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Best Food Mixers UK 2017 Reviews
Food Mixer Reviews – Which is the best food mixer?Well; We have reviewed a wide range of best mixers brands to help you make the right decision:
Is it Andrew James food mixer, Kenwood Chef Mixer, Kitchenaid mixer, Kenwood kMix stand mixer, Bosch food mixer or an assortment of other top food mixers as found in our food mixer reviews page.
- 1 Best Food Mixers Reviews & Comparisons UK 2017
- 2 What is the Best Food Mixer UK 2017?
- 3 Which Is The Best but Cheapest Food Mixer?
- 4 Best Food Mixer under £100
- 5 Best Food Mixer under £200
- 6 Best Food Mixer under £500
- 7 Kenwood kMix KMX52
Best Food Mixers Reviews & Comparisons UK 2017
|Detailed Reviews
|Bowl Size (Litre)
|Weight (kg)
|Customer Ratings
|Best Price
|Detailed Reviews
|Bowl Size (Litre)
|Weight (kg)
|Customer Ratings
|Best Price
|Kenwood kMix KMX52 - Almond Cream
|Bosch MUM57830GB Food Mixer
|Kitchenaid K45SS Classic
|Andrew James 1300 Watt Electric Food Stand Mixer In Stunning Red
What is the Best Food Mixer UK 2017?
Kenwood KMM020 Review : Best Mixer For A Large FamilyThe Best Food Mixer UK 2017 in our opinion based on research and ratings is the Kenwood KMM020 Chef Major Titanium Stand Mixer Silver; It also the best food mixer and processor in one.
Here is why: The Kenwood Chef KMM020 oozes quality and style. It is for the inspired and creative cook who wants to take their culinary skills to new heights of excellence. If you are into creating large meals, cakes and deserts then go for Kenwood KMM020 .
Kenwood KMM020 Chef Major Titanium Stand Mixer Silver comes with a comprehensive 180 recipe book and a DVD/CD with illustrations on how to use various attachments.
- The Kenwood KMM020 comes with 5 years warranty for peace of mind.
- You also get a food processor attached to it when you buy.
- KMM020 also comes with a heat resistant blender that is built with glass for durability and style.
- It has a sizeable 6.7 litre bowl and runs on a powerful 1500 watt motor.
As already pointed out, the Kenwood KMM020 Chef Major Titanium Stand Mixer Silver features a 6.7 litre stainless steel bowl that is good enough for a big family.
- A 1500 watt motor powerful enough to mix heavy ingredients,
- 4 power outlets for additional attachments,
- A 1.6 litre thermos-resist glass blender for smoothies and soups,
- A food processor with 3 reversible discs,
- A K-beater, balloon whisk, a dough hook, creaming beater, dust guard, recipe book and many more.
- Unlike other stand mixers, that have no handles on the bowl, the Kenwood KMM020 bowl has handles for easy manoeuvrability.
With the Kenwood KMM020 Chef Major Titanium Stand Mixer Silver; you can always adjust the attachment with the spanner that comes with it to enable the attachment mix even small items.
If KMM020 is not your thing then no sweat; there is a wide range of other top best kitchen food mixers that could appeal to you.
Take time to read to the end to check out other top food mixers from the cheapest to the mid range to get one that clearly meets your needs.
Food mixers come in many shapes and sizes. Many promise a lot but do they deliver what they say on the tin? Of all the different models , which one is the best? Which one actually delivers on all the key aspects of a quality product: reliability, efficiency and versatility? Do they provide value for money? Let us find out.
Which Is The Best but Cheapest Food Mixer?
If you are looking for the best but cheapest food mixers; check these 2: Kenwood km330 and Kenwood km336
Kenwood km330Kenwood km330 is one of the classic Kenwood models, best choice for beginners. It comes with a very big 4.6 litre mixing bowl and 3 non stick mixing attachments. Apart from this you also get a dust cover, a spatula, a registration card, a user manual, a recipe book and a one year warranty. KM330 classic is motorized by 800watt motor. You can use the classic model to do all sort of stuff ranging from beating eggs, kneading dough, mixing ingredients for home made sauces, cakes, pastries and much more. And the best part is that you are in position to add up to 20 extra accessories like ice cream maker, blender, processor etc to take your cooking skills into a next level while saving time to do other stuff. What is the catch? Read a full km330 classic review.
Kenwood km336KM336 is not of much difference to the km330. It also features a 4.6ltre bowl, an 800watt motor, and 3 power outlets.
Apart from this you also get 3 standard mixing attachments, a user guide, recipe book and a spatula. KM336 can do all that the classic330 can do but with it you also get a free blender as an add-on.
Another difference is in on the gadget body materials that used to make it. While that of 330 is of plastic material; of the 336 on the other hand is of a mixture of aluminium and plastic. Click to read a detailed km336 review.
Best Food Mixer under £100
There is always best products for everyone and food mixers are of no any difference. In case you are looking for the best food mixers under £100; I will recommend that you go for any one of these: Andrew James Multifunctional Red 5.2 or Vonshef food mixer.
Andrew James Multifunctional Red 5.2
All Andrew James mixers are in the price range of under £100. While people prefer Kenwood because of durability; you can't go wrong with the Andrew James Multifunctional Red 5.2. It is almost half the price of the cheapest Kenwood Chef and has a lot going on with.
Andrew James Multifunctional Red 5.2 comes with a generous 5.2 litre mixing bowl, 3 standard mixing attachments. And on top of that you get a 1.5 litre blender and a meat grinder for free.
You also get 2 years warranty. And as if this is not enough; you are also provided with a 128 pages cook book and a user manual.
Use of this kitchen machines as per user guide helps it last longer. All in all a mix of price, a stunning look and add-ons makes Andrew James Multifunctional Red 5.2 a best value kitchen machine worth buying. Read full Andrew James Multifunctional Red 5.2 review.
VonShef Food Mixer
VonShef Food Mixer is good actually; it comes in 2 colours: red plus black the choice is yours.
Vonshef comes with 5.5 litre stainless steel dishwasher safe mixing bowl, 3 standard mixing attachments (a dough hook, a beater and a balloon whisk),a dust cover and a spatula just like many other kitchen machines. Vonshef features 1200 watt powerful motor.
Like Andrew James Red; Vonshef also comes with 2 years warranty for peace o mind. Read a detailed Vonshef kitchen machine review.
Best Food Mixer under £200
Jumping from under 100 pound to best food mixer under 200 can be a wise decision. As in most cases the increase in price range comes with increase in added functionalities; meaning getting more attachments: Here is the list of the best value food mixers under £200.
Bosch MUM46A1
With a plastic body and a 3.9 mixing bowl is the Bosch MUM46A1. It is one of the best gadget in the UK market right now.
As other kitchen machines; Bosch MUM46A1 also comes with 3 mixing attachments (a dough hook, a balloon whisk and a beater).
On top of this you also get a blender, chopping equipments, citrus press, recipe book and accessories holder.
You have to make sure that the bowl is full attached to the MUM46A1 for it to function well. Bosch MUM46A1 is powered by 550 watts motor. Read full Bosch MUM46A1 review.
Best Food Mixer under £500
With a budget of around 500 pounds; you can almost buy any food mixer in the UK Market at Amazon. Here is a list of some of the best food mixer under 500 that you can buy today with full confidence.
Kitchenaid K45SS Classic
Comes with 2 years warranty 4 litre stainless steel mixing bowl, 3 standard mixing attachments (for mixing, beating and whipping), and a user guide is the Kitchenaid K45SS classic. It is one of the best selling Kitcheinaid mixers UK.
It is powered by 250 watts motor. The look and the ability to last longer is what makes the K45SS worth buying.
If a small bowl size, 3.9 litre does not bother you; then go for Kitchenaid K45SS Classic for peace of mind. It is worth extra money and so do other customers recommend it. Read full Kitchenaid classic review.
Kenwood KMC010 Chef TitaniumKMC010 Chef Titanium is of no difference to the Kitchen aid classic; it is made to last longer. However, you get more with KMC010. With KMC010 you get a very big bowl of 4.6 litre.
You also get 3 standard mixing attachments in addition to a food processor and a heat resistant blender. KMC010 is powered by 1400watts powerful motor to make your food preparation a delight.
Above all, you get 5 years guarantee for peace of mind. If you like the KMC010; there is chance that you might like the KMC015 with glass bowl the most. Read full Kenwood KMC010 vs. KMC015 review.
Kenwood kMix KMX52
With a stylish look are the Kenwood kMix stand mixers. They come in various colour: raspberry red, peppercorn black, Barcelona strips, and the kMix KMX52 almond cream being one of them. KMix KMX52 features 500 watt motor. With kMix KMX52 you get 5 litre mixing bowl, 3 standard mixing attachments, a dust cover, a recipe book and a user manual. Above all you get 5 year warranty for peace mind. Read full kMix KMX52 review.


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Good passing and support play are a priority in your soccer coaching sessions. Your players can make it easier to help team-mates pass on the run by creating space for the ball carrier with an overlap. In effect, the overlap creates an attacking 2v1, helps to exploit space in wide areas, provides support and an end product – for instance, a chance to shoot.
What to think about
- The overlapping player runs outside of the ball carrier and past a defender, giving clear indication to the ball carrier of when to pass.
- The ball carrier passes into space in front of the overlapping player.
- The timing of the overlapping run.
- The timing and weight of the pass.
- Shooting on target at the end of the move.
Overlap soccer drill set up
- Create a 35 yards by 25 yards playing area (depending on your players' age and ability).
- Use four groups of players, plus two goalkeepers.
What players must do
- Place each group (A, B, C and D) at the corners of the playing area.
- Starting with two groups at one end, the first player in each (A1 and B1) set off as a pair, with A1 passing to B1. B1 then dribbles towards the centre of the playing area as A1 overlaps.
- B1 passes to A1 for A1 to shoot at goal.
- C1 and D1 repeat while A1 and B1 join the back of groups C and D.
How to advance soccer drill
- Introduce two passive defenders, one to defend each goal.
- Beginning in their own third of the pitch, the defenders come to meet the attackers and aim to stop them from shooting at goal.
- The dribbling attacker now has the option of passing to the overlapping runner or using the player as a decoy.
- Make defenders active to increase the difficulty.
- Make sure the defenders have a turn at attacking.
Use soccer drill skills in a game
Play 4v4, plus two goalkeepers, in a 30 yards by 20 yards playing area. Award extra points for shots on target, goals scored from an overlap or as a result of using an overlap as a decoy.
To receive more easy-to-follow soccer coaching sessions, click the link to subscribe to Smart Sessions soccer coaching plans – they come in advanced and core versions.
Click the link to see an overlap and crossover skills soccer coaching drill.

subset: commoncrawl


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|[JIRA] Updated: (FOR-458) Create a status plugin
|Wed, 09 Mar 2005 03:35:18 GMT
The following issue has been updated: Updater: Dave Brondsema (mailto:firstname.lastname@example.com) Date: Tue, 8 Mar 2005 9:33 PM Changes: Component changed to Plugins (general issues) --------------------------------------------------------------------- For a full history of the issue, see: http://issues.cocoondev.org//browse/FOR-458?page=history --------------------------------------------------------------------- View the issue: http://issues.cocoondev.org//browse/FOR-458 Here is an overview of the issue: --------------------------------------------------------------------- Key: FOR-458 Summary: Create a status plugin Type: New Feature Status: Open Priority: Minor Project: Forrest Components: Plugins (general issues) Versions: HEAD Assignee: Ross Gardler Reporter: Ross Gardler Created: Thu, 3 Mar 2005 3:19 AM Updated: Tue, 8 Mar 2005 9:33 PM Description: Extract the pipelines that create changes.xml and todo.xml into a plugin. Expand the status.xml DTD to support the features described in FOR-454 Allow creation of a page from JIRA as described in the user list thread (subject: Pulling issues from Jira issue tracker to use in Forrest, first post 25/2/05) --------------------------------------------------------------------- JIRA INFORMATION: This message is automatically generated by JIRA. If you think it was sent incorrectly contact one of the administrators: http://issues.cocoondev.org//secure/Administrators.jspa If you want more information on JIRA, or have a bug to report see: http://www.atlassian.com/software/jira
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Mikal Kirkholt
From Wikipedia, the free encyclopedia
|Olympic medal record
|Men's cross-country skiing
|1952 Oslo
|4x10 km relay
Mikal Kirkholt (9 December 1920 – 28 June 2012) was a Norwegian cross-country skier.
He represented the club IL Troll. At the 1952 Winter Olympics in Oslo he finished twelfth in the 18 kilometres and won a silver medal in the 4x10 km relay.[1] He retired after the Olympics, to marry and work in Sunndal, but later returned to live and work at the family farm in Rindal.[2]
- ^ Mikal Kirkholt's profile at Sports Reference.com
- ^ Mollan, Aud (11 July 2012). "Med OL-sølv fra Oslo 1952". Adresseavisen. p. 27.
|This biographical article relating to Norwegian cross-country skiing is a stub. You can help Wikipedia by expanding it.
|This article about a Norwegian Winter Olympic medalist is a stub. You can help Wikipedia by expanding it.
- 1920 births
- 2012 deaths
- People from Rindal
- Norwegian male cross-country skiers
- Olympic cross-country skiers of Norway
- Cross-country skiers at the 1952 Winter Olympics
- Olympic silver medalists for Norway
- Olympic medalists in cross-country skiing
- Medalists at the 1952 Winter Olympics
- Norwegian cross-country skiing biography stubs
- Norwegian Winter Olympic medalist stubs


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You know the gist of this by now. I own a crap load of jerseys. It is a slow period traditionally in the Mets news world at this time of year, so I am sharing my collection with you.
Nope this isn't a retread. This is my blank throwback.
Follow Mets Police on Facebook (and Like/Share please. Thanks!)


text: A priority assignment strategy of processing elements over an on-chip busYa-Shu Chen, Song-Jian Tang, Shi-Wu LoSAC2007The number of bus transactions in System-on-Chip (SoC) grows significantly in recent years. Because of different timing constraints for different applications, how to find a proper priority assignment for processing elements (PEs) of SoC becomes very challenging. In this paper, we first show that the priority assignment problem with one unique… (More)


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My shots keep getting blocked by D
I'm a forward coming into the offensive zone, or I'm already in the slot...
1- The problem happens when there's a D between me and the goalie and I want to use the screen to score.
2- I play in a new league with no slap shots. My slaps that I've always used before in this situation would get through most of the time (maybe the Ds aren't as brave when it's a slap?).
3- I'm stuck using short snaps or wrist shots.
4-A majority of my shots get blocked before getting to the goal.
Are there tricks? Shoot between the Ds leg? On his stick side? On the other side? Past his stick? Under his stick? etc... Are there videos that show a "how to"?
I've always had success shooting through their legs, but you can't just assume they will be spread so you might have to work to open them up. Or you can always cut quickly one way or the other and create some space for yourself. If you have the hands you can put the puck through him and let off a quick shot when you pick it back up. Lots of times goalies will be thrown off by that even without a screen, though it probably won't do you any good if you haven't got a good shot to back it up.
As a forward who plays and blocks shots a lot in his own zone, I block more slapshots than wristers or snappers from defensemen. I never take any of my own when coming in the zone, and I rarely get blocked with my wristers :dunno:
practice pull n draggin the puck to create a slight opening.. the screen will still be in effect.
also shoot low.
Try to move the puck laterally a bit before shooting. Fake the shot and either toe drag pull or cut outside just a bit.
I'm also trying to shoot more from my off leg... Also a work in progress.
Are you faking a shot before you toe drag? That might help. It might freeze them like a goalie. Just a little shoulder dip, or head bob or something might work.
Also, how do you not have this as your avatar?
Shoot high and hard once and they will not stand infront of you for the rest of the game.............. seriously though, plenty of pros are notorious for not getting shots through. If you're looking for a deflection or rebound, you don't have to hit the dead centre of the net, aim for the sides and even a little wide to open your range. If you're alone, well, time to learn that fancy stuff.
Lateral movement with your body and or the puck.
Pull it in to change the angle and snap it off. This Easton video explains it.
Heh, personally, in that situation, I just make sure I can get it through the defender. You may be trying to pick a corner on net but that won't be useful if you can't get it past the defender. You have a good idea of where the net is, just throw it on net but focus on getting it through the defender as a priority. I usually do that and there's still enough of a screen that even a shot that isn't that close to a corner still ends up going in just because of the quicker reaction time required by goalies.
Shoot it low just anything to get it past them. If anything it will deflect off their legs on net.
1) Ya, that's a problem indeed.
2) Well, that rule kinda sucks, but, slapshots are somewhat overrated unless you have a bomb, or have like the most amazing placement ever. They are also way easier to block than a wrister or snap because 99% of players telegraph the **** out of their shots. You're better off with the sick wrister.
3) This is a good thing, bare with me a sec. I know the big slapper gets the praise and the oooh's and ahh's when they go in, but the reality is, they don't nearly as much as the sweet wrister/snap. I'm probably the worst defenceman ever, but if I forward comes down on me and starts to wind up for a slapper, my eyes get wide and I go in and poke/deflect that stuff away. I think any goalie will also tell you, the wristers are much more of a problem than slappers.
4) Eh, that's tough to comment on without seeing you in action.
Anyway, my advice, take wristers, snapers, and crash. If the defenceman gives you a hole to shoot through, as in his legs, use that. Don't try to shoot through anybody, it'll never go through, but if he's skating backwards, and his legs are planted, he's not gonna be able to block most shots you take unless you are shooting it right into him. Getting it on net is worth more than trying for a perfect shot and having it blocked. So many goals come off garbage shots, it's always worth just putting it on net.
Any tips on how to aim the shot if you're using the D as the screen?
I've got the shot using the D as a screen down, but I can't figure out how to aim the shot. Every time I do it I put the puck right in the goalie's chest.
For beginners on breakaways, start with going backhand, and as you go, try going faster to your backhand, you'll find a lot more open net. After you can do that, start to try faking the shot before going backhand, and you'll find success. Watch these highlights of Alex Burrows going backhand and you'll see what I mean.
Watch the pro level, see what they do. In all honesty this is not a hard problem. Go by yourself and set up obstacles. Move, dangle, stay stationary, shoot low, shoot high, work on touch and first touch and one timers and holding onto the puck.
Its practice/repetition... you need more poise. Look at guys like Karlsson, he destroyed the Rangers last year. So much poise and control on top of skating. Its not hard at all to not hit a defender every single time
Put the puck in a shooting position and hesitate for an extra second while skating/coasting. A lot of the time the D will unconsciously commit to the shot and the hesitation means that you'll move a bit off the lane they froze in, giving you the shot. That or drop the shoulder/snap the wrists a bit and actually sell the fake.
you could check out this video:
This channel also has other great tips and techniques on and off the ice.
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text: Recent trends toward globalization, outsourcing, and compressed cycles of innovation and new product introduction have all increased the pressure for instant, error-free exchange of manufacturing and business information around the world. This talk will identify some of the technical barriers to achieving this goal, and avenues for overcoming those barriers. While this work is grounded in the manufacturing sector, these same effects challenge most sectors, including health care, the electrical grid, construction and capital equipment. The talk ends with a comparison of engineering disciplines in the physical world with engineering in the information world. For more information about this seminar, please contact: JoAnne Lambert 510.486.4835, or send e-mail to firstname.lastname@example.com


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prAna Ninebark Reversible Crew - Men's - $35.72
Kick back in comfort with the prAna Ninebark Reversible Crew. This reversible sweater features a drop-needle knit on one side and a solid jersey knit on the other. So when you inevitably spill ranch dressing on yourself, you can turn this shirt inside out and still look presentable. That reversibility can also come on handy when you're on the road and trying to pack lightyou get two different styles with just one shirt. - $35.72


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Transportable Kitchenette
Yet another, portable, transportable, mobile, space-saving kitchen. I'm all over it!!
Mechanical cell phone that saves energy and doesn't require batteries. Saves on recycling harmful energy cells and charges by cranking or spinning the phone using the hole at the bottom.Tags: environment, cell phones, mobile, green, mechanical, Friendly, Earth DayAdded 7 Years Ago from Yankodesign
Squeezable silicone bubble LED's by Diana Lin Design.
this concept combines the best of both Sidekick Mobile phone with a PSP Slim... a girl can dreamTags: electronics, technology, gadgets, mobile, gaming, tech, sidekicks, gizmos, designAdded 9 Years Ago from Yankodesign


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Posted by eddie
this attorney was assigned to me by the US district court in 2011 after being charged for actions against the federal antikickback law (Medical Fraud). His services were to be paid by the federal court system. I met with him on multiple occasins and always felt that he did not have my best interest in mind. Every single time we met he had a different strategy in tackling my dire situation. He was unsure what to do in my case. He never put me at ease and I started to doubt that he was truly there to help my case. He caused me unneeded stress due to his lack of insight what proper actions to take. In his eyes I was going to prison.I terminated with him and sought another attorney. The new attorney was everything I expect from an attorney.I am happy to say that I received a noncustodial sentence.
Posted by anonymous
Mr. Adams is an excellent attorney who is prepared and professional. He made me feel like a very important client, even though my case was not very big. I would absolutely hire Mr. Adams again.


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- U.S. equity funds saw their largest monthly outflow for the year to date, but the $3.3 billion in redemptions was small compared with the $9.1 billion average monthly outflow seen by the category group in 2012.
- International-equity funds led all category groups in September with inflows of $7.3 billion; the group also leads all others for the year-to-date period with inflows of $103.2 billion.
- Alternative mutual funds had the highest organic growth rate among category groups, but the growth was largely driven by just one fund—MainStay Marketfield. The fund, which has a Morningstar Analyst Rating™ of Bronze, brought in $1.7 billion for the month and $10.2 billion year to date.
- Vanguard had the highest provider-level inflows with $3.2 billion, followed by Goldman Sachs and Dimensional Fund Advisors. PIMCO saw outflows of $6.5 billion; since June, heavy outflows of $30.2 billion from PIMCO Total Return have contributed to the firm's overall outflows of $38.2 billion.
CHICAGO, Oct. 11, 2013 /PRNewswire/ -- Morningstar, Inc. (NASDAQ: MORN), a leading provider of independent investment research, today reported estimated U.S. mutual fund asset flows for September 2013. Long-term mutual funds collected tepid inflows of $2.5 billion during the month, as municipal-bond funds saw a seventh consecutive month of outflows. Since March, muni-bond funds have lost $48.1 billion to outflows, surpassing redemptions of $44.8 billion seen from November 2010 through August 2011. Taxable-bond funds endured their fourth-straight month of outflows, although the pace of selling slowed relative to June's record outflows. Morningstar estimates net flow by computing the change in assets not explained by the performance of the fund. Click here for a full explanation of Morningstar's methodology. Additional highlights from Morningstar's report on mutual fund flows:


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So for me it was a big issue of what kind of shape Dai's actually in.
IF we are going to talk about someone who has a body of work argument IMO it was Oda. Yes Dai beat him at NHK but Oda skated consistently well throughout..
I'd feel differently if Dai had more than one good competition this year.
To be frank Dai's placement on the team is a lot like Plush's. Don't get me wrong not nearly as bad or egregious but based on more on what they once were than what they are now.
Actually it STILL hasn't cooled off on twitter - seems like near every tweet about the 2014 US team still provokes at least 1 "Nagasu deserved it" or "hope Wagner (or Edmunds) bombs", etc.


text:
From The Onion.
WASHINGTON—According to a new report released Tuesday by the Federal Aviation Administration, Spirit Airlines, the American low-cost air carrier, is the absolute fucking worst and is actually a giant fucking rip-off.
The 250-page report, which repeatedly calls the entire airline a goddamn scam, openly questions how in the hell Spirit is still in business if it sucks so fucking bad. In addition, the report confirms that the airplanes suck, the terminals suck, and the seats—which don't even fucking recline—suck.
Nobody with any shred of dignity should ever fly Spirit Airlines, the report states.
"The FAA has come to the determination that Spirit Airlines treats its customers like pieces of shit and that everyone should boycott this airline," the report read in part, adding that there are so many hidden fucking fees that it makes customers want to blow their brains out.
"The airline touts its low fares, but it costs $45 to check your bag at the airport, and if you don't check the bag when you get your ticket, it costs a mandatory $100 at the gate. So the flight could end up costing over $300 anyway."
(read more)
Friday, May 10, 2013
Weird People Wearing Animal Masks Of The Day
giggle shudder giggle shudder
Inspired by this Craiglist ad.
Inspired by this Craiglist ad.
"My day was fine. Why do you keep asking?"
Yikes! Al Roker's gaining weight again.
"I don't understand the confusion. This is basic engineering, people."
"This isn't the Feingold bar mitzvah, is it?"
"We must never speak of this party again."
"I feel like I'm getting burned."
I know you're feeling a lot of things right now, son, but I can explain.
Welcome. We've been expecting you.
(sigh) What am I doing with my life?
Subscribe to: Posts (Atom)


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Letter: State a "Lava Nazi"?
Dear Mayor Billy Kenoi and Governor Ige,
As myself and several friends were reminiscing about what has happened to Pahoa since Hurricane Iselle and the approach of Pele, a little jingle came to our minds. After reading the Hawaii Tribune Herald front page on Christmas Day, I have modified Number 1 and 2, and the song needs to be made public, because this is the reality we live now in lower Puna. Sorry Billy, but as the head of all emergency operations in Pahoa, you get all the credit:
On the 12th Day of Christmas, Mayor Billy gave to Pahoa,
12 Stinky Dumpsters
11 Enhanced Penalties
10 Days Between Updates
9 Thousand Empty Houses
8 Circling GreenHarvest Copters
7 Weeks of Detours
6 Evacuation Notices
4 Schools a Movin'
3 Wrapped Poles
2 more Empty Marketplaces
and 1 Puna Geothermal Venture Well…
Yep, Hawaii now has the reputation of "Lava Nazi" when it comes to anyone seeing active moving lava. We now live in a constant "State of Emergency" and the government has it's hands tied because of "Liability." No new businesses can come in to replace the bailed ones – lack of insurance. You can't see the lava because of insurance liability, the town of Pahoa is effectively, how can I put it mildly – "shut down" in anticipation of…… perhaps the lava is coming… no…yes… no, it stopped again… darn, now where do we shop???
Please, Mr. Kenoi and Mr. Ige, there must be a way in the new year to change the way our government is handling lava viewing and helping preserve the business-friendly structure of Pahoa, the "Aloha" reputation of Hawaii and the sanity of Puna residents in general! Look what has been done to Pahoa so far, and Pele has only taken one house.
How do other countries handle live volcanoes and the impact to surrounding communities? How did our own Civil Defense handle the lava the last 30-40-50-100 years? What are we doing here, because how the people are being treated, makes us believe you wish all us humans to leave the area so you can industrialize or something…. There is no doubt we can do much better in 2015!
Sara Steiner


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Listing Provided Courtesy Of: Rome International Realty
Real Living Cypress Realty, Inc.
Last Updated: 5/24/2017 6:31 PM
Description for 1067 Ainsworth ST Lehigh Acres, FL 33974
Nice lot located in up and coming area of Lehigh Acres. Great location conveniently located and close to downtown Lehigh, and Ft. Myers.
Nice lot located in up and coming area of Lehigh Acres. Great location conveniently located and close to downtown Lehigh, and Ft. Myers.
Listing Information
Central Water
No Sewer, Septic, Central Sewer
Cable TV, Electric, Telephone, Water
Room Information
Interior Features
Exterior / Lot Features
Public Roads, Oversize, Irrigation well
Financial Considerations
Listing Price History
Lehigh Acres Real Estate
Lehigh Acres is located in Florida. Lehigh Acres, Florida 33974 has a population of 106,747.
The median household income in Lehigh Acres, Florida 33974 is $39,686. The median household income for the surrounding county is $47,908 compared to the national median of $53,482. The median age of people living in Lehigh Acres 33974 is 33 years.
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Tag Archives: kathryngreenhill
The Darien Statements on the Library and Librarians
I missed the summit type thing on the future of libraries in Darien a few weeks back so I'm really enjoying getting to read the work product from that meeting. I think sometimes our profession suffers from a lack of … Continue reading
Posted in libraries Tagged cinditrainor, darien, johnblyberg, kathryngreenhill, libraries, manifesto 1 Comment
2.0 keeping us connected
Kathryn Greenhill has a great sensible post on why learning emerging techologies is part of every librarian's job. Kathryn worked with other Australian librarians on Library2.0 on the loose, an unofficial unconference for Western Australian library folks (and a few … Continue reading
Posted in librarians Tagged blogs, kathryngreenhill, l2, library2.0, managethis, unconference Comments Off on 2.0 keeping us connected


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In my opinion, the scene in FLCL when Naota (with Haukas aid) has his spirit weapon (a 67 Gibson Flying V) extracted from his head and hits the falling satellite (aka baseball) out of the stratosphere (again with Harus last second help) is one of the best anime scenes of all time. The direction, cinematography, animation, and, of course, over all concept and execution are each 9.9/10, if not perfect 10s from some aspects. And the music for the entire thing (by the Japanese indie rock legends The Pillows) is outstanding, as well. Its overall intensity, suspense, beauty/aesthetics, sentimentality, and completely over the top X factor easily put it into, at minimum, one of the top ten all time great anime scenes. It may be even be top 5.
So what do you guys think? Im not trying to start an argument over the #1 spot (after all, its a personal opinion, and its doubtful that any two serious anime fans would have the same top 10, even top 5 or 3), but whatre some of your favorites anime scenes of all time?


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Gokcen Hotel
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
TripAdvisor Reviews Gokcen Hotel Marmaris
Travel Blogs from Marmaris
Soup Goalie and Borrowed Knives
... minding its own business. Then, out of absolutely nowhere, and silently, Steve takes MY knife, cuts HIS CHERRY TOMATO, and put MY knife back on MY plate. A CHERRY TOMATO. IT'S SMALL ENOUGH TO NOT CUT. THAT'S MY KNIFE. ASK FIRST. NO. NO. NO. STRIKE THREE.
We are just so tired from traveling. Gena and I calculated this morning that we've spent more than 30 hours driving in the car this ...
Arrival in Marmaris
... as a surprise.
No shoes are allowed on deck these are kept on shelves on the main deck, the decks are all wooden hence the reason for no shoes.
It is rather hot in the cabin as I'm unpacking but it it doesn't take long to find a home for everything. (David already befriended the deck hand who has access to the bar).
It's a lovely setting, Marmaris Harbour with vessels of all shapes and ...
Two Young Giffers on a Motorbike in Ankara
... where they will pick it up and take it back to England !!!! Then they will crate it up and fly it to Katmandu, all for £2K plus insurance +++++Then there are our flights at around 1K, so we are talking almost 4K, er I think not. A Turkish company loosely gave us a quote of about half James Cargo, but would not firm it up or be clear as to what we were getting Sooo we are now in Ankara trying to get visas for Azerbaijan, Turkmenistan, Uzbekistan and Tajikistan. The plan ...
Ankara The capital of a Turkey
... is an extremely knowledgable young man who has obviously done his homework -nothing is a bother, he is always pleasant and doesn't get rattled no matter how many questions he is asked. Have included a few extra photos from yesterday. Off to Bursa tomorrow with a wakeup call at 6.30. We will see King Midas's tomb a silk market and a covered bazaar. JK has bought himself ...
A Brand New Year
... of the geographic position.of where we are. This month is the wettest so far and it sometimes feel as though we have turned into rabbits, diving for our burrows as the rain rolls through and popping out when the sun peaks through.
We have just returned from a Swine and Wine run from Rhodes. This is the affectionate term given to the time when you need to renew your stamps into Turkey. ...
Other places to stay in Marmaris
Turunc Hotel17 Eylul Mahallesi Atatürk Cad. No:86, Marmaris | 5 star hotelfrom $153
D-Resort Grand AzurCumhuriyet Bulv. No:17 Marmaris, Marmaris | 5 star hotelfrom $159
Grand Cettia HotelSehit Ahmet Benler Caddesi No. 97, Marmaris | 4 star hotelfrom $100
D Maris BayHisaronu Mevkii, Marmaris | 5 star hotelfrom $388
Elegance Hotels International, MarmarisSiteler Mah. 209 Sk. No:4, Marmaris | 5 star hotelfrom $79
Poseidon HotelUzunyali Cad. Dergah Mevkii, No 143 Marmaris Merkez, Marmaris | 4 star hotelfrom $33
Kervansaray MarmarisMerkez Mah. 19. Sok. No:55 Marmaris Merkez, Marmaris | 4 star hotelfrom $71
Halici Holiday VillageCam Sok. No: 1 , Marmaris | 4 star hotelfrom $53
Orka Nergis BeachKemal Elgin Bulvari 232 Sok. No.165, Marmaris | 4 star hotelfrom $74
- Lovely Holiday, could not fault it!
- Loved the Hotel but big O'NO to the adjoining resturant
- Fab location. Hotel lovely. Great holiay.
Blue Bay Platinum HotelKenan Evren Bulvari, Marmaris | 5 star hotelfrom $120
Tropikal HotelKenan Evren Bulvari No:49, Marmaris | 4 star hotelfrom $105
Grand Pasa HotelDurmazlar Cad 15, Marmaris | 5 star hotelfrom $112
Anemon HotelToyako Onsen, Marmaris | 4 star hotelfrom $54
Sesin Hotel209 Sokak. No.3, Marmaris | 4 star hotelfrom $76
Hotel Club IlaydaEmel Sayin Cad 148 Sok No 6, Marmaris | 3 star hotelfrom $47
Intermar HotelKemal Elgin Bulv. No:55 Marmaris Merkez, Marmaris | Hotelfrom $49
Kayamaris HotelSiteler Mah. 256 Sk. No: 4, Marmaris | 4 star hotelfrom $73
Grand Hotel FarosCami Avlu Mevkii Cevreyolu Cad., Marmaris | 3 star hotelfrom $43
Club Hotel PinetaSirinyer mahl. Kenan Evren Bulv, Marmaris | 4 star hotelfrom $59
Hotel Cettia Beach ResortSiteler Mah. Kenan Evren Bulv. No:51 Marmaris Merkez, Marmaris | 4 star hotelfrom $123
Blue Bay Classic Hotelsiteler mah 209 sk. No.16, Marmaris | 5 star hotelfrom $78


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Christina McCaffrey was blindfolded while her husband-to-be and wedding gown designer David McCaffrey fitted her dress.
Day: January 31, 2013
Fit to be tied
Mika makes his mark in a hurry
At some point late Wednesday night, as he was receiving the Justin Bieber treatment at Scotiabank Place, 19-year-old Mika Zibanejad was surely tempted to pinch himself.
Did all this really happen so fast?
Plane, train, an automobile and a horse
Let the fantasy begin. Couples want their engagement photos to set the scene for the main event.
Dining Out
Golden India serves a solid, varied buffet and some extremely hot curries.
Blackie's NEXT move
Former NAC chef is now a partner in Stittsville-based banquet hall/restaurant.
Senators forced to survive without Spezza
Step right up, Kyle Turris, you've suddenly become the centre of attention for the Ottawa Senators.
You, too, Peter Regin. If ever there was an opportunity to re-establish yourself as a front-line NHL player, this is it.
World of Wine
Cabernet sauvignon flourishes
Thursday Q&A with Avah Taylor
Jamaican-born Avah Taylor is a fashion blogger and personal stylist based in Canada.
Any way you slice it
Grilled cheese is melting hearts and heating up appetites.


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18" Diamond Blue Gradient Planter
Gloss your garden with this lush diamond blue gradient planter. The black round rim blends into the gentle blue color, adding a touch of radiance to your favorite plant or flower. And with the beaded ridges surrounding the planter, your plants are adorned in royalty. Perfect for decorating your patio or front porch.
- Perfect for front or backyard decoration
- Includes: 1 C type filter cartridge with built-in chlorinator that uses 1" tablets and 1 RP filter pump system with GFCI protection
- SureStep™ ladder with safety barrier
- Super durable Polystrength™ PVC sidewalls
- Easy to replace filter cartridge
- Convenient quick release drain plug with garden hose connection
- Easy to store during off season
- Water capacity: 3,800 gallons/14,383 liters
- Model number: 4485-B
- 17.5"L x 17.5"W x 13.3"H
- Material: Polyresin
- Weight limit: 20 lbs.
- Weight: 2.9 lbs.
Shipping & Returns
If you have the option to "Add to Cart", this item is available for shipping. If not, enter your zip code to find a store near you.
Questions? Visit our Shipping FAQS for more info about shipping. For questions about returns see our Returns Policy.


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Pan Dollies
When moving heavy loads of bun pans and sheet pans, you'll want the right tools for the job. The easier it is to transport sheet pans, the faster it is and the more efficient your business will be. With that in mind, we offer our selection of food pan dollies as a great way to transport sheet pans and food pans to and from your busy kitchen. Foodservice Superstore has a great selection of pan dollies and food carriers from top name brands at great prices!
Food carrier dollies are indispensable tools for schools, hospitals, cafeterias, restaurants, commercial kitchens, grocery stores, and many other facilities that receives and/or ships food items and other products. The transport is smooth and effortless, being able to carry up to 800 pounds. They have rounded corners designed to product your equipment and walls from damage. They are great for many uses and they are able to maneuver easily over all types of terrain. Food pan dollies reduce employee injury risk, as they do not have to lift and carry food pans over and around obstacles. The dolly does it for them, making your operation smooth and keeping your employees safe. With a welded aluminum frame, our pan dollies are great for transporting and storing full size or half size sheet pans.


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This sexy Transsexual gets her man's cock shoved down her throat. She wants his cock in her ass, too. Watch as she gets on top of him and ride his cock. She tries out reverse cowgirl and then cowgirl position with his cock in her ass.
- amadeus
- : 3min 6sec
- : 4 Jul 2014
- Exclusive video


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OC's Only Blimpie Closes
Orange County's only outpost of the Blimpie sandwich-shop chain, located at 840 The City Dr. S. in Orange, has closed its doors, part of a reshuffling of businesses that has seen the departure of a doughnut shop, a cell-phone store and a flower shop.
Management for the Orange City Square, which owns the building, has announced that a yet-to-be-named pizzeria will be moving into the plaza.
If you're a fan of Blimpie--and we have to assume that if you're reading this blog, you're probably not because it wasn't very good--you'll have to make your way to Chino for your fix, or head across the Santa Ana River to the Subway at Bristol and Memory.
Follow Stick a Fork In It on Twitter @ocweeklyfood or on Facebook!
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Our weekly guide to Orange County dining includes food news and reviews, as well as dining events and interviews with chefs and restaurant owners.
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Corey Kluber, CLE at CWS ($10,800): Kluber has been knocked around to begin the season, but his 6.38 ERA is largely the result of an ungodly 21 percent HR/FB rate, which is double the figure he kept in 2016. The White Sox have notched the second-lowest wOBA against righties this season, while striking out 25 percent of the time over 385 plate appearances.
Cole Hamels, TEX vs. KC ($9,300): The Royals entered competition Thursday with the third-lowest wOBA in the league before getting blanked for 13 innings by Andrew Cashner and friends. Hamels is another pitcher who has gotten off to a bit of a rough start, but his upside makes for a potentially nice scarcity play on a large slate.
Buster Posey, SF at COL ($5,100): Posey missed the required seven days while recovering from a concussion, but he has gone 5-for-9 in two games since returning to the lineup. Tyler Chatwood spun a complete game when he faced the Giants last week in San Francisco, but he may be without one of his weapons against Posey, as the All-Star backstop notched a 4.3 RAA against the cutter last season.
Anthony Rizzo, CHC at CIN ($5,300): Tim Adleman has been a serviceable starter in the minor leagues, but a lack of strikeouts and a 35 percent hard contact rate led to a 5.15 xFIP in 69.2 innings last season. Adleman has opened the season leaning heavily on his changeup, which could be good news for Rizzo, as he notched a 10.7 RAA against the pitch last year.
Jose Peraza, CIN vs. CHC ($3,600): Peraza hasn�t gotten off to the fast start many had hoped for, but he may have a chance to get things going against a lefty, as he notched a .340 wOBA against his opposite hand in 52 at-bats last season. Almost any willing base stealer is worthy of a look against Jon Lester, and Peraza certainly qualifies, having swiped six bags in just 15 games this year.
Evan Longoria, TB vs. HOU ($4,100): Mike Fiers has been clubbed by righties his entire career, as evidenced by his 1.4 HR/9 rate and 34 percent hard contact rate. Longoria held a reverse split in 2016 in terms of power, finishing the year with a .262 ISO against same-handed pitchers.
Aledmys Diaz, STL at MIL ($4,500): Some may be tempted to look at Wily Peralta�s 2.65 ERA and think this is what we have all been waiting for, but a .174 BABIP against righties despite a 38 percent hard contact rate should give us an idea that regression is coming. Diaz has kept his power against righties despite a miserable start to the year overall, as he has a .261 ISO over 46 at-bats.
Aaron Judge, NYY at PIT ($3,500): Judge could be an option every day at this price, but a matchup against Tyler Glasnow makes him even more appealing, as he has walked seven batters over his 6.2 innings. Consider that he kept a 14 percent walk rate in Triple-A Indianapolis last season, and suddenly a future ace looks like a present stack target. Judge has kept a 5.8 RAA against the curveball, a pitch Glasnow threw 35 percent of the time in 23.1 innings with the big club in 2016.
Nelson Cruz, SEA at OAK ($4,200): Sean Manaea has his strikeout pitch working in 2017, but a walk rate of nearly 13 percent has contributed to a 5.51 ERA over three starts. Cruz demolished lefty pitchers in 2016, registering a .351 ISO and .419 wOBA over 218 plate appearances.
Jay Bruce, NYM vs. WAS ($3,400): A groundballer like Tanner Roark should be perfect for Bruce, who has hit the ball in the air a whopping 55 percent of the time in his 66 plate appearances this year. Bruce has always shown good power against righties, having tallied a .233 career ISO.


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Just Friends
During the bustling hour of lunch time, you come waltzing over to our table. You sit next to me calmly, only to smile and breath a gentle, "Hi."
I can't reply, I am too shocked. Everyone continues on with the conversation, teasing each other softly. It's just another school day.
You glance over with curiosity, pondering on why I am silent. You tug at my hair, slightly smiling at my confused face. My cheeks become red with embarrassment but I still beam at you.
Suddenly all of our friends tease us at liking each other. You laugh at this, making my heart ache at your astonished face. It's as if you couldn't even imagine us together.
It makes me sad. It makes me want to cry. However, I hold back the sadness and laugh along with everyone else.
It's a forced laugh. A fake smile. I hate just being your friend.


text: SCHOLARSHIP INFORMATION SESSION SEPTEMBER 2014 FACTS The average undergraduate student in Canada graduates with $24,000 worth of debt. According to Statistics Canada's Youth In Transition Survey, 36% of students who ceased their studies early cited financial reasons. Source: Studentawards member base & Statistics Canada COSTS OF EDUCATION First year domestic tuition fees by program at York University for the 2013-2014 school year were as follows: Arts and Science ($6,953.89) Business and Commerce ($8,670.79) Engineering and Applied Sciences ($8,618.29) Source: www.electronicinfo.ca COSTS OF EDUCATION If you plan on living ON CAMPUS in residence your first year of university will cost approximately $18,000 This means that an average four year program will cost you 72,000? Source: York University, Fall 2013 WHERE DO I BEGIN? Begin your research early Look closely at the colleges and universities that you are applying to for their own Entrance Scholarships For example, York University offers automatic scholarships and awards, and other's that require an application. For more information go to: http://futurestudents.yorku.ca/funding#cdn-hs General Scholarships Community Scholarships Maple Graduation Awards HOW DO I FIND SCHOLARSHIPS, BURSARIES AND AWARDS? www.studentawards.com: get matched with money for school www.fundyourfuture.ca: great financial planning tools here www.scholarshipscanada.com www.canlearn.ca: provides interactive planning tools to help you make important decisions about saving for, selecting and financing your post secondary education www.electronicinfo.ca College/University Financial Aid Office Websites MYTH: SCHOLARSHIPS ARE JUST FOR "BRAINIACS" Real students DO win real money There are thousands of scholarships and awards that reward students for non-academic attributes: Being creative Being tall Being nice Volunteering Playing hockey, soccer etc. Where you live Your heritage or what languages you speak Entering a contest, responding to a survey Source: studentawards.com WHAT TYPE OF STUDENTS ARE SCHOLARSHIP PROVIDERS LOOKING TO REWARD? In addition to academic success and financial need, scholarship providers look for applications who can demonstrate: Originality and Passion – what makes you stand out from all the other applicants? Volunteering & Community Service – do you give back to the community? Have you volunteered beyond the 40 hour requirement? Leadership & Initiative – are you a founding member or have you taken an active role in a club or organization? Talent – Do you have a vision? Scholarships reward fresh thinking and new ideas Special targeted areas – specific heritage or cultural background, gender, special needs, geography and more Source: studentawards.com STUDENT LOANS OSAP (Ontario Student Assistance Program) You can apply for OSAP once you accept a program (mid to late June) OSAP is only meant to supplement one's educational costs, not pay entirely On average, students receive $7000 - $8000 if they qualify for OSAP – only in special circumstances will a student receive the full $11, 900 York University OSAP Presentation SCHOLARSHIP TIMELINES The Guidance Department will post and announce scholarships on a regular basis from September to June. All of this information can also be found at http://maple.hs.yrdsb.ca Additional information related to Scholarships may be found on the bulletin board directly outside of guidance. Students applying for scholarships are reminded it is your responsibility to meet all deadlines. There are an abundance of scholarship opportunities available; we encourage you to go on these sites, see what is out there, and apply to as many as possible. SCHOLARSHIP TIMELINES Make an appointment with your Guidance counsellor to ask questions about the process or get help with up-coming applications Organize your documents early (transcript requests, letters of references) Don't wait until the last minute – start your work well ahead of deadlines MAPLE HIGH SCHOOL AWARDS Check the Maple HS website to look for information about applying for the Graduation Awards. These applications will be due in May. Lieutenant Governor's Community Volunteer Award Enrico Cimino Memorial Award Director's Achievement Award Roy Foss Leadership Award The Student Trustee Award for Character City of Vaughan Proficiency Award Lion's Club Award Maple Perseverance Award TRANSCRIPTS TRANSCRIPTS are required when applying for Scholarships REMEMBER to submit a "Transcript Request Form" to Guidance well ahead of the time you need it. The Transcript Request Form can be printed off from the Maple HS website under Scholarships. The first 2 transcripts that are printed are FREE of charge. Each additional transcript after the first 2 will cost $1.00 KRISTI FUNG – GRADUATE MAPLE HS, 2012 Currently attending University of Waterloo with an Honours in Biomedical Science Major First year cost was approximately $16,000 and 78% was funded by scholarships, bursaries and awards


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Check out best and selected wallpapers of beautiful Hollywood actress Jessica Alba. Here we present some most searched Wallpapers of Jessica Alba
Jessica Marie Alba is an American television and film actress and model. She began her television and movie appearances at age 13 in Camp Nowhere and The Secret World of Alex Mack (1994). Alba rose to prominence as the lead actress in the television series Dark Angel (20002002).[2][3] Alba later appeared in various films, including Honey (2003), Sin City (2005), Fantastic Four (2005), Into the Blue (2005), Fantastic Four: Rise of the Silver Surfer and Good Luck Chuck both in 2007.
Alba has been called a sex symbol. She appears on the "Hot 100" section of Maxim and was voted number one on AskMen.com's list of "99 Most Desirable Women" in 2006, as well as "Sexiest Woman in the World" by FHM in 2007. In 2005, TV Guide ranked her # 45 on its "50 Sexiest Stars of All Time" list. The use of her image on the cover of the March 2006 Playboy sparked a lawsuit by her, which was later dropped. She has also won various awards for her acting, including the Choice Actress Teen Choice Award and Saturn Award for Best Actress on Television, and a Golden Globe nomination for her lead role in the television series Dark Angel.
Celebrities list


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Extreme Cold is a Hot Technology
Despite its name, coolant often doesn't provide much cooling. Here's a different approach to enhancing tool life that involves dramatically cooling the tool.
Coolant lubricates a machining process and clears chips. Despite the name, however, it often doesn't provide much cooling. A very different approach to enhancing tool life involves dramatically cooling the tool—using fluid colder than -300ºF. As this article describes, cryogenic machining might deliver the next dramatic leap forward in tool performance.


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Dr. Stuart Flynn has been named dean of The University of Arizona College of Medicine – Phoenix in partnership with Arizona State University.
Flynn, who has been interim dean of the Phoenix expansion of the medical school since last May, accepted the appointment from Dr. William M. Crist, vice president of health affairs for the UA. The appointment was effective Monday.
Prior to serving as interim dean, Flynn was the associate dean for academics at the College of Medicine – Phoenix since June 2006.
"Dr. Flynn has done a superior job in taking the reins of the important expansion of the College of Medicine," said Crist. "He is the right person to continue leading this campus and I have every confidence that the Phoenix campus will continue to grow, succeed and serve the state of Arizona under his leadership."
Flynn was instrumental in developing and implementing the curriculum, working closely with counterparts from Arizona State University. Flynn also provided key leadership in the formative stages of the Phoenix expansion. He teaches anatomic and clinical pathology and the translational interface between basic sciences and clinical medicine.
"I am thrilled with the opportunity to guide this emerging campus into a premier educational and research center," Flynn said. "The College of Medicine – Phoenix is at the hub of an exciting development as part of the Phoenix Biomedical Campus. We have the perfect milieu to train the next generation of physicians in an exceptional fashion while simultaneously advancing our research mission to improve health care. And we will do this with our counterparts in Tucson, as well as our excellent partners in Maricopa County."
Flynn received his medical degree and residency training at the University of Michigan before completing postdoctoral work in oncologic pathology at Stanford University. He came to the College of Medicine – Phoenix from the Yale University School of Medicine, where he was a professor of pathology and surgery, as well as an accomplished researcher and academic leader for 20 years. He received Yale's Teacher of the Year Award in 2004 and "America's Top Physician's Award" from the Consumers' Research Council of America in 2003, 2004 and 2005.
Flynn has authored more than 100 articles, books and monographs and has received numerous honors and teaching awards. He is a member of the National Board of Medical Examiners Pathology Test Committee and the U.S. Medical Licensing Examination Step I Test Material Development Committee.
Flynn's research has included studies of cancers, including lymphomas and leukemias, endocrine disease, as well as immunodeficiencies, such as AIDS.


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When somebody can't find a guide on how to accomplish a particular task, we here at Hackaday admire those individuals who take it upon themselves to write one for the benefit of others. Instructables user [his handy tutorial should get you up to speed for your own projects.] couldn't find a write-up on how to connect Amazon's Alexa service, and Echo to his Raspberry Pi home security system, so
[PatrickD126] shows how loading some software onto the Raspberry Pi is readily accomplished along with enabling Alexa to communicate more directly with the Pi. From there, it's a matter of configuring your Amazon Web Services account with your preferred voice commands, as well as which GPIO pins you'd like to access. Done! [PatrickD126] notes that the instructions in the guide only result in a temporary solution, but suggests alternatives that would allow your project to operate long-term.
Continue reading "A Handy Tutorial For Voice-Command Awesomeness"


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Andy Schleck refused to revel in his elevation to 2010 Tour de France champion following the Court of Arbitration's decision to strip Alberto Contador of the crown.
Contador was yesterday banned for two years for testing positive for clenbuterol during the 2010 Tour, meaning Luxembourg rider Schleck moves up from second place to the top of the podium.
He was not celebrating the fact, however.
"There is no reason to be happy now," he said. "First of all I feel sad for Alberto. I always believed in his innocence.
"This is just a very sad day for cycling. The only positive news is that there is a verdict after 566 days of uncertainty. We can finally move on.
"I trust that the CAS judges took all things into consideration after reading a 4,000-page file.
"If now I am declared overall winner of the 2010 Tour de France it will not make me happy.
"I battled with Contador in that race and I lost. My goal is to win the Tour de France in a sportive way, being the best of all competitors, not in court. If I succeed this year, I will consider it as my first Tour victory."
It was initially announced Contador had failed a doping Test in September 2010, shortly after he had won his third Tour - he was also victorious in the sport's biggest race in 2007 and 2009.
The 29-year-old always maintained his innocence, claiming he failed the test after eating contaminated meat, and rejected an offer from the Spanish Cycling Federation (RFEC) to serve a 12-month suspension.
In February 2011, the RFEC then decided to withdraw any sanction against Contador, a decision which was subsequently appealed at CAS by the International Cycling Union (UCI) and World Anti-Doping Agency (WADA).
CAS yesterday partially upheld that appeal, ruling Contador must serve a two-year period of ineligibility starting retroactively on January 25, 2011, minus the period of the provisional suspension served in 2010-2011 (five months and 19 days).
All results obtained since January, 2011 will be wiped from the record books, meaning that in addition to Contador losing the 2010 Tour crown, his achievement in winning the 2011 Giro d'Italia will no longer be recognised.
Michele Scarponi is the new winner of the 2011 Giro.
In explaining the reasons behind their judgement, a CAS statement read: "Alberto Contador alleged that the presence of clenbuterol in his system originated from eating contaminated meat.
"The UCI and WADA submitted that it was more likely that the adverse analytical finding of the athlete was caused by a blood transfusion or by the ingestion of a contaminated food supplement than by the consumption of contaminated meat.
"The panel found that there were no established facts that would elevate the possibility of meat contamination to an event that could have occurred on a balance of probabilities.
"Unlike certain other countries, notably outside Europe, Spain is not known to have a contamination problem with clenbuterol in meat.
"Furthermore, no other cases of athletes having tested positive to clenbuterol allegedly in connection with the consumption of Spanish meat are known.
"The panel concluded that both the meat contamination scenario and the blood transfusion scenario were, in theory, possible explanations for the adverse analytical findings but were however equally unlikely.
"In the panel's opinion, on the basis of the evidence adduced, the presence of clenbuterol was more likely caused by the ingestion of a contaminated food supplement."
Contador will now miss the 2012 Tour and the London Olympics.
- More about:
- Cycling
- Nutrition
- Performance-Enhancing Drugs
- Spain
- Tour De France


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I'm recording the process of my "Ginseng in May" sketch that I'm doing for the first Kingston, AR art show. And it's the first art show I've ever entered. This sketch is the first I've ever done that took so long, lol, so this is a first on many levels.
Follow along at my Wild Ozark Nature Journal website: http://www.wildozarknaturejournal.com/ginseng-in-may/
Here's how it started out:
"Ginseng in May" – the finished sketch:
At the Wild Ozark Nature Journal Blog I go into explanations of how, why and what I did. Here's a link to all of the ginseng-related posts at this blog. Under the "Ginseng" tab on the menu at the top of this page, you'll find other pages on ginseng that don't show up as posts.
About the voice behind this blog, Madison Woods
I'm a creative old soul living way off the beaten path with my husband in the wild Ozark Mountains. Besides homesteading, growing plants & making crafty things and newsletters, I write books and stories. My rural fantasy fiction, written under the pen name, Ima Erthwitch, usually takes place in a much altered Ozarks.
Ways You Can Support Wild Ozark
- Spread the Word
Share this post or tell a friend about my website. "From little acorns do mighty oaks grow." A little thing like sharing could start momentum! This is a free and tremendously powerful way to help.
- Buy a Book
See all of my books here:
Nonfiction: Madison Woods Amazon Author's Page.
Fiction: Ima Erthwitch Amazon Author's Page.
- Shop at our Nature Boutique
Unique gifts, books, and information for the nature lovers in your life. Adding more items as time allows: Wild Ozark Nature Boutique.
- Become a Patron
A small monthly stipend of even $1 from enough supporters will help me continue the educational outreach and construction of habitat gardens. More information here: https://www.patreon.com/wildozark


text: Library Fundraising and Friend-Raising on the Web by Laura Blanchard English | 31 May 1998 | ISBN: 083890727X | 204 Pages | EPUB | 1 MB Since successful library fundraising has always been about outreach, what better way to reach out than through the information superhighway. That's what Adam Corson-Finnerty and Laura Blanchard, innovators at the University of Pennsylvania, had in mind when they developed this guide to wired fundraising. Buy Premium From My Links To Get Resumable Support,Max Speed & Support Me Code: Download ( NitroFlare ) http://nitroflare.com/view/88F9BAFF0C49105/j4vyl.Library.Fundraising.and.FriendRaising.on.the.Web.by.Laura.Blanchard.rar


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Suspended License Information for Massachusetts
Reinstate Suspended Drivers License in Massachusetts
Receiving a drivers license suspension in Massachusetts is a serious matter. It means that you do not have driving privileges for a definite period of time.Having a suspended driving license in Massachusetts is more than simply not being able to drive. You are also responsible for:
- Paying traffic fines.
- Paying reinstatement fees.
- Serving other penalties from the MA RMV, such as:
- Jail time.
- Ignition-interlock device installation.
- Alcohol awareness class enrollment.
Information Related to Suspended Licenses
- Violations
- Suspension Periods
- Consequences
- Hardship Licenses
- Traffic School
- In Person Reinstatement
- Phone Reinstatement
- Mail Reinstatement
- Fees
How You Can Incur a Suspended Drivers License in Massachusetts
There is a wide variety of violations that you can commit which can result in a suspended or even a revoked drivers license in Massachusetts. Some of the reasons for suspension include:
- If you failed to pay traffic tickets.
- If you accumulated too many surchargeable points on your MA driving record, with violations such as:
- Criminal traffic violations (DUI)
- Civil traffic violations, such as speeding
- Accidents you caused
The Massachusetts court system also has the power to suspend your driving license. They may do so if:
- You failed to pay child support.
- The court considers you a threat.
- You are not operating a vehicle properly.
- You commit drivers license fraud.
Suspension Periods
There are five ways that an accumulation of surchargeable points can lead to a suspended drivers license in MA. However, the suspension periods vary from situation to situation. The breakdown of violations and the drivers license suspensions associated with them are as follows:
- Three speeding tickets in 12 months: mandatory 30-day suspension
- Three surchargeable events in 24 months: indefinite suspension until driver takes a Driver Retraining Program
- Five surchargeable events in three years: indefinite suspension until driver takes a Driver Retraining Program
- Seven surchargeable events in three years: mandatory 60-day suspension
- Three major moving violations or a combination of any 12 major and minor violations in five years: four-years of revoked drivers license
In addition to these violations, refusing a chemical test when accused of driving under the influence will also result in suspension. The breakdown of periods is as follows:
- If 21 or over and first DUI: 180-day suspension
- If 21 or over and second DUI: three-year suspension
- If under 21 and first DUI: three-year suspension
Consequences for Driving with a Suspended License
If you are ever caught operating a vehicle with a suspended drivers license, you can expect to experience the following penalties:
- Additional suspension time
- More fines
- Possible time in jail
To make sure that you drivers license hasn't been suspended, you can order your driving record, which has all issuances and suspensions of driving licenses.
How to Obtain a Hardship License
In the event your drivers license has been suspended for any of the following reasons, you will be eligible to apply for a hardship license:
- Habitual Traffic Offender
- Drug Conviction (94C)
- Driving under the influence of drugs or alcohol
- First Offense Alcohol or Drug Program (24D)
This license will allow you to operate a vehicle to go to school or work while you wait for your suspension to end. However, in order to obtain one, you will have to attend a hearing at a Hearing Court in Massachusetts. Here, you will be provided with the steps that you must take in order to receive these privileges.
Massachusetts Traffic School
All major traffic violations will result in points on your drivers record in Massachusetts. Whereas other states allow you to enroll in a defensive driving course in order to erase points from your record. The only way that these surchargeable points will be removed from your driving record is if:
- You have been involved in less than three surchargeable events in the last five years.
- Your last surchargeable event is three years old or older.
- All of your out-of-state violations in the last five years have been reported to the Merit Board.
- You have at least three years of safe driving experience
Otherwise, your points will expire after a period of six years. In any case, online traffic school is still a very valuable resource. By enrolling in a program, you will be able to lower car insurance premiums because your provider will consider the safe driving habits that you learned in the course.
How to Reinstate a Suspended Drivers License
You will quickly find out that points on your driving record can be the least impactful penalty on you. This is because the process to reinstate suspended drivers license documents in Massachusetts is long and difficult. You will have to:
- Wait for the drivers license suspension period to end.
- Serve your jail or parole time, if applicable.
- Pay all traffic fines.
- Enroll in drug or alcohol awareness class, if applicable.
- Purchase SR22 insurance, if applicable
- Pay the reinstatement fee. You can choose to make your payment in one of three ways:
- In person
- By phone
- By mail
In addition, if you were convicted of being a habitual traffic offender, operating under the influence or vehicular homicide or manslaughter, you will also have to see a hearing officer before you reinstate revoked drivers license or suspended credentials.
In Person
You can visit any local full-service Registry of Motor Vehicles office in Massachusetts to pay your reinstatement fees in person. The MA RMV accepts cash, checks or money orders.
By Phone
You will need an American Express, Visa, MasterCard or Discover card in order pay your drivers license reinstatement fees over the phone. If you have one of the following area codes or are out-of-state, you must call (857) 368-8000:
- 339
- 617
- 781
- 857
If your area code is not listed, you can call 800-858-3926, and if you want the TTY line, use 877-768-8833. The MA RMV Telephone Center is available from 9 a.m. to 5 p.m. on weekdays, excluding holidays.
By Mail
To pay by mail, make your check or money order payable to MassDOT and mail it to the following address:
Driver Control/ Court Records Registry of Motor Vehicles P.O. Box 55896 Boston, MA 02205-5896
Reinstatement Fees
Be prepared to pay various fees throughout the process of reinstating suspended drivers license credentials. Unfortunately, it is impossible to provide a breakdown of suspended drivers license reinstatement fees because in Massachusetts, fees are based on a wide variety of factors:
- Reason for suspension
- County fees where conviction was assessed
- If alcohol and drug classes
These are just a few variables the RMV takes into consideration to total your reinstatement costs. As a general guideline though, reinstating suspended drivers licenses in MA can cost between $100 and $1,200.
Note: If you disagree with charges of DUI or a traffic ticket, it is recommended you contact a traffic ticket lawyer or a DUI attorney to fight the charges.


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As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population.
We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820–821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433–434), and TIA (code 435) between 2001–2005. Cost analyses were based on diagnosis-related groups.
The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005).
The burden of hip fragility fractures in Italy is comparable to that of AMI and strokes.
Demographic trends from the last 50 years have indicated an increased life expectancy in developed countries. Among those countries, Italy has one of the highest life expectancies, which has increased up to 77.9 years for men and 87.4 years for women in 2010.1–3 For these reasons, Italy represents an interesting international case study about the effects of aging on chronic, degenerative illnesses such as hip fractures, cardiovascular diseases (CVD), and cerebrovascular accidents (CVA), which currently pose major health care challenges in many countries. Both acute myocardial infarctions (AMI) and strokes are known to be a relevant cause of morbidity, mortality, and disability, with their incidence progressively increasing in the oldest age groups.4–16 CVD are the primary causes of morbidity and mortality in Italy,2 with AMI representing a leading cause of hospitalizations and health care costs, as shown by our previous research.17
CVA, including transient ischemic attacks (TIA), as well as ischemic and hemorrhagic strokes, represent the second most prevalent causes of mortality worldwide,4,5 and are considered to be the main cause of disability in the elderly.6–8 One-third of patients experiencing a stroke show high levels of disability after 1 year.9,10 About 7%–12% of patients who experienced a previous TIA will experience an ischemic stroke within 1 year (with an additional 4%–7% of patients experiencing strokes after 5 years from the initial TIA).10,18 AMI and strokes are associated with a 15%–25%11–16 and 30%–60%9 1-year mortality rate, respectively. The risk of recurrence is remarkable for strokes.9 The Italian Longitudinal Study on Aging (ILSA) has estimated an annual incidence of 196,000 strokes, of which 20% represent relapsing episodes.19
On the other hand, hip fractures in the elderly Italian population are progressively increasing, with a 15%–25% 1-year mortality rate,20,21 and a high risk of disability.22–25 In Italy, about 18,000 elderly people per year become completely disabled as a consequence of hip fractures.2 For these reasons, the World Health Organization considers osteoporosis and osteoporotic fractures to be as critical a health problem as AMI and strokes.3 In our previous research, we have shown how the incidence and costs of hip fractures are comparable to those of AMI.26 As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures suffered by elderly people in Italy versus major cardiovascular events (strokes and AMI) occurring in the whole adult population.
Information concerning all hospitalizations that have occurred in Italy is registered in hospital discharge records maintained at the Italian Ministry of Health. This information is anonymous and includes patients' age, diagnosis, procedures performed, and length of hospital stay. In the present study we have analyzed the number of hospitalizations occurring in Italy because of hip fractures, AMI, and strokes, considering also the direct costs related to hospitalization and rehabilitation. As these were observational analyses of anonymous numerical data, no approval from an ethical committee was required.27 We focused on the hospitalization data available for consultations, which corresponded with the period from 2001 to 2005.
Some data concerning hip fractures and AMI partially overlapped with those presented in our previous studies about these topics (from the years 2001 to 2005, both for hip fractures and AMI), with the number of hospitalizations and their associated costs being consistent with some previously published figures.17,28–30 Hip fractures were defined by the following ICD-9-CM diagnosis codes for major diagnosis: 820.0–820.1 (femoral neck fractures); 820.2–820.3 (pertrochanteric femoral fractures); and 820.8, 820.9, and 821.1 (other femoral fractures). Given that we intended to assess the burden of femoral fragility fractures, we excluded patients aged 45 to 64 from the analysis of hip fractures, which represented no more than 8% of all hip fractures. Strokes were defined by ICD-9-CM diagnosis codes 430, 431, 432 (hemorrhagic strokes); 433 and 434 (ischemic strokes); and 435 (TIA). AMI was defined by the ICD-9-CM diagnosis code 410 (all extensions). We have only included patients with a primary diagnosis of AMI.
Population data were obtained from the Italian Institute for Statistics for 2001–2005.1 All data were stratified by sex and age groups (45–64, 65–74, and ≥75 years; in the analysis of hip fractures, the youngest age group was not included as these fractures were not likely to be a consequence of osteoporosis), and were processed by using Stata (StataCorp, College Station, TX) and Excel (Microsoft Corporation, Redmond, WA) software programs. Descriptive statistical analyses were performed in order to calculate the incidence of each condition in each sex and age subgroup across the 5 examined years.
The analysis of direct costs was based on diagnosis-related groups (DRGs), which were considered to be a proxy for computing hospitalization costs. Ministerial Decree DM 549/1997 defined the national DRG rate list that was adopted during the 5 years examined in our study. Italian regions are allowed to reduce these rates locally, by an average rate of 15%. For this reason, in our analysis we used the 1997 DRG rates reduced by 15%, in order to be more conservative.
As was the case in our previous research,26,28–30 the DRGs that were considered relevant to hip fractures were: 209 (surgical procedures on major joints and hip replacement), 210–211 (hip and femur surgery), and 235–236 (hip, femur or pelvis fractures). Since not all patients that were assigned these DRGs had a main diagnosis of hip fracture (actually, osteoarthritis accounts for a substantial number of hip replacements), only 30% of costs ascribed to DRG 209 and 80% of costs ascribed to DRGs 210, 211, plus 100% of costs ascribed to DRGs 235 and 236 were attributable to a main diagnosis of hip fracture.26,28–30 We considered these rates to represent the weight of hip fracture-related costs for each DRG, based on national estimations provided by the Ministry of Health, which were confirmed by specific analyses performed on the whole hospitalization database from the Tuscany region (about 4 million inhabitants), and on those of the Local Health Authorities of Lecce (about 1 million inhabitants).26,28–30 As was the case in our previous studies, we also included rehabilitation costs following hip fractures in the analysis, assuming a 5% acute mortality rate.26,28–30 Detailed figures of the rehabilitation path following hip fractures have been published previously in separate articles and are summarized in Figure 1.26,30
Cost analysis concerning strokes was based on DRG 14 (hemorrhagic and ischemic strokes) and DRG 15 (TIA). We have also provided an estimation of the rehabilitation costs following strokes; actually, patients experiencing a stroke may be treated as an inpatient or outpatient in order to perform specific rehabilitative interventions. According to the ministerial guidelines for rehabilitative interventions approved on May 7, 1998, patients with stroke undergo intensive rehabilitation (in hospital settings or while institutionalized immediately after hospital discharge) for the recovery of major disabilities, and require at least 3 hours of specific exercises per day for a maximum of 60 consecutive days, including both in-hospital and day hospital rehabilitative programs (code number 56, rate fixed at 250 Euros per day). Patients who complete intensive rehabilitation usually start a 6-month ambulatorial or home-based rehabilitation program in order to recover residual disabilities or to preserve their achieved progress (this corresponds to a cost of 80 Euros per day for 180 consecutive days, according to the Ministerial Decree DM May 7, 1998).
To be conservative, we assumed that only one out of five patients do not perform in-hospital intensive rehabilitation because an ambulatorial or home-based rehabilitative program for 180 days usually begins immediately (at a rate of 80 Euros per day). We have not excluded readmissions of the same patients from our analysis because – as is the case of relapsing stroke – the path of rehabilitation is repeated as described above. Conversely, when computing rehabilitation costs, we have excluded patients with TIA because these kinds of CVAs are defined as events that do not result in residual disability, and therefore they do not need rehabilitative interventions. At the same time, we have taken into account an average 20% overall acute mortality rate following stroke (patients who have not started rehabilitative programs), as reported by the ILSA.19
As we did in our previous studies when we computed direct costs due to AMI,17,26 we have included DRG 121 (CVD with AMI and cardiovascular complications, patient alive), DRG 122 (CVD with AMI without cardiovascular complications, patient alive), and DRG 123 (CVD with AMI leading to death). We also included DRGs used for surgical procedures performed following AMI (bypass and angioplasties) on the basis of regional estimations from the Lazio region, and from the Local Health Authorities of Lecce in Southern Italy, as in our previous studies.17,26 These analyses showed that 1% of surgical DRG 107 (coronary bypass) and 15% of surgical DRG 112 (angioplasty) were attributable to a main diagnosis of AMI, whereas the majority of coronary bypasses and angioplasties were matched with other ICD-9-CM diagnosis codes, but not with AMI.17,26 Hospitalization costs were evaluated for all patients (≥45 years of age), as well as for elderly patients separately (≥75 years old). We also computed the costs associated with postoperative rehabilitation following AMI, while examining the rate fixed by the Italian Rehabilitation Guidelines for intensive rehabilitation (rate classified as code n.56; ie, 250 Euros per day). According to the Italian Ministry of Health guidelines for rehabilitative activities published on May 7, 1998, the average length of rehabilitation is 21 days, including both inpatient and outpatient, or home-based rehabilitative programs. We computed only rehabilitation costs for 85% of the patients, assuming a 15% acute mortality rate following AMI.11–16
As shown in Table 1, a total of 85,762 hospitalizations due to hip fractures (17,597 men and 66,674 women) were recorded in 2005 for people ≥ 65 years old (+12.9% compared to 2001). As summarized in Table 1, the majority of hospitalizations due to hip fractures occurred in patients ≥ 75 years old (n = 72,072; 15,285 men and 56,787 women; +13.6% compared to 2001), particularly among women of this age group (n = 56,787; +12.2% compared to 2001). Hospitalizations due to hip fractures in men ≥ 75 years old (n = 15,285) increased by a rate of 19.0% from 2001, thus representing the highest increase observed in the subgroup analyses. Patients ≥ 85 years old (n = 29,308; 5661 men and 23,647 women) accounted for 37% of overall fractures among members of the population ≥ 65 years old (data not presented). As shown in Table 2, hospital costs were 467 million Euros in 2005 (+25.2% compared to 2001), with rehabilitation costs reaching 532 million Euros in the same year (+27.0% compared to 2001). Pooling all data together, hospitalizations due to hip fractures in the elderly resulted in expenditures of approximately 6.8 billion Euros over the 5-year period (including both hospital and rehabilitation costs).
The total hospitalizations for hemorrhagic and ischemic strokes (including TIA) were 187,883 in 2005 (97,941 men and 89,942 women), with a general increase of 5.1% when compared to 2001 (n = 178,703; men: 92,451; women: 86,252). This observed increase was due to a +19.4% rise in the number of ischemic and hemorrhagic strokes experienced by people ≥ 75 years old (12,198 additional hospital admissions in this age group occurred between 2001 and 2005). The total number of hospital admissions following hemorrhagic strokes was 30,263 in 2005 (men: 15,760; women: 14,503) and 27,613 in 2001 (men: 14,261; women: 13,352), showing a +9.6% increase over the 5-year period (Table 3). As shown in Table 3, the number of hospitalizations due to ischemic strokes and TIA was 109,707 (men: 59,065; women: 50,642), plus 47,913 (men: 23,116; women: 24,797) in 2005, and 95,613 (men: 51,614; women: 42,999) plus 55,477 (men: 26,576; women: 28,901) in 2001, respectively. Thus, while ischemic strokes increased by a rate of +14.7%, the number of hospitalizations that occurred as a result of TIA showed a −13.6% reduction over the 5-year period.
When looking at the data by age group, the number of hospital admissions following TIA decreased in both younger and older patients, while there was a significant increase in patients over 75 years old with respect to both hemorrhagic and ischemic strokes. In 2005, the last year examined, among the subgroup of patients aged 45–64 years old, 20,589 men and 11,121 women (total: 31,710) were hospitalized following hemorrhagic or ischemic strokes (including TIA). In people aged 65–74, 31,988 hospital admissions among men and 20,640 hospitalizations among women were registered (total: 52,628), while in the oldest group (≥75) we recorded 45,364 and 58,181 hospitalizations (total: 103,545) following strokes in men and women, respectively. Men accounted for 52% of the total hospital admissions in 2005, but women ≥ 75 years old were the most represented affected population. The number of men hospitalized because of both hemorrhagic and ischemic strokes (including TIA) was always higher than women in each examined year, with the only exception being patients > 75 years old, where a higher number of hospital admissions among females versus males was always recorded both for hemorrhagic (8428 versus 7115 in 2005) and ischemic strokes (33,120 versus 26,498 in 2005), including TIA (16,633 versus 11,751 in 2005).
As shown in Table 4, the overall hospitalization costs sustained for strokes in adults ≥ 45 years of age decreased from 658 million Euros in 2001 to 640 million Euros in 2005 (−2.7%), with hemorrhagic and ischemic strokes showing an average cost per patient of 3515 Euros in 2005, and TIA generating costs of 3089 Euros per patient in the same year. Hospitalization costs totaled 3.3 billion Euros over the 5-year period, with people ≥ 75 year old accounting for about 60% of these expenditures (1.9 billion Euros). As summarized in Table 4, rehabilitation costs following strokes were estimated between 2.6 billion Euros in 2001 and about 3 billion Euros in 2005 (an increase of +13.6% over the 5 years), and rose from 1.3 billion Euros to 1.6 billion Euros (+19.3% in 5 years) when only data for patients ≥ 75 years old were examined. Total rehabilitation costs from 2001 to 2005 were estimated to be about 14 billion Euros, with people ≥ 75 years old accounting for 7.4 billion Euros. When considered together, hospitalization and rehabilitation costs reached a total of 3.6 billion Euros in 2005 alone. Rehabilitation costs per patient were estimated to be 15,733 Euros in the same year.
Table 5 presents the number of AMI cases that occurred in adults between 2001 and 2005. The total number of hospitalizations due to AMI among patients ≥ 45 years old were 97,913 in 2001, 106,842 in 2002, 113,315 in 2003, 116,303 in 2004, and 117,750 in 2005, showing an increase in hospitalizations of 20.3% over the 5-year period. In 2005, 75,586 men and 42,164 women were hospitalized with a primary diagnosis of AMI, with an increase of 17.2% and 26.2%, respectively, over the 5-year period. The number of patients hospitalized that were ≥65 years old constantly increased over this period, rising from 65,275 in 2001 to 82,382 in 2005, with a corresponding increase of 26.2%. In the youngest age group (45–64 years old), a total of 29,925 AMI hospitalizations in men and 6443 hospitalizations in women were recorded during 2005. In the same year, among the subgroup aged 65–74, 21,621 men and 10,145 women were hospitalized for AMI, with the number of hospitalizations among the oldest group (≥75 years old) being 24,040 and 26,576 in men and women, respectively. The increasing rates across the 5-year period among men and women were 9.4% and 22.0% in the youngest age group, 14.3% and 17.5% in people aged 65–74, and 31.8% and 36.3% in the oldest subgroup, respectively. It should be noted that among AMI patients ≥ 75 years old, the number of women hospitalized was always higher than the number of men, while almost 5000 AMI hospitalizations per year involved people under 45 years old (data not shown).
Overall hospitalization costs incurred for AMI admissions and treatment for adults ≥ 45 years of age ranged between 305 million Euros in 2001 and 370 million Euros in 2005 (Table 6), with an average cost of 3142 Euros per patient in the latter year. Rehabilitation costs following AMI were estimated at between 437 million Euros in 2001 and 525 million Euros in 2005 (an increase of 20.1% over the 5-year period), which rose from 291 million Euros to 368 million Euros (+26.5%) from 2001 to 2005, when only data for patients ≥ 65 years old were examined.
Figure 2 shows how the incidence of hip fractures among elderly people has increased between 2001 and 2005, and how the incidence of AMI and strokes occurring across the whole adult population also increased during this time; conversely, hospitalization due to TIA has decreased. Figure 3 shows that hospital costs incurred in 2005 by the national health care system for hip fragility fractures among the elderly were comparable to those associated with strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. These costs were higher than the costs resulting from AMI and TIA. Furthermore, rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs associated with hip fractures and AMI have been found to be comparable (about 530 million Euros in 2005).
This is the first study conducted that aimed to compare the incidence and costs of hip fractures in the elderly with those generated by strokes and AMI in Italy. This research is based on data from a reliable institutional database (national hospitalization records). The number of hospitalized patients with hip fractures has been presented, excluding patients who were readmitted, and specific figures have been provided regarding the oldest age groups (ie, people ≥ 75 and ≥85), where the higher prevalence of osteoporosis is acknowledged.
Our results concerning the incidence of strokes in Italy seem to be consistent with rates provided by the ILSA study group.19 The number of hospitalizations following hemorrhagic and ischemic strokes per 10,000 inhabitants has increased year over year between 2001 and 2005, with this trend being remarkable in people aged 75 years and over. Breakdown by age and sex confirmed the marked increase with age and the predominance of hospitalizations in men. Conversely, the number of hospitalizations for TIA decreased consistently over the 5-year period, possibly as an effect of medical efforts in the prevention of CVAs. However, many TIAs may go unreported (such as so-called silent strokes) in community dwelling people.31
Relevant differences (mostly due to rehabilitation costs) were found between our results and those of the Economic Longitudinal Incidence-based Project for Stroke Evaluation (EcLIPSE) study, which had previously assessed an overall cost of 11,600 Euros per patient within 6 months from hospital admission following stroke.32 Our findings concerning individual costs are higher, mostly due to a comprehensive evaluation of the rehabilitative process followed by the patients, and because the EcLIPSE study involved only 449 patients from eleven Italian hospitals.32 However, the EcLIPSE study estimated that the overall social burden of strokes in Italy costs up to 3 billion Euros per year, thus being close to the results of our analyses (3.6 billion Euros in 2005). Our estimations concerning individual costs generated by strokes in Italy (about 30,000 Euros per patient within 12 months) seem to also be consistent with findings from an international review, which considered values between 7975 USD and 54,546 USD as a reliable estimation of the annual cost per patient.33 Annual health care expenditures for each patient experiencing a stroke have been computed to be 17,800 Euros by a recent French study,34 while a multicenter study carried out in France, Germany, Sweden, and the UK reported a value of 9800 USD as being a minimum annual cost per patient.35
The main limitation of our study was represented by the fact that, for strokes, we were not able to detect readmissions of the same patients, although this did not influence the cost analysis. Actually, DRGs are entirely paid for if a person is hospitalized twice or more, and if the rehabilitation cycle is repeated for each CVA experienced by the patient. Another limit in this study is that rehabilitative paths followed by the patient may present with some regional differences.
In actuality, many people do not complete 60 days of intensive rehabilitation or 180 days of ambulatorial or home-based exercises. A cycle of extensive rehabilitation (including in-hospital, nursing home, ambulatory, or home-based rehabilitative programs) may be performed for the completion of a previous intensive rehabilitative cycle, or in the case of transient or minor functional restrictions. Extensive rehabilitation requires 1–3 hours of physical therapy per day for a maximum of 120 consecutive days (corresponding to a cost of 125 Euros per day, as defined by code n.60 in the Ministerial guidelines of May 7, 1998). After these 120 days, patients may enter home-based rehabilitation programs to recover residual disabilities or to preserve any achieved progresses. On the other hand, a proportion of patients (difficult to estimate) continue intensive rehabilitation cycles for more than 2 months per year, or they can prolong their outpatient rehabilitative program for more than 6 months. These cases, as well as the financial aids granted by the government (7500 Euros per year) for individuals with permanent disabilities following strokes, have not been considered in our cost analysis.
Sudden mortality has not been considered when computing AMI incidence,11,15 although this did not underestimate our cost analysis. The observed increase in the incidence of AMI may reflect the efficacy of the newly established emergency service (with a reduction of sudden deaths and the transfer of the same patients from a hospital to another hospital for angioplasty), but this increase could also result from the publication of new diagnostic criteria, which occurred in 2000. The very high increase of AMI cases occurring in women between 45 and 64 years old (almost double that of men in the same age group) is perhaps a consequence of new risk factors that are becoming more prevalent among younger women (ie, smoking), and highlights the need to implement preventive strategies among women in this younger age group. A complete evaluation of AMI consequences would also require the analysis of data concerning postacute phase costs (pharmacological treatments and long-term follow-up), as well as indirect costs, which represent an issue that is very difficult to assess. Some authors have suggested that these latter costs may have a high economic impact.36–40
The results of our study confirm the extremely high burden of hip fractures in Italy, which is actually comparable to that of strokes and higher than that of AMI, both in terms of hospitalizations and health care expenditures.
The authors report no conflicts of interest in this work. Disclosures concerning the past 5 years include: PP has received grants for consulting/speaking by Sanofi-Aventis, Amgen-Dompè, Servier, and Eli-Lilly. AM, MG, AM, AB, RG, RDB, LR, CG, FG, MLB, LM, DD, and GI have received research grants and funding for consulting/speaking by Merck, Sanofi-Aventis, Novartis, Stroder, Servier, Ely Lilly, Roche, Nicomed, and Amgen Dompè. AA, GC, CN, GM, MS, DD, MB, VM, SM, MG report no conflicts of interest.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.