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Field Fisher Waterhouse (FFW) has won one of its biggest roles yet for Nintendo, landing a lead role advising on the launch of its UK online retail store.
Nintendo was already a client of the firm, with Palo-Alto based partner Phil Lee holding the relationship. The firm's London office is understood to have done an 'informal' pitch for the work, led by senior technology associate David Lewis.
FFW worked alongside the entertainment company's in-house legal team on the website launch, which enables Nintendo to sell directly to the UK market. The majority of Nintendo's in-house lawyers for Europe are headquartered in Germany, with a handful based in the UK. The European legal arm is managed by general counsel Martina Franke.
Managed by relationship partner Phil Lee, FFW's London office advised on all commercial, IP and regulatory matters of the website launch, including negotiating deals with key suppliers and and advising on data privacy issues. Lewis led the team, working alongside e-payments partner Paul Graham, commercial IP partner David Bond, privacy specialist Leonie Power and technology associates Nick Ball and Chris Eastham.
Nintendo's go-to adviser for competition advice in Europe, Hogan Lovells, was on standby for the deal.
FFW is not understood to be on a formal legal panel at Nintendo, which has been known to use Freshfields Bruckhaus Deringer in Germany and Osborne Clarke in the UK.
In 2007 Nintendo of Europe commanded a substantial legal budget of around £1.35m in a console launch year, making the company a valuable but demanding client. It is not known how the business has increased its legal spend since.

subset: commoncrawl


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All in a good cause
I'm delighted to have been asked to support the Pampers/UNICEF Gift of Life campaign. During October, November and December, for every Pampers product pruchased with the '1 Pack = 1 Life-Saving Vaccine' logo, Pampers will provide UNICEF with the funding for one life-saving tetanus vaccine to help protect a mother and baby in need.
The campaign is being backed by the British actress and mum-of-three Natascha McElhone (right). It's such a simple idea – but one that will make a difference to the lives of thousands of newborn babies in developing countries.
You can pick up a packet of Pampers at Tesco, Ocado, Asda, Boots, Superdrug and Sainsbury's.
written by Liz Jarvis
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2 Responses to All in a good cause
Hi Liz, great to see this post. There are a few posts like this today. They are all a great reminder of the campaign.
For me, Pampers has always been the best nappy and, after clicking on the UNICEF website, it's great to know that over the years I've helped towards providing the 44 million vaccines that have come from UK funding alone – and without even lifting a finger. It has to be the easiest way to help less fortunate mothers and their children…
« Do Dads need their own space – and if so, just how much? How to have the perfect playdate… »


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|Is Brad Stevens now the front-runner in NBA coach of the year race?
|04.02.16 at 2:31 am ET
It might be time to call Brad Stevens the front-runner in the race for NBA coach of the year.
After all, his team, missing its most versatile defender on the court, was able to pull off something no other team in the NBA had been able to do since Jan. 27, 2015.
In beating the Golden State Warriors Friday night, 109-106, without Jae Crowder, the Celtics ended Golden State's regular season home win streak at 54 games and gave Stevens the signature win to date of his three-year tenure in Boston. The Celtics became the first team since San Antonio on Nov. 11, 2014 to beat the Warriors in regulation in a regular season game in Oakland.
The Celtics, who improved to 44-32, withstood charge after charge down the stretch from the record-hungry Warriors, who fell to 68-8 on the season. They withstood Steph Curry going off for 21 of his 29 points in the third quarter. Stevens got Thomas involved in the offense early in the third quarter, as Thomas scored his first 18 points of the game in the period. Stevens diagramed play after play, including the game-clincher, an side inbounds from Marcus Smart to Thomas for a layup with 8.3 seconds left in the game.
"It was a heck of a game," Stevens told reporters after the game. "When Curry got going in the third quarter, the biggest moments of the game were us scoring consecutively when he scored because when he got going, that's usually when they run away with a 10-0 run or a 12-0 run. We had to play. Guys had to play really well. We didn't have a guy play poorly. That's what it takes to beat a team like this. They're outstanding."
Perhaps most impressive was the fact that Stevens had his team ready just 24 hours after a 116-109 grueling loss in Portland.
"I think the biggest meaning is the idea that we can bounce back from a night like [Thursday] night where we expended a considerable amount of energy and came up short, flew here, got in late and came to compete again," Stevens said. "I thought that probably the other biggest moment of the game was when we were struggling to score in the second quarter, they weren't scoring a ton and kind of kept us in the game. We were fortunate to win but at the same time, we made a lot of plays to win the game."
|Studs and Duds: Celtics shock Warriors, end longest home winning streak in pro sports history
|at 1:06 am ET
The Celtics pulled off the unthinkable Friday night in epic fashion.
Playing without Jae Crowder, Boston got 22 points from Isaiah Thomas, 21 points from Evan Turner and 20 points and 12 rebounds from Jared Sullinger to lead the Celtics to a 109-106 win over the Golden State Warriors at Oracle Arena, ending the longest home winning streak in major pro sports history.
Steph Curry got a clean look in the final seconds at a potential game-tying three. The shot rimmed out and the Celtics had their best win of the season and the signature win of the three-year Brad Stevens era.
The Warriors, who committed 22 turnovers, had won 54 straight regular season games at home and hadn't lost on their home court since Jan. 27, 2015, when they fell in overtime to the Bulls. The Warriors last lost on their home court in Game 2 of the NBA finals last June to the Cavaliers. The win also avenges Boston's heartbreaking double-overtime loss to the Warriors on Dec. 11 at TD Garden.
It was just Golden State's eighth loss of the season, dropping them to 68-8 on the season. They must win five of their final six games to break the record of the 1996 Chicago Bulls.
The win improves the Celtics to 44-32 on the season and pull to within a half-game of the Hawks (45-32), who lost in overtime to the Cavaliers Friday night.
The Warriors came out gunslinging. Their first three field goals were 3-pointers, racing out to leads of 6-0 and 9-4. But that gunslinging mentality also led to six turnovers in the first six minutes, five of which were committed by Steph Curry.
Thanks to great defense from Avery Bradley, Isaiah Thomas and Marcus Smart, the Celtics were able to hold the combination of Curry and Klay Thompson scoreless until Curry's 3 with 4.3 seconds left in the first quarter, a trey that gave the Warriors a 23-21 lead after the opening 12 minutes. The Warriors finished the first quarter with eight turnovers.
The Celtics were killing themselves at the free throw line, missing six of their first 11 attempts. The Warriors took a 35-28 lead but the Celtics scored the next eight points to take a one-point lead, capped by an Evan Turner three with 3:01 left in the first half. Curry's second three ended the Celtics' run. The Warriors continued their remarkably sloppy play with the ball in the second quarter, committing five more turnovers and 13 for the first half. Avery Bradley's three with 2.3 seconds left in the first half gave Boston a 45-43 lead heading to the locker room.
Curry had just two field goals (both threes) and six points in the first half, while committing seven turnovers.
|Jae Crowder (rest) to sit out against Warriors
|04.01.16 at 8:07 pm ET
As expected, Jae Crowder will not play tonight in Oakland as the Celtics try to stun the Warriors.
The forward returned Thursday in Portland from an eight-game absence due to a high ankle sprain. In his first game back, he collected a double-double with 13 points and 10 rebounds. He will sit out against the 68-7 Warriors to rest his ankle and let the healing continue.
Crowder had indicated Thursday morning in Portland that he likely would not be able to play in back-to-back games and that his preference would be to play the lower-tempo Blazers rather than the high-octane Warriors.
In the first meeting with the Warriors on Dec. 11 at TD Garden, Crowder had 15 points and five rebounds in a team high 47 minutes, 47 seconds of action. The Celtics lost that game, 124-119, in double-overtime.
#NEBHInjuryReport: Jae Crowder (rest) will not play tonight against the Golden State Warriors.
— Boston Celtics (@celtics) April 1, 2016
|Avery Bradley, Celtics look forward to challenge of 68-7 Warriors: 'That's what I play basketball for'
|at 2:08 am ET
Even though they suffered an emotionally draining loss in Portland, the Celtics say they're ready for the biggest challenge of the season Friday night in Oakland.
The 43-32 Celtics will be going up against the 68-7 Warriors, who are in the midst of an NBA-record 54-game home winning streak, including a perfect 36-0 this season.
"It's fun. That's what I play basketball for every single night — to go up against the best players," Avery Bradley said after Thursday's 116-109 loss in Portland.
The last time the Celtics and Warriors met, Golden State was on another amazing streak. Heading into their Dec. 11 meeting at TD Garden, the Warriors had won 23 straight to open the season. They extended the streak to 24 but barely, outlasting the Celtics, 124-119, in double overtime. Steph Curry scored 38 points while Draymond Green added 24 as the Warriors improved to 24-0.
That streak ended the next night in Milwaukee but the Celtics made their case that they were legit this season.
Now, Isaiah Thomas takes one look at the Eastern Conference standings and sees more urgency. Thursday's loss dropped Boston to sixth place, a game behind the Heat and the Hornets in the loss column.
"We've got to win," Thomas said.
|Brad Stevens on Stephen Curry's amazing 3-point skills: 'It's why the game is great'
|02.29.16 at 7:30 pm ET
When he wasn't jumping off trampolines and dunking or rebounding shots for his 10-year-old son Brady this weekend, Brad Stevens was joining his son and his friends in watching the amazing feats of Stephen Curry Saturday night.
In a performance for the ages, the amazing shooting guard for the Golden State Warriors made 12-of-15 from 3-point range Saturday night in an overtime win at Oklahoma City. The coup de grace was Curry's pull-up 32-foot three that was the winning dagger in the 121-118 Warriors' victory.
"My son had two friends sleeping over and we were all watching the game," Stevens said. "It was great. It was great as a fan to watch and see. I've gotten a chance to grow up and see some of the greats play and see some of the greats make plays. It was fun to watch a group of 10-year-olds react to all those shots and react to all those things going in. It's why the game is great."
Stevens has always been a fan at heart of the game. When he played at Zionsville High in Indiana, he wore No. 31 in tribute of his favorite player, another 3-point wizard by the name of Reggie Miller.
Curry's game-winner Saturday reminded everyone watching that his range is literally anywhere across the timeline, something that is rare. Has Stevens ever coached against something like that?
"Twice a year, twice a year since I've been here," Stevens said of Curry, who he will see again in Oakland on April 1. "Very, very few guys. I think the amount of difficulty he hits shots with is incredible."
While Curry is by far the leading MVP candidate in the league this season, there are others that are having remarkable statistical seasons, including Anthony Davis and Russell Westbrook, both of whom enter Monday's action averaging double-doubles so far. Westbrook is averaging 24.4 points and 10.2 assists while Davis is at 24.1 points and 10.2 rebounds.
"It's interesting. There are a few guys, though, that are having incredible years and doing incredible things and not talked about quite as much," Stevens said. "I think the whole idea of range and extending range and widening the court for everybody else with your range, it's in vogue and he's taken it to a new level."
|Report: Celtics trying to trade David Lee – and his contract – before trade deadline
|02.15.16 at 1:48 pm ET
While Celtics players continue to get their rest over the All-Star break, their general manager enters his busiest week of the season. President of basketball operations Danny Ainge is not just listening to offers for his three first-round picks this June while building his roster for a deep playoff run, he's trying to move players.
The biggest challenge this week for Ainge might be what to do with center David Lee. His skills might still be valuable to a team that needs depth in the middle.
And while that would certainly seem to be a perfect fit for the team he's currently on, the Celtics, like every team that has had him, would like to be free of the contract.
Specifically, Lee's cap hit is $15,493,680, is easily the highest on the Celtics and the sixth-highest such figure among power forwards in the NBA, behind the likes of Chris Bosh ($22.1 million), LeMarcus Aldridge ($19.6 million), Kevin Love ($19.6 million), Blake Griffin ($18.9 million) and Paul Millsap ($18.6 million).
Lee has started just four of 30 games this season, averaging just 7.1 points and 4.3 rebounds while shooting a career-low 45.3 percent from the field. He hasn't played since Jan. 10 at Memphis and has been a DNP for the last 18 games.
Now 32, Lee is in the final year of a six-year, $79.5 million deal he signed with the Knicks in 2010, using the Bird exception. The Boston Herald reports that Ainge is unlikely to move Lee before Thursday's NBA trade deadline.
"David Lee was tough for Golden State to move all of last year," the Herald reported, citing a league source. "And it finally came down to him being moved for Gerald Wallace. David Lee has no value. It's his contract. David Lee's value comes in if they get one of these big name players."
The Celtics acquired Lee and his expiring contract last summer from the world champion Golden State Warriors, sending Gerald Wallace and Chris Babb to Golden State. If Ainge can't move Lee, the forward could accept a buyout from the Celtics by Mar. 1, allowing him to sign with another team in time for the playoffs.
|5 things we learned as Celtics nearly stun Warriors
|03.01.15 at 8:24 pm ET
The Celtics are holding their own against the NBA's elite.
Less than three weeks after beating the Eastern Conference-leading Hawks, the Celtics gave the West-leading Warriors all they could handle, establishing a 26-point first-half lead in front of a raucous home crowd before Golden State chipped away and crumbled their hosts, 106-101.
Once again, Isaiah Thomas ignited the C's scoring effort with 20 points — missing a 3-pointer that would have tied the game in the final seconds — to go along with five assists in 29 minutes off the bench. Tyler Zeller's 17 points led all five Celtics starters in double figures, followed by Brandon Bass (15 points, 12 rebounds), Avery Bradley (12 points), Marcus Smart (10 points) and Evan Turner (10 points). Jae Crowder added 17 rebounds and nine points off the bench.
Still, it wasn't enough to overcome a Warriors team that owns the league's best record (46-11) and features MVP favorite Stephen Curry, who netted 37 points to lead all scorers. Meanwhile, the Celtics drop to 23-34 and remain on the outside looking in on the East's eighth and final playoff seed.
For a complete box score, click here.
Since taking a 5-4 lead 1:55 into the game, the Celtics held the Warriors at bay longer than anyone expected, but it was only a matter of time since the league's top-scoring team got back in the game. Over the course of 12 minutes from the end of the third quarter to late in the fourth — as Shaun Livingston gave them a spark off the bench, Green heated up and Curry remained on fire — Golden State outscored the Celtics 32-15 to grab their first lead since the opening minutes.
If the Celtics have any hope of making the playoffs, it'll be their improvement on the defensive end that will make the difference between a first-round series and a lottery pick. Six games after holding the Hawks to 42.3 percent shooting, the C's held the Warriors to 42.1 percent — not an easy task two of the game's most prolific shooters. Curry and Klay Thompson (20 points) were always going to get their points, but the C's built their lead by holding Golden State's frontcourt — Draymond Green, Harrison Barnes, Andrew Bogut, David Lee and Andre Iguodala — to combined 4-of-20 shooting in the opening 24 minutes. That's especially impressive considering the Celtics are sans Jared Sullinger and Kelly Olynyk.
Quite simply, Thomas has been a dominant offensive force during his Celtics tenure, anchoring a unit that scored 117.9 points per 100 possessions during his first four games in Boston. Even more impressive, he owns a usage rate of 35.4 percent, meaning more than a third of the C's possessions are running through Thomas when he's on the floor. His 58.2 true shooting percentage during that four-game stretch would rank among the NBA's best guard over a full season. Sunday night was no different, as his 15 points before the break led a 65-point first-half for the Celtics. He cooled off in the second half, finishing just 8-of-21 from the field and missing eight of his 11 3-point attempts, but his presence remains a revelation.
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Signs are important infrastructure assets—they tell residents and visitors how to get from here to there, alert them to possible danger, and impart other vital information that could keep your department out of litigation. Sometimes, though, they can be a cause of complete and utter confusion—and amusement.
Got some funny or strange signs of your own? E-mail your photos to me at email@example.com— Jenni Spinner


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Mobile App
HGAE Thrissur
Holy Grace Academy of Engineering
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Holy Grace Academy of Engineering is situated at Mala, Kuruvilassery (po), Thrissur Dt, Kerala, India, Pin 680732 in Thrissur.
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Holy Grace Academy of Engineering - HGAE Thrissur - HGAE
The Holy Grace Academy of Engineering situated at Mala, Thrissur, amidst a lush green ambience, offers the perfect setting for a learning environment that is truly inspirational. The B.Tech program it offers is affiliated to Calicut University and approved by AICTE. It is a complete industry endorsed package with the university syllabus at its core and all that the industry needs strategically bound around as super competency add-on modules. In terms of content and design, the B.Tech program of Holy Grace Academy of Engineering is packed with many specialities and differences. A stress on innovation is the foundation of the programme which will help students to equip themselves with creative thinking and idea generation as well as about the practical aspects of translating those ideas into practice. The vision of ABCIET is to be the leading centre of learning and innovation in emerging areas of business and management education. For every course the college imparts practical training to its students that helps them to understand better, improve their demonstrative skills, eliminate hesitation and in this process strives to mould them into industry ready professionals. Mission of ABCIET is 'to foster critical analysis by training students both in theory and practice so as to equip them with skills needed for facing global challenges with team work and human values. And to build quality network with the Industry, educationists and the society for exchanging knowledge'. The modern teaching methodology assists the students in getting an all around view of engineering, technology and the entrepreneur world. The diligent faculty team of the college possesses hands-on experience and up to date knowledge of their subject and area of expertise.
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Holy Grace Academy of Engineering Placements
The placement cell of the Holy Grace Academy of Engineering is equipped to offer students the necessary skills to ensure placements in reputed national and international companies. The division concentrates on giving the students a thorough level of knowledge on handling the complex interview process of various companies who will test their knowledge levels and industry exposure.
Visiting Companies
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The institution offers a voluminous library with innumerable reference books and periodicals. Students can avail the services of the E-library which brings you in touch with more than 200,000 volumes of e-books and other publications. Annual Fest on innovative trends in the technical field in order to keep the students up to date with the latest technological developments. The Hostel is situated within the campus and emanates a family atmosphere. The residents of the hostel are offered remedial classes coupled with regular spoken English sessions. Transportation is provided to Ernakulam, Thrissur, Guruvayoor, Iringalakuda, Paravoor, Chalakudy, Angamali, Vypin etc. There are AC buses on select routes.
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O You That Hear This Voice
By William Byrd
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Soprano, Alto, Bass, Optional Keyboard
Composed by William Byrd (1540-1623). Arranged by Russell L. Robinson. Octavo. Duration 1 minute, 45 seconds. Published by Carl Fischer (CF.CM9213).
Item Number: CF.CM9213
Russell Robinson has arranged this William Byrd consort song for SAB chorus with an optional keyboard part,and a bass part constrained to only one octave, making this arrangement appropriate for groups at various levels. This melancholy song of solemnity and piety from the 16th century is perfectly suitable for concert or festival. Duration: 1:45.


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Joe began his story:
"When we were younger, we were all given a medallion. Mine was blue, Del's was green, Coral's was purple, Sam's was yellow, Sookie's was red and Dil's was multicoloured, with Gagamot's being black.
"We were all told we had powers, just like you'se have, and we were all excited. Having powers, being magic. It was over whelming. Then we were told about the fight.
"Being powerful had it's responsibilities, and I don't think we were ready for them - well Gagamot anyway. He missed most of the classes and didn't really take it that seriously. That drove Dillon mad.
"Then when we faced .... when it was time, we went, without all our training. We thought we were ready but we wasn't. At the last stand, Gagamot left us, and we failed.
"Our powers have faded now, and only a strand is left in us - enough to teach you lot. We were scared at first. Generation after genereation passed us, and still there was no sign of another seven. But then you came - only six this time. I see nature has changed it's mistake.
"We have kept track of Gagamot, as best as we could. It's a bit hard, under the circumstances with his power making him the master of the shadows. But our sources have informed us that he is helping the bad side.
"And that's what I've come here to tell you today. Our scout team, have just sent us a message, saying that it seems Gagamot is searching for something. We don't know exactly what yet, but we know its not good.
"If he finds what ever he finds, he's surely going to pass it over to the bad side, which will surely only make them more powerful, other wise they wouldn't want it. That's where you come in.
"We need your help, into researching what it is, and finding it before they do. Your the only ones that can, by standing together to use your powers. Find it before he does, and we may stand a chance."
He coughed, and then fell silent. I didn't know what to make of it; it was a lot to take in. I looked at everyone, and saw even Willow had a bewildered look on her. So he hadn't told her this part. Joe looked at us closely, and then sighed.
"I guess, the best thing to say know is, have you got any questions?" he asked.


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* 3 Open Box items are available and will be eligible for a discount of 10%, except laptops, televisions & clearance products. Not applicable to Demo items. See in-store for details.
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Today!:The Beach Boys
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Artist: The Beach Boys
Date Released: March 8, 1965
Label: Capitol
Produced By: Brian Wilson
- Do You Wanna Dance?
- Good To My Baby
- Don't Hurt My Little Sister
- When I Grow Up (To Be A Man)
- Help Me, Ronda
- Dance, Dance, Dance
- Please Let Me Wonder
- I'm So Young
- Kiss Me Baby
- She Knows Me Too Well
- In The Back Of My Mind
- Bull Session With Big Daddy


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Author's Note: This is my very first fic I have written, so go easy on me. It's basically a work in progress about the Kindred of Roanoke, focusing on a core cast of protagonists. The setting is Roanoke, VA(Including Roanoke County and the City of Salem), though in real life, there is no Goth Nightclub called Club Saturn.
This fic ignores the Revised Era Metaplot, so Gangrel are still part of the Camarilla, and the Time of Judgment never happened. Think of it as a reboot of the continuity, if you will.
World of Darkness belongs to White Wolf, not me.
Chapter I: Club Saturn
The flashing lights and loud Electro music echoed throughout Club Saturn, the hottest nightclub in the Valley. The dazzling colors of the strobe lights starkly illuminated the dark walls beautifully, and many young club-goers, mostly Goths and college kids danced to the music emanating from the DJ's Booth. Near the bar was Takeru Kojima, a young man of Japanese parentage, but was raised in the Roanoke Valley. Takeru was somewhat tall, around six feet, unusual for a man of his age and ethnicity, though he was very thin and delicate-looking. He had long black hair, with blue streaks, and his feminine face made him look like a stereotypical bishounen from some anime flick. He was clad in a black leather jacket, a Mayhem T-Shirt, gray jeans, biker boots, sunglasses, and fingerless gloves.
Takeru had been one of the Damned for ten years now, nine steps removed from Caine, and bearing the Brujah blood. He suffered the Embrace to a female Brujah named Shannon, one of the trusted members of her Clan. Takeru never really cared for vampiric politics, but felt an undying sense of loyalty and brotherhood to his sire, as well as his clan as a whole. Given that the Brujah were a clan of warriors and thinkers, Takeru would be willing to die for his clan and the Camarilla as a whole, and always carried a large hunting knife with him. He treasured the sharp, shining steel blade, though he had fortunately never needed it, at least not yet.
He stood impatiently, waiting for the Prince to call forth the meeting of all vampires in the city, of every Clan and bloodline, to come to the Elysium, the safe haven behind Club Saturn. Eyeing a beautiful Goth girl, he licked his lips. Apart from her marvelous and flawless body combined with beautiful black clothing and silver jewelry, Takeru eyed her for another reason. She would provide nourishing blood and a most wonderful ecstasy from the feeding, known to Kindred as The Kiss.
Sadly, he had to wait. He couldn't bite into the girl's neck in a club full of mortals. The first tradition of his kind was The Masquerade, he must never reveal his true nature to those not of the blood. If any mortals knew he was a vampire, it would be Final Death for him. He never liked Club Saturn's music, though the atmosphere was nice. Takeru never cared for Electro and outright hated Gothic music. He preferred Classic Rock, Heavy Metal, and occasionally a bit of Classic Country. He was a Rocker and a Metalhead, and to him, Goth music was only behind Hip-Hop and Alternative Rock in terms of wretchedness. But, he had to endure the cacophony while waiting for his sire.
Then from the sea of club-goers, colored lights, artificial fog, and loud music arose Shannon. Shannon was Takeru's sire, a thirty-something brunette who made him the creature he is today. Her hair was a dark brown, and her eyes a dull green. She dressed casually, usually just a denim jacket, T-Shirt, and black jeans. She was Takeru's superior, and she was always straightforward and brutally honest.
"Mr. Kojima, I presume?"
"Yes, Miss Callahan. Is the meeting ready?"
"Soon, my child, but we must head out now. The Prince says it is urgent."
And so the plain brunette and the bishounen metalhead left the club floor and headed up a dark, semi-hidden staircase towards the office of the Prince of Roanoke.


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12595 Camwood Trail, Baxter, MN 56425
About the Listing
Great 4 bed/ 2 bath home in a great Baxter neighborhood! Home features 4 bedrooms on one level Large living room, lower level family room and rec room, main level laundry-mud room off the oversized 2 stall attached garage. Large kitchen features plenty of countertop and cupboard space, dining room features a built-in hutch and a patio door that walks out to a deck over looking the backyard. All this on a 1.73 acre lot make this a great home for those looking for a little more room!
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Property Details for 12595 Camwood Trail, Baxter, MN 56425
Bedrooms: 4
Bathrooms: 2 Full
Lot Size: 1.73 Acres
Lot Dimensions: 243x300x256x301
Year Built: 1990
Garage Dimensions: 2 car
Garage: Attached Garage, Driveway - Asphalt, Garage Door Opener
Style: (SF) Two Stories
Water: Well, 4-Inch Submersible, Drilled
Sewer: Private, Tank with Drainage Field
Square Feet: 3126
Above Ground Sq Ft: 2352
Below Ground Sq Ft: 774 (approx)
Room Information for 12595 Camwood Trail, Baxter, MN 56425
Main Floor
Living Room: 12.8x27.3
Dining Room: 12.5x13.5
Kitchen: 12.5x17
Office: 11x13.7
Laundry: 16x6.8
Lower Floor
Family Room: 12x26
Recreation Room: 13.2x19
Utility Room: 12x23
Upper Floor
Bedroom 1: 12.6x17.2
Bedroom 2: 10.3x13.8
Bedroom 3: 12x13.4
Bedroom 4: 12x9.8
Dining Room Description: Breakfast Area, Kitchen/Dining Room
Family Room Characteristics: Lower Level, Family Room
School Information for 12595 Camwood Trail, Baxter, MN 56425
School District: Brainerd
School District Phone: 218-454-6900
Interior Features for 12595 Camwood Trail, Baxter, MN 56425
Appliances: Range, Exhaust Fan/Hood, Dishwasher, Refrigerator, Washer, Dryer, Water Softener - Owned
Air Cond: Central
Heating: Forced Air
Fireplaces: Yes
Basement: (774 sq Finished) Full, Partial Finished, Concrete Block
Exterior Features for 12595 Camwood Trail, Baxter, MN 56425
Lot Description: Tree Coverage - Medium
Lot Dimensions: 243x300x256x301
Roof: Asphalt Shingles, Pitched
Zoning: Residential-Single
Financial Considerations for 12595 Camwood Trail, Baxter, MN 56425
Tax Amount: $2,439
Taxes w/Assessments: $2,454
Tax/Property ID: 033450010010009
Tax Year: 2016
Monthly Payment = $0
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José Olé has a great new offer for the holidays! You can print a $2 off coupon for yourself, and for every coupon printed, they will donate $2 to Children's Miracle Network Hospitals. What a great way to save and give at the same time! One coupon per household. Can't be combined with any other … Read More →
New P&G GIVE Education Mail In Rebate
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How You Can Help Tornado Victims
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DonorsChoose.org: FREE $15 Gift Code to Help a Classroom
Want to help out a public school classroom in the United States without spending any money? For a limited time, text Possible to 77177, then reply with your zip code and you'll get a FREE $15 DonorsChoose.org gift code to support a classroom of your choice! Once you get your code, simply choose a classroom … Read More →
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McCourt Construction Company Inc.
60 K St Ste 2 Boston, MA 02127-1617
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Jennairreplacementparts.com is a 1 year old domain.
It was registered by Domain Administrator , who can be reached at . The site is owned by Maytag Properties, LLC. Registration details show that it was registered on 08 Jan 2016 through Corporation Service Company and will expire on 08 Jan 2017.
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Watch Denpa Onna to Seishun Otoko
You are viewing Episode list with English Subbed. Navigate the episode to watch the video..
Total of Episodes: 13
Genres: Comedy, Romance, Aliens ,
Plot Summary: Makoto Niwa is a high school boy who, since his parents are away on business, lives with his aunt's family. It is there he meets his mysterious cousin of the same age Erio Touwa—who happens to tie a futon around her upper body and is a self-proclaimed alien. Her staple food is pizza. Erio had been missing for half a year and was found floating in the sea. She doesn't remember anything about what happened during that period of time, but she began to think that it was the act of an alien and wanders the neighbourhood wrapped in the futon.
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Aboriginal Cultural Education. PROGRAM VISION "to provide support for Aboriginal communities, through a culturally inclusive learning environment". Welcome to Country. Uncle Des Dyer of the Darug Nation Secretary of the Darug Tribal Aboriginal Corporation.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Aboriginal Cultural Education
PROGRAM VISION"to provide support for Aboriginal communities, through a culturally inclusive learning environment"
Uncle Des Dyer
of the Darug Nation
Secretary of the
Darug Tribal Aboriginal Corporation
Unit 1 -Demonstrate a general understanding of traditional Aboriginal cultures and cultural diversity
Unit 2 -Identify impacts of colonisation on current issues of service delivery to Aboriginal people
Unit 3 -Demonstrate protocols and processes to collaborate in genuine partnerships
Demonstrate a general understanding of traditional Aboriginal cultures and cultural diversity
Due Date: 18th June 08
Aboriginal Education & Training Unit
Miller College, South Western Sydney Institute TAFE
Cnr Banks & Hoxton Park Rd, NSW 2168
Phone: (02) 9825 7429
Fax: (02) 9825 7458
Mob: 0430 040 144
E-mail: email@example.com
Section 1 - Living and Lifestyle
Activity 1
In your groups briefly discuss;
Then draw an ideal community map on the paper provided.
Examples of services you may need in your community
Activity 2.1
In your group's folder ;
Region of Australia
On the opponent side of your community drawing
List the unique attributes to this area prior to 1788 (First Fleet)
Four topic areas to cover ;
Activity 2.2
Region of Australia
With the other half of the page
List what do you think consisted in the day to day life for Aboriginal people in that environment?
Three topic areas to cover ;
Activity 2.3
Region of Australia
On the side of your community drawing
Morning Tea
Aboriginal Australia ;
There are 500 different
Aboriginal language
groups and nations.
General characteristics:
Three Nations in the Southeast region:
Evolution Activity – Aboriginal English
Aboriginal English
Hey! Bra see the goldfish?
Them no goldfish
Yes they are!
I see their Beady eyes
ABR, C DA Goldfish
M NO Goldfish
IC, D BD I's
Welcome To Country
"Welcome to Country ceremonies is a right of the local Aboriginal Custodians not a privilege"
Knowing the Protocol
In the past,
It's been common practice to acknowledge the Aboriginal Local Land Councils as the custodians of the land.
However, Aboriginal Local Land Councils are organisations setup to aide with capacity building for Aboriginal people and in most cases are
Aboriginal Local Land Councils can be used as a gateway to get in contact with the custodians of the land
Acknowledgement of Country
"Acknowledgement of Country" is a way that the wider community can demonstrate respect for Aboriginal protocols and can be performed by anyone that is participating in any event
Examples of "Acknowledgment of Country" could be:
Example 1:
I would like to show my respect and acknowledge the traditional
custodians of the land, of elders past and present, on which this
meeting takes place.
Example 2:
I would like to acknowledge the _____________ people who are
the traditional custodians of this land. I would also like to pay respect
to the elders both past and present of the _______________ nation
and extend that respect to other Aboriginal people present.
Source: Welcome to Country and Acknowledgement of Country: Guidelines and Protocols for NSW Public Schools and TAFE NSW Institutes.
WARNING:New GovernmentFINGERNAIL POLICY
Removal of community members with fingernails
Getting it Right - Referencing
Getting it Right - Referencing
Terms Aboriginal peoples use,
What Do You Use?
If unsure,
Use generic terms such as "Aboriginal"
until you confirm what's most appropriate.
There is no harm in asking!
People are generally happy to respond to
questions if they are asked respectfully and
'As a general rule' – only use the terms you
have personally checked out with people
that you know and have a relationship with.
Role of Elders and Darug History
Role of Elders and Darug History
Uncle Des Dyer
of the Darug Nation
Secretary of the
Darug Tribal Aboriginal Corporation
WARNING:New GovernmentHAIR POLICY
Removal of community members with lighter coloured hair
(cannot be a member from the Fingernail Policy)
Dreamtime and Dreaming
The expression 'Dreamtime' is most often used to refer to the 'time before time', or 'the time of the creation of all things',
'Dreaming' is often used to refer to the current and unbroken link that Aboriginal peoples have with creation
Law & Lore
"The Spirit Ancestors of the Dreaming set down
the Law governing Aboriginal peoples."
"Aboriginal lore is the learning and transmission of
cultural heritage."
Kinship System (NT model)
Aboriginal Kinship is a multi-level system which
identifies cultural subgroups;
Kinship systems enable:
WARNING:New GovernmentMISSION POLICY
Only two communities may operate
In a moiety system the society is divided into
two halves.
Every thing in a person's moiety is regarded as a 'relation'.
Skin Group - It is a highly complex structure, in
some cases going into 16 generational levels.
The skin group determines:
Exploring Aboriginal Kinship
Episode 2
Aunt can only be your father's sister.
Uncle canonly be your mother's brother.
The mother's sister is called "mother" as well, and not "aunt".
The father's brother is called "father", not uncle.
Ego calls his/her mother's sister - "mother", he will obviously call herchildren "brother and sister", and not cousin.
The same is true for your father's brother's children.
The only persons called "cousins" are the children of your Mother's Brother and your Father's Sister.
Afternoon Tea
219 Years Has Past In Your Two Communities
Government Plan - Community Reconstruction
Communities Consultation
Activity 3
The facilitator has been ask to conduct research on the local communities.
What's your first community?
What's your community name?
What was some of the activities you did as child in your community?
What was some of the activities you did as an adult in your community?
Genocide by Another Name
Assimilation Series
Rapid WriteQuickly write for 3 mins (without your pen leaving your paper) about today's community exercise
Aboriginal Cultural Education
"From each, according to his abilities, to each according to his needs" Karl Marx (1875)


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Holiday Inn Express Hotel & Suites Catoosa
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
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- Suites
- Free High-Speed Internet
- Continental Breakfast
- Swimming pool
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TripAdvisor Reviews Holiday Inn Express Hotel & Suites Catoosa
Travel Blogs from Catoosa
Arriving in Oklahoma & the Tulsa State Fair
... horns! Welcome to Oklahoma :) Passed through Weatherford home of astronaut Thomas Stafford. Saw our first oil related industry and the subs back out 72 degrees! Arrived at our b & b for the night in Tulsa and the suns! Spent the afternoon and evening at the Tulsa State Fair and saw our first rodeo including steer wrestling, barrel racing and bull & bronco ...
Tulsa - Oklahoma
... pesymistyczne zalozenia, mniej niz optymistyczne ( pesymistyczne zazwyczaj mieszcza sie w granicach zera ). Dzisiejszy dzien cos we mnie zmienil. Pomimo bycia w wielkiej niewiadomej ucze sie tym specjalnie nie przejmowac. Przestalem snuc czarne wizje. W pewnym sensie to zmiana mojego charakteru, gdyz normalnie przejmuje sie najmniejszymi pierdolami ...
Iceland 2015, 2.0!!
I know! We are crazy! But we had such an amazing time in Iceland in February we decided to go back in the summer to see the country without all the snow, ice, and cold! This time of year Iceland is an amazing green and much warmer. It's like the difference of going to mountains during ski season and going in the summer! Same place but two totally different and ...
Tulsa Route 66
We left Tulsa today to start our adventure on Route 66 after a quick trip to Catoosa to see the whale we came back to see the sights of Tulsa. There are several neon signs and some Art Deco buildings. One of these bushings is the blue some gas ...
Friday the 13th
We had a good night's sleep. Miss Pat has everything organized and put in its place. We sat around and sipped on our morning coffee. We finally got the energy to get dressed and start our day. First stop was JT's stalls to pet the ponies, then Bed Bath & Beyond, followed by Cracker Barrel and a trip to Wal-Mart. What ...


text: The Takeaway Published by The Takeaway Musician Terence Blanchard uses jazz to rebuild New Orleans Download this audio Want to embed this player? Use the code below. More info. <iframe frameborder="0" scrolling="no" height="130" width="100%" src="https://www.wnyc.org/widgets/ondemand_player/takeaway/#file=/audio/json/8067/&share=1"></iframe> Share on Facebook Share on Twitter Email a Friend Terence Blanchard is a prolific composer and musician. He's written film scores for over thirty movies including, "Malcolm X", "When the Levees Broke: A Requiem in Four Acts", "Inside Man" and "Miracle At St. Anna", Spike Lee's upcoming film about the lives of four African-American soldiers fighting in World War 2. Three years ago Blanchard was working on the score of "Inside Man" in Los Angeles when he turned on the television and saw hurricane Katrina hit his home city of New Orleans. Recovering from the disaster and rebuilding and reinvigorating the Crescent City has been his passion ever since. Terence Blanchard joins The Takeaway on the eve of the third anniversary of Hurricane Katrina hitting New Orleans, to talk about how he's using music to rebuild the city he loves.Guest: Terence Blanchard, trumpeter, bandleader, arranger, film score composer, artistic director of the Thelonious Monk Institute of Jazz Performance at Loyola University in New Orleans and New Orleans native


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Research Question: Is nuclear power a viable solution to global warming?
Example Keywords:
Example Articles found Performing Search across All EBSCOhost Databases:
When accessing our databases from off campus, you'll be asked to login. Type your Madison College username and password to access the databases from off campus.
This is the same username and password that you use for student email, blackboard, myMadisonCollege, etc.


text: This pages Zoom slider/button doesn't work in W7 like in XP This page's zoom slider/button doesn't work in W7 like in XP: Cell Size and Scale There is a slider button below the picture that is suppose to zoom the picture as you move the button to the right. It works on my XP Pro computer but not on my new Dell Studio 15 laptop. .... If you get that wonderful page to work you will understand why I want it to work for me. Guidance will be appreciated, .... Stan Hilliard ..... I don't know why my paragraphs run together on this site. Is there a setting that I don't know about?


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Konoha Comrades!!
6,321pages onAdd New Page
this wiki
this wiki
|"Konoha Comrades!!"
|(木ノ葉の仲間!!, Konoha no Nakama!!)
|Chapter Info
|Itachi and Sasuke, Brothers (#25)
|"For the Sake of Those Precious"
|Naruto #218
|"Future and Past"
|Sasuke Recovery Mission
|Naruto #128
Sasuke tries to ignore Naruto and continue on to Orochimaru. Remembering Sakura's earlier failure to persuade Sasuke, Naruto asks why he would turn away from everything and everyone in Konoha. Sasuke responds that he owes them nothing and has finished his business with the village. When Naruto attacks him in anger, Sasuke adds that he didn't become any stronger by staying in Konoha. Orochimaru can give him the power he desires. Naruto reminds him of Orochimaru's actions and his intents to take Sasuke's body. Sasuke does not care, so Naruto promises to bring Sasuke home by force if necessary.


text:
Mighty Red Membership
I've been an extra good Liver bird recently and made sure that I have tidyed my room, done all of my homework on time and eaten all of my veg, and I've done it all for one reason….. so that my Mum and Dad will renew my LFC Official Membership for 2016/17!
I was so excited when my Dad went online last night and signed me up for an LFC Official Mighty Red Membership. Now I just have to wait for my Membership pack to arrive in the post, it's got lots of cool stuff in it. I can't wait to be able to use my lunch tin, water bottle and pencils at school and show all my mates that I am LFC's number 1 fan. I might share some of my stickers with my class mates, but the door plaque is definitely going on my bedroom door, so that my sister Ruby Red knows that it's my dressing room!
I can't wait for the season ahead, I hope I get invited to loads of exciting events like last year, from the Membership Christmas Party to the Junior Soccer School, 2015/16 was a boss season and I can't wait for more of the same!
Whether you're a 'Little Liver', a 'Teen Red' or part of the 'Mighty Red' age group like me, there is a junoir Membership to suit fans of all ages, plus they all come with a fantastic Membership pack and benefits that will last all season long.


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Boulder, CO: Monday Sprints - de Ronde van Valmonte, North-South Short LoopA short, quick 7.75-mile lunch loop to get the legs opened up after the weekend.
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Mike Brikowski
this wiki
|Powerpuff Girls? Hey, let me tell you something, Perez. Those girls are lousy good for nothings.
|~ Mike Brikowski telling Perez about the Powerpuff Girls.
Later, he tricks the Mayor into calling the Powerpuff Girls, and when they arrive, Brikowski tricks them into entering a place with confiscated super-weapons. He uses a gas gun to put the Girls to sleep and threatens to drop them into a vat of acid, crossing the Moral Event Horizon for making the police look bad, but Blossom says that's not true. He is then arrested by the other police, including the Chief and his old partner, Perez. Perez tries to stop the crane, but he fails and the Girls are doused in the acid. Luckily, the Girls survive due to their super-powers. As he is being taken to jail, Brikowski claims he's a good cop gone bad, though Blossom points out that he's a bad cop gone worse, much to the narrator's amusement, who tells him he won't get any donuts while serving time in prison.
- It is hinted that Brickowski also shoplifts, since almost all the things in his apartment still have tags on them.
|Powerpuff Girls Villains


text:
|Home | About | Journals | Submit | Contact Us | Français
Stroke caregivers often express the need for information about stroke and assistance with stroke-related care in the early discharge period. The Telephone Assessment and Skill-Building Kit (TASK) is an 8-week program that addresses caregiver needs. This study explored the efficacy of the TASK program in improving stroke caregiver outcomes.
Guided by a conceptual model, 6 outcomes (optimism, task difficulty, threat appraisal, depressive symptoms, life changes, general health perceptions) were measured in 40 caregivers randomized to the TASK (n = 21) or an attention control group (n = 19). Data were analyzed using analysis of covariance (ANCOVA), controlling for baseline scores and minutes spent with the nurse.
Significant increases in optimism at 4 weeks, 8 weeks, and 12 weeks were found, with medium effect sizes for the TASK group relative to the control group (p < .05). Significant improvements in task difficulty at 4 weeks, and threat appraisal at both 8 weeks and 12 weeks were also found (p < .05).
Caregivers receiving the TASK intervention improved in optimism, task difficulty, and threat appraisal. Further testing of an enhanced version of the TASK program is warranted, with attention directed toward more distal stroke caregiver outcomes.
Stroke is a leading cause of serious long-term disability.1 Because of disability, 68% to 74% of stroke survivors require the care of family members.2,3 These family caregivers need to quickly learn how to assist stroke survivors with a variety of impairments (including motor, sensory, visual, language, cognitive, and affective),1,4 while adapting to the changes in their own lives as a result of providing care.5–9 Caregivers' needs are often not met because of inadequate training from health care providers.6,10,11 Such unmet needs can increase caregivers' stress, strain, and risk for mortality,12 as well as impede the rehabilitation of the survivor13 and increase the survivor's risk for costly, long-term institutionalization.13
Many authors recommend that future interventions focus on meeting caregivers' specific needs.6,14–19 Clinically tested interventions should help caregivers gain skills that would help them avoid negative caregiver outcomes. The purpose of this study was to determine the preliminary efficacy of the Telephone Assessment and Skill-Building Kit (TASK), an 8-week intervention program that assesses caregivers' unmet needs and helps them to obtain needed information and skills in the early discharge period.
Assessment of stroke caregiver needs from the caregiver's perspective is increasingly emphasized in the literature,6,18,20,21 as well as in current patient care guidelines for stroke rehabilitation.22,23 These guidelines22 recommend that health care providers involve family caregivers in making decisions and planning treatments for survivors, be alert to the stress and support needs of caregivers, provide information on community resources and services, and provide patient and family caregiver education about stroke and potential complications. Despite these recommendations, family caregivers are commonly neglected by health care providers in the practice setting6,10,11 and, as a result, experience a variety of unmet needs.6,20
Integrative reviews suggest that skill-building interventions are more helpful than psycho-educational support interventions.17,24–26 Stroke family caregivers have needs for building skills within a variety of areas. Caregivers desire more information about warning signs of a second stroke, risk factors, and recommended lifestyle changes.6,27 Managing emotions and behaviors in stroke survivors is among the most stressful aspects of providing care and contributes to caregiver depressive symptoms.5,21,28,29 Needs and concerns about providing physical care include such things as assisting the survivor with activities of daily living, managing symptoms and deficits, and managing medications.5,6,30 Providing instrumental care includes dealing with financial issues, providing transportation, assisting with household tasks, as well as finding someone to care for the survivor while the primary caregiver is away.5,6,21 Finally, caregivers commonly neglect their own needs, including dealing with their emotions and depressive symptoms, shouldering new responsibilities, balancing caregiving with existing responsibilities (e.g., employment), asking family and friends for help, keeping their social life going, as well as keeping their energy level up and taking care of their health.6,21
Caregivers with unmet needs can experience depressive symptoms, negative life changes, and poorer physical health. These depressive symptoms can be associated with added strain, which has been shown to be a risk factor for caregiver mortality.12 Estimates of the prevalence of depressive symptoms in stroke caregivers range between 30% and 52%,13,31,32 with the poorest mental health occurring when survivors are discharged home early.33 Factors associated with caregiver depressive symptoms include difficulty with caregiving tasks, high threat appraisal, and negative life changes.5–9 Tasks most difficult for caregivers include managing finances, managing the survivor's behaviors, and providing emotional support to the survivor.5 Negative life changes include lack of time for family and friends and worsening emotional well-being, physical health, and financial well-being.8,9 The wide variety of unmet caregiver needs (e.g., obtaining information, managing emotions and behaviors, providing physical and instrumental care, dealing with personal responses) that contribute to negative caregiver outcomes (e.g., difficulty with tasks, high threat appraisal, depressive symptoms, negative life changes, poor health) underscore the need for multicomponent caregiver interventions in this population.
Research has not produced sufficient evidence on stroke caregiver interventions that can be easily incorporated into practice.10,13,18,23,25,34 Visser-Meily and colleagues18 identified 22 studies in that area from January 1966 to March 2003; in updating their review to December 2008, five additional studies were found.35–39 Out of the total of 27 studies reviewed,18,35–39 only 13 (48%) reported positive results on one or more outcome measures. Several potential reasons for the nonsignificant findings have led to recommendations for future research.
A recent meta-analysis of four stroke caregiver intervention studies highlighted the importance of a theoretical rationale to guide such studies so that interventions can be better explained.40 This recommendation has appeared in other caregiver literature as well.24,41 Forster et al25 concluded from their review of stroke caregiver intervention studies that the provision of information alone had no effect on mood, perceived health status, or quality of life for stroke caregivers. Other interventions that combined education with problem-solving strategies were much more effective than the use of education alone.25,42,43 These studies as a whole suggest the importance of using a combination of approaches; this view is consistent with caregiver meta-analyses that reveal that multicomponent interventions using skill-building strategies are relatively more effective.17,26,44 Caregiver intervention studies that better target the needs and concerns of family caregivers, rather than the needs of stroke survivors, have been strongly recommended.18 Other studies indicate that tailoring interventions to the individual needs of caregivers is more effective than group interventions.16,17,19 These recommendations are also consistent with caregiver studies that suggest selecting caregivers who have the most needs, then tailoring interventions to address those needs.45,46
Recommendations regarding methodological issues have also been made. Lee and colleagues40 recommended that more attention be directed toward ensuring treatment fidelity of stroke caregiver interventions. Correct timing and length for interventions (7–9 sessions) is also recommended.17,18,47 In terms of outcomes measurement, quality outcome measures relevant to stroke caregivers are essential because existing research has been limited by the use of measures that lacked sensitivity to detect relevant changes.18,48
Tele-health is another area relevant to intervention design, because many stroke caregivers are unable to attend on-site sessions and face-to-face visits in the home are expensive and time-consuming.49 Although video-conferencing is gaining popularity, some caregivers have expressed discomfort with the technology, which includes concerns about privacy and home security. Other drawbacks include poor connectivity and costs related to installing equipment in the home.49 Currently, no reported stroke caregiver interventions have been delivered completely by telephone; most involve at least one face-to-face visit.50
The TASK intervention was designed based on recommendations from the literature. A conceptual model derived from Lazarus' theory51,52 was used to evaluate the TASK intervention. TASK is an individualized, multicomponent intervention designed to promote skill building in stroke caregivers based on their needs and concerns. Delivered completely by telephone, the eight-session TASK intervention is initiated within 1 month after the stroke survivor is discharged to the home setting, a time period when caregivers have the opportunity to identify and articulate their needs. Treatment fidelity and quality outcome measures were carefully considered in the design of the study.
The conceptual model for the study (Figure 1) was derived from Lazarus's transactional theory of stress.51,52 Lazarus posits that when individuals encounter a stressful situation, personality and situational factors are mediated by appraisal, resulting in emotional and adaptational outcomes.51,52 In this study, caregiver optimism represents a personality factor, task difficulty represents a situational factor, threat appraisal represents a mediator, depressive symptoms represent an emotional outcome, and life changes and general health perceptions represent adaptational outcomes. Threat appraisal is defined as the anticipation of harm or loss associated with providing care.7–9,51,52 Caregiver life changes refer to changes in social functioning, subjective well-being, and physical health specifically as a result of providing care,7–9 consistent with Lazarus's definition of adaptational outcomes.51,52
The TASK intervention was designed to reduce caregiver task difficulty by addressing caregivers' needs in four main areas: (a) finding information about stroke, (b) managing the survivor's emotions and behaviors, (c) providing personal care, and (d) providing instrumental care. It was also designed to increase caregiver optimism and reduce threat appraisal by helping caregivers deal with their personal responses to providing care. Reducing task difficulty and threat appraisal and improving optimism were expected to result in better emotional and adaptational outcomes for the caregiver. The conceptual model derived from Lazarus's theory has been supported in prior studies.7–9 For example, model constructs including task difficulty, threat appraisal, and depressive symptoms explained a significant amount of variance in life changes.7–9 Caregiver threat appraisal was also found to be an independent predictor of caregiver emotional distress and general health perceptions.7
A randomized controlled clinical trial design was used to test the efficacy of the TASK intervention. Guided by the conceptual model in Figure 1, six theoretically based outcomes were measured at baseline, 4 weeks (half-way though intervention), 8 weeks (end of intervention), and 12 weeks (4 weeks after end of intervention). Caregiver and stroke survivor characteristics were also measured at baseline.
Written tip sheets were developed for each of the 32 items in the Caregiver Needs and Concerns Checklist (CNCC)6 addressing the five areas of skill-building needs: (a) finding information about stroke, (b) managing the survivor's emotions and behaviors,(c)providing physical care,(d)providing instrumental care, and (e) dealing with personal responses to providing care. In addition, five process tip sheets provided skill-building strategies such as strengthening existing skills, screening for depressive symptoms, maintaining realistic expectations, problem solving, and communicating with health professionals. A workbook detailing stress management strategies53–55 for the survivor and the caregiver was also developed.
The tip sheets and workbook were revised based on evaluations by 10 experts including 4 nurses, 1 project manager involved in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) studies,56 1 neuropsychologist, and 4 experienced stroke caregivers. The final TASK notebook contained 38 written tip sheets, a stress management workbook, and a brochure on family caregiving from the American Stroke Association (ASA). After baseline, the notebook was mailed to caregivers randomized to the TASK intervention. Caregivers in the TASK intervention group received eight weekly calls by a nurse who facilitated caregivers' weekly assessment of skill needs using the CNCC,6 followed by individualized interventions that addressed priority skill needs identified by the caregiver. The individualized interventions based on each caregiver's priority skill needs enabled the caregivers to build their skills in the areas most pertinent to them during the early discharge period.
The attention control group received a brochure on family caregiving from the ASA and eight weekly calls from a nurse. During the calls, nurses only provided active listening and paraphrasing; they provided no advice or information to the caregivers other than telling them to contact their health care provider or to contact the ASA for additional materials.
Special effort was made to enhance, maintain, and track treatment fidelity of both the TASK intervention and attention control conditions during the pilot. The Treatment Fidelity Checklist (TFC) published by Borelli and colleagues41 was used as a guide. The TFC includes topics related to design, training, delivery, receipt, and enactment of interventions.41 Design involved monitoring treatment dose for both intervention and control groups. Two caregivers in the TASK group and two in the control group missed one out of the eight weekly nurse calls. The remaining 36 caregivers completed all eight calls. Number of minutes of telephone contact was monitored as well. The design was also enhanced by basing the TASK intervention on a conceptual model that allowed for tailoring of interventions to meet individual caregiver needs. Training was provided for the nurses using standardized protocols and treatment manuals for both intervention and control groups. Prior to interacting with caregivers, nurses were required to "pass" role-playing sessions using structured checklists. Nurses were also required to have a current registered nurse license. Delivery was monitored through audio-taping of calls and evaluation of adherence to protocols using checklists. Individualized retraining was provided based on evaluations. Receipt was assessed by asking caregivers to rate the amount of information they received each week (too little, just right, too much). Enactment was assessed by asking caregivers to rate (a) how much they used the skill-building strategies from the prior week (not used, used a little, some, a lot); (b) how helpful each of the TASK tip sheets were (not helpful, little, moderate, very, extremely); and (c) how their problems were resolved (not resolved, making progress, fully resolved, resolved on its own).
Caregivers were recruited from a local rehabilitation hospital and three local acute care hospitals. The participant flow diagram is provided in Figure 2. A total of 293 caregivers were screened from March 2005 through June 2006. Of those, 69 (23.5%) could not be contacted, 43 (14.7%) refused participation, and 131 (44.7%) were ineligible. Of the 131 ineligible caregivers, 47 considered the stroke survivors to be the same as before the stroke or had fewer than two caregiver tasks; 35 reported that the survivor was in long-term care; 16 reported that the survivor had died; 10 caregivers were unable to hear or read or were not fluent in the English language; 10 reported that the survivor had a history of alcohol or drug abuse or severe mental illness; 8 reported that the survivor did not have a stroke; 4 caregivers were outside the enrollment window; and 1 caregiver was pregnant.
Following baseline data collection, a total of 50 caregivers were randomized to the TASK intervention (n = 26) or attention control group (n = 24) using a block randomization procedure in blocks of six to promote equal sample sizes. Randomization assignments were created a priori by the statistician, with outcome data collectors being blinded to randomized group allocation throughout the study period. Five caregivers were removed from the analysis because of minimal difficulty with tasks. This exclusion criterion will be used in future studies to conserve resources and to target the intervention to caregivers most in need, as recommended in other caregiver research.45,46 There was very low attrition over the course of the study. One survivor died from pancreatic cancer and one died from chronic liver failure. Screening procedures will be revised in the future to avoid enrolling caregivers managing end of life issues. Only one caregiver in the TASK group and two caregivers in the attention control group were lost to follow-up. The final sample for data analysis included 40 caregivers (TASK, n = 21; attention control, n = 19). The study was approved by the university institutional review board, and caregivers gave informed consent prior to data collection.
A demographic data form was used to collect information regarding caregiver and stroke survivor characteristics. Stroke survivor impairment was measured using the Stroke Specific Quality of Life Scale Proxy (SSQOL-Pr), a 49-item tool measuring quality of life in stroke survivors from the perspective of the caregiver.57,58 SSQOL-Pr subscales represent quality of life domains that are specifically affected by stroke. These domains represent common areas of stroke impairment from the perspective of the caregiver. Five subscales were selected for this study consistent with the conceptual model (mobility, self-care, language, thinking, and personality). Possible subscale scores range from 1 to 5, with lower scores meaning more impairment. The SSQOL-Pr was necessary because some survivors had aphasia and/or cognitive impairment and because stroke survivors were not enrolled into the study. Both the SSQOL and the SSQOL-Pr have acceptable evidence of internal consistency reliability, construct validity, and responsiveness to change,57,58 although the SSQOL-Pr scores have yielded lower scores for quality of life perceptions than SSQOL scores for patients.57 Cronbach alphas for the SSQOL-Pr have ranged from .83 to .92.9 In this study, Cronbach alphas were acceptable (mobility .93, self-care .83, language .96, thinking .74, personality .91).
The Revised Life Orientation Test (LOT-R) was used to measure caregiver optimism as an antecedent personality factor. The LOT-R consists of six items rated on a Likert-type scale, with higher scores indicating greater optimism. The LOT-R has documented evidence of reliability and validity59 and has been used in studies with stroke caregivers9,60,61 as well as cancer caregivers.62 Cronbach's alpha for this study was .73.
Perceived difficulty with tasks was measured by the Oberst Caregiving Burden Scale Difficulty Subscale (OCBS). The OCBS measures the perceived difficulty associated with 15 different types of caregiving tasks, with scores ranging from 15 to 75.5 Item responses range from not difficult =1 to extremely difficult = 5. Acceptable evidence of both content and construct validity has been reported in cancer caregivers.63 Evidence of construct validity, including unidimensionality, has been reported in stroke caregivers.5 Internal consistency reliability estimates in stroke caregivers have ranged from .84 to .94.5,7–9 Cronbach's alpha for this sample was .85.
Defined as the anticipation of harm or loss associated with providing care, threat appraisal was measured by the Appraisal of Caregiving Threat Subscale (ACS). The ACS measures the degree to which caregivers' tasks, relationships, interpersonal support, lifestyle, emotional and physical health, and the overall personal impact of caregiving are appraised as threatening.64 Scores range from 12 to 60, and items are rated on a 5-point Likert-type scale ranging from strongly disagree to strongly agree. Evidence of internal consistency reliability, content, and construct validity has been reported in cancer caregivers.64 Internal consistency reliability estimates in stroke caregivers have ranged between .86 and .92.7–9 Cronbach's alpha for this sample was .92.
The Patient Health Questionnaire Depression Scale (PHQ-9) measuring caregiver depressive symptoms is based on the nine DSM-IV criteria for depressive disorders. Items are rated on a 4-point scale ranging from not at all to nearly every day, with total scores ranging from 0 to 27. Evidence of internal consistency reliability, validity, specificity, and sensitivity has been reported in primary care populations65 as well as in stroke survivors.66 In stroke caregivers, internal consistency estimates have ranged from .80 to .86.9 The advantages of using the PHQ-9 are its brevity as well as its clinically meaningful cutoff points for no (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), and severe depression (20–27) that are easily interpreted by health care providers.65,66 Cronbach's alpha for this sample was .84.
The 15-item Bakas Caregiving Outcomes Scale (BCOS) measures caregiver life changes specifically as a result of providing care.8,9 Items address changes in social functioning, subjective well-being, and physical health consistent with Lazarus's51,52 definition of adaptational outcomes. Items are rated on a 7-point scale ranging from changed for the worst to changed for the best. Total scores range from 15 to 105, with lower scores indicating more negative life changes. Evidence of content validity, internal consistency reliability, test-retest reliability, construct validity, criterion-related validity, and unidimensionality for the total scale has been reported in three different samples of stroke caregivers.8,9 Internal consistency reliability estimates have ranged from .77 to .90.8,9 Cronbach's alpha for this sample was .92.
The SF-36 Health Survey General Health Subscale (SF-36GH) is a widely used measure with established psychometric properties.67 The SF-36GH consists of five items rated on a Likert-type scale that are scored to range from 0 to 100, with higher scores indicating better general health perceptions. The SF-36GH has been used in research with stroke caregivers with acceptable documented reliability.7–9 Cronbach's alpha for this sample was .87.
Data were screened and double-checked for errors in data entry. One-sample Kolmogovov-Smirnov Z tests were used to assess normality, and Cronbach's alpha was used to estimate internal consistency reliability. No significant non-normality was detected, and Cronbach's alphas ranged from .73 to .96 for all of the scales. Descriptive statistics, independent samples t tests, and chi-square tests were used to describe caregiver and survivor characteristics and to assess for baseline group differences. There was a significant difference in the total number of minutes spent on the telephone with the nurse for the TASK group (mean =236.8 minutes) relative to the attention control group (128.8 minutes), t =4.252, p < .001. This difference indicated the need for adjustment of the findings to account for dose-response effects.68 Total number of minutes of telephone contact with the nurse was therefore used as a covariate in assessing preliminary intervention effects for each of the outcomes. For each time point, data were analyzed using univariate analysis of covariance (ANCOVA) for each outcome, controlling for baseline scores and number of minutes spent with the nurse. The study was not designed to have sufficient power to detect treatment by group interactions, because it was a pilot; therefore separate univariate models were tested for each time point separately. This was a pilot study, so no adjustments were made to the significance level because of multiple testing. Partial η2 was used to estimate effect sizes using SPSS for ANCOVA (small, ≤.08; medium, .09–.24; large, ≥.25).69,70 Partial η2 is used in ANCOVA to represent the percent variance in the dependent variable explained by the independent variable (i.e., treatment group) while controlling for covariates.69,70 It is a comparable estimate to r2.69,70 Outcomes included caregiver optimism, task difficulty, threat appraisal, depressive symptoms, life changes, and general health perceptions. Alpha of p < .05 for a two-tailed test was used to interpret the findings.
Caregiver and stroke survivor characteristics for each group, including survivor impairment, are provided in Table 1. Similar to other caregiver studies,8,9,46,71,72 the mean age of caregivers was 57 years, with 73% of the caregivers being female, 58% spouses, 25% adult children, and 17% representing other types of relationships. In terms of race, 25% were African American, 73% Caucasian, and 2% other, which is reflective of the region where recruitment sites were located. There were significant differences in terms of survivor gender, with more male survivors in the attention control group (χ2 = 5.11, p = .02). Adjusting for this variable did not influence the findings. There were no other significant baseline group differences in caregiver and survivor characteristics. Survivor impairment scores were moderate across all five subscales on a 1 to 5 scale, with 5 meaning low impairment.
Table 2 provides data regarding the preliminary efficacy of the TASK program in relation to the attention control group. Significant increases in caregiver optimism at 4 weeks, F(1, 36) = 5.95, p = .02, η2 = .14, 8 weeks, F(1, 36) = 6.13, p = .02, η2 = .15, and 12 weeks, F(1, 36) = 6.40, p = .02, η2 = .15, were found, with medium effect sizes for the TASK intervention group relative to the control group. Significant decreases in task difficulty at 4 weeks, F(1, 36) = 5.30, p = .03, η2 = .13, were found; however, findings were not significant at 8 and 12 weeks, most likely because of the low scores at these time points for the intervention group. There were no significant improvements in threat appraisal at 4 weeks; however, threat appraisal at both 8 weeks, F(1, 36) = 5.67, p = .02, η2 = .14, and 12 weeks, F(1, 36) = 8.50, p = .01, η2 = .19, was significantly decreased, with medium effect sizes. Although not significant in this small sample, moderate decreases were found for depressive symptoms at 4 weeks, F(1, 36) = 3.35, p = .08, η2 = .09; however, the effect sizes became small at 8 and 12 weeks. Small, nonsignificant improvements were noted in life changes, and general health perceptions remained fairly stable. Table 3 shows the adjusted means and standard error estimates for each of the outcomes at each time point. Figures 3 and and44 provide visual graphs of the data based on the adjusted means.
By addressing individual needs and concerns through skill-building interventions, the TASK program was hypothesized to improve stroke caregiver outcomes based on a conceptual model derived from Lazarus's theory.51,52 The TASK intervention was found to be most efficacious at improving caregiver optimism. This finding may be surprising because optimism is typically regarded as a relatively stable personality trait that influences how one appraises stress.51,59 Bakas and colleagues9 found that caregiver optimism was moderately negatively correlated with threat appraisal and depressive symptoms, consistent with previous stroke caregiver research.61 In cancer caregivers, optimism was found to be an important predictor of caregiver depression, as well as an influence on their health and daily schedule.62 Optimism may be regarded as an important trait to identify caregivers at risk for negative outcomes such as depression62; findings from this study suggest that the TASK intervention improves optimism. The TASK program includes stress management strategies that help caregivers deal with their personal responses, such as recognizing automatic negative thoughts and replacing them with more positive, realistic thoughts.53–55 These findings suggest that interventions designed to enhance optimism through stress management techniques might have the potential to reduce threat appraisal and decrease caregiver depressive symptoms. The TASK program was shown to be efficacious in reducing caregiver threat appraisal at both 8 and 12 weeks. Although not statistically significant in this small sample, the TASK program did reveal a medium effect size for decreasing caregiver depressive symptoms at 4 weeks in comparison with the attention control group. Specifically, there was a 2.64-point difference in PHQ-9 scores between the groups. The findings regarding the efficacy of the TASK intervention in increasing optimism and reducing threat appraisal and a trend toward reducing depressive symptoms provide support for the conceptual model.
Further support for the conceptual model was the finding that the TASK intervention was efficacious at reducing task difficulty at 4 weeks relative to the control group. The TASK intervention included strategies to help caregivers find information about stroke, manage the survivor's emotions and behaviors, and provide physical and instrumental care based on the caregivers' self-identified needs. Task difficulty in the TASK group dropped rapidly from baseline to 4 weeks and then remained consistently low at 8 and 12 weeks. Caregivers in the control group showed a slight increase in task difficulty at 4 weeks and then dropped gradually at 8 and 12 weeks, never reaching the low levels attained by the TASK group. In other words, the caregiving needs were met much earlier in the intervention group than in the control group. This finding has important clinical implications, particularly for stroke caregivers during the first few weeks of providing care after discharge when their needs are the greatest.6,10,20,21,23
Although TASK effects on more distal outcomes of depressive symptoms, life changes, and general health perceptions were not significant, data trends in Figure 4 showed fewer depressive symptoms and more positive caregiver life changes in the TASK group relative to the control group. These findings suggest the need to improve the TASK intervention not only to influence these outcomes indirectly through the proximal outcomes of optimism, threat appraisal, and task difficulty but also to influence depressive symptoms and life changes directly. For example, in addition to using skill-building strategies to reduce caregiver depressive symptoms in caregivers who identified managing their own emotional responses as a need, the TASK intervention could be enhanced by actively screening all caregivers for depressive symptoms using the PHQ-9, then applying a care-managed approach for treating depressive symptoms in those caregivers who screen positive for depression. Such approaches involving antidepressants and care management by a nurse have been successfully used in studies with stroke survivors.73,74 The AIM intervention73 involved "activating" the stroke patient to recognize their own depressive symptoms, "initiating" the use of antidepressant medications, and "monitoring" and adjusting treatment by a nurse. Mitchell and colleagues74 developed a brief psychosocial/behavioral intervention in conjunction with antidepressant therapy to reduce depressive symptoms in stroke patients. These types of interventions could be incorporated into the TASK program to better meet the needs of caregivers who screen positive for depression. The TASK program incorporated the use of stress management strategies derived from cognitive behavioral therapy53–55 to address the self-identified emotional needs in caregivers, which likely contributed to improved optimism and reduced threat appraisal in this study. Strengthening the use of these stress management strategies in caregivers who screen positive for depression, along with initiating and monitoring antidepressant therapy, would help to better treat depressed caregivers and would extend the theoretical basis of the intervention to target those most in need.
To directly affect their life changes, caregivers could be screened for deterioration in aspects of their lives using the BCOS,8,9 with individualized interventions targeted toward these areas. In this study, caregivers tended to identify needs related to the care of the stroke survivor before identifying needs regarding their personal responses to providing care. Rather than waiting for caregivers to begin to self-identify their needs, the TASK intervention could be enhanced by actively screening for life changes earlier in the intervention process to allow more time to focus on the caregiver's personal responses to providing care. In other words, while addressing caregiver self-identified needs regarding the care of the stroke survivor, the TASK program could also provide individualized interventions based on responses to the BCOS to enhance life changes earlier in the intervention process.
Findings on general health perceptions were inconclusive, suggesting that the measure may have been too global to detect any effects from the TASK intervention. Future research should include more specific health measures, such as the self-care and healthy behaviors measure used in the Resources for Enhancing Alzheimer's Caregiver Health study (REACH II).75 The self-care and healthy behaviors measure consists of 11 questions that address such areas as getting enough rest, getting routine checkups, and adhering to a medication schedule.75 The TASK intervention could be further enhanced by screening for self-care and healthy behaviors and delivering individualized interventions based on the results.75 The research agenda for stroke caregiving must move beyond psychological distress and depression to address the health of family caregivers.10 In one landmark prospective study, family caregivers experiencing strain had a 63% higher risk of mortality compared with non-caregiving controls.12 Other studies found that stroke caregiver perceptions of their own health worsened over the course of providing care.8,9 Because insufficient attention has been given to the health status and health promotion activities of family caregivers,10,13,18,76,77 further enhancement of the TASK intervention to address these areas in stroke caregivers is recommended.
Because this was the first pilot study testing the efficacy of the TASK intervention, the sample size was small. A larger, more adequately powered randomized controlled clinical trial is recommended to test the revised TASK intervention using an intent-to-treat design.
Another limitation of the study was the potential for treatment diffusion because the same nurse made calls to caregivers in both TASK intervention and attention control groups. Despite detailed training and monitoring of adherence to TASK intervention and attention control protocols, the possibility of treatment diffusion could have affected the findings. Using separate nurse interveners for the TASK intervention and attention control groups is strongly recommended for future studies.
Lastly, generalizability of the findings from this study is limited to stroke family caregivers who reflect the sample characteristics shown in Table 1. Hispanic caregivers and those from minority groups other than African American were poorly represented. Multisite studies would be needed to recruit a more ethnically diverse sample for future testing of the TASK intervention.
The TASK intervention exhibited evidence of efficacy in increasing caregiver optimism and in reducing task difficulty and threat appraisal. These findings provided support for the conceptual model derived from Lazarus's theory.51,52 Further methodological refinements in the TASK intervention are recommended to better screen for and treat caregiver depressive symptoms using a care-managed approach.73,74 Screening for negative life changes using the BCOS8,9 to further individualize interventions earlier in the intervention process for caregivers is also recommended. The TASK intervention could also include screening for self-care and healthy behaviors to better individualize interventions to improve caregiver health.75 Findings from this study support the use of the CNCC to allow caregivers to self-identify their needs, from which individualized skill-building interventions can be delivered. The point at which caregivers should also be screened for depressive symptoms, life changes, and healthy behaviors to further individualize skill-building interventions to address more distal stroke caregiver outcomes requires further study. Too many interventions delivered at once early in the intervention process may overwhelm the caregiver, however waiting too long to focus on more distal stroke caregiver outcomes may not allow enough time for interventions to be efficacious. Finding the trigger point when caregivers are ready to focus on their personal responses to providing care is important and may be the optimal time to provide the additional screening for depressive symptoms, life changes, and healthy behaviors. The length of the TASK program may also need to be extended for those who screen positive for depression and for those who require more skill-building interventions to improve life changes and healthy behaviors. These are factors that need to be considered in revising the TASK intervention to address more distal stroke caregiver outcomes. Once the TASK intervention has been revised, it should be tested for efficacy in a larger randomized clinical trial using an intent-to-treat design. Efforts to recruit a more ethnically diverse sample should be considered in future studies as well.
Despite recent efforts toward establishing stroke systems of care, stroke survivors and family caregivers do not consistently receive the training they need for transitioning to the home environment.20,23,78 Based on recommendations from the literature, the TASK program was designed to be a multicomponent program to promote skill building based on the needs and concerns of caregivers during the first few months after survivors are discharged home. Delivered completely by telephone, the TASK program offers an inexpensive way to provide stroke caregivers with information about stroke, assistance with stroke-related care, and follow-up after discharge. The TASK program not only addresses caregiver needs regarding the care of the survivor but also addresses caregiver needs related to their personal responses to providing care. In this small pilot study, the TASK program showed improvements in caregiver optimism, task difficulty, and threat appraisal consistent with the conceptual model derived from Lazarus's theory.51,52 Further testing of an enhanced version of the TASK program in a larger randomized controlled clinical trial is warranted, with attention in subsequent studies directed toward more distal caregiver depressive symptoms, life changes, and health outcomes.
Funding for this study was provided by the National Institute for Nursing Research (NINR) NIH # K01 NR008712 (PI Tamilyn Bakas). We thank Joan S. Grant, DSN, CS, Professor, University of Alabama School of Nursing; Kurt Kroenke MD, Professor, Indiana University School of Medicine; and Merle Mishel, PhD, FAAN, Professor, University of North Carolina at Chapel Hill School of Nursing for their training and consultation on this project and Phyllis Dexter, PhD, RN, Assistant Scientist and Editor, Indiana University School of Nursing Center for Nursing Research, for her editorial assistance. We also thank the research staff (Kelly Gannon, Ann Harlow, Samantha Jessup, Charles Kain, Janet Kain, Ann Larner, Marjorie Pike, Barbara Poole, Sherry Riggio) and the many content reviewers for the TASK program (Nancy Chernott, Joan Grant, Ann Harlow, Marjorie Kurt, Judith Matthews, Karen May, Laurie Plue, Jean Renken, Ken Rueth, Michael Shain) for their expertise. Thanks also to the family caregivers who participated in this project.
Tamilyn Bakas, Indiana University School of Nursing, Indianapolis, Indiana.
Carol J. Farran, Rush University College of Nursing, Chicago, Illinois.
Joan K. Austin, Indiana University School of Nursing, Indianapolis, Indiana.
Barbara A. Given, Michigan State University College of Nursing, East Lansing, Michigan.
Elizabeth A. Johnson, Ball State University School of Nursing, Muncie, Indiana.
Linda S. Williams, Richard L. Roudebush Veterans Administration Medical Center, and Associate Professor, Indiana University School of Medicine, Indianapolis, Indiana.
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