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1 Technical Report # 37 Assessing the Performance of Pharmacy Agents in Counseling Family Planning Users and Providing the Pill in Benin: An Evaluation of Intrah/PRIME and PSI Training Assistance to the Benin Social Marketing Program March 2003 By: Maia A. Ambegaokar, MBA, MSc Virgile Capo-Chichi, MD Boniface Sebikali, MD, MPH Nene Stanley Echitey, MD PRIME II
2 This publication was produced by Intrah at the University of North Carolina at Chapel Hill for PRIME II project and was made possible through support provided by the Center for Population, Health and Nutrition, Global Bureau, U.S. Agency for International Development, under the terms of Grant No. HRN-A The views expressed in this document are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development or the PRIME project. Any part of this document may be reproduced or adapted to meet local needs without prior permission from Intrah provided Intrah is acknowledged and the material is made available free or at cost. Any commercial reproduction requires prior permission from Intrah. Permission to reproduce illustrations that cite a source other than Intrah must be obtained directly from the original source. Intrah would appreciate receiving a copy of any materials in which text or illustrations from this document are used. PRIME II is a project for training and supporting primary providers of reproductive health services around the world. PRIME II is implemented by Intrah in collaboration with Abt Associates, Inc.; EngenderHealth; PATH (Program for Appropriate Technology in Health); and TRG (Training Resources Group), Inc. ISBN # Suggested citation: Ambegaokar, M.A.; V. Capo-Chichi; B. Sebikali and N.S. Echitey. Assessing the Performance of Pharmacy Agents in Counseling Family Planning Users and Providing the Pill in Benin: An Evaluation of Intrah/PRIME and PSI Training Assistance to the Benin Social Marketing Program. Chapel Hill, NC: Intrah, PRIME II Project, (PRIME Technical Report # 37) 2003 Intrah Intrah School of Medicine The University of North Carolina at Chapel Hill CB # 8100, 1700 Airport Road, Suite 300, Chapel Hill, NC USA Phone: Fax: East/Southern Africa P.O. Box Nairobi Kenya Phone: Fax: Asia/Near East IFPS Liaison Office 50M Shantipath Gate Number 3 Niti Marg Chanakyapuri New Delhi , India Phone: Fax: West/Central/North Africa B.P Dakar-Fann, Sénégal Phone: Fax: Latin America/Caribbean Federico Henríquez y Carvajal #11 Los Casicasaz Santo Domingo, Dominican Republic Phone: Fax: For more information on this publication or to order additional copies, please contact the Communications Unit at the Chapel Hill office listed above. ii
3 Table of Contents Authors and Acknowledgements... vii Acronyms...ix Executive Summary...xi Introduction...1 Methodology...5 Results...13 Findings/Conclusions and Recommendations...29 Annexes (in French)...31 iii
5 Tables and Annexes Tables Table 1 Sample drawn...8 Table 2 First stage samples...11 Table 3 Second stage samples...11 Table 4 Characteristics of the four agents' group...13 Table 5 Overall performance scores...14 Table 6 Scores of clients' right to access and to information...15 Table 7 Proportions citing method advantages and disadvantages...16 Table 8 Proportions asking at least two eligibility questions...17 Table 9 Scores explaining pill use...18 Table 10 Proportions explaining what to do if one pill missed Table 11 Proportions explaining what to do if two pills missed Table 12 Proportions explaining danger signs Table 13 Proportions prescribing the low dose pill (Harmonie ) Table 14 Proportions prescribing the high dose pill (Stédiril ) Table 15 Test scores pre-training, post-training and current Table 16 Share of groups giving correct answers to test questions Table 17 Pill brands in stock Table 18 Harmonie clients Table 19 Condoms and spermicides in stock Table 20 IEC materials available Annexes Annexe 1 Fiche d'observation de l'agent de pharmacie (Observation guide for pharmacy agents) Annexe 2 Questionnaire de test de connaissances (Knowledge test questionnaire) v
6 Annexe 3 Annexe 4 Annexe 5 Annexe 6 Annexe 7 Annexe 8 Annexe 9 Instrument de collecte d'information sur l'appréciation de la formation par les agents pharmacie formés (Data collection tool on trained pharmacy agents perception on training) Instrument de collecte d'information sur les conditions de travail des agents de pharmacie (Data collection tool on working conditions of pharmacy agents) Instrument de collecte d'information sur l'appréciation de la formation par les pharmaciens (Data collection tools on pharmacists perception on training) Equipe ayant conduit le suivi/évaluation (Follow-up/Evaluation team) Liste et code des clients déguisées (List and code of mystery clients) Liste de pharmacies pour le pre-test des instruments à Cotonou (List of pharmacies for the pre-test tools in Cotonou) Liste des agents enquêtés (List of agents surveyed) vi
7 Authors Maia A. Ambegaokar, Consultant for PRIME/Intrah, Demographer based at the London School of Hygiene and Tropical Medicine, England Virgile Capo-Chichi, Consultant for PRIME/Intrah, Specialist in Biostatistics at CERRHUD Boniface Sebikali, Resident Advisor for PRIME II in Benin Nene Stahley Echiley, CBD Coordinator at PRIME/Intrah Regional for WCNA. Acknowledgments The authors wish to thank the following persons and institutions for their technical and logistic support and/or their contribution to this report: Mrs. Angelica Kobilke, Head of the Family Planning Department at PSI/Benin Dr. Leontine Idohou from the Benin Pharmacists Order Ms. Alicia Dinerstein, Family Team Leader and Ms. Laura Hoemeke, Technical Advisor for USAID/Benin The PRIME II/Benin team - Mr.AmouBienvenu - Mr. Collinet Aklinkpoe The surveyors (disguised clients) In addition, the authors would like to thank Ms. Barbara Wollan, Processing Assistant for Monitoring and Evaluation Unit, Intrah/PRIME II, Chapel Hill, for formatting this document. vii
9 Acronyms ABPF COC HIV FP IEC MOH PSI RH STD Beninese Association for Family Promotion (Association Béninoise pour la Promotion de la Famille) Combined Oral Contraceptive Human Immunodeficiency Virus Family Planning Information, Education, Communication Ministry of Health Population Services International Reproductive Health Sexually Transmitted Diseases ix
11 Executive Summary In 1998, Population Services International (PSI) started a social marketing program and launched a low-dose pill (brand name, Harmonie ). In this context, PSI/ABMS developed a collaborative intervention with PRIME/Intrah in order to improve the quality of family planning (FP) services within private sector (pharmacies) by training pharmacy agents in contraceptive technology and FP counseling. In November and December 1999, an evaluation was conducted on the workplace performance of these agents when counseling a new user of FP and providing the pill. This report describes and presents the findings of that evaluation. Twelve mystery clients reported on counseling sessions conducted with 127 pharmacy agents of 71 pharmacies. These agents were categorized into one of four groups: 1) trained in '98 and updated in '99; 2) trained once in '99; 3) not trained, but working in a pharmacy where at least one agent had been trained; and 4) not trained, and working in a pharmacy where no one else had been trained. The results of the observation were scored and the scores of the first three groups of agents were compared to those of the last group. Significance levels of the difference in the means or the proportions were measured at cut-off values of p <.01 or p <.05. Both groups of trained agents were found to perform significantly better than the base group of untrained agents when the counseling session was assessed as a whole. The trained agents were more likely than the untrained ones to prescribe a low dose pill. Weaknesses remain, however, in the quality of the pharmacy assistants' counseling as they are not yet providing comprehensive information about other methods available in the pharmacy, such as condoms and spermicides. After the mystery client visits, members of the evaluation team interviewed 115 of the agents, including 46 of the trained agents (who took a knowledge test) and 50 of the pharmacists. Two problems with the working environment of the agents were identified that may be related to the problems with counseling performance: lack of Information, Education and Communication (IEC) materials to help agents remember key messages in FP counseling and lack of supervision to reinforce proper performance. The training approach (in which agents read documentation on their own in advance of half-day formal sessions) was appreciated by agents and by pharmacists because it allowed advance preparation. Pharmacists would like to send agents to similar training and would like to see training conducted on other subjects, especially sexually transmitted diseases (STDs)/human immunodeficiency virus (HIV). Executive Summary xi
13 Introduction Backgrounds and Problem The pharmacy sector in Benin has expanded dramatically over the past ten years. There are now approximately 125 private sector pharmacies operating throughout the country, the majority in the two biggest cities in the south, Cotonou and Porto Novo. Operating as small businesses in the private sector, these pharmacies were established by trained pharmacists who have invested in the building and the stock. They employ sales agents who are not necessarily trained in pharmacology but have a range of different backgrounds and educational levels. These pharmacies sell FP commodities, including condoms, spermicides and a range of different types of combined oral contraceptive (COC) pills. Research conducted in 1997 and 1998 indicated a tendency among providers in Benin to recommend even to new users combined pills containing a relatively higher dose of estrogen. In this context, PSI/Benin launched the low-dose pill Harmonie in April As part of its marketing strategy and in order to improve the quality of service provision, PSI undertook, in collaboration with Intrah/PRIME, to train private sector pharmacy personnel in contraceptive technology. Six main activities have taken place since the start of this training collaboration. 1) April 1998: Discussions among representatives of PSI/Benin, Intrah/PRIME, the Ministry of Health (MOH) and the National Association of Pharmacists led to the decision to undertake the training of pharmacy personnel. Plans were made for the first round of training and the training materials were developed. Intrah/PRIME developed a specialized, non-traditional training approach (involving self-study at home followed by half-day workshops) because it was not possible for pharmacy personnel to be absent from their jobs for long periods. 2) May 20, 1998: An information day was organized for 76 private sector pharmacists from all regions of Benin. Themes discussed during this day included reproductive health (RH) in Benin, perspectives on social marketing, WHO medical eligibility criteria, and recent research on unwanted pregnancies and induced abortion in Benin. Pharmacists were informed about the training plans and encouraged to send their staffers. 3) May - June 1998: Eighty pharmacy agents were trained in contraceptive technology in four training events, two held in Cotonou and two in Porto Novo. Each training event was held over three days, with a half-day workshop each day and the remaining time for home study. The subjects covered during the training included RH in Benin, quality of care and access to services as applied to the pharmacy setting, how to offer FP services in a pharmacy, and technical knowledge about COCs, progestin-only pills and emergency contraception. 4) November - December 1998: A follow-up study was conducted to determine the effects of the training on the quality of service performance among agents who had been trained. Seventy-one of the original 80 agents were still Introduction 1
14 working. The decision was taken to study a sample of 30%, or 21, of these and compare them to two other samples of 21 agents, those who had never been trained but worked in a pharmacy where there was a trained agent and those who had never been trained and worked in pharmacies with no other trained agents. Mystery clients were sent to sample pharmacies to request FP. They repeated their visits until the agreed number of agents in each group had been reached. The results indicated that trained agents performed better than those who worked in the same pharmacies but were untrained, and that these in turn performed better than untrained agents working in pharmacies where no one was trained. Despite this ranked difference, however, levels of performance among the trained agents were still deemed not high enough. 5) February 1999: Three training sessions of one day each were held to update 44 of those agents trained first in May and June of This training reviewed the subjects covered in the earlier training (counseling, providing FP in a pharmacy and technical issues related to oral contraceptive pills and emergency contraception) and in addition presented new material on barrier methods (condoms and spermicides) and on STD/AIDS prevention. 6) April 1999: Sixty additional pharmacists' agents were trained in contraceptive technology. As during the first round, the training methodology allowed participants to receive the training documents in advance and read them before the sessions, reducing the amount of time that needed to be spent away from their work site. Given this background of one full year of collaborative efforts to improve the performance of private sector pharmacist s agents, PSI/Benin and Intrah-PRIME decided to undertake an evaluation. The purpose of this evaluation was to determine what effect the training interventions had had on workplace performance and what, if any, difficulties were hindering the appropriate application of the information learned during training. At a broader level, the key question was whether or not the training interventions had improved the quality of FP services provided by the pharmacy agents. Study Purpose and Objectives In November/December 1999, a team comprising consultants and resource persons from PRIME/Intrah, PSI, Beninese Association for Family Planning (ABPF) and the MOH of Benin has undertaken this evaluation study. The overall goal of the evaluation was to determine the effectiveness of the training in contraceptive technology in terms of performance of expected tasks by trained personnel in the private sector pharmacies. The specific objectives were: 1) To determine the current level of knowledge and performance of the trained personnel; 2) To identify those factors influencing the pharmacy agents performance either 2 Assessing the Performance of Pharmacy Agents in Counseling FP Users and Providing the Pill in Benin
15 positively or negatively; 3) To determine the views of the trained agents and the pharmacists regarding the training approach that had been used; and 4) To make recommendations about further assistance to the trained personnel and the extension of the training program to other personnel and other private pharmacies. Conceptually, this study can be thought of in three parts: - first, an assessment of trained pharmacy agents knowledge and performance, and of the context in which they work; - second, a review of the views of the trained agents and their pharmacists regarding the training approach used; - third, an examination of still existing needs for training and other informational support to the pharmacies. Introduction 3
17 Methodology Study Design Fundamental to achieving the study objective was a methodology that would allow unbiased observation of workplace performance by the pharmacy agents, as well as a way to quantify levels of performance and capture real differences. One of the main techniques used by researchers studying quality of care is observation by mystery clients. Mystery clients are trained observers in the role of ordinary clients who seek care from health practitioners and then report back on what was and was not said or done by the provider. The use of mystery clients can have fewer biases than the other common technique for quality of care assessment, the use of a trained observer who sits in on a real session between a client and a provider and notes what does or does not happen. This is because providers may be influenced to change their behavior by the knowledge that they are being observed (known as observation bias). However, mystery clients must be very carefully trained, and must be given a simple, quick and consistent way to report their observations immediately after the session with a provider. Clearly, the use of mystery clients is not suited to all types of health care, but counseling, as a service that does not require invasive procedures, is ideal for this technique. Thus, in this study mystery clients were used to assess agents performance when counseling a new user of contraception and prescribing the pill. These mystery clients were trained by the evaluation team to all act out exactly the same role so that each agent was being confronted with a standardized situation. The role played by the mystery clients was that of a young woman in her twenties who wished to avoid a pregnancy. The client was to explain this to the pharmacy agent who received her. If asked whether she had ever used any contraceptives before, she was to say no." If asked whether she had ever heard of any contraceptives before, she was to say, vaguely, no, I do not think so, I am not sure." If asked, after being given information about methods, what she wished to choose as a method, she was to select the pill. If asked any of a series of questions that might make a client ineligible for the pill, she was to say no to these. In order to make the situation believable, the mystery clients were told to purchase the pills, or if the circumstances warranted it, say they would come back with money to buy them. At the end of the visit, the mystery clients were to ask the name of the person who had served them, saying they might want to come back with more questions. After completing the visit to the pharmacy, the women playing the mystery clients were asked immediately to find a place to sit and fill in an observation checklist to indicate whether or not the agent who had served them had done or said certain things. The performance of agents who had received training was to be compared to that of other agents who had not participated in the training. A similar evaluation conducted one year earlier had found that the performance of trained personnel was better than that of untrained personnel. It had also found that untrained pharmacy agents working in a pharmacy in which at least one assistant had been trained performed better than untrained agents working in a pharmacy in which no one had been Methodology 5
18 trained. As a result of that finding, this study was also designed to test for that ranked relationship, which suggested that the training was having a beneficial effect not only on the participants, but also on their work place colleagues. Thus, the pharmacies that the mystery clients were told to visit included some that had sent agents to the training and some that had not done so. The mystery clients were blind to the status of the pharmacies they visited and the personnel they saw; that is, they did not know whether the pharmacies they were entering had or had not sent any agents to the PSI-PRIME/Intrah training and they did not know the names of the trained agents. In addition to assessing the performance of pharmacy agents when counseling and prescribing pills to a new user, this study was also designed to 1) measure the ability of agents to recall the knowledge covered during the training and contained in the course materials they had been given; 2) determine what aspects of the agents working environment might be affecting their performance; and 3) ascertain the views of the agents and their pharmacist bosses regarding the training approach used and further training needs. Information about these aspects was collected after the mystery clients had visited a pharmacy. A follow-up team of evaluators went back to each pharmacy to administer the other instruments. To measure the current knowledge of the trained agents, it was decided to administer a written test. The content of this test was drawn from the training material. In addition to having covered the information during the training period itself, the agents would have had in their possession the course materials and, in theory, could have used these materials to update their knowledge in the period since the training. The agents were not informed in advance about the test and therefore had no time to revise. The results on the test could then be compared to the results obtained on the pre-training and post-training tests. To assess the working conditions of the agents, in order to see what elements of their working environment might be affecting their performance, it was decided to interview both trained and untrained agents. The interview asked about contraceptives currently in stock in the pharmacy, IEC materials available for use in the pharmacy, and supervision of their work by the pharmacist. In addition, the interview covered some basic characteristics of the agents, including age, level of education, years worked in as a pharmacy assistant, and other relevant training received. Finally, to ascertain the views of the trained agents and the pharmacists regarding the training approach, interviews were conducted with each of them. The interviews sought to determine what the participants and their bosses thought of the training technique used, which involved self-study at the work site followed by half-day formal training sessions. The interview with the agents also asked whether they still had and used the course materials and whether they had been able to apply the 6 Assessing the Performance of Pharmacy Agents in Counseling FP Users and Providing the Pill in Benin
19 knowledge since the training. In addition, with the pharmacists, the interview asked what they thought the effect of the training had been on their agents performance and what further training they would be interested in having their agents receive. In summary, the research involved the use of several methodologies: formal knowledge testing, mystery clients observation of performance, and interviews with the pharmacists and their trained agents. The research objectives and methodologies were developed by the evaluation team composed of representatives of PRIME/Intrah, PSI, ABPF and the MOH, and were approved in advance by the MOH and the National Association of Pharmacists. Instruments Five data collection instruments were used. Copies appear in the appendices of this report. The first instrument is the observation guide, filled in by the mystery clients immediately after having completed a session with a pharmacy agent. The observation guide has five sections: - The first concerns the manner in which the client is greeted and listened to, and whether or not the agent ensures confidentiality by conducting the counseling session in a private place. - The second section covers the provision of information about contraception, whether samples of methods are shown to the client, whether both advantages and disadvantages of methods are cited and whether the client is encouraged to ask questions and to make her own choice. - The third section concerns whether the agents ask questions having to do with eligibility criteria for the pill. - The fourth section covers whether or not the agent recommends a low dose pill or a high dose pill or states that a prescription is needed. - The fifth and final section covers the directions and explanations the agent should give about how to use the pill and what to do if pills are forgotten. The second instrument is the test of the trained pharmacy agents knowledge. There are 18 questions on the test, 16 of which consist of statements which the agent must indicate are either true or false. The two remaining questions are open-ended and require the agent to write out a response. The third instrument used is an interview guide about the working environment of the agents, both trained and untrained. This asks what brands of pill are in stock and whether there are condoms or spermicides in stock. It also covers what IEC materials are available in the pharmacy, including informational flyers, posters, image flip charts for counseling clients, and model penises for teaching condom use. The interview guide also asks whether or not the agent has sold any Harmonie brand pills and whether he or she receives any supervision from the pharmacist or any guidance from the PSI salesmen. Methodology 7
20 The fourth instrument is a guide for an interview with the trained agents about what they thought of the training, whether they have used the course materials since then, whether they have shared the information with their fellow agents who were not trained, and whether they have had a chance to apply what they learned in the period since the training. The fifth instrument is a guide for the interview with the pharmacists whose agents attended the training. They are asked whether the agents whom they sent for training now receive clients better, provide clients with information on contraception, re-supplying clients for the pill and make referrals to clinics where appropriate. They are also asked whether they require a prescription for the pill, and why or why not. In addition, they are asked what they thought of the training approach and what further training or related assistance they would like to have provided. Sampling Procedure The sample was drawn from the PSI records of pharmacies in the south of the country. (Few pharmacies from the north had participated in the training, and as a result of the high cost of the long travel distances, PSI preferred to limit the study to the southern sector of the country.) The localities included in the final sample were the large cities of Cotonou and Porto-Novo, as well as Abomey, Bohicon, Come, Igolo, Lokossa, Ouidah and Sakete. The sample drawn included all the pharmacies in the evaluation zone that had sent at least one agent to the training and were still operational (of which there were 60) plus a randomly selected group of 12 pharmacies from the same zone which had not sent agents to the training, giving a total sample drawn of 72 (see table 1). Table 1: Sample drawn Pharmacy Type Location Total Cotonou Porto-Novo Others Trained agent No trained agent TOTAL The sampling plan had to take into account the fact that, when she entered a pharmacy, the mystery client would not necessarily be served by an agent who had received the training or by an equivalent, untrained agent. She might be served by the pharmacist, by a trained agent or an untrained agent. In order to increase the likelihood that the mystery clients would come across a sufficiently large number of trained agents, three different mystery clients were sent to visit each pharmacy sampled. There were 12 mystery clients in all and the plan was that each one would make 18 separate visits to pharmacies. This would result in 216 attempted visits. The second part of the sample depended on the first. When the mystery clients returned with their completed observation sheets at the end of the day, the evaluation 8 Assessing the Performance of Pharmacy Agents in Counseling FP Users and Providing the Pill in Benin
21 team would then code them into one of five potential groups: Agent participated in 1998 training and in 1999 update sessions, Agent participated in 1998 training only, Agent participated in 1999 training only, Agent did not participate in any training, but at least one other agent in that pharmacy did participate in at least one training (a contact pharmacy), Agent did not participate in any training, and no other agent from that pharmacy did so either (a non-contact pharmacy). To make it simpler to compare the two types of pharmacies, we distinguish between contact pharmacies and non-contact pharmacies. The contact pharmacies are those that have sent at least one agent at least one time to one of the PSI- PRIME/Intrah trainings. These are the pharmacies that have been in contact with the training intervention. The non-contact pharmacies are those that have not sent their agents to training. That is, they have not experienced contact with the training intervention. The research team therefore expected to have observations of three types of trained agents (trained in 98 and updated in 99, trained once in 98, and trained once in 99), all from the contact pharmacies, of course, plus two types of untrained agents (from the contact pharmacies and from the non-contact pharmacies). However, the size of the resulting sample was not predicted. The experience of the evaluation conducted one year earlier suggested that a large number of visits would be necessary to end up with about 20 cases per group. Based on that experience, the sample plan of three mystery visits per 60 contact pharmacies and three mystery visits per 12 noncontact pharmacies was determined, in the expectation of having approximately 30 cases per group. These groups would then be the sample for the second phase research activities: testing trained agents knowledge of the training subjects, interviewing agents in both contact and non-contact pharmacies about their work environment, and interviewing agents and their pharmacist bosses in contact pharmacies about the training approach used. Field Work The evaluation team was composed of six people, representatives of PRIME/Intrah, PSI, ABPF and the Benin MOH. The team began by formulating the objectives for the study, drafting and finalizing the instruments, and deciding on the sampling approach. A plan was developed for training the young women who would act as mystery clients. These women were all educated, most at a university level. The training provided them with sufficient understanding of contraceptive technology and oral contraceptives so that they would be able to understand and interpret what the pharmacy agents said during the counseling session. They were trained over two days and then sent out to conduct two pre-tests of the observation approach, after which the observation tool was revised. The data collection involved two phases. The mystery clients first visited the pharmacies. They were organized in four teams of three members. Each member of Methodology 9
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In the 1970s Eddie Stobart built its high profile brand on the courtesy of its drivers, the quality of its fleet and exceptional service. These benchmark standards remain intact, but Stobart also understands the customer service, employment practices and environmental challenges that face modern businesses today.
Over the last few years the Group has evolved beyond its position as an independent road transport and logistics business to a leading UK provider of multinational transport and logistics solutions.
Spring 2010 saw Stobart Group Plc break new ground by taking a controlling interest in a new joint venture with A.W. Jenkinson Forest Products, the UK's leading supplier of Biomass Fuels. The combination of the two companies brought the creation of Stobart Biomass Products Limited, which specialises in sourcing sustainable biomass, primarily waste wood, for the new generation of minimum-carbon power plants. Eddie Stobart now operates over 60 Moving Floor Trailers of which the Scania R Series with TAG axle is ideally suited.

subset: commoncrawl


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This movie really is an underrated gem. Somehow most critics have
become totally unable to accept Woody Allen's work for what it is and
compare it only to other movies from the same years.
Woody Allen has said many times that he has no interest in looking back to his old work and, in my opinion, it really shows. From someone who has often raved about the 'Radio Days' of his youth and adores prewar Jazz, he has steadily developed into a director who has no trouble catching the modern every day lives of the people around him. Recreating the atmosphere from his older movies would only show the inability to move on, along with the rest of the world.
Anything Else is proof of that. It's a modern movie with a typical Woody Allen style dialogue that works on several levels. Between the jokes and witty remarks and often great replies, lie the worries of any young guy or girl that has to learn to deal with life's fears and frustrations. Anything Else also has a really nice atmosphere and a great pace - the movie at almost 2 hours never feels like it's stalling or going nowhere. The story moves forward constantly. Biggs really is the star here and is a perfect Young Woody Allen. Ricci is only a supporting character, but both she and the rest of the cast really make this into a believable, relaxed and enjoyable experience.
For those who are willing to learn a little: this movie does make a simple, but very true point about learning to deal with life.
Photography, directing, editing and writing is really first class work - nothing less than what you get in other top Woody Allen movies. Beautiful locations, great camera work and typical Woody style jazz really make this into a perfect 10/10.
The lack of awards and negative reviews are just like Dobel (Woody Allen) says in this movie: You know....it's just like anything else.
Go see it for yourselves!
In medias res: narrator Jerry Falk, a fledgling comedy writer with an inept agent, is about to celebrate an anniversary with his girlfriend Amanda. There's trouble in paradise: she's late (and has already eaten), she's been uninterested in sex for months, and her quixotic mother is moving in with them. Jerry looks back to meeting Amanda and dumping Brooke. A constant is his friendship with another wannabe comedy writer, a 60 year old teacher named David, prone to long walks and advice filled talks. As Amanda and Jerry's relationship founders and her mom's noisy presence makes writing difficult for him, he and David plan something different. Wouldn't anything else be better?
Added By: Kaiac
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Movie Reviews
Underrated gem!
This movie really is an underrated gem. Somehow most critics have
become totally unable to accept Woody Allen's work for what it is and
compare it only to other movies from the same years.
One of the best recent Woody films
This film is one of Woody's best. Basically is it criticised by people
who don't like Woody Allen for being like all the others, or by people
that do like him because it's not quite his usual story line. The only
weakness is that Jason Biggs is not quite up to the task, and looks a
little lacking in confidence in places. Christina Ricci is excellent as
ever, and Woody does a great job playing the eccentric old man, a role
that is much more appropriate to his age than many he has attempted to
play since he became middle aged (20+ years ago!).
This is packed with interesting views on life, great jokes (not Woody's usual repetition of the same jokes like the "polymorphously perverse" line) and touching reflections on relationships.
Highly recommended.
I've always been a big fan of Woody Allen. He's the sort of Director (and
guess actor as well) that you either love or hate. There's no middling
territory in that regard...
Anyway, in this film, I particularly admire the way that he's riskily used Jason Biggs and Christina Ricci. I've always found the latter to have great promise...As a child in Adams Family Values when she verbally attacked the somewhat "up his own arse" Summer Camp leader over what she perceived to be the hypocrisy of "Thanks Giving", I stood up in the cinema in ovation...Note that talking or shouting or clapping in a British cinema (I'm British) is strictly forbidden (except during showings of Star Wars)...However, with the sole exception of Buffalo 66, Christina has flopped over recent years and I hope for her sake that Woody Allen has now helped to relight the fire inside.
Jason Biggs is another quantity altogether. The only film I've ever seen him before this one was American Pie. (American Sh*te more like!) But, all actors are obviously talented people and deserve the opportunity to show what they can really do at some stage or other...Like Bruce Willis's coming of age and quality in Pulp Fiction, or Jim Carey's in The Truman Show, Jason Biggs may now have turned a corner and opened the doors onto a new level in his Hollywood career.
The film particularly struck a raw nerve with me as after breaking up recently with the love of my life, I saw the exact/or at least very similar thing happen to Bigg's character in this film. Allen's brilliant characterisation and understanding of even the most insane people and situations, helped me a little to come to terms with some things which in my own life are causing me a lot of pain at the moment. Girls like Ricci's character do exist (surely in abundance) and more more or less normal guys like myself and Biggs in 21st Century city life really do find that getting it right as our parents' generation did much more easily in "love", is like looking for a needle in a haystack...My search, needless to say, goes on. Thanks Woody! You are my Shrink!


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Join us for Taste of the Beach from March 23-26 and a dinner is on us!
Crabpot is located in the heart of Duck, where you can park your car and walk to tons of local restaurants, great shopping and family friendly activities. Local favorite Roadside is right around the corner, and everyone's favorite Duck Donuts is right across the street. Don't miss the soundside boardwalk for a scenic walk to more restaurants and shopping.
Relax in your own private pool and hot tub, or the beautiful beaches are just a short walk away. For indoor entertainment the lower level has a rec room with a pool table and wet bar.
Pets Allowed. No Smoking
There are no reviews at this time for this property.


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My story is the same, only that it is in Utah, and the scammer's name is Rick Salisbury. I hope nobody falls for this, my fear is that a novice renter will. Anyone who's ever rented or leased would, I hope, see that this is too good to be true, hence the googling of the number.Good Evening,How are you and your family I really hope i am not getting back to you very late about the house you want to rent, I had to leave Saint George, UT in a hurry due to my recent promotion and it involves me working out of the Saint George, UT. My family and i just moved from Saint George, UT to Virginia. We intend selling the house if we find a Tenant that would be ready for a lease to own after a year in the house, if not, then we will continue with normal rentals. We have made the monthly rent significantly low and affordable as good faith for my happiness for my recent promotion. If you want more photos of the House, let us know. I am currently working as a counsellor for the United States Aid for International Development (US-AID) here in Virginia. Please visit http://www.usaid.gov/, you can also support our mission.All we care about is someone to take very good care of it with passion of it being it's own. A colleague of mine introduced me to this internet site of advertisement when the formal reality company i gave the house to manage for me since am not in Saint George, UT but due to the high price they put on the house which make people not to rent the house from them so i have to withdraw the house from them and start doing the rental by my self. I want to be convinced you are capable enough to taking care of our property for us We don't want it to be used anyhow,i want you to get back to me on how you will be taking care of the place or perhaps the experience you have in your previous places of living or lived.I want you to note that all utilities are included in the rent.I look forward to hearing from you so that i can forward you a rental application form if you are interested in renting our place. I guess by now you should eager to view the house because it is a lovely home. So far, we have seen a couple of interested families but we shall rent to the best tenant according to our choice. . The rent is 600 while the security deposit is also 600. The house is ready for move in.. YES UTILITIES INCLUDED AND LEASE IS 6 MONTHS TO A YEAR WITH OPTION OF LEASE TO OWN..The house is for rent now but would be really interested in a lease to own in the future..Here is the address to the house 2261 S Tonaquint Dr 19, Saint George, UT 84770. You can go by and take a look at the house to know if you are Okay with before i send the rental application to you since i will not be there to tour the house with kindly take your time to look at the environment and the neighborhood of the house to know if you are Okay with the house. Here is the property information below and i also attached pictures of the interior of the house with this email.PROPERTY INFORMATIONPrice: 600Deposit: 6003 Bedrooms2 full, 1 partial BathroomsSingle-Family HomeRefrigeratorDishwasherMicrowaveWasherDryerAttic Status: For RentRange: Other Zip: 847701,400 sqftPatioCall or email us for more inquiry when you check the house out.Regards,RickYou can call me on this number : 949-415-8780.
Receiving many calls a day stating they are from Bank Visa fraud and checking on certain account. Reported to Bank and Visa Customer service, they stated this was a scam and not give out any info. Also recommended t report to local Police dept.
Caller ID is Pay Processing. A Landline. 534 Delaware Street New Castle DE 19720 PROBABLE ID THEFT / MEDICARE FRAUD
Caller said that he wanted me to call a david green and that he was calling from pulisher clearing how with a delievery for me and that it was a chrismas promotion. I told him I was going into a meeting and he kelp call me back over and over again.
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Some phone scams have a local flavor to it and you might not even know about it. Victims generally don't report the matter for fear of embarrassment or when the amount is a petty sum. Do not ever let the … Continue reading
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Results for (949) 415-xxxx
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949-415 Area Code/Exchange Map in Laguna Beach, California
Comments 949-415-xxxx
949-440-1769harry cock says : Feb 23, 2017 at 02:39 pm some guy named brian lives in riverside county
949-391-8752Anonymous says : Jan 24, 2017 at 12:05 pm SAID HE WAS NEIGHBOR OF THE ISLAND TRYING TO GET OVER HIS SOCIAL ANXIETY. WANTED TO TELL ME A JOKE
949-281-1132Anonymous says : Jan 12, 2017 at 01:58 pm Received call on 01-12-17 saying Microsoft is reporting major errors on my computer and offered to help. Told him I was unable to access my computer at this time. Said he\'d call back. Bogus???
949-584-2111Anonymous says : Jan 7, 2017 at 09:28 am
949-258-9340a says : Dec 21, 2016 at 05:04 pm this person keeps calling they also looked up my personal info
949-754-7312ANN SMITH says : Dec 16, 2016 at 11:31 am THIS NUMBER CALLED AND SAID THEY WERE EXTREMELY UNPROFESSIONAL AND RUDE.... THEY SAID THAT THEY WERE A WELLS FARGO CALLING ABOUT AN APPLICATION MADE AT A CAR DEALERSHIP. I HAVE NOT TRIED TO BUY A VEHICLE FOR YEARS. THEN THEY TRIED TO GET MY SOCIAL SECURITY NUMBER. EITHER THIS IS SOME FRAUDULENT PERSON OR A VERY UNPROFESSIONAL WELLS FARGO EMPLOYEE WITH THE WRONG NUMBER FOR THE PERSON WHO MADE AN APPLICATION, BUT IT WASNT ME!!!
949-267-3385Carla Hernandez says : Dec 13, 2016 at 09:34 am
949-287-1226Richard Dehls says : Nov 24, 2016 at 09:21 am I just received a call on Thanksgiving morning from 949 287-1226 claiming to be from Microsoft saying that I have a major problem with my computer. They requested that I push 1 and speak with an agent in Laguna Beach CA. It has to be a complete scam. I will report it to Microsoft as well.
949-521-0625Anonymous says : Nov 11, 2016 at 05:14 pm No one answered when I said hello but they kept calling back without leaving a message
949-637-0783K says : Sep 21, 2016 at 09:39 am It was a recording stating that the IRS is opening a law suite on me


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Houghton Place, located in Houghton Estate, features complimentary WiFi, an outdoor pool and a garden. Guests are offered free parking.
Rooms come equipped with a minibar, a flatscreen television with satellite channels, safety deposit box, desk and washing machine. The private bathroom comes with a fitted shower, a bath and a hairdryer.
For dining, the guesthouse is situated close to several restaurants guests can choose from.
Have you been here? Rate and review your experience below!
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Houghton Place is located on 7th Street in Houghton Estate.
Venue Name:Houghton Place
51 7th Street, Houghton Estate, Johannesburg.
Check In:14h00 - 23h00
Check Out:10h00 - 11h00
TripAdvisor Traveler RatingBased on 20 reviews
Deshen Says:
My Wife and I spent a night at Houghton Place for our anniversary. We stayed as a little getaway to celebrate,and Sam really spoiled us by preparing the room with candles and chocolate. Service was...
Doud1227 Says:
Very nice and decorated house. Large and confortable room. The neighborhood is calm and safe. Easy access to downtown with metro and large malls nearby. Sam and Jannice are very friendly and...
Jakalui Says:
Our stay was just perfect ! The house is just splendid, decorated with excellent taste. Rooms are spacious, comfy and service was just amazing as well as our breakfast ! Sam made us feel at home from...


text: Hi everyone, I'm pretty certain at this point which Coastal group I'll join under. However, I still do my research to try to stay up to date. Today's Question: How do you know that you hav an authentic Director's Release? I came across a website today that is selling the coastal packages/releases at a significanty lower cost and without having to pass up 2 sales. I'm aware that the retail packages can be sold for whatever $$ (as told by a reputable level 3 director)... But how would one know if there director's release is the real deal? Are they tracked? Do they have to send copies to someone? Is there a form somewhere that states you've completed training sales and who they are? Any info is appreciated. Thanks


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Calgary Counselling - Michael Haggstrom, PhD Psychotherapist/Counsellor Calgary
depression, therapy, Depression Counselling
NEED SOMEONE TO TALK TO? NEGATIVE moods can make our lives unmanageable. DEPRESSION can affect even the strongest of people. DEPRESSION brings on negative thinking, challenges with problem-solving, low-self worth, worry, inability to achieve your goals, feeling stuck in life and losing a sense of purpose. DEPRESSION can be caused by negative events like a relationship breakup, job loss, being afraid, worrying too much, financial issues, grief and more. THERE'S NOTHING INNATELY WRONG WITH YOU. Help is there for you. WE ARE a private counselling services and can help with depression counselling, stress management, mood control, anxiety disorders, anger management and more.
CALLUS @ 403-220-1101. EMAIL - [email protected]
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Want to Increase Your Relationship Intimacy? Here at Solutions for Life Calgary, WE CAN HELP. Communication. Connection. Passion. Sex. Passion. Meaning. We can help get your relationship back on track. Relationship Counselling Centre Calgary. CALL US 403-220-1101.
Work-Life Balance & Stress Management, Calgary Counselling Services.
ANGER MANAGEMENT Calgary, Counselling Services. Dr. Michael Haggstrom has 25 years experience. His team is ready to help. Call 403-220-1101.
PROFESSIONAL RELATIONSHIP DATING Counselling & Advice. Dr. Michael Haggstrom & Colleagues can assist you in getting more successful with finding the right person for you. CALL US 403-220-1101. WE CAN HELP.
HELP WITH ANXIETY in Calgary, Counselling Therapy Professionals. WE HELP PEOPLE learn how to manage mental stresses and worries that overwhelm you. GAD Generalized Anxiety Disorder. SOCIAL ANXIETY. OCD Obsessive Compulsive Disorder. PANIC Disorder TRAUMA PTSD Post-Traumatic Stress Disorder. CALL US 403-220-1101.
We offer INDIVIDUAL COUNSELLING in Calgary to help people achieve greater success, peace of mind and happiness. REACH personal goals. HEAL past issues. OVERCOME anxiety and depression. LEARN anger management. DISCOVER stress management skills. KNOW how to transform negative thinking and CREATE a more positive life. CALL US 403-220-1101. WE ARE HERE TO HELP.
WE HELP PEOPLE get through separation and divorce in Calgary. It can be a messy process when a relationship ends. Heartbreak. Anger. Sadness. Grief. Financial worries. Asset division. Joint Parenting. Lowered Self-Confidence. Sleepless nights.
COUNSELLING CAN HELP YOU move on by reorganizing your life in a way that brings you peace again. No one should go through the pain of divorce without help. Call us 403-220-1101
Dr. Michael Haggstrom is the counselling director and has over 25 years experience.
Our passion is to help couples resolve conflict, create better intimacy, improve their sex lives, work through their conflicts/challenges and learn the skills of problem-solving.
Here are a private and confidential service in Calgary offering relationship & marriage counselling from 10:00am to 8:00pm. Our offices are centrally located with free onsite parking.
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N:o 23, Kotka by Eeva Haavisto
Welcome! You are browsing as a guestWould you like to see 14 projects made from this pattern and much more? join Ravelry now What am I missing?
by tiinav Flickr
© Juha Koivula
by Tyi Flickr
N:o 23, Kotka
Pohja musta, kuviot valkoiset.
Black background, white pattern.


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Home > Academics > University of Texas Authors > Presidential Campaign Quality: Incentives and Reform
By BUCHANAN
Item #9780131841406
Bruce Buchanan is Professor in the Department of Government, College of Liberal Arts.
View author's profile here.
This book uses case stories, facts, statistics, and logic to argue that presidential campaigns can better serve ordinary citizens than they do now. It explains and then helps resolve a stubborn political paradox—showing what is wrong and suggesting how to fix it. A unique treatment of the subject matter advocates political reform based on greater citizen involvement—introducing readers to a plan of action and engaging them as part of the process
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Have a Tax Question? Ask a Tax Expert
Hello, I'm Robin. Welcome to JustAnswer. I'm reviewing your question now and typing up my reply. I'll post that in just a few moments.
I need to caution you though, unless you entered a contest or lottery in Spain, this letter is most likely a SCAM.
Numerous email and postal scams are circulating the world, referring to lotteries in Spain and claiming that the recipient of the letter has won a large sum of money. Then they ask the person to pay the tax.
That is not how it would work. The true lottery in Spain is not taxable.


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Display Ads
Dir. of Advertisers
Mail: Boy Scout Week
Groene at the Legislature: Discipline in the classroom
More opinion
Registrations due for prescribed fire training
Volesky honored for range management work
More Ag News
I am writing to you in hopes of bringing awareness to North Platte and surrounding communities on the dolphin slaughter taking place in Japan.
They round up whole pods of dolphins, corral them into a cove and slaughter them with knives and spears. They take babies from their mother's and the best looking dolphins and sell them to aquariums.
The images of what takes place in Taiji, Japan are horrific. These slaughters are inhumane and unnecessary as dolphin meat contain unhealthy amounts of mercury. This goes on for months and they kill around 20,000 dolphins per year like this.
I urge you to please take some time to look at some of the gruesome pictures and help save the dolphins. They sure don't deserve this kind of treatment. It's heart breaking to think all of this murdering takes place to make a buck.
Here are some links to websites with more information about Japan dolphin slaughters.
Here are some websites where people can get involved to work towards stopping the slaughter. There is a petition people can sign.
By Jennifer Shelton, North Platte
Flatrock Publishing, Inc.
1300 E 4th St., Suite F
North Platte, NE 69101


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The 2016 Boston Synchronized Skating Classic
Hosted by The Skating Club of Boston and Team Excel
Saturday, November 19, 2016
New England Sports Center
121 Donald Lynch Blvd.
Marlborough, MA
Thank you all for a wonderful competition!
Post-Competition Quick Links: ActionPhotos Results
Questions? Please contact the event Chair, Deanne Benson.
Photography, videography, and live-streaming of the event were provided by Snapshot Sports Media LLC.
Registration for the 2016 Boston Synchronized Skating Classic is closed (Entryeeze for registered teams available here).
The competition is open to all 6.0 and IJS teams. Once again, we will be proud participants in the Eastern Synchronized Skating Challenge Series.
As is required by U.S. Figure Skating, all coaches requesting to be credentialed at the Boston Synchronized Skating Competition must be compliant with U.S. Figure Skating and PSA coaches requirements. Information can be found at the U.S. Figure Skating web site.
Please Note: All IJS teams must post their planned program sheets on the U.S. Figure Skating website.
The Boston Synchronized Skating Classic is sanctioned by both U.S. Figure Skating and Skate Canada.


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Discovery Channel Land and Sky Telescope
At a Glance
Discovery Channel Land and Sky Telescope is designed with x30 magnification, and is great for both wildlife watching and gazing at the night sky.
Features and benefits for Discovery Channel Land and Sky Telescope
- x30 magnification telescope
- Includes tabletop tripod
- Comes with compass and 2-piece moon phase guide
- Great for inspiring the imagination and discovering the world
Watch birds, animals and insects outside or from indoors with the Land and Sky Telescope. During the day, set the telescope up with the tabletop tripod included and gaze out into the garden, and at night peer up into the sky for a great view of the stars.
Suitable from 8 years.
Don't Forget...
We stock more items from the Discovery Channel, perfect for learning about the world around us.
Safety warning: WARNING! Not suitable for children under 36 months. Small parts. Choking hazard.
What's in the box:
- 1 x telescope (viewing tube)
- 1 x tripod
- 1 x moon phase guide
- 1 x compass
- 1 x instruction manual
Product Specifications
|0.69 kg
smaller items may be delivered via Royal Mail.
Exceptional circumstances beyond our control such as bad weather or courier delays may cause your order to take longer to deliver
uk returnsELC are happy to refund or exchange any unused merchandise returned within 30 days of purchase upon production of your receipt, as long as they are returned in an unused condition and in their original packaging. Please see Terms and Conditions for details. This does not affect your rights if the product is faulty or mis-described.
International returns
If you are unhappy with an item that you have ordered, you are able to return it to us at your own cost. If the product is faulty, we can re-order this for you. If you do not wish to be re-sent the faulty product, you can send it back to us at your own cost – once we have received the goods, we will reimburse any postal charges you may incur. Click here for more information on our international returns policy.
How does this help my child ?
Discover the WorldDiscover the World
This toy inspires your child to explore and enjoy the world around them.
This toy encourages your child to enjoy using their imagination.
Thinking SkillsThinking Skills
Some text here.


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The Megapixel Race Heats Up...
The New Class Of 8Mp Digital Cameras Raise Expectations & Issues
Like with all technology
driven product segments, "bigger is better" now applies
to the digicam marketplace. While 5- to 6-megapixel cameras dominated
2003, this year will be when 8-megapixel cameras battle for supremacy.
While the pace of change in the industry has pushed megapixel counts
higher, there are some cautionary notes, which will only be resolved
by getting our hands on these cameras, most of which were not available
as we went to press.
Despite these apparent drawbacks
we don't think this trend toward higher megapixel counts will stop.
Before we have a look at the current crop, let's do a quick review
of some of the issues that these, and all digital cameras, have to deal
Digital 8-Megapixel
8-Megapixel Digicams
Sony F828
Canon PowerShot Pro1
Konica Minolta DiMAGE
Nikon Coolpix 8700
Olympus C-8080 Wide
- Celebrity Shooter Matthew Jordan Smith Shows You How to Take Great Portraits of Women (VIDEO)
- Ask A Pro: Scott Kelby Answers Your Photography Questions
- 3 Legged Thing Corey Magnesium Alloy Travel Tripod with AirHed Neo Ball Head Review
- Here's the Lowdown on Making Dramatic Photos by Shooting from a Low Camera Angle (VIDEO)
- Which Lens Is Best for Portraits: A Fast 85mm F/1.4 Prime or a Versatile 70-200mm F/2.8 Zoom? (VIDEO)


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By: Chris Kramer
December 15, 2010
James Farrell, the chief executive and president of the financially troubled Evergreen State Bank, recently filed for chapter 7 bankruptcy protection .
Farrell's wife joined him in his chapter 7 filing, and the couple listed $50,000 in assets and debts between $1 and $10 million on their filing, Madison.com reports.
Farrell's bankruptcy attorney explained that his client bought stock in Evergreen years ago, borrowing heavily from two other banks to do so. Currently, "the stock is worth far less than what he owes on it," the attorney said. Farrell's creditors are owed more than $2 million, and want to be paid, he added.
Evergreen State Bank is under-capitalized due to a large volume of defaulted loans, according to the news source. The bank is reportedly under federal orders to boost its capitalization. Farrell recently told shareholders that the bank's officials are looking for investors, but he also warned them that the value of the company's common stock is expected to fall substantially and possibly "be rendered worthless."
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Tell me something about National Insurance Corporation.
NIC known as National Insurance Corporation was incorporated on 6th December 1906. Today, NIC stands as the oldest insurance company in India and the only Public Sector Undertaking non life insurance Company headquartered in the Eastern part of the country. NIC offers best job prospects. It offers recruitment from time to time for various posts in officers Scale I cadre and assistant cadre.