons why socialism is not much of a force than it is today. We must understand, first of all, that revolution is not a simple process of raising the crimson red banner and rallying everyone who is exploited and oppressed to muster under it and rise up. Capitalism is a very sophisticated enemy. It is a system which knows how to bribe and buy-off those who challenge it. It knows how to absorb reforms and innovations that offer a pretense of solving the people's problems. It knows how to create a culture that makes it appear there are no bitter class antagonisms under the surface of society. And it is also very good at discrediting and slandering the ideas of social revolution and socialism in the minds of the people. In trying to change this system, we should never forget that these factors constitute an important part of the objective conditions under which we work. There are no short-cut schemes to alter them, only painstaking, and prolonged educational work of illumination and enlightenment.
People are seeking an alternative to the situation. They are disgusted by the capitalist politics. The world is divided not between "good men" and "bad men," not between black, brown and white, not between foreign-born and native-born, but between working people and their capitalist exploiters. The government pretends to be the impartial umpire of the social struggle. This is a lie. The capitalist class has shown itself unfit to rule because it cannot even feed its slaves. To establish democracy is the aim of the Socialist Party. Not the fake limited political democracy but the real economic and social democracy which comes from a society where men and women collectively own their own means of livelihood, the factories and industrial machinery where "we shall have an association, in which the free development of each is the condition for the free development of all." In the view of Karl Marx and Frederick Engels "The proletarian movement is the self-conscious, independent movement of the immense majority, in the interests of the immense majority."
The theory of socialists is that if the enormous wealthy of society, controlled by the few, were controlled by the people, poverty could be eliminated, an end could be made to the mass murder of war, and mankind could live in peace and plenty. In a revolution, the power and wealth of society change hands. They are transferred from one class to another. In our time, there are two fundamental classes in society, the working class and the capitalist class. This kind of social revolution would be necessary on a world scale this kind of revolution would be necessary on a world scale. Since capitalism is a global system, to be successful, socialism must replace capitalism globally. The minority class owns the wealth, profits from it, keeps down the standard of living of the majority class which has no wealth. The workers are cajoled and propagandised to protect the wealth owned by the ruling class and to maintain the profits and privileges of the ruling class.
Socialism can be constructed only on the basis of a highly productive economy capable of producing abundantly. Where there is scarcity, with the consequent scramble for the meagre necessities, the fight for privileges takes place; the material basis for a privileged bureaucracy appears. Genuine socialists have confidence in the ability of the working class to overthrow capitalism and do not have the slightest doubt of the ability of the workers to dispose of the capitalist class.
Thanks to the extraordinary development of industrial technology, the world's vast resources and the existence of skilled workers, the organisation of socialist production on such a scale as to ensure plenty and thereby economic equality for all, can be assured almost immediately. Once workers have made their revolution, the decisive factors of resources and technology will provide the material basis for the broadest workers' democracy, leading to the fulfillment of the revolution in the classless socialist society. But the thing now is to make the revolution.
58 sec ago
Over the past 50 years, more than half of the world's countries have carved out pieces of their territories to hand over to foreign investors as special economic zones (SEZs). The International Labor Organization (ILO) estimates that more than 66 million people—most of them young migrant women—work in the world's more than 3,000 SEZs. "Any country that didn't have an SEZ 10 years ago either
58 sec ago
For more than five years, the rebel Sudan People's Liberation Army-North (SPLA-N) and government forces have fought each other to a standstill in the border states of South Kordofan and Blue Nile. Neither side has attained a significant military advantage. The fighting in South Kordofan generally takes place from November to June, before the region's rainy season muddies all access points to
3 hours 13 min ago
"Every second, one person is displaced by disaster," the Oslo-based Norwegian Refugee Council (NRC) reports. "In 2015 only, more than 19.2 million people fled disasters in 113 countries. Disasters displace three to ten times more people than conflict and war worldwide. As climate change continues, it will likely lead to more frequent and severe natural hazards; the impact will be heavy,
Read more: http://socialismoryourmoneyback.blogspot.com/2016/07/the-looming-climate-change-crisis.html
3 hours 13 min ago
MSF CALLS FOR MAJOR HUMANITARIAN RESPONSE AS TEAMS CONTINUE TO REACH AFFECTED AREAS A major humanitarian operation is needed to save lives in northeastern Nigeria's Borno state, where more than 500,000 people are living in catastrophic conditions in villages and towns affected by the conflict between the military and Boko Haram, the international medical humanitarian organization Doctors
Read more: http://socialistbanner.blogspot.com/2016/07/catastrophic-malnutrition-in-borno-state.html
3 hours 13 min ago


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power electronics engineer jobs
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Senior Power Electronics/Analog Engineer
WiTricity Corporation - Watertown, MA
We are seeking a *Senior Power Electronics/Analog Engineer*. Experience in designing and developing power electronic circuits for various functions such as...
Senior Engineer, Power Electronics (High Power)
WiTricity Corporation - Watertown, MA
Senior Engineer, Power Electronics (High Power)*. Seeking a Senior Power Electronics Engineer for the wireless battery charging electronics team in our...
Electrical Engineer - Analog/Power Supply
Midmark Corporation - Lincolnshire, IL
Knowledge of generally acceptable standards and practices related to electronic design of medical products. Collaborate and guides other designers and engineers...
Sr. Electrical Engineer - Design
MTS Systems - Flint, MI
Interfaces effectively with application engineers, project engineers, and peers within the same discipline and with other disciplines....
Field Service Electrical Engineer
PV Pros, Inc. - Hoboken, NJ
Manage tasks delegated to Pure Power engineers. The engineer shall possess experience and understanding in the design, installation, and operation of commercial...
Principal Software Engineer C++ / Simulink
NEC Energy Solutions, Inc. - Chesterfield, MO
Electrical engineering or power system experience (fundamentals of power and power transmission systems, knowledge of inverter principles) Power system...
Senior Power Electronics Engineer
TeraDiode Inc. - Boston, MA
High Power Electronics:. Electrical power monitoring/conditioning. TeraDiode is seeking a highly talented Electrical Engineer specializing in high-power, high...
Sr. Electrical Engineer - Electric Vehicle Power
Delta Products Corporation - Livonia, MI
Hands-on experience with electronic power products. Design or application engineering of power electronic products:....
Product Compliance Engineer - Electrical
Charles Machine Works - Perry, OK
Prepare documents of conformity for new electronics products. Understand necessary requirements for wireless frequencies, power levels, and certifications....
Electrical OR Plant Engineer
Environmental / Scrap - San Francisco, CA
ELECTRICAL ENGINEER / PLANT ENGINEER*. Responsible for plants processes & new technologies that involve all electronics, electronic controls & processes*....


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Articles tagged eddie van halen
12 Oct 2015 // 10:30 AM
Van Halen, helmed by a vivacious David Lee Roth and a steady Eddie Van Halen, put on a fine, festive old-school hard rock party not to be outdone. The good times have not gone anywhere!READ more
4 Mar 2012 // 10:00 PM
The David Lee Roth-fronted Van Halen returns after a 28-year absence. Who else has made fans wait that long? Quite a few, it turns out.READ more
31 Mar 2011 // 7:00 AM
Has there been anything else remotely akin to the waste of potential, time, and opportunity that we've had the last two decades with Eddie Van Halen?READ more
//Mixed media
The Stray Birds "Sabrina" (audio) (premiere) // Music
The Bourgeois "Summer of George" (audio) (premiere) // Music
//Pm Picks
Bad Graphics Are Still Impressive in 'Spirits of Xanadu'
// Moving Pixels
"Spirits of Xanadu wrings emotion and style out of its low fidelity graphics.READ the article


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Anyone anti baby wearing?
Jessica + Mike = DD1 9/26/10
~Amy - MTHFR C677T Homozygous
Zach 12/09 (Egg Allergy, Eczema)
Alexandra 04/13 - Our rainbow baby!
only time i am "anti" baby wearing is when it is certain times or situations, IE cleaning the house with chemicals, cooking etc. i was never a clingy baby and my mom baby wore, in fact my mom couldnt get me to stay around here for the longest time, once i figured out how to problem solve she had to padlock the doors because i was stacking and unlocking locks at the top of the fram to go and visit my grandmother (lived next door through the back yard not like i was 2/3 years old hiking around town lol) i was a very very independant kid. i was more social with adults then i was kids my own age for a while but after 1st grade i outgrew that, most of it was from havign to move schools and going from a french school to an english one (wasnt use to a english spaking school so was slightly withdrawn until i was use to it)
R.I.P. alexander april 8, 2011
I will likely put little one in a baby carrier when I'm shopping but otherwise will not likely do it.
Baby wearing is ANCIENT...its amazing all those babies grew up to be.. Yanno...adults.
If you're doing it correctly with a GOOD carrier of wrap, there is pretty much no downside to babywearing.
I don't know how I would be able to function without wearing this baby, when I also have to manage a 2 year old. I am NOT one of those people who carry their infant car seat around- I think it's so awkward. I will be wearing this baby basically any time I'm outside of the house. Not sure what the negatives are as long as you have a good carrier (I have a Beco Butterfly 2)
New Baby Due 4/13
Learn more
Look how far your child has come.
Review your child's growth milestones.
Read about 3 years 2 months : Week 2.
Your growing child
Your 3-year-old: Manners
Your 3 1/4-year-old: Understanding differences
Your 3 1/4-year-old: The birds and the bees
Your 3 1/4-year-old: Hand washing
Your 3 1/4-year-old: The art of conversation
Learn more
What's next for your growing child?
Get a glimpse of what's to come.
Read about 3 years 4 months.


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State, Local Government Employment Remains Flat in Jobs Report
The latest jobs report shows state and local government employment remained mostly unchanged in March.
State and local government employment remained mostly unchanged in March, continuing a trend of flat jobs growth.
The Labor Department reported Friday that local governments lost a total of 3,000 jobs in March, with February figures revised upward by 2,000. The public education sector accounted for nearly all of the cuts.
State payrolls were also relatively frozen for the month, adding only 2,000 jobs nationwide.
Governments aren't about to begin a hiring spree, but the numbers signal public sector job cuts could be slowing. States and localities frequently slashed 20,000 or more jobs each month throughout much of 2010 and 2011.
So far this year, state and local governments added a combined 14,000 jobs.
More cuts could be on the horizon, though, for some public agencies.
In Alabama, the state's general fund revenues are expected to sink nearly 20 percent next year. A state House committee approved a budget earlier this week that would slash spending by 30 percent for non-education departments. The executive director of the Alabama State Employees Association told the Associated Press he did not think substantial layoffs could be avoided.
Some agencies facing budget shortfalls in Alabama and other states have left openings unfilled to stave off job cuts.
Government employment mirrored stagnant private sector job growth in March. The U.S. economy added only 120,000 jobs, the smallest gain in five months, with the seasonally-adjusted unemployment rate falling from 8.3 to 8.2 percent.
The weak jobs report followed positive news earlier this week that the four-week average number of first-time filings for jobless benefits dipped to the lowest level in four years.
View historical data for state and local government employment:
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Major Recommendations
The definitions of adults who are disadvantaged may be found at the end of the "Major Recommendations" field.
Recommendation 1: Identifying Adults at Risk
Who Is the Target Population?
Adults who are disadvantaged:
- Who smoke and/or
- Who are eligible for statins and/or
- Who are at high risk of cardiovascular disease (CVD) due to other factors
Who Should Take Action?
Service providers and commissioners (for example, general practices, primary care trusts (PCTs), community services, local authorities and others with a remit for tackling health inequalities).
What Action Should They Take?
- Primary care professionals should use a range of methods to identify adults who are disadvantaged and at high risk of premature death from CVD. These include:
- Primary care and general practice registers (for example, to identify adults who smoke; who are from particular minority ethnic groups; or who have family members who have had premature coronary heart disease)
- Primary care appointments (for example, during routine visits and screening)
- Systematic searches in pre-identified areas or with specific populations (for example, using direct mail or telephone)
- Analyses of quality outcomes framework (QOF) data
- Those working with communities should use a range of methods to identify adults who are disadvantaged and at high risk of CVD. Methods to use include:
- Health sessions run at a range of community and public sites, including post offices, charity shops, supermarkets, community pharmacies, homeless centres, workplaces, prisons and long-stay psychiatric institutions. (Lifestyle factors such as smoking or other indicators, such as blood pressure, could be used to identify those at risk)
- Culturally sensitive education sessions that include a CVD risk assessment and which take place in black and minority ethnic community settings (including places of worship)
- Outreach activities provided by community health workers (including health trainers)
- Service providers should monitor these methods and adjust them according to local needs.
- Service providers should encourage everyone who is disadvantaged to register with a general practice.
Recommendation 2: Improving Services for Adults and Retaining Them
Who Is the Target Population?
Adults who are disadvantaged:
- Who smoke and/or
- Who are eligible for statins and/or
- Who are at high risk of CVD due to other factors
Who Should Take Action?
Service providers (for example, PCTs, general practices, community services, local authorities and other organisations with a remit for tackling health inequalities).
What Action Should They Take?
- Provide flexible, coordinated services that meet the needs of individuals who are disadvantaged. For example, this could include providing drop-in or community-based services, outreach and out-of-hours services, advice and help in the workplace and single-sex sessions.
- Involve people who are disadvantaged in the planning and development of services. Seek feedback from the target groups on whether the services are accessible, appropriate and meeting their needs.
- Gain the trust of adults who are disadvantaged. Offer them proactive support. This could include helplines, brochures and invitations to attend services. It could also include providing general practitioners (GPs) with postal prompts to remind them to monitor people who are disadvantaged and who have had an acute coronary event.
- Develop and deliver non-judgemental programmes to tackle social and psychological barriers to change. These should be tailored to people's needs. For example, they could make use of social marketing techniques. (Social marketing involves using marketing and related techniques to achieve specific behavioural goals.)
- Ensure services are sensitive to culture, gender and age. For example, provide multi-lingual literature in a culturally acceptable style and involve community, religious and lay groups in its production. Where appropriate, offer translation and interpretation facilities. Promote services using culturally relevant local and national media, as well as representatives of different ethnic groups. Consider providing information in video or web-based format.
- Provide services in places that are easily accessible to people who are disadvantaged (such as community pharmacies and shopping centres) and at times to suit them.
- Provide support to ensure people who are disadvantaged can attend appointments (for example, this may include help with transport, postal prompts and offering home visits).
- Encourage and support people who are disadvantaged to follow the treatment that they have agreed to. For example, encourage them to use self-management techniques (based on an individual assessment) to solve problems and set goals. It could also involve providing vouchers for treatments (such as nicotine replacement therapy [NRT]). (For recommendations on the principles of behaviour change, see 'Behaviour change at population, community and individual levels' [NICE public health guidance 6].)
- Routinely search GP databases (and other electronic medical records) to generate lists of patients who have not collected repeat prescriptions or attended follow-up appointments. Make contact with them.
- Address factors that prevent people who are disadvantaged from using services (for example, they may have a fear of failure or of being judged, or they might not know what services and treatments are available).
- Support the development and implementation of regional and national strategies to tackle health inequalities by delivering local activities which are proven to be effective.
- Use health equity audits to determine if services are reaching people who are disadvantaged and whether they are effective*. (For example, by matching the postcodes of service users to deprivation indicators and smoking prevalence.)
*Health equity audits typically consist of six steps: 1) Agreeing partners and issues for the audit 2) Undertaking an equity profile 3) Identifying high-impact local action to narrow key inequities identified 4) Agreeing priorities for action 5) Securing changes in investment and service delivery 6) Reviewing progress and assessing impact. DH (2004) Health equity audit: a self-assessment tool. London: DH.
Recommendation 3: System Incentives
Who Is the Target Population?
Service providers (for example, PCTs, community services, local authorities and others with a remit for tackling health inequalities) and practice-based commissioning (PBC) groups.
Who Should Take Action?
Policy makers, planners and commissioners.
What Action Should They Take?
- Support and sustain activities aimed at improving the health of people who are disadvantaged by:
- Using relevant indicators to measure progress and compare performance across areas or organisations
- Ensuring, wherever possible, that all targets aim to tackle health inequalities – and do not increase them
- Ensuring exception-reporting does not increase health inequalities: PCTs should be provided with additional levers and tools to monitor and benchmark exception-reporting and to reduce persistent rates of exception coding
- Considering the provision of comparative performance data to encourage providers to meet targets
- Using local enhanced services to encourage providers and practitioners to identify and continue to support those who are at risk of premature death from CVD and other smoking-related diseases
- Provide incentives for local projects that improve the health of people who are disadvantaged, specifically those who smoke or are at high risk of CVD from other causes or are eligible for statins. Ensure the projects are evaluated and, if effective, ensure they continue.
Recommendation 4: Partnership Working
Who Is the Target Population?
Adults who are disadvantaged:
- Who smoke and/or
- Who are eligible for statins and/or
- Who are at high risk of CVD due to other factors
Who Should Take Action?
Planners, commissioners and service providers with a remit for tackling health inequalities. This includes PCTs, general practices, community services, PBC groups, local strategic partnerships, local authorities (including education and social services), the criminal justice system and members of the voluntary and business sectors.
What Action Should They Take?
- Develop and sustain partnerships with professionals and community workers who are in contact with people who are disadvantaged. Use joint strategic needs assessments, local area agreements, local strategic partnerships, the GP contract, world class commissioning and other mechanisms. (For recommendations on community engagement see 'Community engagement to improve health' [NICE public health guidance 9]).
- Establish relationships between primary care practitioners and the community to understand how best to identify and help adults who are disadvantaged to adopt healthier lifestyles. For example, they should jointly determine how best to support health initiatives delivered as part of a local neighbourhood renewal strategy.
- Establish relationships with secondary care professionals (for example, those working in respiratory medicine and CVD clinics) to help identify patients at high risk of further cardiovascular events. Offer these patients support or refer them on, where appropriate.
- Develop and maintain a database of local initiatives that aim to reduce health inequalities by improving the health of people who are disadvantaged.
- Develop and sustain local and national networks for sharing local experiences. Ensure mechanisms are in place to evaluate and learn from these activities on a continuing, systematic basis.
- Ensure those working in the healthcare, community, and voluntary sectors coordinate their efforts to identify people who need help.
Recommendation 5: Training and Capacity
Who Is the Target Population?
Service providers (for example, general practices, PCTs, local authorities, community and lay workers and others with a remit for tackling health inequalities).
Who Should Take Action?
Commissioners and service providers (for example, PCTs, community services, local authorities and others with a remit for tackling health inequalities).
What Action Should They Take?
- Ensure there are enough practitioners with the necessary skills to help people who are disadvantaged to adopt healthier lifestyles. (For examples of the skills needed, see National Guideline Clearinghouse (NGC) summaries of National Institute for Health and Clinical Excellence (NICE) public health guidance 1.: 'Brief interventions and referral for smoking cessation in primary care and other settings'; 'Workplace health promotion: how to help employees to stop smoking' [NICE public health guidance 5]; 'Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities' [NICE public health guidance 10]; and the NICE Standard for training in smoking cessation treatments or updated versions of this.
- Ensure practitioners have the skills to identify people who are disadvantaged and can develop services to meet their needs. (For a set of generic principles to use when planning and delivering activities aimed at changing health-related behaviour see: 'Behaviour change at population, community and individual levels' [NICE public health guidance 6]. For advice on getting communities involved see 'Community engagement to improve health' [NICE public health guidance 9].)
- Ensure service providers and practitioners have the ability to make services responsive to the needs of people who are disadvantaged. For example, they should be able to compare service provision with need, access, use and outcome using health equity audits. (For examples of the training and skills needed, refer to national organisations such as the Faculty of Public Health, British Psychological Society, Skills for Health and the Institute of Environmental Health.)
Adults who are disadvantaged include (but are not limited to):
- Those on a low income (or who are members of a low-income family)
- Those on benefits
- Those living in public or social housing
- Some members of black and minority ethnic groups
- Those with a mental health problem
- Those with a learning disability
- Those who are institutionalised (including those serving a custodial sentence)
- Those who are homeless
Clinical Algorithm(s)
None provided
- Cardiovascular disease
- Hyperlipidemia
- Hypertension
- Other smoking-related diseases
Guideline Category
Assessment of Therapeutic Effectiveness
Risk Assessment
Clinical Specialty
Family Practice
Internal Medicine
Preventive Medicine
Intended Users
Advanced Practice Nurses
Allied Health Personnel
Health Care Providers
Physician Assistants
Public Health Departments
Social Workers
Guideline Objective(s)
To help National Health Service (NHS) organizations, local health and social care services as well as the community and voluntary sectors plan and deliver the most effective and most cost-effective services to reduce the rate of premature death from cardiovascular disease and other smoking-related diseases
Target Population
Adults in England who are disadvantaged* and who smoke and/or are eligible for statins and/or who are at high risk of cardiovascular disease due to other factors.
*Note: Adults who are "disadvantaged" include, but are not limited to:
- Those on a low income (or who are members of a low-income family)
- Those on benefits
- Those living in public or social housing
- Some members of black and minority ethnic groups
- Those with a mental health problem
- Those with a learning disability
- Those who are institutionalised (including those serving a custodial sentence)
- Those who are homeless
Interventions and Practices Considered
- Identifying adults at risk for cardiovascular disease and/or other smoking-related diseases
- Improving services for adults and access to services
- Providing system incentives for local projects that improve the health of disadvantaged people
- Developing and sustaining partnerships with healthcare professionals and community workers
- Ensuring adequate training of service providers and practitioners
Note: These interventions and practices are considered within the context of providing smoking cessation and statin interventions as the basis of the recommendations.
Major Outcomes Considered
- Rates of contact with disadvantaged adults and sources of contacts
- Rates of premature deaths from cardiovascular disease and other smoking-related diseases
- Rates of smoking cessation and use of smoking cessation medication
- Rates of lipid testing and use of statins
- Rates of blood pressure monitoring
- Rates of treatment compliance
- Identification of barriers to outreach
- Cost-effectiveness
- Quality of life
Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Note from the National Guideline Clearinghouse (NGC): Key questions were established as part of the scope. They formed the starting point for the review of evidence and facilitated the development of recommendations by the Public Health Interventions Advisory Committee (PHIAC) (refer to appendix B in the original guideline document for a list of the key questions).
The two overarching questions focused on the use of statins to combat cardiovascular disease (CVD) and smoking cessation activities.
Evidence of Effectiveness
Two reviews of effectiveness were conducted.
Identifying the Evidence
The following databases were searched (from 1995 to 2007):
- AMED (Allied and Complementary Medicine)
- ASSIA (Applied Social Science Index and Abstracts)
- British Nursing Index
- CINAHL (Cumulative Index of Nursing and Allied Health Literature)
- Cochrane Central Register of Controlled Trails
- Cochrane Database of Systematic Reviews (CDSR)
- Database of Abstracts of Reviews of Effectiveness (DARE)
- EPPI Centre Databases
- HMIC (Health Management Information Consortium – comprises King's Fund and DH-Data databases)
- PsychINFO
- SIGLE (System for Information on Grey Literature in Europe)
- Social Policy and Practice
- Sociological Abstracts
Other relevant databases (including sources of grey literature) were also searched, along with references from included studies. The following websites were searched:
- Community Development Exchange (CDX)
- Department of Health coronary heart disease policy section
- European directory of good practices to reduce health inequalities
- National Health Service (NHS) networks
- World Health Organization (WHO) Health Evidence Network
In addition, information was sought from experts.
Selection Criteria
Studies of primary and secondary prevention activities were included in the effectiveness reviews if they aimed to:
- Find and then support adults at increased risk of developing (or with established) coronary heart disease (CHD) (note, the statins search included CVD)
- Provide adults at increased risk of developing (or with established) CHD with support services – or improved access to those services (note, the statins search included CVD)
- Find and help people who smoke (aged 16 years and over) to stop or reduce the habit
- Provide people who smoke (aged 16 years and over) with smoking cessation services – or improve their access to those services.
Studies were excluded if the interventions:
- Did not aim to reduce or eliminate premature deaths from CHD or other smoking-related causes
- Tackled the wider determinants of health inequalities (for example, using macro-level policies to tackle poverty and economic disadvantage).
Economic Appraisal
The economic appraisal consisted of a review of economic evaluations, four cost-effectiveness reports, and a supplementary cost-effectiveness analysis.
Review of Economic Evaluations
The review was conducted using the databases listed for the effectiveness reviews and the following economic databases:
- Econlit
- Health Economic Evaluation Database (HEED)
- NHS Economic Evaluation Database (NHS EED)
The small number of studies involved and the difficulties involved in making direct comparisons across studies (for instance, due to lack of information on the base year used to estimate prices) meant that it was not possible to undertake a quantitative synthesis of the results.
Currency Review
The National Institute for Health and Care Excellence (NICE) undertook a review of this guideline in 2011 and determined that the information is current. See the NICE Web site for the review decision.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Study Type
- Meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs (including cluster RCTs)
- Systematic reviews of, or individual, non-randomised controlled trials, case-control studies, cohort studies, controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, correlation studies
- Non-analytical studies (for example, case reports, case series)
- Expert opinion, formal consensus
Study Quality
++ All or most criteria have been fulfilled. Where they have not been fulfilled the conclusions are thought very unlikely to alter.
+ Some criteria have been fulfilled. Those criteria that have not been fulfilled or not adequately described are thought unlikely to alter the conclusions.
- Few or no criteria have been fulfilled. The conclusions of the study are thought likely or very likely to alter.
Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence
Evidence of Effectiveness
Quality Appraisal
Included papers were assessed for methodological rigour and quality using the National Institute for Health and Clinical Excellence (NICE) methodology checklist, as set out in the NICE technical manual 'Methods for development of NICE public health guidance' (see appendix E in the original guideline document). Each study was described by study type and graded (++, +, -) to reflect the risk of potential bias arising from its design and execution.
Summarising the Evidence and Making Evidence Statements
The review data was summarised in evidence tables (see full reviews [see the "Availability of Companion Documents" field]). The findings from the reviews were synthesised and used as the basis for a number of evidence statements relating to each key question. The evidence statements reflect the strength (quantity, type and quality) of evidence and its applicability to the populations and settings in the scope.
Study of Current Practice
The mapping review aimed to identify and describe smoking cessation interventions and the provision of statins in disadvantaged areas and among disadvantaged individuals. See the original guideline document for more details.
Cost-Effectiveness Analysis
An economic model was constructed to incorporate data from the reviews of effectiveness and cost effectiveness. The approach was applied to all four cost effectiveness reports. The results are reported in:
- 'Economic analysis of interventions to improve the use of statins interventions in the general population.'
- 'Economic analysis of interventions to improve the use of statins in disadvantaged populations.'
- 'Economic analysis of interventions to improve the use of smoking cessation interventions in the general population.'
- 'Economic analysis of interventions to improve the use of smoking cessation interventions in disadvantaged populations.'
An additional, supplementary economic analysis was undertaken to answer a number of questions posed by Public Health Interventions Advisory Committee (PHIAC).
The above reports are available on the NICE website at: http://www.nice.org.uk/PH15 .
Fieldwork was carried out to evaluate the relevance and usefulness of NICE guidance for practitioners and the feasibility of implementation. It was conducted with practitioners and commissioners who are involved in smoking cessation services and statin provision. Participants included: strategic health authority directors, primary care trust directors of public health and public health teams, commissioning managers and performance managers, general practitioners (GPs) and primary care nurses. They also included community pharmacists, health trainers and managers and representatives from other public and voluntary organisations, including New Deal for Communities.
The fieldwork comprised:
A qualitative study involving a range of different professionals across four locations (Coventry, Liverpool, London and Northampton) carried out by Dr Foster Intelligence. The main issues arising from this study are set out in appendix C under fieldwork findings. The full fieldwork report 'Reducing the rate of premature deaths from CVD and other smoking-related diseases: finding and supporting those most at risk and improving access to services' is available on the NICE website: http://www.nice.org.uk/PH15 .
Methods Used to Formulate the Recommendations
Informal Consensus
Description of Methods Used to Formulate the Recommendations
How Public Health Interventions Advisory Committee (PHIAC) Formulated the Recommendations
At its meetings in November 2007 and March 2008 PHIAC considered the evidence of effectiveness and cost effectiveness to determine:
- Whether there was sufficient evidence (in terms of quantity, quality and applicability) to form a judgement
- Whether, on balance, the evidence demonstrates that the intervention is effective or ineffective, or whether it is equivocal
- Where there is an effect, the typical size of effect
PHIAC developed draft recommendations through informal consensus, based on the following criteria.
- Strength (quality and quantity) of evidence of effectiveness and its applicability to the populations/settings referred to in the scope
- Effect size and potential impact on population health and/or reducing inequalities in health
- Cost effectiveness (for the National Health Service [NHS] and other public sector organisations)
- Balance of risks and benefits
- Ease of implementation and the anticipated extent of change in practice that would be required
Where possible, recommendations were linked to an evidence statement(s) (see appendix C of the original guideline document for details). Where a recommendation was inferred from the evidence, this was indicated by the reference 'IDE' (inference derived from the evidence).
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
Smoking cessation interventions are generally cost effective, irrespective of the target audience, the methods used to identify and recruit adults or the type of service offered. It is also cost effective to identify adults in secondary care who are disadvantaged and need statins (and then prescribe these drugs). In primary care, the cost effectiveness of identifying people at risk of cardiovascular disease (CVD) and providing them with statins is determined by the number at risk of CVD in the baseline population. (The more people at risk, the more cost effective it becomes to identify them and provide them with statins.)
Smoking Cessation
The cost per quality-adjusted life year (QALY) of smoking cessation interventions for disadvantaged groups is low or very low. It is rarely likely to exceed 6,000 pounds.
Secondary prevention of CVD (that is, after a CVD event) among a disadvantaged population costs an estimated 4,000 pounds per QALY gained (3,100 pounds per QALY for finding the person and 900 pounds per QALY for treating them with statins). Therefore, it is cost effective.
Whether or not it is cost effective to provide statins to prevent a first occurrence of CVD among a disadvantaged population depends on the number of people at risk in the baseline population. Data from a USA study of financially disadvantaged women aged 40 to 64 who enrolled in the National Breast and Cervical Cancer Early Detection Program was analysed. The analysis found that it is cost effective if more than 14% of the population is at risk. For example, when 40% were at risk of CVD, primary prevention was estimated to cost 8,500 pounds per QALY gained (4,900 pounds per QALY for finding the person and 3,600 pounds per QALY for treating them). This compared with about 125,600 pounds when only 1.6% were at risk (122,000 pounds per QALY for finding them and 3,600 pounds per QALY for treating them).
Method of Guideline Validation
Clinical Validation-Pilot Testing
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation
The draft guidance, including the recommendations, was released for consultation in April 2008. At its meeting in June 2008, Public Health Interventions Advisory Committee (PHIAC) considered comments from stakeholders and the results from fieldwork and amended the guidance. The guidance was signed off by the National Institute for Health and Clinical Excellence (NICE) Guidance Executive in July 2008.
Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type and quality of supporting evidence is identified and graded for each recommendation (see Appendix C of the original guideline document).
Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
- Improved identification and support of those most at risk of early death
- Improved access to services
- Reduced rates of premature death from cardiovascular and other smoking-related diseases
Potential Harms
Not stated
Qualifying Statements
Qualifying Statements
- This guidance represents the views of the National Institute for Health and Clinical Excellence (NICE) and was arrived at after careful consideration of the evidence available. Those working in the National Health Service (NHS), local authorities, the wider public and the voluntary and community sectors should take it into account when carrying out their professional, managerial or voluntary duties.
- Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
- This guidance should be used alongside NICE guidance on smoking cessation, lipids and statins.
Implementation of the Guideline
Description of Implementation Strategy
National Institute of Health and Clinical Excellence (NICE) guidance can help:
- National Health Service (NHS) organisations meet the Department of Health (DH) standards for public health as set out in the seventh domain of 'Standards for better health' (updated in 2006). Performance against these standards is assessed by the Healthcare Commission, and forms part of the annual health check score awarded to local healthcare organisations.
- NHS organisations, social care and children's services meet the requirements of the DH's 'Operating framework for 2008/09' and 'Operational plans 2008/09–2010/11'.
- NHS organisations, social care and children's services meet the requirements of the Department of Communities and Local Government's 'The new performance framework for local authorities and local authority partnerships'.
- National and local organisations within the public sector meet government indicators and targets to improve health and reduce health inequalities.
- Local authorities fulfil their remit to promote the economic, social and environmental wellbeing of communities.
- Local NHS organisations, local authorities and other local public sector partners benefit from any identified cost savings, disinvestment opportunities or opportunities for re-directing resources.
- Provide a focus for children's trusts, health and wellbeing partnerships and other multi-sector partnerships working on health within a local strategic partnership.
- NICE has developed tools to help organisations implement this guidance. These are available on the NICE website at http://www.nice.org.uk/PH15 (see also the "Availability of Companion Documents" field).
Tackling Health Inequalities
- Health inequalities are so deeply entrenched that providing disadvantaged groups or areas with better services – and better access to those services – can only be one element of a broader strategy to address the distribution of the wider determinants of health. All activities need to be developed and sustained on a long-term basis.
- The recommendations focus on system and structural changes to ensure effective clinical and public health practice can take place. This requires a comprehensive approach at all levels of the health system (for example, involving both practitioners and commissioners) and in partnership with others in the wider public, community and voluntary sectors. The recommendations are not aimed at clinical practice itself as the relevant advice is found in other NICE guidance.
- Effective implementation of the recommendations will require:
- An appropriate infrastructure and resources for commissioners, planners and service providers
- Policy initiatives which prioritise health inequalities and ensure action to tackle them are included in primary care trust plans and local area agreements.
Implementation Tools
Quick Reference Guides/Physician Guides
Slide Presentation
Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Staying Healthy
IOM Domain
Identifying Information and Availability
Bibliographic Source(s)
|National Institute for Health and Clinical Excellence (NICE). Reducing the rate of premature deaths from cardiovascular disease and other smoking-related diseases: finding and supporting those most at risk and improving access to services. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Sep. 62 p. (Public health guidance; no. 15). [25 references]
Not applicable: The guideline was not adapted from another source.
Date Released
2008 Sep (reaffirmed 2011)
Guideline Developer(s)
National Institute for Health and Care Excellence (NICE) - National Government Agency [Non-U.S.]
Source(s) of Funding
National Institute for Health and Clinical Excellence (NICE)
Guideline Committee
NICE Project Team
Public Health Interventions Advisory Committee (PHIAC)
Composition of Group That Authored the Guideline
NICE Project Team Members: Mike Kelly, CPHE Director; Antony Morgan, Associate Director; Lesley Owen, Lead Analyst; James Jagroo, Analyst; Dylan Jones, Analyst; Catherine Swann, Analyst; Alastair Fischer, Technical Adviser (Health Economics)
Public Health Interventions Advisory Committee (PHIAC) Members: Professor Sue Atkinson, CBE Independent Consultant and Visiting Professor, Department of Epidemiology and Public Health, University College London; Mr John F Barker, Children's and Adults' Services Senior Associate, North West Midlands Regional Improvement and Efficiency Partnership; Professor Michael Bury, Emeritus Professor of Sociology, University of London. Honorary Professor of Sociology, University of Kent; Professor Simon Capewell, Chair of Clinical Epidemiology, University of Liverpool; Professor K K Cheng, Professor of Epidemiology, University of Birmingham; Ms Jo Cooke, Director, Trent Research and Development Support Unit, School for Health and Related Research, University of Sheffield; Dr Richard Cookson, Senior Lecturer, Department of Social Policy and Social Work, University of York; Mr Philip Cutler, Forums Support Manager, Bradford Alliance on Community Care; Professor Brian Ferguson, Director, Yorkshire and Humber Public Health Observatory; Professor Ruth Hall, Regional Director, Health Protection Agency, South West; Ms Amanda Hoey, Director, Consumer Health Consulting Limited; Mr Alasdair J Hogarth, Head Teacher, Archbishops School, Canterbury; Mr Andrew Hopkin, Assistant Director, Local Environment, Derby City Council; Dr Ann Hoskins, Deputy Regional Director of Public Health/Medical Director, NHS North West; Ms Muriel James, Secretary, Northampton Healthy Communities Collaborative and the King Edward Road Surgery Patient Participation Group; Dr Matt Kearney, General Practitioner, Castlefields, Runcorn. GP Public Health Practitioner, Knowsley PCT; Ms Valerie King, Designated Nurse for Looked After Children, Northampton PCT, Daventry and South Northants PCT and Northampton General Hospital. Public Health Skills Development Nurse, Northampton PCT CHAIR Professor Catherine Law Professor of Public Health and Epidemiology, UCL Institute of Child Health; Ms Sharon McAteer, Public Health Development Manager, Halton and St Helens PCT; Mr David McDaid, Research Fellow, Department of Health and Social Care, London School of Economics and Political Science; Professor Klim McPherson, Visiting Professor of Public Health Epidemiology, Department of Obstetrics and Gynaecology, University of Oxford; Professor Susan Michie, Professor of Health Psychology, BPS Centre for Outcomes Research and Effectiveness, University College London; Dr Mike Owen, General Practitioner, William Budd Health Centre, Bristol; Ms Jane Putsey, Lay Representative, Tutor and Registered Breastfeeding Supporter, The Breastfeeding Network; Dr Mike Rayner, Director, British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford; Mr Dale Robinson, Chief Environmental Health Officer, South Cambridgeshire District Council; Ms Joyce Rothschild, Children's Services Improvement Adviser, Solihull Metropolitan Borough Council; Dr Tracey Sach, Senior Lecturer in Health Economics, University of East Anglia; Professor Mark Sculpher, Professor of Health Economics, Centre for Health Economics (CHE), University of York; Dr David Sloan, Retired Director of Public Health; Dr Dagmar Zeuner, Joint Director of Public Health, Hammersmith and Fulham PCT
Financial Disclosures/Conflicts of Interest
All members of the Public Health Interventions Advisory Committee are required to make an oral declaration all potential conflicts of interest at the start of the consideration of each public health intervention appraisal. These declarations will be minuted and published on the National Institute for Health and Clinical Excellence (NICE) website.
Members are required to provide in writing an annual statement of current conflicts of interests, in accordance with the Institute's policy and procedures.
Potential members of the Public Health Programme Development Groups (PDG), and any individuals having direct input into the guidance (including expert peer reviewers), are required to provide a formal written declaration of personal interests. A standard form has been developed for this purpose which also includes the Institute's standard policy for declaring interests. This declaration of interest form should be completed before any decision about the involvement of an individual is taken.
Any changes to a Group member's declared conflicts of interests should also be recorded at the start of each PDG meeting. The PDG Chair should determine whether these interests are significant. If a member of the PDG has a possible conflict of interest with only a limited part of the guidance development or recommendations, that member may continue to be involved in the overall process but should withdraw from involvement in the area of possible conflict. This action should be documented and be open to external review. If it is considered that an interest is significant in that it could impair the individual's objectivity throughout the development of public health guidance, he or she should not be invited to join the group.
Guideline Status
This is the current release of the guideline.
The National Institute for Health and Care Excellence (NICE) reaffirmed the currency of this guideline in 2011.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) format from the National Institute for Health and Clinical Excellence (NICE) Web site .
Availability of Companion Documents
The following are available:
- Identifying and supporting people most at risk of dying prematurely. Quick reference guide. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Sep. 8 p. (Public Health Intervention Guidance 15). Available in Portable Document Format (PDF) from the National Institute for Health and Clinical Excellence (NICE) Web site .
- Costing statement: identifying and supporting people most at risk of dying prematurely. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Sep. 7 p. (Public Health Intervention Guidance 15). Available in Portable Document Format (PDF) from the NICE Web site .
- Identifying and supporting people most at risk of dying prematurely. Slide set. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008. 16 p. (Public Health Intervention Guidance 15). Available in Portable Document Format (PDF) from the NICE Web site .
- Identifying and supporting people most at risk of dying prematurely. Consultation documents. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008. (Public Health Intervention Guidance 15). Available in Portable Document Format (PDF) from the NICE Web site .
- The public health guidance development process. An overview for stakeholders including public health practitioners, policy makers and the public. London (UK): National Institute for Health and Clinical Excellence (NICE); 2006 Mar. 46 p. Available in Portable Document Format (PDF) from the NICE Archive Web site .
Patient Resources
None available
NGC Status
This NGC summary was completed by ECRI Institute on January 23, 2009. This summary was updated by ECRI Institute on June 27, 2011 following the U.S. Food and Drug Administration advisory on Zocor (simvastatin). This summary was updated by ECRI Institute on April 13, 2012 following the U.S. Food and Drug Administration advisories on Statin Drugs and Statins and HIV or Hepatitis C drugs. The currency of the guideline was reaffirmed by the developer in 2011 and this summary was updated by ECRI Institute on October 30, 2013.
Copyright Statement
This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.
NGC Disclaimer
The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.
All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.
Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion-criteria.aspx.
NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.


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