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Wednesday, November 16, 2016
Outcome bias
I grew up in Wheaton, Ill., one of Chicago's western suburbs, and became a Cubs fan by default. All my friends were Cubs fans, my dad took us to Wrigley for games (never Comiskey!), and the Cubs games were televised on channel 9 while the White Sox were usually on a UHF channel (44) that was hard to tune in (if you remember wiggling a dial to get your grainy local UHF signals, you are old like me). This photo is from a game I attended in 1969 with my family. That year, and every year since 1945, ended the same way: with the Cubs failing to win the NL pennant.
So last night's victory is a gigantic step forward for the Cubs, who will now play Cleveland in the World Series. By now you're asking, "yes, but that's a game and this blog is about infection prevention, what's the connection"?
See Cub manager Joe Maddon's quote in this piece, about how he approaches challenges:
"When you get to this particular moment, to try to avoid being outcome-biased, just … continue to work on the process, which is inning by inning—score first, win the inning. Those are the kind of thoughts that get you beyond this moment."
I think you can interpret this quote in two ways, each of which applies to infection prevention.
First, he may have meant to say "avoid being outcome-focused." In other words, stop wasting energy worrying about your outcomes, instead put your energy into the processes that you know will, eventually, move the outcome in a favorable direction. This is becoming increasingly difficult in infection prevention as Centers for Medicare and Medicaid Services pay-for-performance programs put more and more pressure on rates. The temptation is to put time and energy into activities that might impact the outcome quickly but without doing anything to improve the safety of patients (gaming the definitions, empiric treatment approaches, changing lab practice). Counterproductive, and in many cases also bad for patients.
Alternatively, he could have been literally referring to "outcome bias," which is an error in evaluating the quality of a decision, or the effectiveness of a practice, when the outcome is already known. This might lead one to deviate from an effective practice because a bad outcome occurred in the past when the practice was in place, or to institute a dubious practice because prior implementation was coincident with a favorable outcome. This ignores the fact that outcomes are often influenced by a myriad of factors, many of which are not understood or not under the decision-maker's control.
The infection prevention take-home from either interpretation? Focus on those practices that have been demonstrated to improve outcomes—keep your eye on the process and the outcomes will follow. Avoid gimmicks that might move the outcome needle but for which no evidence exists that patients will benefit.
Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.
Labels: Controversies in Hospital Infection Prevention, Daniel Diekema, guest post, infectious disease, medicare, outcomes, pay-for-performance
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Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
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Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
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Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
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Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
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Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
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Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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White Coat
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This program provides everything you need in philosophy, anatomy, chanting, business, wisdom, sutras, kriyas, meditation, pranayama, adjustment, art of teaching, and more. The approach is contemporary and eclectic. Zen Den Yoga School brings to life the ancient teachings of yoga through accessible spiritual lessons.
Located in central Boca Raton, Florida, the Zen Den Yoga School Wellness and Retreat Center is a peaceful place. Small intimate groups will enjoy a pampering experience in a single, double, or triple room.
if you would like to share a twin-bedded room with another single traveler of the same gender, Zen Den Yoga School will do their best to match you with a roommate. Otherwise, a single supplemental fee may apply.
The house is surrounded by lush plants and vegetable gardens, a resort style pool and hot tub, and lots of outdoor seating to enjoy the tropical climate. Inside, there is a lot of welcoming space to meditate, study, or socialize with other guests. The center also has a fully-stocked state of the art kitchen and bicycles for guests to explore nearby attractions.
At Zen Den Yoga School, they teach Sadhana Yoga, the yoga of personal spiritual practice, including both Ashtanga inspired Vinyasa and the truest traditional Sivananda Hatha flows. Taught in one-month intensive classes and six-month part-time classes. The approach is contemporary and eclectic, they bring to life the ancient teachings of yoga through accessible spiritual lessons.
One month intensive courses are Monday through Friday 07:45 to 15:30 with one hour lunch, and two 15 minute breaks throughout the day, you will also meet every Tuesday evening from 17:30 to 20:00 and every other weekend from 07:45 to 15:30.
The graduates commonly report receiving much more than a yoga certificate from the program. It is often described as a life-changing experience that provides an opportunity for individuals to know themselves and a deep and lasting way. Zen Den Yoga School offers the students the opportunity to embark on a journey that brings them to a place of deeper knowing.
The yoga teacher training offers much more than the physical aspect of yoga, it guides you to a path of inner knowing. You will do a two-hour asana practice in the morning and in the afternoon you will do two to three hours of asana workshop. So total asana each day are four to five hours of practice and workshops.
The schedule includes multiple yoga classes, group discussions, as well as other training and bonding events. Upon arrival, you will receive the 200-hours yoga teacher training manual, The Bhagavad Gita, yoga anatomy, Ashtanga yoga - David Swenson, The Shivananda Companion to yoga, and yoga sutras.
The students get the opportunity to practice asanas and the respective alignments; explore the meaning of the yoga sutras and Bhagavad Gita; experience and learn several meditation techniques, and perform regular peer-teaching. They also get introductions to the business and marketing of being a yoga teacher, including a thorough understanding of how to be advantageous in saturated markets.
Many of the graduates continue to practice with Zen Den Yoga School after they graduate; some even teach at the studio, but all share a bond and stay in touch.
Sadhana Yoga means yoga as a spiritual practice. Zen Den Yoga School offers two variations of asana practice that are a blend of various traditions. The Vinyasa Flow practice is derived mainly from Ashtanga yoga and is a fast-paced flow. The second is a Hatha practice derived from Sivananda tradition, which is more meditative with longer held poses. Both sequences together provide you with a great foundation to build any type of yoga class upon.
Zen Den Yoga School accepts participants of all levels and feels that all benefit from having a diverse group to learn with. However, they prefer an intimate experience so the students get the most from their training. Training sessions will be capped. Zen Den Yoga School asks that participants make a commitment to complete the course and attend all sessions and to put in the effort to be successful.
Zen Den Yoga School and School Yoga Institute are registered yoga schools with Yoga Alliance at the 200-hour and 500-hour level. All the yoga teacher training courses are recognized by Yoga Alliance. Upon successful completion of the course, you will receive a certificate from Zen Den Yoga School and School Yoga Institute and be able to register with Yoga Alliance as a RYT (registered yoga teacher).
Ira Schneider
Ira started to practice yoga consciously in 2007. He says consciously because, after getting his 200 hour certification he realized there were many parts to yoga besides the physical practice. These other paths of yoga (prana yama, meditation, positive thought) he had already been practicing from the time he was a little boy. This inward feeling of something larger then himself was always present through his years as an entrepreneur, teacher, consultant and individual being.
Boca Raton is one of the most fun and active cities in South Florida. In a tropical setting, beautiful homes line the streets around long stretches of white beaches. With tons of waterfront on the intra-coastal and Atlantic Ocean, you will find lots of biking paths, themed restaurants, shopping areas, and a great nightlife. All within a 10-minute bike ride, guests will discover shopping malls, art and marine life museums, libraries, beaches, water sports, grocery stores, and lots of restaurants and bars.
Daily breakfast, lunch, and snacks are included in the price of the retreat.
For the best practical preparation, Zen Den Yoga School offers workshops throughout the training on weekends, after regularly scheduled classes have ended, for a nominal additional cost.
In-between classes there is free time to disconnect; you may enjoy the sun at the salt water pool, bike to the infamous tropical blue beaches with a free rent bicycle, enjoy the local shops or soak in the hot tub which is always on.
Other activities at an additional cost are paddle boarding (stand up and or yoga), interactive cooking class, golfing, snorkelling or diving, language of energy transformational clearing and life coaching, massage treatment, and acupuncture treatment.
Massages and treatments are available for an extra fee upon request.
"I had an amazing time at my 200 hour RYT with Ira, Valerie and my fellow students. Ira's knowledge about the eight limbs of yoga is so inspiring and he made sure all of us leave the program ready to teach. The school is intense but we had a great time with sunset meditation, weekly breakfast together etc. If you're looking for a teacher training that will set you apart as a teachers this is the school to choose. I already miss my little Zen Den family!"
BookYogaRetreats.com website, edited
"Going to Zen Den was a peaceful experience. I won't go into too much details and spoil the adventure for anyone who hasn't been there before,but I will say that the various flavors of things we did helped me to getting better shape overall. I recommend Zen Den to anyone who wants to "disconnect to reconnect.""
BookYogaRetreats.com website, edited
"I had an amazing time at Zen Den Yoga school even without being prepared for living in a shared house with Yoga student (future instructors). Everyone involved me from my arrival onwards as being part of the family and the hosts Ira and Valerie were super caring about me!"
"Both are so perfect in their professions: Ira in sharing his knowledge (not teaching as I learnt), holding the yoga classes in a special way and organizing a variety of different methods in meditations, only during this 6 days of my stay. And Valerie as a nutrition and energy flow specialist is a great synergy for all their visitors and students!"
"For me being a retreat guest, only, they still passionately voluntary organised all activities surrounding such as acupuncture, massage, SUP and other special exclusive classes."
"For all those of you who want to change their lives in terms of learning more about the yoga philosophy and meditation, getting to know more about your body & own behaviours, becoming grounded and still enjoying the beach, sun and the town of Boca Raton I highly recommend to stay at the Zen Den school. It's a magical place and will remain forever in my heart, same as all the friends I made there, totally unexpected.... I believe all was meant to happen (even without my usual ahead planning) and I returned home with a changed and super-positive mind-set!"
"Namaste and thank you Ira and Valerie!"
BookYogaRetreats.com website, edited
"A friend of mine referred me to Zen Den Yoga School. These classes have helped me find my peace. After taking many of Ira's classes, I was able to learn how to focus and most of all let go of my stress. I was never really a big yoga person, but now I have converted and it feels amazing."
Zen Den Yoga School website, edited
"Amazing class. The restorative class is the most popular (and I can tell); well of course, after a hard day of work we need to be restored physical and mentally!"
Zen Den Yoga School website, edited
"The Zen Den Yoga School teacher training program was great. I´m practicing everything what I learned, and my students are really happy. Ira is very good teacher, and he knows all the things related with the program that he offers. It is a very good choice to become a yoga teacher. The price is good and the yoga house has everything to make the study time very nice! I highly recommend it."
Zen Den Yoga School website, edited
"Teacher training experience at this studio has been a very interesting journey! Joe'class is great. Everybody at the studio shares an amazing energy and I look forward to come back every week. Thank you Ira."
Zen Den Yoga School website, edited
"Zen Den Yoga & Wellness Retreat - great experience w/great hosts! Very transformative experience - many different and unique activities like acupuncture, shamanic breath work (one of my personal favorites), Tai Chi, Qigong, Bars, massage. All this plus bike-riding to the beach (15 minutes away), and Mizner Park shopping and restaurants. Valerie and Ira were wonderful hosts - both with their own expertise. They were professional and personal at the same time. I'm certain I'll be back in the near future!"
Tripadvisor website, edited
"Zen Den Yoga was an amazing retreat. Upon arrival, Val and Ira give you a tour of the beautiful home. There is a pool and hot tub in the backyard (hot tub a definite plus, especially due to the soreness from all the yoga!). They also taught us how to make our breakfast and lunch shake, which were flavourful and made me feel great! There are multiple yoga classes offered each and every day. "
"Val and Ira were amazing hosts. They made sure all of their guests were happy during their stay. They were able to recommend fantastic restaurants around the area. They also offered use of their bikes to get to the yoga studio, beach, restaurants, etc. Ira runs most of the meditation and yoga classes - which are all awesome! Val gave a wonderful massage. They set up the most relaxing acupuncture appointments for us. "
"This stay was the best way to spend a vacation. Both mind opening and relaxing. Thanks Ira and Val! "
Zen Den Yoga School website, edited
"I finally made it to Zen Den Yoga School and I also spent 4 days in their yoga retreat. Val and Ira are so helpful and the classes are unlike any other yoga classes I've been to because they make sure you get so much out of it rather than focusing on themselves. This was the most important part of my journey, to be able to be supported rather than seeing people growing and feeling left behind."
"I also spent 4 days in their yoga retreat and I love that you are away but at the same time within walking distance to shops and good restaurants. I had a much needed healing and deep tissue session with Val and I was impressed how strong she is. I am so glad I did this, you showed me I was ready for this journey. Thank you Val and Ira!"
Zen Den Yoga School, edited
"I took a chance with a friend and went to Zen Den Yoga School for my spring break this year. I have been practicing yoga for a few years now, but am still learning. On the first day, Val and Ira were super welcoming! They greeted us and showed us around their beautiful home where we would be staying. I stayed in the "beach" room, which had great open windows with picturesque trees. "
"Yoga classes are offered in the morning and afternoons, with morning meditation. I learned how to make smoothies for breakfast and lunch, which definitely kept me nourished during yoga classes."
"I felt that I was able to experience the best of both worlds. I practiced yoga, relaxed and also took in the sites and restaurants Boca Raton had to offer as well. "
"Ira was able to teach me how to correctly position my yoga poses, and I really enjoy the small class atmosphere. I felt like I had made new friends quickly in both Val and Ira and other guests staying at the retreat. Val's massage and energy therapy was absolutely amazing. She is a true talent. "
"I would recommend staying and would love to travel to Zen Den again in the future. Namaste :)"
Zen Den Yoga School, edited
"My Zen Den Yoga School 200 Hour experience has been everything that i Had hoped for and more. I decided to take the 30 Day Intensive and intense it is! My main concern when choosing a school was finding one that supported my yogic beliefs, one that was inline with the way i was introduced to yoga by the amazing instructors at my home studio. I am happy to report that Zen Den Yoga School answered all my desires plus more. Not only was traditional yoga asana covered with an emphasis on alignment, meditation, anatomy and physiology, sacred text (yoga sutras and bagavad gita) we also were taught nutrition, and were introduced to other cultural beliefs and helped to understand how all are similarly related. The learning environment is one of structure and flexibility with open discussions and no one ever being right or wrong. Zen Den offers housing at their Yoga House. Although i live locally and had no need to stay there, we would have some lectures at the house and it was comfortable and serene environment and the ladies that stayed there seemed to enjoy it very much. I would highly recommend this school for anyone interested in becoming a yoga instructor or even for deepening one's own practice. I do intend, and at some point in the future on returning to pursue my 500 hour training with Zen Den Yoga School, Many thanks to Ira and Val."
Zen Den Yoga School, edited
"To my Yogi Family, It has been a pleasure attending the 200 hour yoga teacher training and getting to create a bond with such beautiful people! The universe brought us together for a reason and i want to thank all for being a part of my growth. Ira, I want to thank you for taking your time with me and helping me awaken my soul. This is the beginning of a new book to put on my shelf and it is truly a blessing to have started at Zen Den. I want to thank of you at Zen Den for the atmosphere you created and the ever lasting impression that has been left on my heart and soul. I love you guys and i am forever grateful! This is not good bye or a farewell; it is a connection that will be lasting and more memories that will be made."
Zen Den Yoga School, edited
"Hi Val! Hi Ira! Just wanted to thank you for a wonderful time! I do apologize for not having properly said goodbye, I left Miami too late, (we were having fun) and missed Friday night's class. Sarah and I went out that night, she probably told you. ;-) I arrived in Geneva with a fit body and a rested mind, with lots of intentions to come back! I really enjoyed my time at the retreat, the classes and the interaction with you two and the rest of the folks. Have a great start of the year, and hope to see you again! Warmly, Esther"
Zen Den Yoga School, edited
"I really enjoyed this retreat! I learned so much! To name a few: Meditation, chakra clearing, yoga sequences, healthy lifestyle and eating habits! Come and see for yourself! You will feel energized, relaxed and happy when you leave! Val and Ira will nurture and support you on your journey to find inner peace and Zen!"
Zen Den Yoga School, edited
"I just completed my 200 hr yoga teacher training at zen den yoga school with Ira Ohm. My time spent was truly a trans-formative experience. I have learned so much in regards to mind, body, and soul connections. This course was so much more than just learning and being able to teach yoga; it was an in depth dive into the history and life style of yoga and a deep soul searching moment. I would recommend this course to anyone looking to get certified to teach at the 200 hr level or anyone just wanting to strengthen their practice. Truly and whole hearted blessed to have had the opportunity to grow within the teachings of Zen Den Yoga School. Namaste."
Zen Den Yoga School, edited
"Going to Zen Den is always a great experience whether it is for a class or an event. The atmosphere and people in the den are very welcoming and knowledgeable."
Zen Den Yoga School, edited
"I have been practicing with Ira and his teachers for the past 4 years. Ira is an amazing teacher. It's has been a great pleasure to practice along with many of his students during teach trainings. I have seen incredible changes in many of his students."
Zen Den Yoga School, edited
"Zen Den has been like a second home since I moved to Florida. Between the innovative teachers, exciting workshops and classes there is little to do but enjoy yourself in this beautiful space. As a newly certified 200 hour teacher and practitioner of Ira Ohm's for almost 2 years I can say with gratitude and confidence that Zen Den has changed my life."
Zen Den Yoga School, edited
"I did the 6-day retreat and extended 1 more days. It was a GREAT JOURNEY for me."
"First, Boca Raton is a very nice city (I was amazed :) ). Very wealthy, clean, and beautiful. You can do so many things there - I tried good restaurants (recommended by Ira and Valerie), went to the beach almost every day, visited Boca Raton Museum of Art, explored different parks along the beach, etc. There are so many places to see and activities to do there. I feel 1 week stay is quite of sort, 1 month would be perfect to "breath and enjoy" Boca Raton :)"
"Above the location, the hosts are the best part of my experience. Ira and Valerie are very kind and nice. They are there to help you make the best out of your journey. Yoga classes, nutrition coaching, meditation guiding, acupuncture, massage, breath work... Should try them all! You will be surprised of what it can help your body and your mind. "
"Overall, I learned, practiced, and enjoyed every minute of my retreat. Hope you all will have a chance to experience it!"
BookYogaRetreats.com website, edited
"Zen Den Yoga retreat was exactly what I was hoping for. Valerie and Ira were great hosts. The house is well kept and tastefully put together. I found it relaxing, to hang out there, during down times. They also supply bikes for adventures away from the house; and it's a very short ride to stores, restaruants, ect. Uber is another way to venture further out. The morning classes were just right and Ira is very good at giving quality instructions during the classes to avoid injuries and achieve the poses. Very knowledgable, both of them. I plan to return."
BookYogaRetreats.com website, edited
"Zen Den Yoga was an amazing retreat. Upon arrival, Val and Ira give you a tour of the beautiful home. There is a pool and hot tub in the backyard (hot tup a definite plus, especially due to the soreness from all the yoga!). They also taught us how to make our breakfast and lunch shake, which were flavorful and made me feel great! There are multiple yoga classes offered each and every day. "
"Val and Ira were amazing hosts. They made sure all of their guests were happy during their stay. They were able to recommend fantastic restaurants around the area. They also offered use of their bikes to get to the yoga studio, beach, restaurants, etc. Ira runs most of the meditation and yoga classes - which are all awesome! Val gave a wonderful massage. They set up the most relaxing acupuncture appointments for us. "
"This stay was the best way to spend a vacation. Both mind opening and relaxing. Thanks Ira and Val!"
BookYogaRetreats.com website, edited
"What is the truth is always what it seems to each individual in each moment given our states of mind and being. We have had over 200 students graduate from our yoga teacher training's and over 200 retreat guests stay with us over the past two years. So we are writing to share feedback as to what took place with the retreat guest who didn't even stay the night to experience her retreat. This guest shared a tremendously long story of her personal life details, poured out her emotions and points of views to me for the half an hour ride where we had picked her up from the airport. She shared that she took herself off of her meds, that she practiced yoga once a week, and everything else was to much for her to handle given her mental state of mind and the events leading up to her coming to our retreat. We arrived at the house and I gave her a tour of our hydroponic vegetable garden in the front of the house. (Take a look at our pics on the website zendenyogaschool.com) I spent time describing how the timers, the feed barrels, and the pumps all worked around the clock to keep everything growing. I explained the difference between the tower grows, box garden and jack pots. We are currently growing cabbage, kale, carrots, tomatoes, arugula, spinach, onions, basil, sun flowers, cucumbers, kolrabi and more. All of these fresh organic vegetables are for our retreat guests and yoga teacher training students. We then entered the house and I brought her to her clean private room with organic cotton sheets, bedding an area rug, and an orchid. It is true this orchid didn't have flowers on it, however the orchid was far from dead. It is alive and well with four beautiful healthy large leaves and roots growing out absorbing the moisture from the pot and air. I am assuming this guest didn't know anything about the stages of orchid growth. In the common areas, we make a point to change our cut flowers out each week. On a daily basis we clean out the flowers that die along the way. I then made her an organic fruit and protein smoothie and gave her a tour of the rest of the house. The house is very zen with yogi quotes, paintings, Buddha statues, and a large Om adorning our walls. The bathroom mentioned above (there are 2 in the house) has a full tub and shower along with a sink and toilet. It is Italian tumbled marble on the floors and walls. The tub is not only a tub but also a jacuzzi. It is likely this guest mistakenly hit the close the drain button as if to have a bath but didn't know it. Among our many weekly guests, housekeeper, and ourselves, we would know right away if there was a bad drain in the shower and would fix it immediately. To continue, our sink counter is made of wood and granite, with a big bowl sink made from stainless steel. The toilet is an efficient water use toilet and the bathroom door is wood with frosted glass. The entire retreat house has wall to wall Italian porcelain floors, an open window floor plan with lots of natural light, a state of the art kitchen with European appliances all stainless steal, stove, microwave, appliances, and oven. Our dishwasher and refrigerator are top of the line, and we have a Vitamix, a commercial grade juicer, as well as full set of pots, pans, coffee maker etc. It's possible the pool could have had some leaves in it because we have bamboo trees around the pool and it is often breezy here by the beach. We personally skim the leaves twice a day, and we have a pool maintenance person come once a week to keep our salt water pool running in tip-top condition. It is possible the hot tub cover may have some dirt on it from time to time due again to the beach breezes, however we can assure you the hot tub is very clean, and it is even an ionized hot tub so we do not use chlorine. "
"After I made her the smoothie and gave her the tour, I showed her the map we have of the area. Around that time some other happy jovial guests came into the house, grabbed some things and jumped on the bikes we offer for use and went to the beach. This said she just wished to settle in, then she changed her mind and said she would go take a walk. She was a very nervous woman. I assured her she was safe in East Boca Raton, we are one of the wealthiest zip codes in the entire USA. Our own daughter who is 10 rides her bike on the same roads this woman took her walk on, and so do all of our guests who are 98% women. I then left the house and went to my store. About 15 minutes later this guest walked in our store, which is just two blocks from the retreat. I said hello and introduced her to my store manager. She left shortly after. On my way back to my own home, two blocks away and one house behind the yoga retreat house, I saw her walking. I honked and waived and she waived back, we are guessing based on her review that she has poor vision and confused me with a stranger. Four hours later at 7pm, she did not show up for class. I asked our other guests if she was coming and they mentioned that they saw her get into a cab. I called her to see that she was okay, particularly as it concerned me that she was off her medication and seemed so nervous. I reached her on the phone, and she explained she was having panic attacks and a break down. She said was afraid she was going to lose all rights to her baby because she abandoned her to come to South Florida for a retreat. She then told me she rented a car and was driving back to Jacksonville, Florida. She told me not worry about the money, she said that she was not ready to leave her comfortable environment and that this was all her fault. I assured her that when she was ready that she had credit with us and we would always welcome her here. She thanked me and got off the phone."
"Sarah we are truly sorry you are going through so much challenge in your life right now. Be assured that everything will work out, just focus on the good. When we are not healthy our mind is a hard adversary instead of a good team mate coloring everything we experience. We wish you the best during your recovery from your traumatic experiences with your family. We really wished to have been able to support you through this as we do with so many people who come to us from all over the world. Namaste."
BookYogaRetreats.com website, edited
"I recently visited Zen Den. Very glad I went. Valerie and Ira are knowledgeable coaches and treat you with respect. Loved the Yoga house and the surrounding area. Great value."
Zen Den Yoga School Facebook page, edited
"I had a horrible experience there and did not even stay the first night. The quotes healing environment, is right off of a very busy, loud road. The house is very hectic and nothing is state of the art. The only decoration in my entire blank room was a dead, rotting orchid. There was also a huge vase of a variety of dead, wilted flowers in the entrance to greet you. Very bad energy wise. The pool was covered in leaves, the hot tub was filthy with dirt. I took a shower in the one, very small bathroom for three people to share and the shower backed up water to my calves before draining. I tried to take a peaceful walk and was honked and hollered at by so many men I felt nervous and went back to the house. It is not in a safe area for a woman to walk alone. Nothing about this environment was healing, peaceful or Zen like and I feel truly duped. When I fled by taxi without sleeping in my bed or taking any yoga courses, five hours after I arrived Ira Shneider Ohm told me I had already been charged and not to expect any refund. I plan on contacting the Better Business Bureau and the Chamber of Commerce. I was in a very vulnerable emotional state and was really seeking peace. "
BookYogaRetreats.com website, edited
"Zen Den Yoga is the place which clearly translates the definition of Mind, Body and Soul. Had an amazing experience at the retreat and yoga classes connecting and rejuvenating with self. Val and Ira are so much full of knowledge and experience with health and wellness. Can't wait to go back whenever time and opportunity arises. So much to learn and gain yet from this amazing yoga school."
Yelp website, edited
"Step away from your daily routine and offer yourself a different kind of vacation... combined it with a retreat that focuses on health, wellness, meditation,yoga, and more, joined with walks and sunbathing on the beaches of Florida. (It would be good to have a car to explore the beaches or you can take one of the bicycles available at the house). Zen Den Yoga School offered all of that which is what attracted me to it. You can go on your own or with a partner, friend, parent, or group, and experience life for as many days as you choose in a zen-like house with saltwater pool and hot-tub. If you are open to learning and to new experiences, and if you believe that life is a journey of expanding and discovering more about who you are, then you have come to the right place! Both Valerie and Ira, your hosts, have big hearts and aim at providing a holistic experience so that you come away feeling more knowledgeable and grounded than when you first arrived."
BookYogaRetreats.com website, edited
""Ira and Valerie were great and helped me with so much. This retreat with all the yoga and meditation was just what I needed. The house was nice and well equipped and also only a short walk from the studio. I came away from the retreat feeling completely revitalized and knowing things about myself that I previously didn't know!""
BookYogaRetreats.com website, edited
""The retreat at Zen Den Yoga was filled with yoga and other classes. Ira is a patient and knowledgeable teacher. The acupuncture and massage treatments helped to refresh and energize me, and the shakes were nourishing. It was an enjoyable and worthwhile retreat with my friends.""
BookYogaRetreats.com website, edited
"I took the Zen Den Yoga Teacher Training in August 2014 and since I´m from Germany I had to stay at the beautiful Yoga House for the whole month. I have to admit: it was the best time I ever had. Was it challenging? Totally! Was it worth it? More than that! It was an awesome experience, I met great people there, the energy was unbelievable and I´m still thinking back on the time I had there! I´m grateful I took the chance and the challenge to fulfill my dream which I am now working with everyday! Get your Yoga on, it´s totally worth it! Namste."
Zen Den Yoga School website, edited

subset: commoncrawl


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Dr. Joel RobbinsMay 26, 2009
My doctor, Dr. Joel Robbins, is GREAT! His take on how the body works makes the most sense to me when he needs to explain something to me.
|"Dr. Joel Robbins has made a career-long study in the field of nutrition as it relates to health. He holds both a chiropractic and a naturopathic degree, offering his patients alternatives to their health problems through natural treatment methods and nutrition. He is the director of the Living Health Concepts team, has authored a number of works on health and nutrition, is a sought-after speaker in his field, and is the founder and president of the College of Natural Health."
Here is Part 1 of 3 of my consultations with Dr. Robbins. Most of his consultations are via phone.
If you are interested in having a consultations with him, call him at 918.488.0444. Let him know that Lane sent you!
If you want to see Meetings 1-4, you can find them on my YouTube channel or my other YouTube Channel.


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Greetings Guest!!Dismiss Notice
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Windows 7 64 Bit Good or Bad?
Discussion in 'UO Siege Perilous' started by SoulWeaver, May 3, 2010.


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American English File 4 Workbook
With Multi-ROM
By (author) Clive Oxenden Christina Latham-Koenig Paul Seligson
Format: Paperback
Normal Price: $40.95
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Availability: Available to Backorder, No Due Date for Supply
American English File 4 Workbook by Clive Oxenden
Book DescriptionAmerican English File gets students talking thanks to its unique and proven formula combining confidence-building, opportunity, and motivation. High-interest content is organized in lively, achievable lessons, using humor and imagination to encourage students to communicate and enjoy learning English. Solid grammar, vocabulary, and pronunciation foundation carefully supports the work with the four skills and gradually builds students' confidence and performance in English. The Workbook helps students to study more effectively, with clear links to the Student Book and the Students' Website. The Multi-ROM, available with the Workbook, includes an interactive CD-ROM and an audio CD, with video extracts and activities, interactive grammar quizzes, vocabulary banks, pronunciation charts, and listen and practice audio material.
Buy American English File 4 Workbook book by Clive Oxenden from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9780194774666
Imprint: Oxford University Press, USA
Publisher: Oxford University Press, USA
Publish Date: 1-Mar-2008
Country of Publication: United States
Books By Author Clive Oxenden
New English File: Advanced: Student's Book, Paperback (February 2010)
Four-skills English course with fun lessons, digital resources, and strong online support - loved by students and teachers at all levels.
American English File Starter: Student Book with Online Skills Practice, Paperback (January 2010)
Four-skills American English course with a communicative methodology, engaging texts, and a strong pronunciation syllabus - designed to get students speaking.
American English File Level 4: Teacher's Book, Paperback (April 2009)
Four-skills American English course with a communicative methodology, engaging texts, and a strong pronunciation syllabus - designed to get students speaking.
New English File: Beginner: Student's Book, Paperback (March 2009)» View all books by Clive Oxenden
Four-skills English course with fun lessons, digital resources, and strong online support - loved by students and teachers at all levels.
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As for whether he made an impression on (Nate) McMillan, (Glenn) Robinson said he hoped his coach noticed how he performed with confidence and aggression, particularly in the open court.
"We'll see what happens," he said about competing for a rotation spot. "I'll let (McMillan) decided that. I just wanted to show him a little bit more, so I'll keep it in the back of his mind, where he's like, 'I got to play him.'"
Source: Nate Taylor of the Indianapolis Star
Have something to add to this story? Share it in the comments.


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Macro of small wicker basket with lid.Taken with Canon T2i and 100mm lens; f/8, 1/2 sec, ISO 100.
basket wicker woven macro brown
This is really beautiful Lynn. Love the in and out of focus wicker contrasts.
Thank you Maree, I was thinking of the wicker/basket challenge when I took it, so i had to watch the negative spaces.
I'm so honored…thanks to everyone !
Is there a tiny snake in there Lynn? Nice shot.Click the banner to take you to the group. Your work is welcome here and please enjoy it.
Thanks Derek…I hope not! But it looks like a perfect place for a baby cobra!
Love the depth of field.. wonderful pattern work… congratulations Lynn
Thank you Maria…will do!
Great work
Glad you like it, Joy…thank you!
Congrats on your features. This is truly a fantastic photograph.
Thank you Grace…simplicity is grand!
amazing detail Lynn. I am always amazed at work here on Red Bubble that is so clear and artistic. I love the softened wicker in the background. Almost expect a cobra to pop out. LOL. very nice work.
I love your comments, Jane! This was the first image that I shot specifically for a RB challenge! Thanks so much for your comments and the fave!
Lovely salt grass baskets I use to see a lot of these for sale in South Carolina
Those would make nice photos!!! Thank you for your comment!!!
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text: Lot's of fundamentalists (remember, I am one) call these "sins" or "worldly" and therefore evil and wrong for a Christian who is right with God. No poll here. Would like your opinion and, if possible, Scripture. Just copy the list of the DIRTY DOZEN below: 1. Is going to a movie theater sin? 2. Is watching television/dvd/video a sin? 3. Is attending a live theater (play) a sin? 4. Is dancing a sin? 5. Is using tobacco (any form) a sin? 6. Is listening to rock music a sin? 7. Is using cuss words/minced oaths (4-letter anglo saxon) a sin? 8. Is using playing cards a sin? 9. Is playing games with dice a sin? 10. Is wearing slacks (ladies) a sin? 11. Is going to a public beach/mixed swimming a sin? 12. Is playing pool/billiards a sin? Bonus: Is drinking alcohol in any form a sin? Thank you for sharing.


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iPhone apps
Checkers Professional
Checkers is the classic strategy board game with the goal of capturing all the opponent's pieces. The game is deceptively simple yet full of intricacy as those that take on the Expert level will find.Steeped in history, games similar to Checkers….. Read more
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AdBrite is taking a unique approach to online ad placement with the launch of its new Open Targeting Exchange (OTX), a competitive marketplace for algorithms and ad targeting technologies.
Instead of using a single algorithm to determine which ad should appear on which site, AdBrite will now use OTX to let different providers compete. The new service allows those providers to bid in real-time for the right to place AdBrite's inventory.
"We expose our pages and ads and user profiles to our targeting partners, and they come back to us with what ads best match a given user and pageview," said AdBrite VP Marketing Paul Levine. "We allow them to set their own margins, so they can get pretty aggressive and have a real profit motive."
OTX will be integrated seamlessly into AdBrite's network, said Levine, so the transition will not noticeably impact functionality for advertisers or publishers. The company is banking that it will mean higher revenues for both, however.
The service debuts with two launch partners, ad network Lucid Media (formerly Entrieva) and Personifi, a firm that provides ad targeting and optimization. Ajay Sravanapudi, CEO of Lucid Media, characterized OTX as a solution to the disconnect between networks and targeting technologies.
"Most large ad networks have reach but weak targeting technology, while most technology providers have great targeting but lack reach," he said; hence, OTX would help advertisers and publishers get the best of both worlds.
AdBrite is currently reviewing applications from nearly two dozen other potential partners and plans to have several more on board in coming weeks, said Levine,
"Why tie yourself to one algorithm that may work great now but in a few years will be left behind?" said Levine. "As good an algorithm as one company can make, it's always better to tap into many."
This is not the first time AdBrite has taken an open approach to its network. Just last month, it signed deals with numerous other networks to sell inventory in its own marketplace. Networks such as Advertising.com, Burst Media, AdPepper Media, PrecisionClick and CPX Interactive now traffic ads with AdBrite.
AdBrite serves more than 50,000 Web sites, mostly small to mid-size, with nearly a billion page views a day, placing it fourth behind Google, Yahoo, and AOL's Advertising.com, said Levine. In January of this year, AdBrite ads reached 85 million unique users, according to the company.
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Baltasar Gracian Quotes (122 quotes)
If you know some quotes that would be a good fit here, send us a note!
Picture Source: Wikimedia CommonsBaltasar Gracian
Born: January 8, 1601
Died: December 6, 1658 (aged 57)
Nationality: Spanish
Occupation: Philosopher, author
Bio: Baltasar Gracián y Morales, SJ was a Spanish Jesuit and baroque prose writer. He was born in Belmonte, near Calatayud. His proto-existentialist writings were lauded by Nietzsche and Schopenhauer.
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"Several technological and political forces have converged, and that has produced a global, Web-enabled playing field that allows for multiple forms of collaboration without regard to geography or distance - or soon, even language."


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"Laughing Gecko" Krabi Hotel Tip by ElDiabloRojo
Krabi Hotels: 167 reviews and 326 photos
The Laughing Gecko was a fantastic experience. The owners were very welcoming and friendly. They also have excellent dinners which they provide for a minimal fee every night. It is very close to the beach and it is just on the outskirts of Ao Nang. My bamboo hut was cheap and very comfortable. I arrived intending to stay the night and ended up staying for a week. Without a doubt the Laughing Gecko was my best experience in Thailand. Highly recommended!
Address: www.laughinggeckothailand.com
Price Comparison: least expensive
Price: less than US$20
Theme: Pension/Guesthouse
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The early spring flowers have finally emerged in all of their glory, making us forget all about our love of comfy, cozy socks and hot soup. Now we want to play in the great outdoors! We're ready to entertain outdoors, and happen to have beautiful spring flowers on the brain. Here are a few ways to make … Continue reading Garden Party DIY Roundup
Top 5 DIY Coasters
There's no easier way to spice up your living space than with some cute coasters. Fortunately, there's tons of coaster DIY projects out there, and we've picked out 5 of our personal favorites. Which one do you like best? DIY Citrus Coasters DIY Stained Glass Coaster by Sincerely Kinsey DIY Color Blocked Coasters by … Continue reading Top 5 DIY Coasters


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PAWS WG IETF-84 Device to Database Protocol for White Space July, 2012 Subir Das, John Malyar, Don Joslyn
Protocol Layer +-+-+-+-+-+-+-+-+-+-+-+-+ | PAWS | +-+-+-+-+-+-+-+-+-+-+-+-+ | HTTPS | +-+-+-+-+-+-+-+-+-+-+-+-+ | TCP/IP | +-+-+-+-+-+-+-+-+-+-+-+-+ | IP | +-+-+-+-+-+-+-+-+-+-+-+-+ 2
Protocol Features/Functionalities WSD Initialization WSD Registration Database Query and Response Channel use Notification and Response WSD Validation WSD = White Space Device 3
Mailing List Discussion Points and Issues Purpose of WSD Initialization Purpose of WSD Registration Device Authentication Data Model Lat/Long representation Use of separate 'geolocation', 'civiclocation' elements Use if 'vCard' for 'deviceowner' data element Use of 'iCalendar' for channel availability time 4
WSD Initialization Assumption WSD Knows the URI of the DB or the discovery service WSD establishes HTTPS connection with the DB Server certificate is authenticated against a well known certificate authority WSD initialization is performed using INT-REQ and INT- RESP messages. The purpose of this step are two folds: To perform the Client authentication using a shared secret ( by using Digest Authentication) 'Authinformation' data element is used for this purpose To exchange several authority/domain specific information which are not possible to obtain during DB discovery, e.g., Device type, Serial number, Regulatory id, frequency when Master WSD should query the database, Result code and so on 'Capabilityinfo' and 'Protocolinfo' data elements are used for this purpose 5
WSD Registration WSD registration is performed using REG-REQ and REG- RESP messages. The purpose of this step is: Provide the database with operational parameters such as owner and/or operator contact information, location and antenna height parameters and so on 'Devicelocation', and 'Deviceowner' data elements are used for this purpose This step may be required by some spectrum management authorities Registration can be mandatory upon its initial contact with the database, or when its registered parameters change 6
Device Authentication We believe that device authentication should be done by using a shared secret model instead of a client certificate and we provide the following: The use of Digest Authentication is identical to that for HTTP [RFC2617] and in particular SIP [RFC3261] with the following modifications: The URI and method included in the challenge are empty The realm represents one 'security realm' The device's serial number is currently mapped to 'username' and the device's shared secret is mapped to 'password' MD5 is replaced by SHA-1 7
Data Model: Example Draft currently specifies the simple data elements for device location and device owner (light weight and self contained) 8 Device Location: Latitude ; type=float longitude ; type=float Locuncertainty; type==number Locconfidence; type=number HAGL; type=number HAGLuncertainty; type=float Antennatype; type= int Device Owner: Ownername; type=string Address ; type=string Phonenumber; type=alphanumeric Email; type=alphanumeric Using the structure as specified in RFC 5491 and RFC 5139 may be fine but we have concerns over future compatibility (e.g., recent open geospatial name space change seehttp://www.ogcnetwork.net/node/1829)http://www.ogcnetwork.net/node/1829
Use of vCard and ical Our understanding is that PAWS requirements would use less than 20% of the properties defined in vCard and iCal PAWS Requirements related to vCard use are Name; postal address; email address ; and phone number; PAWS Requirements related to ical use are Duration; and Time ; Can we simply use the following from iCalendar (RFC 5545)? DTSTART, DTEND / DURATION 9
Message Encoding with JSON: Example AVAIL-CHAN-REQ POST/AVAIL-CHAN-REQ HTTPS/1.1 Host:WSP.example.com:443 Content-Type:application/PAWS+json; charset=utf-8 content length: XX { "Protoversion": "1.0", "messagetype": "AVAIL_CHAN_REQ", "Authority": "US", "Devicetype": "F", "Deviceidentity": "TTT1234", "Deviceserialno": "01AB23CD45EF", "Latttitude": "40.5414", "Longitude": "-74.4750" "Locuncertainty": "2", "LocConfidence": "95", "HAGL: " 25", "HAGLuncertainty": "1", "Antennatype":"MM", "Geolocationcode":"DEFAULT", "Requesttype":"allchannels", "Authscheme": "DIGEST", "Realm":"PAWS-DDI", "Nonce": "7b52009b64fd0a2a49e6d8a939753077792b0554" "Cnonce":"bd307a3ec329e10a2cff8fb87480823da114f8f4", "qop": "auth" "resp": "4dfb972d427b4100c821d53b8bea9b2c33b74a7e", } 10 AVAIL-CHAN-RESP POST/AVAIL-CHAN-RESP HTTPS/1.1 200 OK Server: Example PAWS Date: Fri, 12 June 2012 06:24:27 GMT Expires: Fri, 12 June, June 2012, 20:30:00, GMT Cache-control : private Content-Type:application/PAWS+json; charset=utf-8 content length: YY { "Protoversion": "1.0", "Messagetype": "AVAIL_CHAN_RESP", "Authority": "US", "Resultcode": "success", "Authscheme": "DIGEST", "Realm":"PAWS-DDI "Nonce": "7b52009b64fd0a2a49e6d8a939753077792b0554"} "qop": "auth", "Channellist": [ { "Channelno": 2, "Minfreq": 54, "Maxfreq": 60 "MaxEIRP": 4000, "Datetime": "20120612T235959Z", "Duration": "1440, mins", "Availability": true.. { "Channelno": 51, "Minfreq": 692, "Maxfreq": 698, "MaxEIRP": 4000, "Datetime": "20120612T120000Z", "Duration": "720, mins ", "Availability": true }
Next Steps/Considerations We have received comments from several folks (Thanks to the reviewers!) such as, 'Channel number' should be optional and frequency should be mandatory Device authentication should be optional Device authentication may be performed by using cert where available Regulator specific attributes should be listed or profiled in the Appendix 'Device owner/operatorinfo' may be represented using 'vcard' 'Channel/Frequency' availability may be represented using 'ical' Our goal is to discuss further and address them as appropriate in our next version 11
Questions? Feedback? 12
Backup Slides 13
DB Query Database query and response are performed using AVAIL- CHAN-REQ, and AVAIL-CHAN-RESP messages. The purpose of the step is To query the WS database with the required parameters for obtaining WS channel/frequency information 'Devicelocation', and 'Availablechannellist', data elements are used for this purpose Used channel/frequency notification and response are performed using USE-CHAN-NOTIFY and USE-CHAN- RESP messages. The purpose of this step is, To notify the used channel/frequency information to the database 'Devicelocation', and 'Usedchannellist' data elements are used for this purpose 14
WSD Validation WSD validation is performed by using DEV-VALID-REQ and DEV-VALID-RESP messages. The purpose of this step is Master WSD verifies the identity of the slave WSDs when required by the spectrum management authority 'Devicelocation' and 'Slavedevicelist' data elements are used for this purpose 15
Data Model Structure 16 Object Element Attribute Initialization Registration DatabaseQuery Devicevalidation Capabilityinfo Protocolinfo Authenticationinfo Deviceowner Availablechannellist Devicelocation Usedchannellist Slavedevicelist Devicetype Deviceidentity Lattitude/Longitude Max/Min Freq HAGL MaxEIRP........
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audjpy - massive correction finishing
FX:AUDJPY Australian Dollar/Japanese Yen
Weekly chart -- massive ending diagonal has reached its target. Over the next days and weeks, I'll be looking for long entry signals for a long-term advance north. Brexit has caused quite a few markets to hit their final targets....
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audjpy -- bullish, in impulse
eurcad - target reached


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- Affiliations:
1 Department of Mechanical Engineering, Technical University of Denmark
2 Thermal Energy, Department of Mechanical Engineering, Technical University of Denmark
- Abstract:
- In areas with large shares of Combined Heat and Power (CHP) production, significant introduction of intermittent renewable power production may lead to an increased number of operational constraints. As the operation pattern of each utility plant is determined by optimization of economics, possibilities for decoupling production constraints may be valuable. Introduction of heat pumps in the district heating network may pose this ability. In order to evaluate if the introduction of heat pumps is economically viable, we develop calculation methods for the operation patterns of each of the used energy technologies. In the paper, three frequently used operation optimization methods are examined with respect to their impact on operation management of the combined technologies. One of the investigated approaches utilises linear programming for optimisation, one uses linear programming with binary operation constraints, while the third approach uses nonlinear programming. In the present case the non-linearity occurs in the boiler efficiency of power plants and the cv-value of an extraction plant. The linear programming model is used as a benchmark, as this type is frequently used, and has the lowest amount of constraints of the three. A comparison of the optimised operation of a number of units shows significant differences between the three methods. For the heat pump, the linear optimization yields the lowest amount of operation hours. Using binary integer variables, heat pump operation is increased by 23 %, while for a non-linear approach the increase is more than 39 %. In terms of the total amount of heat produced by heat pumps, the two approaches exceed the reference by approx. 23 % and 32 % respectively. The results indicate a higher coherence between the two latter approaches, and that the MIP optimisation is most appropriate from a viewpoint of accuracy and runtime.
- Type:
- Conference paper
- Language:
- English
- Published in:
- Proceedings of Ecos 2013 - the 26th International Conference on Efficiency, Cost, Optimization, Simulation and Environmental Impact of Energy Systems, 2013
- Main Research Area:
- Science/technology
- Publication Status:
- Published
- Review type:
- Peer Review
- Conference:
- 26th International Conference on Efficiency, Cost, Optimization, Simulation and Environmental Impact of Energy SystemsInternational Conference on Efficiency, Cost, Optimization, Simulation and Environmental Impact of Energy Systems, 2013
- Publisher:
- Chinese Society of Engineering Thermophysics
- Submission year:
- 2013
- Scientific Level:
- Scientific
- 253255982


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60 results was found matching keyword
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Báo Tuổi Trẻ English 8 month(s) ago
The Ho Chi Minh City transport department is evaluating a plan to build an elevated highway connecting Tan Son Nhat International Airport with the city center in an attempt to ease traffic congestion on overloaded airport roads.
Keywords: Transport DepartmentConnectingTan Binh DistrictThe Ho Chi Minh Cityeaseclear upInvestment Plan
Báo Tuổi Trẻ English 9 month(s) ago
Two port officials have been relieved of their positions after an overloaded tourism ship capsized in the central city of Da Nang last weekend, leading to three losing their lives.
Keywords: captainThao VanHan RiverBoatstransportThe Da Nang Peoplehave
Báo Thanh Niên English 9 month(s) ago
1 related news
Just days after local media reported on a plan to build a new airport for Hanoi, the Ministry of Transport has revealed its own proposal to dramatically expand the city's existing airport Noi Bai, which has become overloaded.
Keywords: Noi BaiThe Civil Aviation AuthorityNoi Bai AirportexpandOverloadeddramaticallytransport
Báo Dân Trí English 9 month(s) ago
Dozens of migrants were missing Friday after an overloaded fishing boat sank off the coast of Libya, the third major tragedy in the Mediterranean in as many days, Italian rescuers said.
Keywords: MigrantscoastoffrescuepeopleshipwreckDozens
VietStock FI English 10 month(s) ago
Newly-appointed transportation minister Sun Chanthol met with representatives of the nation's logistics and transportation industries yesterday to discuss the problems and bottlenecks that are keeping basic transport costs high, reducing the Kingdom's trade competitiveness and putting a burden on both citizens and infrastructure.
Keywords: ministerfreightsolvetransportOverloadedPetrolTrucks
Báo Tuổi Trẻ English 11 month(s) ago
An overloaded truck was passing a bridge in the Central Highlands province of Dak Lak on Friday morning when it caused the structure to tumble down into two pieces.
Keywords: saptumbleFacebookTwitterOverloadedCentral HighlandsThe Central Highlands
SaiGon GP English 12 month(s) ago
The Prime Minister has just issued his instruction on adopting measures against the overloading in big hospitals including building more satellite medical clinics.
Keywords: HospitalssatellitePhysiciansbigdistinguishreduceinstruct
VietnamNet English 12 month(s) ago
2 related news
Hanoi's transport infrastructure is alarming since a number of recently-launched works have become overloaded, Secretary of the municipal Party Committee Hoang Trung Hai raised his concern at a meeting with the Transport Ministry in Hanoi on March 7.
Keywords: transportHa DongVietnam NewsVehicleshavebecomeOverloaded
Overloaded hospitals in the South Vietnam have reduced much, said head of the Health Ministry's Medical Examination and Treatment Department Luong Ngoc Khue at an annual meeting held by the Ministry with the leaders of hospitals in the South in Ho Chi Minh City on March 3.
Keywords: HospitalspromiseenoughOverloadedcheckcentertend
VietnamNet English 13 month(s) ago
VietNamNet Bridge - Many parents said they fear their children would be overloaded if they have to learn both English and Korean.
Keywords: learnEnglish MoetTraining DepartmentprepareVietnam NewsVietcombankThe Hanoi Education
Báo Thanh Niên English 13 month(s) ago
Police in the north-central province of Quang Binh on Saturday caught 108 violating buses at a single checking point in the area, most were both overloaded and overspeed.
Keywords: BusesPassengersNghe An ProvinceinsideOverloadedThanh Hoa Policepoint
VietNamNet Bridge – Khuat Viet Hung, vice chairman of the National Traffic Safety Committee, speaks to the newspaper Lao dong (Labour) about his plan to reduce the number of transport accidents, deaths and injuries.
Keywords: Traffic SafetyAccidentstransporttrafficreduceparticularlyTrucks
Báo Thanh Niên English 13 month(s) ago
2 related news
Dozens of flights to and from Tan Son Nhat were delayed on Wednesday and the holiday travel reached its peak, putting the airport's runways under unprecedented strain that can last through this weekend.
Keywords: Tan Son NhatFlightsOverloadedstraintravelPuttingschedule
Báo Dân Trí English 13 month(s) ago 1 duplicate news
Pollution caused by rotten products and wastewater has become alarming at the Long Bien Market, the biggest wholesale market of the northern region, reported Thoi Bao Kinh Doanh (Business Times) Newspaper.
Keywords: marketwholesaleLong BienFruitsVegetablessmellcenter
VietNamNet Bridge – In the past few days, thousands of people from Ho Chi Minh City and other southern provinces like Dong Nai, Long An and Tay Ninh have flocked to the Tan Son Nhat International Airport to welcome their relatives who were overseas Vietnamese returning home for the lunar New Year (Tet). In that situation, the airport has been severely overloaded.
Keywords: bayNguoiTan Son NhattableViet KieucenterOverloaded
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AFTER a relentlessly cold winter and damp spring, summer has arrived with blessed relief. All hail the sun! But summer sunlight can raise air-conditioning bills, and ultraviolet rays cause fabrics to fade. Screens and scrims reduce these effects while allowing rooms to glow with suffused light. Some screens are neutral, while others provide a shot of color for days when the sun refuses to shine.
1. These textured linen panels come in lilac, white, flax, aloe, natural or dark brown. Available in five lengths, from 44 inches ($22) to 108 inches ($44). From the West Elm catalog; to order a catalog, (866) 428-6468 or www.westelm.com.
2. Sandy Chilewich is known for vinyl flooring. In partnership with Silent Gliss USA, a shade manufacturer, she now makes Vinyl Lace, a semitransparent window material, in a variety of weaves. A 36-by-54-inch shade is $346. All are custom made. For Silent Gliss retail sources nationally, (800) 938-7225 or www.Homecollection.info.
3. Larson is a sheer fabric of strands of viscose thread, linen and polyester, $148 a yard at Richard's Interior Design, 1390 Lexington Avenue (91st Street); (212) 831-9000.
4. Stainless Steel Sheer is made of woven polyester sprayed with stainless steel. It comes in four colors: brass, zinc, steel and titanium; $77 a yard (to the trade) at Clarence House, 211 East 58th Street or www.clarencehouse.com for showrooms in other cities.
5. Conrad shades offer added protection when backed by an optional roller shade. The fabrics are all custom-woven of palm leaves, mulberry and other fibers. Fifty weaves are available, and they come in any dimension from decorator showrooms around the country. Prices start at $770 for a 48-by-60-inch shade (without backing). For locations, www.conradshades.com or (866) 426-6723.
6. Cotton voile panels, called Bubble, come as 42-by-84-inch-long tab-top curtains ($62); they come custom-made in other sizes. From London Lace, (800) 926-5223 or www.londonlace.com.
7. A sheer curtain with a 48-inch valance is a modern take on plain-Jane curtains. Made of a blend of linen and cotton, it comes in white or light blue. The 42-inch-wide panels come in three lengths: 48 inches ($49), 95 inches ($59) and 106 inches ($69). From the Spiegel catalog, www.spiegel.com or (800) 345-4500.
8. Kimono Panels have a floral print on the outer surface of filmy georgette fabric. The inside panel is organdy. The panels are 42 inches wide and 84 inches long; $58 each at Anthropologie. For store locations, (800) 309-2500 or www.anthropologie.com.Continue reading the main story


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pause balls
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- Quality: High
- Size: 7.64 MB 304.91 KB
This Gif entitled pause balls was created from the youtube video 2 years ago. It uses 18 frames per second and is displayed at 360px resolution. This animated image plays for 9 seconds, was built with high quality and an estimated weight of 7.64 MB for download. This animation was originally created from the video from 00:10 to 00:19.
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Small Double Memory Foam Mattress
4ft/120cm Mattresses
Our entire collection of Small Double Memory Foam Mattresses is made from the highest quality memory foam. There are many orthopaedic and health benefits to using a Small Double Memory Foam Mattress. Its unique structure absorbs your body weight and promotes a straighter sleeping position for an undisturbed sleep.
A Small Double Memory Foam Mattress is the ideal choice if you have a limited amount of space or are in need of a mattress for a smaller guest room. These are 4ft/120cm Mattresses, compared to the 4ft6 width of a regular double, giving you the space for two people but making all the difference if you have less space available. Have a look through our buyers guides and see what is thre best option for your needs! If you're unsure whether this is the right choice for you, then don't hesitate to contact us today!
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Small Double Zen Superior Coolmax Memory Foam MattressNot on promotion53Medium SoftCoolmaxZen


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Washington State L&I Medical Coding Compliance Auditor, Medical Program Specialist 1 in United States
Position is open until filled - Apply today!
Take your medical coding training and auditing experience to the next level with the Department of Labor & Industries. Join a professional team with a high work ethic dedicated to the review, analysis and monitoring of health services billed to the Department of Labor and Industries.
We are currently seeking a Medical Coding Compliance Auditor to perform complex medical coding audits. This position utilizes advanced medical coding knowledge to analyze patient medical records to ensure that a provider's services are billed in compliance with applicable laws, rules, policies and procedural coding guidelines.
Some of what you will do
- Review medical records, interpret and apply L&I; payment policies, rules, laws and procedural coding guidelines (CPT®, HCPCs, local codes) in order to determine whether a provider's services were documented and billed appropriately.
- Communicate analytical findings and directives to healthcare providers through the issuance of audit reports and legal orders.
- Lead post audit discussions and negotiations with providers and/or attorneys to achieve resolution.
- Draft settlement agreements.
- Work with the state's Attorney General's office in preparation of court hearings and provide testimony at court hearings related to audit findings.
- Perform quality assurance reviews of audits performed by other team members.
- Provide consultative services to department staff and medical provider's regarding laws, rules and payment policies which affect payment to healthcare providers.
Who should apply - What we are looking for Written and oral communication skills are a critical function of this position. As an applicant, you must be able to demonstrate your expert level writing ability. Successful applicants must be able to work independently in addition to being a strong team player. The ability to communicate and receive constructive feedback from your team members is essential.
Preferred Education and Experience Bachelor's degree with a major study in public or business administration, nursing, health care administration or closely allied field; and three years of experience in medical coding/auditing;
Associates degree with a major study in public or business administration, nursing, health care administration or closely allied filed and certification or accreditation as a medical coding specialist (i.e. CCS, CPC, CPMA, CHCA); and two years of experience in medical coding/auditing.
(Medical coding/auditing experience we seek includes the review/analysis of medical documentation, the interpretation and application of healthcare policies, rules and laws, and the application of various healthcare coding structures including both CPT® and HCPCS Level II.)
The successful candidate will be required to obtain the Certified Professional Coder (CPC®) certification from the AAPC within 2 years from date of hire and maintain certification by obtaining ongoing CEUs (currently 36 CEUs every 2 years).
Experienced healthcare medical coder/auditor with the demonstrated ability to:
- Objectively review medical documentation for appropriate procedural coding.
- Understand and apply various healthcare coding structures (including both CPT® and HCPCS Level II).
- Understand general medical terminology.
- Interpret and apply laws, rules and policies related to the payment of healthcare services.
- Apply critical thinking and analytical skills.
- Effectively and professionally communicate complex information in both oral and written format in a way that is understandable to the audience.
- Build rapport and partner with others.
- Independently analyze and weigh the risks verses benefits in decisions and recommendations related to provider billing and bill audit issues.
- Apply organization and time management skills with minimal supervision.
- Manage multiple projects and assignments at one time.
- Apply negotiation and conflict resolution skills.
- Maintain confidentiality in the performance of this role.
- Effectively use various computer applications (including: internet, Microsoft Word and Excel) to conduct research, create reports and detailed spreadsheets.
Note: please include a letter of interest/cover letter detailing your knowledge and experience related to this career opportunity. Supplemental Information
This job announcement may be used to fill multiple vacancies. Application review starts immediately and the hiring authority reserves the right to offer the job at any time. It's to your advantage to apply quickly.
Employees driving on state business must have a valid driver's license. Employees driving a privately owned vehicle on state business must have liability insurance on the privately owned vehicle.
Prior to any new hire into L&I;, a background check, including criminal record history, will be conducted.
To apply, follow the "Apply" link above
Jobs advertised as Open Continuous will be closed without notice. Apply quickly!
We're looking for evidence that you have what we're looking for. Your application materials will be used for deciding who'll be selected for interview.
For more information about the Department of Labor & Industries visit: http://www.lni.wa.gov/
Contact us at: email@example.com
Persons with a disability, who need assistance in the application process, or those needing this announcement in an alternative format, may call (360) 902-5700. Applicants that are deaf or hard of hearing may call through the Washington Relay Service at 7-1-1.
The State of Washington is an Equal Opportunity Employer
Job Type: Full Time - Permanent
Job Number: 2016-02833
Department: Dept. of Labor & Industries
Agency: State of Washington
Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504.
Website: http://www.careers.wa.gov
Salary: $4,005.00 - $5,253.00 Monthly
Location: Thurston County – Tumwater, WA


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Seamless Global Solutions
Our clients and their advisors confidently rely on our extensive international experience and country specific expertise to seamlessly address their most complex global financial advisory needs.
Whether you are looking to access an international pool of buyers for your company or require a valuation for your foreign entity or subsidiary, we provide one point person to coordinate all technical and administrative aspects of international projects.
We have successfully completed projects in over 50 countries and every major economy. Select a region below for more information regarding our international capabilities.


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Soft Picnic Set
Guide price: £25
Last updated on 21st Nov 2009
Soft Picnic Set
An absolutely delightful toy with everything you could need for a pretend picnic, all made out of pretty fabric. It includes lots of food, such as chicken drumsticks, cake, watermelon, sandwich ingredients and even a little bottle with a stopper and some goblets, and it all comes in a sweet checked basket, which is lovely to play with and useful for storage. Measures 28cmH x 20cmW x 15cmD. 3yrs+.
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CQ Researcher: Covering today's most important issues
Search for books, articles, media, and more
For a list of major databases, use Search & Find
An 'Enchanted Palace'
A humanistic "masterclass" for Houghton Library's 75th anniversary.
Honoring the Crimson Line
Reception at ongoing exhibit salutes Harvard's military past, present.
'To Pimp A Butterfly' Joins Harvard Library's Archives Along With Three Other Classics
9th Wonder chooses four albums to immortalize in Harvard Library's new Hip Hop archive.
Inaugural DataFest Reflects A Growing Interest
Conference builds awareness of data science resources at Harvard.
The Glass Universe
In a new book, Dava Sobel brings the women "computers" of the Harvard Observatory to light.
The Long Crimson Line
An exhibition from the University Archives depicts Harvard's military history.
The Sweep of Jazz History
Pianist and composer Randy Weston visited campus on the eve of Harvard acquiring his personal archive.


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Gear Up
Customer Service
Due to the seasonal nature of the outdoor business, demand for certain products, ordering constraints from our suppliers we may not have every color, size and style of product available as indicated. We at Gear Up For Outdoors Ltd. are constantly attending Vendor Product Trade shows 6-months to 1-year in advance to assure the most current products are purchased! We try to stock the most current colors, styles, and sizing! Should we be sold out of a particular product our customer service representative will contact you immediately to let you know what other choices are available to you! If there is a particular style, color or size that you may require we can Special Order this product depending upon the availability. Our customer service representative will inform you of availabilities. Special Orders are Non-Refundable. A surcharge will be applied to the product price due to added shipping & handling charges. Gear Up For Outdoors Ltd.
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Flomasta Central Heating Circulating Pump
Flomasta central heating circulating pump provides a flow range volume of 3.5m³/h and accomodates a temperature range of -10 - 95 °C. High quality and long lasting this product is excellent for domestic and general use with a variety of different systems.
- Energy rating - A
- Guarantee - 24 month
- Next Day Delivery . Order by 7pm (2pm Sunday) for next day delivery. (note that this will be subject to different terms and conditions)
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- Keeping your home's heating as efficient as possible helps to save energy.


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Tinderbox Rose Geranium essential oil
Rose Geranium (Pelargoniums: odorantissimum/graveolens) pure, botanical essential oil. 15ml. Floral, liberating, non irritating scent for the home...
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Famous Birthdays Today, October 27: Kelly Osbourne, Charlie Lenehan, Bryan Craig, Theodore Roosevelt, John Cleese, Stephan Elshaarawy, Scott Weiland
Our Top#1 Famous Birthdays Today is for the daughter of Ozzy and Sharon Osbourne, Kelly Osbourne. She is an English actress, singer-songwriter and television star, born in Westminister, London and, from Yareah, we wish her and her special family all the best in this special day. Happy birthday, Kelly Osbourne!
I was dating this guy and we would spend all day text messaging each other. And he thought that he could tell that he liked me more because he actually spelt the word 'YOU' and I just put the letter 'U'.
Kelly Osbourne
They are the only people in the world who I can truly trust and rely on. Touring gets really lonely. I guess I have friends around me but when you're paying them can they ever really be true friends?
Kelly Osbourne
Today is also the birthday of Charlie Lenehan, member of the duo Bars and Melody, born in England in 1998. Happy birthday, Charlie Lenehan!
More famous birthdays today, October 27: Bryan Craig, actor born in Florida in 1991, who played the role as Morgan Corinthos on General Hospital in 2013; Theodore Roosevelt, 26th President of the United States, born in New York in 1858; John Cleese, actor born in England in 1939; Stephan Elshaarawy, soccer player born in Italy in 1992; and Scott Weiland, singer born in California in 1967.
Have a very nice day, dear friends.
A wonderful thing about true laughter is that it just destroys any kind of system of dividing people.
John Cleese
If God did not intend for us to eat animals, then why did he make them out of meat?
John Cleese


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19503 S. West Village Parkway, Venice, FL 34293Request info Add to list
To view building contacts please sign in with your Pro account or create a pro account.
Dan H M.
Company: requires Pro account
Email: requires Pro account
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- Available Spaces
|Space Type
|Office Space
|For lease: $530/mo
|796 sqft
Large reception and 5 offices
|Office Space
|For lease: $840/mo
|1,261 sqft
|Conf. 2
|Office Space
|For lease: $300/mo
|352 sqft
|Conf. 5
|Office Space
|For lease: $300/mo
|298 sqft
|Conf. 6
|Office Space
|For lease: $300/mo
|317 sqft
|Conf. 7
|Office Space
|For lease: $250/mo
|250 sqft
|Suite A1
|Office Space
|For lease: Per Person Pricing
|91 sqft
Building Details:
• Year Built: 1999
19503 S. West Village Parkway is an office property for lease in Venice, FL. The property currently has 7 office spaces for lease and is marketed by HARRY ROBBINS ASSOC INC.
Be one of the initial business in the new 10,000 acre development of West Villages. Located between Venice and North Port. Ground has already been broken for new housing in this development with a new shopping, dining and entertainment area to be constructed with a planned 2018 opening. State Collage of Florida campus is located adjacent to this office park and a future Sarasota Memorial Hospital medical and wellness complex. A new state of the art Spring Training Destination is planned for the Atlanta Braves here at West Villages as well.
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