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Brief Interventions for Weight Loss in Primary Care
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Overweight and obesity are common and important causes of chronic disease. This should mean that primary care physicians feel tackling obesity is important, but it is uncommon for them to do so. Physicians perceive that this is not their job; they fear offending their patients and are unclear what may be effective. In this review we found two systematic reviews showing that motivational interviewing can lead to effective weight loss but it may not be practicable in this setting. Two trials show referral to specially trained nurses in primary care appears ineffective. Several randomized trials show referral to commercial weight management companies is effective. Observational data but no trials suggest that screening for and opportunistic brief interventions may motivate attempts to lose weight and lead to some weight loss. We conclude there is insufficient evidence to promote treatment opportunistically but sufficient evidence to refer patients wanting to lose weight to commercial weight management services.
KeywordsBrief intervention Weight loss Obesity Overweight Primary care Weight management Lifestyle Interventions
Overweight and obesity are important causes of disease in most countries of the world, with excess body weight contributing toward 44 % of the global burden of diabetes, 23 % of ischemic heart disease burden, and 7–41 % of certain cancer burdens, as well as other medical conditions [1]. Research shows that weight loss is associated with significant improvements in health outcomes, such as reduced mortality, improved lung function, reduced blood pressure and improved lipid profiles [2]. Even modest weight loss (i.e., 5–10 % of initial weight) through lifestyle changes has been linked with a 58 % reduction of type 2 diabetes over four years amongst overweight adults with impaired glucose tolerance [3], with benefits still identifiable after ten years, despite weight regain [4]. Similar findings were also reported in the Finnish Diabetes Prevention Study [5, 6]. Whilst these weight loss programs have been successfully implemented at moderate scale in a research context [5], they tend to involve in-depth counseling or support to change diet and physical activity behaviors and a high level of contact with a specialist over an extended period of time. There is some evidence that the effectiveness of such interventions do not necessarily translate to a routine primary care setting [7].
Not only is obesity a major risk factor for disease, it is also common worldwide; rates in the UK are amongst the highest, only exceeded by the USA. It is estimated that by 2050 the majority of the UK's population will be obese [8]. This means it is common for primary care physicians to see patients in whom obesity has not yet caused disease as well as those patients where obesity has been a contributing factor to their disease. For example, over 80 % of the UK's population visits their general practice annually [9], and, on average, patients have five-and-a-half consultations within the year [10]. In England, a physician with a patient list of 2000 adults will typically have 520 (26 %) patients who are obese (BMI ≥30 kg/m2), and 840 men and 640 women (42 % and 32 %, respectively) who are overweight (BMI 25.0–29.9 kg/m2) [11] and who may benefit from weight loss interventions. Many more of the patients seen in primary care will be gaining weight and at high risk of subsequent obesity and so there are also opportunities for the primary prevention of weight gain in this setting.
Preventative medicine is a normal part of the physician's workload [12]. Most vaccines are delivered by primary care teams. Hypertension screening, diagnosis, and management are delivered mainly by primary care teams. It is common for physicians to identify smokers and make brief interventions to motivate cessation and provide or refer to services offering medication and behavioral counseling to support cessation. Thus it appears that there is a prima facie case for primary care teams to help manage obesity and to prevent the diseases that might occur or treat the complications of obesity through weight loss. What may seem surprising though, is that physician involvement in weight loss is uncommon.
In the UK, Michie investigated 40 physicians' and 47 nurses' communication about weight with their overweight and obese patients [13]. When there was no identified medical problem, only 38 % of physicians and 14 % of nurses reported raising the issue on less than 50 % of occasions. When they did raise the issue of overweight, only 9 % offered some form of support to help lose weight. Furthermore, Noordman and colleagues explored the frequency of physicians discussing lifestyles choices with their patients [14]. Analysis of video recordings from a random sample of 6203 medical consultations between 1975 and 2008 in Dutch primary care practices revealed that overall, physicians only discussed obesity related issues, such as nutrition and physical activity in 10.3 % and 13.2 % of consultations, respectively. These data demonstrate the limited frequency of physicians discussing weight management with patients in primary care.
Why do physicians intervene so seldom in relation to the opportunity to do so? Physicians perceive there to be several practical obstacles to effective weight management including: a lack of time during consultations [15]; a lack of knowledge, including uncertainty about the best ways to assist and limited confidence in their ability to address weight management [16, 17]; negative attitudes about obesity linked to a belief that patients, and not physicians, have the onus to act first [18]; and fear of offending patients by raising or discussing the issue of excess weight [13]. Physicians commonly believe that obesity is best addressed through societal interventions to prevent weight gain or when patients take greater personal responsibility for weight control, implying that these may be more important than action in primary care [19].
In addition, whatever physicians might do has to be fitted into routine consultations, typically only 10 minutes long in primary care practice. There are two key questions: first, what can be done for patients who ask their physicians for support to lose weight, and, second, is there sufficient evidence to justify screening for and proactively identifying and managing obesity? Much more evidence is required for the second, but it would mean placing obesity on the physicians' agenda in the same way that hypertension is, where physicians offer and are often managed to screen for and intervene to detect hypertension. We therefore examine the literature to identify evidence of the suitability, practicability, and effectiveness of different approaches to weight management for overweight and/or obese adults presenting in primary care.
Approaches to Weight Management in Primary Care
In other aspects of health promotion, time constraints are overcome by delivering brief interventions. Brief interventions are usually opportunistic and delivered during a consultation about something else and where the practitioner takes the opportunity to raise a topic that is either unrelated to or not directly the topic of the current consultation [20]. They take only a few minutes. In practice, the term is used interchangeably with brief behavioral counseling, sometimes with multiple sessions, which are obviously scheduled and where behavior change is directly the topic of the consultation. Brief interventions originated from addiction-based research and reviews demonstrate their effectiveness in reducing problem drinking and motivating smoking cessation [21, 22]. These reviews demonstrate that genuinely brief (1 minute), opportunistic interventions can motivate some patients consulting for reasons unrelated to the behavior to either reduce their alcohol consumption or stop smoking.
Accordingly we consider whether brief interventions can be effective for weight management in primary care by reviewing evidence [20, 23] considering data on current practice and the views of physicians [13, 16, 17, 24, 25] and identify five brief interventions.
Brief Advice
Brief advice, delivered in a single session, is often aimed at increasing awareness of health risks and is the physician's preferred intervention, rather than delivering a high-intensive intervention specifically targeting physical activity or dietary habits, goal setting or prescribing weight loss medication [13, 17, 26]. Survey data suggests that advice to lose weight by a physician is strongly associated with future weight loss 'attempts' for overweight and obese patients [25, 27]. In 1996, the US Behavioral Risk Factor Surveillance System found that 42 % of obese patients reported that their physician had 'ever' advised them to lose weight [24, 25] and people who received advice were more likely to have tried to do so (odds ratio [OR] 2.79 [2.53–3.08]). Rose and colleagues recently conducted a systematic review and meta-analysis of survey data examining physician-provided advice and its association with changes in patient weight loss behavior [28•]. The type of advice given included; general advice to lose weight, specific advice related to weight loss, information or communication regarding overweight and the use of motivational interviewing to promote weight loss. The odds ratio for the association between physician intervention and an attempt to lose weight was 3.85 (95 % CI 2.71, 5.49; p < 0.01). Two studies suggested that people who received some kind of advice lost about 1–2 kg more than people who did not. Five other studies suggested that weight loss was more common in those who did receive an intervention. These survey data suggest that a brief advice-orientated intervention, which could easily be delivered by physicians, may motivate weight loss. However, the data are all observational. It is possible that the association arises because patients who are thinking of losing weight discuss this with their physicians. There is evidence that conversations about exercise and nutrition are more frequently initiated by patients than by physicians [14], so these data are weak evidence for causality. We sought more robust evidence of effectiveness from randomized trials, however no such evidence was found.
Accordingly, while there is evidence that physician-provided advice can have positive influences on weight loss-related behaviors, there was variation between studies in the type of advice given (e.g., general advice to lose weight vs. specific advice about weight loss). This makes it difficult to develop guidance for effective advice.
Motivational Interviewing
Motivational interviewing is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change, and it incorporates three key elements: 'collaboration' between the patient and physician; 'evoking or drawing out' the patient's thoughts about behavior change; and encouraging the patient's 'autonomy' [29]. To engage and deliver motivational interviewing competently, physicians require specialist skills and expertise, usually involving training that follows a sequence of eight stages and takes at least two days, plus on-going supervision and follow-up training. Additional time may be required if the physician is not familiar with the health topic in hand [20].
Rubak and colleagues conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) using motivational interviewing as the intervention compared to a control condition for a wide-range of health conditions [30]. The meta-analysis included six trials of motivational interviewing versus control for weight management. The mean change in BMI was −0.72 (0.33 to 1.11) kg/m2, which we calculated is approximately 2 kg difference. The median follow-up for all studies in the review was 12 months. Across all behavioral areas, they reported that studies that compared 15 minutes of motivational interviewing to control were less likely to show statistically significant differences than studies that compared 60 minutes of counseling to a control. A more recent systematic review of RCTs investigated the effectiveness of motivational interviewing versus control in overweight or obese adults (n = 1448) [31•]. Follow-up ranged from 3–18 months. In the nine interventions tested in eight trials with weight change as the outcome, the mean reduction in weight was −1.47 kg [95 % CI −2.05, −0.88) kg. The data in Rubak et al. [30] and Armstrong et al. [31•] do not report whether or how participants who were lost to follow up were included in the analysis. A recent RCT compared the effectiveness of delivering standard exercise and nutritional information plus up to five face-to-face motivational interviewing sessions over a six-month period (intervention), with the provision of standard information only in a single session (control) in adults with more than one cardiovascular risk factor, including excess weight [32••]. At six months the difference in mean change in weight was −0.75 kg and at 18 months was −0.81 kg, neither difference was significant.
This evidence indicates that while motivational interviewing can be effective for weight loss, in the short term (≤6 months), the application of this approach by a generalist physician on a large scale seems doubtful given the amount of time required for training and delivery (≥15 minutes, with multiple sessions). This may explain why motivational interviewing techniques are not widely implemented as opportunistic interventions in a primary care setting.
Primary Care-led (In-house) Weight Management Services
In many instances, physicians may advise overweight and/or obese patients to see non-specialist healthcare professionals, such as nurses or healthcare assistants, on a one-to-one basis at the practice to review their weight and deliver behavioral weight management. This takes a small amount of physician's time, yet provides patients with help to lose weight, rather than just advice to do so.
In many cases, nurses in the UK offer an ad hoc program with little training. However, there are national organizations that offer a program and training to deliver it. The Counterweight program offers a structured behavioral program to help patients achieve a 5–10 % weight loss (5–10 kg) by providing them with skills to change unhealthy eating and activity behaviors. Patients meet with practice nurses, either on a one-to-one basis (10–30 minutes per session), or in groups (60 minutes per session), for nine sessions over a year. A recent evaluation of 1906 patients (mean BMI 37 kg/m2), using baseline observation carried forward (BOCF), reported that mean weight loss at one year was 1.3 kg, with 30.7 % of patients achieving ≥5 % weight loss [33]. There are no randomized trials of the Counterweight program to show whether this is more than might have been achieved if patients tried to lose weight without such support.
Two recent RCTs suggest that training healthcare assistants and/or nurses to deliver support programs has limited effectiveness. The CAMWEL study randomized 381 overweight adults (BMI ≥25 kg/m2) to either a structured one-to-one lifestyle program for weight loss delivered over 14 session (30 minutes each) in a year by healthcare assistants in general practice, or usual care [34••]. At one year, using BOCF, weight losses were small in the intervention group (1.4 kg) and not significantly different to the control treatment (0.8 kg), though more patients lost ≥5 % baseline weight (32.7 % in the structured program vs. 20.4 % in the usual care group). Similarly, in the Lighten Up trial, 740 obese adults (≥30 kg/m2, 18+ years) were randomized to minimal control or one of six interventions (12 week programs), two of which were either physician- or pharmacist-led care [35, 36••]. Dietitians trained physicians and pharmacists in weight management. Using intention to treat (ITT) analysis, physician and pharmacy care achieved similar and small weight loss to the minimal control (1.0 kg at one year). Only 14.3 %, 15.7 % and 17 % of patients in the pharmacy, physician and minimal control arms respectively, achieved ≥5 % weight loss at one year. Data on this type of service are limited and there is probably considerable heterogeneity in the services offered by in-house primary care teams. However the failure of these two well-planned programs to give better weight loss than control means that such interventions cannot be recommended in general.
Referral to Commercial Weight Management Services
There is evidence from trials and routine practice of the effectiveness of commercial providers in delivering weight management services [37]. Most of this is based on self-referrals, but there is growing interest in establishing partnerships between physicians and commercial weight management services analogous to those offered in other areas of health promotion.
Referral to commercial weight management services may overcome some of the perceived obstacles for physicians to offer weight management interventions. Firstly, evidence from trials show that commercial weight management services are an effective way for patients to lose weight, and that they can be easily implemented via primary care [35, 36••, 38••]. Thus, with minimal training physicians could be educated about effective strategies and confidently offer effective treatments to their patients. Secondly, referring patients to commercial weight management services would only take physicians less than a minute, and does not require specialist in-depth knowledge and skills to deliver. Furthermore, in contrast to motivational interviewing interventions or most other services delivered within primary care, referral to commercial weight management services such as those presented here, would provide patients with regular (weekly) group-based sessions lasting ≥60 minutes, delivered by dedicated weight management consultants; elements that have been identified as important requirements for long-term behavior change [30, 44]. Finally, these services are already operating at a meaningful scale and with relatively low costs compared to services delivered by health professionals.
There is some evidence that referral to commercial weight management services is acceptable to patients. Ahern and colleagues interviewed 16 female participants in a research trial comparing standard care within a practice with referral to a commercial weight management service to explore their accounts of weight loss interventions to identify possible reasons why those who attended a commercial weight management service achieved greater weight loss [45]. They reported that people who did not require specialist clinical care, wanted support and motivation to lose weight rather than education and as such, found referral to the commercial weight management services very fitting. This study also suggested that many, though not all patients favored referral to external services. Those people perceived that primary care did not offer appointments at convenient times (e.g., evenings and weekends) and offered only infrequent support.
These data indicate that referring people who ask for help to commercial weight management services is an effective and practicable approach for primary care physicians.
Weight Loss Medication
When purely behavioral approaches to weight management in primary care have not resulted in weight loss despite commitment from the patient, it is reasonable for physicians to consider pharmacotherapy, which forms part of the national guidelines (e.g., [46, 47, 48]). A meta-analysis of primary care relevant trials looked at the evidence that orlistat (currently the only drug licensed specifically for weight loss in the UK) can increase weight loss in the context of a group behavioral treatment [49•]. In 12 trials that could be combined for meta-analysis (n = 5910), participants randomly assigned to orlistat (plus behavioral treatment) lost 3.0 kg more (95 % CI −3.9, −2.0 kg) at one year than those who received a placebo. The authors also found that metformin led to a 1.5 kg greater weight-loss than placebo, though metformin is not licensed for use in this way. The combination of pharmacotherapy and behavioral support is important. Wadden and colleagues showed that combining both medication and lifestyle modification resulted in more weight loss (mean [SD] 12.1 [+/−9.8] kg) than pharmacotherapy (sibutramine) (5.0 [+/−7.4] kg) or lifestyle modification alone (6.7 [+/−7.9] kg) [50]. Obesity treatment guidelines therefore encourage physicians to only prescribe weight-loss medications alongside behavioral interventions (e.g., [46, 47, 48]).
There is reasonable evidence that motivational interviewing addressing why patients might change their behavior can result in modest weight loss. Likewise, referral to a commercial weight management service is also effective. There is no strong evidence that training primary care teams to deliver weight management is effective. There is no strong evidence that it is effective for physicians to screen for and offer intervention to people who are not seeking support to lose weight.
Motivational interviewing typically aims to help people resolve ambivalence about whether to act and is not confrontational. This style of counseling means that it is suitable, in that it is unlikely to offend patients. However, it may fail on practicability grounds because the length of time taken to deliver an opportunistic intervention makes it unfeasible in many settings. In addition, the skill requirements for practitioners mean that specialist training is required.
The evidence from observational data suggests that even brief advice to lose weight may trigger weight loss attempts and useful weight loss. This may suggest that screening and opportunistic intervention could be effective, but there is currently no evidence to justify this from robust randomized trials.
One intervention that appears to be suitable, practicable, and effective is referral to commercial weight management services, such as Weight Watchers, Slimming World and Rosemary Conley. For people who ask for help to lose weight this may represent the current best approach. In many cases, the trials have tested interventions that consisted of lengthy or indefinite entitlement to free weight loss support from these programs. In practice, many such programs are limited, typically in the UK to three months. Nonetheless, both trial and observational data suggest such short courses may be effective, though further data would be welcome. However, the widespread availability of such programs in many countries and their acceptance by the population suggests they have an important role to play in supporting primary care to tackle obesity.
Most of the evidence to date relates to patients who are seeking weight management interventions or motivated to take up such an offer. There is insufficiently robust evidence to justify screening and opportunistic interventions for obesity. Given the high prevalence of obesity, a pragmatic approach is to first enhance the provision of support services to patients seeking treatment or with specific obesity-related comorbidities to build experience and confidence in treating obesity in primary care. Meanwhile, more research is needed to expand the range of suitable, practicable, and effective interventions available in primary care and to examine whether screening and opportunistic intervention could have a population level-impact on weight.
Amanda L. Lewis has received grant support for 2012–2015: A randomised controlled trial of the effectiveness of brief weight management for obese adults in primary care. 2012–2015. MRC NPRI Phase 4; 2011–2013: Development of a community midwife-led intervention to prevent excessive weight gain in healthy and overweight pregnant women. 2011–2013. National Schools of Primary Care; Weight management in primary care. 2011–2014. National Schools of Primary Care PhD studentship; Development and initial evaluation of attentive eating intervention for weight management in primary care. National Schools of Primary Care; plus National Schools of Primary Care Seedcorn funding.
Susan A. Jebb has received grant support for 2012–2015: 'An RCT to test the clinical and cost-effectiveness of primary care referral to a commercial weight loss provider' NPRI; 2012 2013: 'Managing overweight and obese adults: update review ' NICE Review:; 2012–2016: 'A randomised controlled trial of the effectiveness and cost-effectiveness of a brief weight management intervention for obese adults in primary care' NPRI; 2012–2015: 'A randomised controlled trial to test the impact of a fruit and vegetable supplement on endothelial function and cardiovascular risk' NSA; 2011–2015: 'Behaviour Health and Research Unit' Department of Health Policy Research Programme; 2011–2013: 'Telling 'good' population health science from 'bad' science' MRC Population Health Sciences Research Network; 2011–2013: 'A randomised controlled trial to examine the efficacy of regular weighing and feedback in preventing excess weight gain in pregnant women' NSPCR; 2009–2014: 'Centre for Diet and Activity Research' UKCRC.
Paul Aveyard is funded by the UK Centre for Tobacco Control Studies, a UKCRC Public Health Research: Centre of Excellence. Funding from British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, and the Department of Health, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. Paul Aveyard has received grant support for 2012–2015: A randomised controlled trial of the effectiveness of brief weight management for obese adults in primary care. 2012–2015. MRC NPRI Phase 4; 2011–2013: Development of a community midwife-led intervention to prevent excessive weight gain in healthy and overweight pregnant women. 2011–2013. National Schools of Primary Care; Weight management in primary care. 2011–2014. National Schools of Primary Care; plus National Schools of Primary Care Seedcorn funding. for 2012-2015: 'An RCT to test the clinical and cost-effectiveness of primary care referral to a commercial weight loss provider' NPRI; 2012 2013: 'Managing overweight and obese adults: update review' NICE Review.
Compliance with Ethics Guidelines
Conflict of Interest
Amanda L. Lewis is a Postdoctoral Research Fellow for NIHR SPCR; she has also received hospitality from Weight Watchers twice and Slimming World once; and is involved with a publicly funded trial where the treatment courses are donated by Rosemary Conley and Slimming World.
Paul Aveyard has received lunch and dinner courtesy of Weight Watchers twice and Slimming World once.
Susan A. Jebb serves on the advisory board for Tanita Medical; is Head of Diet and Obesity Research for the Medical Research Council; has received payment for lectures including service on speakers bureaus from Rosemary Conley 'Diet and Fitness' Club; has received a fee for nutrition-related articles for Rosemary Conley 'Diet and Fitness' magazine; has received honoraria as Chair of NICE Public Health Advisory Committee.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.


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The user updated "alert" (not really called an alert what is it called?) in the timeline doesn't show anything. User created does though.
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akp982 is an IT service provider.
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Gum disease has been linked to breast cancer
As the saying goes: flossing teeth every day keeps breast cancer away. No? Well, it should.
New research has shown that women with gum disease are 14 per cent more likely to develop breast cancer.
Scientists suggest this is because gum bacteria can enter the bloodstream and spread to the breast tissue.
Researchers at the University of Buffalo are behind the new findings, a result of monitoring 73,737 postmenopausal women enrolled in the Women's Health Initiative Observational Study.
None of the participants had suffered with breast cancer, but 26.1 per cent had experienced gum disease.
Smoking status was also taken into account, as previous work has found the effects of gum disease can depend on smoking.
The women were looked at again after 6.7 years, with 2,124 now diagnosed with breast cancer.
From here the researchers found that the risk of the cancer was 14 per cent higher in the women with gum disease.
Taking smoking into consideration, the women who had quit smoking in the last 20 years and had gum disease had a 36 per cent higher risk of breast cancer.
The smokers with gum disease at the time of the study had a 32 per cent risk, though scientists did point out that the association "was not statically significant".
The non-smokers and those who had quit more than 20 years ago, with the gum ailment, were six and eight per cent more at risk respectively.
"We know that the bacteria in the mouths of current and former smokers who quit recently are different from those in the mouths of non-smokers," lead study author Dr Jo Freudenheim said.
Dr Freudenheim adds that further research is needed to establish a causal link.
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Information Security Architect
Pleasanton , California
February 03, 2017
Join our team and experience Workday!
It's fun to work in a company where people truly believe in what they're doing. At Workday, we're committed to bringing passion and customer focus to the business of enterprise applications. We work hard, and we're serious about what we do. But we like to have a good time, too. In fact, we run our company with that principle in mind every day: One of our core values is fun.
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Workday delivers a user experience and infrastructure that is unparalleled among business applications, and we are looking for those who want to push the boundaries of design, security, and development.
As a team, we leverage Workday's information security, compliance and privacy programs in support of the sales organization in providing prospective customers with insight into the investments Workday makes in these areas. Specifically, taking a transparent approach to explaining and detailing the programs, processes, policies and technical solutions in place to protect the confidentiality, integrity and availability of Customer Data
Your day to day ... the fun part!
Liaison directly with Workday's CSO, Cloud Operations, Compliance teams and others on a regular basis
Assist the Sales Team with due diligence activities by providing guidance and expertise
Communicate the value of Workday's programs to prospective customers to help differentiate Workday from our competitors
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You exhibit a strong combination of technical skills, industry experience and an unimpeachable stage presence. You are masterful at building, articulating, and disseminating the Workday response to the prospect's due diligence processes required.
You have strong technical knowledge of enterprise application architecture
Your comprehensive security background covers encryption technologies, network architectures, communications security, authentication methodologies, etc.
You have a solid working knowledge of information security standards and guidelines
You're experienced with security certifications and audits (ISO 27001, ISO 27018,SOC-1, SOC-2 etc.)
You have strong communications skills, both written and oral
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Workday is a leading provider of enterprise cloud applications for finance and human resources. Founded in 2005, Workday delivers financial management, human capital management, and analytics applications designed for the world's largest companies, educational institutions, and government agencies. Organizations ranging from medium-sized businesses to Fortune 50 enterprises have selected Workday.
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I didn't want to publish this post. When I started writing it, it quickly turned into Bitchfest 2011 scheduled to perform in a venue for one. I didn't want to publish it because I wanted to maintain a positive vibe here and write about all sorts of enlightening things, not the darkness of my personal hell. Then I decided, fuck it, it's my blog so I'm going to publish it anyway. That's pretty enlightened of me, right?
I'm finding that unless you are also currently the primary caregiver of multiple, small, non-sleeping children, 24 hours a day, that empathy is hard to come by. I mean, wasn't I supposed to know this shit was hard? No one has a baby thinking it's going to be all designer onesies and chubby ankles, right? And didn't I consciously go and have a second one KNOWING exactly what I was in for? Furthermore, haven't mother's been taking care of infants since, like the DAWN OF TIME and with far less gadgetry? So what the hell are you bitching about you spoiled, first-world, crazy woman?!
Unfortunately, knowing that my problems aren't life-threatening or world-ending doesn't make me any less frustrated. Similarly, knowing that it's only temporary, helps to ease that frustration for about five minutes until the overwhelming, blurry-eyed weariness sets in again. So, if maybe I can break it down on a biological level, people can understand why I spend most of my days trying not to hit things.
A mother, particularly a breastfeeding mother, is biologically, physically and chemically responsive to her baby's cry. A nursing mom, (myself included in the early weeks), may express breast milk when they hear their baby cry. It makes sense that there is a strong symbiotic relationship between mother and child, you know, so we feed them and don't leave them to marinate in their own fluids. In fact, I was told by my pediatrician that "colicky" infants (like the kind I make) might just be ahead of the evolutionary curve. Ever hear the saying, the squeaky wheel gets the grease? Well, the crying infant gets the boob.
As for my personal experience, I can feel every nerve ending in my body tingle when my son cries. It feels similar to grabbing a live electrical wire, which I've done while changing light fixtures. I am particularly sensitive when I'm lying prostrate, sound asleep at 3 o'clock in the morning. The moment he lets out his first whimper, a jolt of electric energy courses through my limbs that pops my eyes like the jump cut of every zombie movie ever made. If I have to listen to him cry for more than five minutes (which happens a couple of times a night) all that electric energy starts to make me nauseous. It actually sucks worse than I can make it sound because you have to factor in the emotional aspect of this equation which is just too sad to mention.
You can die from sleep deprivation people. Literally, like, die. There's a reason they use it as a means of torture, because it's effective. It's actually most effective when you let someone fall asleep for just a little while and then keep waking them up, again and again which happens to be exactly what my son does. Personally, I'd rather be water-boarded. Studies have shown that a sleep deprived person is more impaired than someone over the legal limit of intoxication. Speaking of intoxication, chronic sleep deprivation feels similar to a really shitty hangover; a perpetual, all-I-want-to-do-is-eat-greasy-food-and-sleep, kind of hangover. Chronic sleep deprivation (I'm going on four months people) can make a relatively sane, rationale person, do insane, impulsive things like destroy Diaper Genies and hallucinate.
A month after my daughter was born, my husband and I went to Lowe's. I stopped to read a magazine at the checkout counter and when I looked up, they were gone. I shit-you-not within ten minutes I had the store manager locking the front doors and calling a Code Adam. Turns out they were in the gardening section. THAT is what sleep deprivation will do to you.
I bet I can guess what you're thinking? "So how are you able to spend so much time writing silly shit on the Internet if you're SO sleep deprived? Shouldn't you be sleeping RIGHT NOW if you're so tired?"
You're probably right, I should. But honestly, writing, yoga and caffeine are the only things GIVING me energy right now. Because what I know for sure is that when you're doing what you love, what you were born to do, it fills you up with all the things you need to go on in the face of adversity. So I keep typing. I have to keep typing or I will probably get myself banned from every large box store in the Puget Sound region.
Well, well, will you lookey there? I actually did write something enlightening. Yeah me.
Now Playing at Bitchfest 2011: Hush Little Baby Don't Say a Word…(so Mommy can type a few thousand of them and feel sane again.)


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Investigators hunting for the wreckage of Malaysia Airlines Flight 370 are set to scan the ocean floor in waters as much as 6.4 kilometres deep in the southern Indian Ocean on Sunday, amid a renewed hunt for the vanished plane.
The GO Phoenix search vessel is scheduled to arrive in its search zone on Sunday and start about 12 days of sonar surveys, the Australian Transport Safety Bureau, which is co-ordinating the operation, said in a statement on its website.
Two more ships are preparing to start work in the region as part of a year-long search.
The survey of the ocean bottom remains the best hope to find the wreckage of the Boeing 777-200, which may help answer how the plane disappeared en route to Beijing on March 8 with 239 people on board.
An earlier scan of 850 square kilometres of seafloor in April and May, prompted by what were at first believed to be signals from the aircraft's black box emergency beacon, found no debris.
"The complexities surrounding the search cannot be understated," the bureau said on its website.
"It involves vast areas of the Indian Ocean with only limited known data and aircraft flight information."
Martin Dolan, chief commissioner of the bureau, said in an interview on September 10 that he was "cautiously optimistic" the plane would be discovered, based on the amount of analysis performed on data indicating the path of the aircraft.
The only clues so far to the final resting place of the aircraft have been data exchanges with an Inmarsat satellite, which suggested it ditched somewhere along an arc of ocean west of Perth.
Survey vessels using ship-based sonar have scanned about 110,000 square kilometres of ocean along this arc, producing maps to help guide the ocean-floor search beginning on Sunday.
The resolution of the maps was about 110 square metres per pixel, Daniel O'Malley, a spokesman for the bureau, said. That compares to the 64-metre length of an intact 777-200.
The GO Phoenix, owned by Perth-based oil and gas services company Go Marine Group, has been hired by Phoenix International, which has been contracted by Malaysia's government and its state oil company Petroliam Nasional.
It will tow a side-scan sonar vehicle close to the sea floor to search for features of the ocean bottom. The vehicle can cover 194 square kilometres a day, according to its manufacturer.
Side-scan sonar sends out beams of soundwaves nearly parallel to the ocean floor, and uses the reflected sound to detect the "shadows" of objects sticking above the surface.
The technology was used to detect the wreckage of Air France flight 447 in the Atlantic Ocean off the coast of Brazil, as well as the Tudor warship Mary Rose under the seabed near Portsmouth, England.
The sonar being used by Phoenix is capable of spotting features as small as 100 square centimetres as far as 1.2 kilometres away, according to the manufacturer's website.
That is equivalent to someone at one of the piers of San Francisco's Golden Gate bridge picking out a compact disc case on the opposite side.
GO Phoenix is expected to arrive at its allocated underwater search area later on Sunday.
The Joint Agency Co-ordination Centre says the vessel will conduct operations in the area for about 12 days before sailing to Fremantle to be resupplied.
Two more vessels contracted by the Australian government from Dutch engineering group Fugro NV will also take part in the search.
The M/V Fugro Discovery has arrived at Fremantle and is expected to join the Indian Ocean search for MH370 later this week.
The vessel had fit-out work done in Durban, South Africa, before arriving in Western Australia, and will have search equipment and a mission crew mobilised over the next few days.
The Fremantle Port Authority says the Fugro Discovery is scheduled to leave the port on Friday.
Fugro Equator is likely to be used as a search vessel when its bathymetric work finishes later this month.
Washington Post, AAP
This story was corrected to reflect the fact that the GO Phoenix and Go Marine Group were hired by Phoenix International, not directly by the Malaysian government and state oil company Petroliam Nasional.


text:
Citation Edit
Watts v. Network Solutions, Inc., 202 F.3d 276 (7th Cir. 1999).
Factual Background Edit
Plaintiff owned a gift-marketing company and asserted rights in the mark BIRTHDAY BALLOONS. Although plaintiff had not yet obtained a federal trademark registration, he claimed that he was the first to use the mark in interstate commerce. When NSI refused plaintiff's request to register the domain name "birthdayballoons.com" because another party had already registered it, plaintiff sued NSI for, among other things, contributory trademark infringement. Plaintiff alleged that NSI committed contributory infringement by continuing to "supply" the domain name to the existing registrant, in violation of plaintiff's rights in BIRTHDAY BALLOONS.
Trial Court Proceedings Edit
Rejecting this argument, the court noted that plaintiff failed to present any evidence that NSI knew that the registrant was engaging in trademark infringement. In fact, plaintiff failed to prove that the registrant even used the domain name in connection with the sale of any goods or services in interstate commerce. The court thus affirmed the district court's grant of summary judgment to NSI.
Source Edit
- This page uses content from Finnegan's Internet Trademark Case Summaries. This entry is available under the Creative Commons Attribution-Share Alike License 3.0 (Unported) (CC-BY-SA).


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Listen to free music played by mcneilmortensen
Blip.fm is internet radio made social. It's easy to search for, play, and discover free music recommended by real people. Join today to create your own free station and start listening to @mcneilmortensen.
mcneilmortensen This song is an insperatenel one according to @AmazingasIam and I actuel agree with her. Enjoy. O. xx (reblip)
Lighthouse Family – Lifted| play
Feb 11, 2010 at 12:08 pm via YouTube | AMAZON | ITUNES
belcanto9900 gave props on Feb 14 at 3:02 pm
mcneilmortensen @belcanto9900: thanks to menten us. O. xx (reblip)
Lucky Lips – Cliff Richard| play
belcanto9900 gave props on Feb 14 at 3:01 pm
mcneilmortensen Thank you for loving me Owen. A. xx
Bon Jovi – Thank You For Loving Me| play
Feb 14, 2010 at 12:16 pm via YouTube | AMAZON | ITUNES
Kri_STINA gave props on Feb 14 at 4:16 am
mcneilmortensen One of our friends has just inspired us to blip this so here is Mumford and Sons with Winter Winds. A & O. xx
Mumford and Sons – Winter Winds| play
Feb 9, 2010 at 2:31 pm via YouTube | AMAZON | ITUNES
snapbadger gave props on Feb 9 at 6:31 am
mcneilmortensen HIP HURRA DET' MIN FØDSELSDAG! O. xx
Feb 8, 2010 at 11:42 pm via YouTube | AMAZON | ITUNES
nesnetrom gave props on Feb 8 at 4:40 pm
mcneilmortensen Here's another song for Everton FC. A. xx
Everton FC – Raise Your Voice For Everton| play
Feb 6, 2010 at 12:30 pm via YouTube | AMAZON | ITUNES
technogiant gave props on Feb 6 at 4:33 am
mcneilmortensen "Oh, we're half way there, woah-oh, livin' on a prayer..."
Bon Jovi – Livin' On A Prayer| play
theshoegrl gave props on Feb 4 at 3:24 pm
mcneilmortensen This is for @elisasm because she loves the song. Nyde det Elisa!
Alexandra Burke – Broken Heels| play
Safetybelt gave props on Jan 29 at 6:04 am
mcneilmortensen ...or this.
Delerium & Sarah McLachlan – Silence| play
Safetybelt gave props on Jan 29 at 6:02 am
mcneilmortensen I am #nowplaying No Promises by Bryan Rice. Enjoy. O. xx
Bryan Rice – No Promises| play
Jan 24, 2010 at 3:19 pm via YouTube | AMAZON | ITUNES
suzan gave props on Jan 24 at 7:20 am
mcneilmortensen I love this song and if it wins NMGP it will be twelve points to Norway from Denmark in the ESC in May. O. xx (reblip)
Norge 2010 – Didrik Solli-Tangen.wmv| play
Jan 24, 2010 at 1:52 pm via YouTube | AMAZON | ITUNES
sputnicker gave props on Jan 24 at 5:59 am
mcneilmortensen @stats28: happy birthday honey! A & O. xx
Stevie Wonder – Happy Birthday| play
stats28 gave props on Jan 11 at 12:03 pm
mcneilmortensen Here is the cover of the blast from the past I blipped before it. I love this version as well. A. xx
Wheatus – A little respect| play
OhYouPrettyThings gave props on Jan 10 at 4:18 am
mcneilmortensen Happy birthday to David Bowie.
David Bowie – Rebel Rebel| play
OhYouPrettyThings gave props on Jan 8 at 4:39 am
mcneilmortensen @rignall: congratulations on your engagement! A & O. xx
mcneilmortensen I am in heaven when Anthony kisses me and I just love him so much. O. xx
ATC – I'm In Heaven When You Kiss Me| play
mcneilmortensen This is my choice for tomorrow except that it will be the Boyzone version and not this one. RIP Janis. A. xx
Westlife – In This Life| play
mcneilmortensen I know we said it last night but sod it! HAPPY NEW YEAR EVERYONE! A & O. xx
ABBA – Happy New Year| play
nureinkuss gave props on Jan 1 at 3:39 am
mcneilmortensen I played this after my parents died earlier this year so here it is again for Owen's grandad. RIP. A. xx
One Day Like This – Elbow ♪| play
DirtyGem gave props on Dec 22 at 5:23 am
mcneilmortensen It's been such a manic Monday today but, then again, that's nothing new...
sarahlaidler gave props on Dec 21 at 3:13 pm
spacespencer gave props on Dec 21 at 10:02 am


text:
Books about permaculture and related subjects
"Permaculture: Principles and Pathways beyond Sustainability by David Holmgren The publication in...Permaculture: Principles and Pathways beyond Sustainability
"Books for the Permaculture Designer A selection sorted by Zones. Please add your favourite books...Books
"THE EARTHCARE MANUAL; A Permaculture Handbook For Britain and Other Temperate Countries ...The Earthcare Manual
"The Little Book of Organic Farming - Soil Association, 2003 This is a book review of the little...The Little Book of Organic Farming
"Eat More Raw A Guide to Health and Sustainability - Steve Charter, Permanent Publications, 2004...Eat More Raw, A Guide to Health and Sustainability
This category has only the following subcategory.
- [×] Resources (6 P)
Pages in category "Books"
The following 7 pages are in this category, out of 7 total.


text:
CAPE MAY — City Council wants a ballot referendum asking voters to change the funding formula in the Lower Cape May Regional School District from one based mostly on property values to one based on enrollment.
The city is in the school district along with Lower Township and West Cape May. In recent years, the city's number of students declined and its funding share increased, due in part to escalating property values at the shore.
A resolution asking for the referendum, passed unanimously by council Tuesday, said city taxpayers pay the equivalent of $72,074 per pupil for the 85 students they send to the schools, which include a junior high and high school handling grades 7 through 12. In contrast, the resolution said, Lower Township taxpayers pay $7,753 for each student they send.
The resolution said the district was set up in 1956 with the costs apportioned based on enrollment from the three towns, but in 1975 the state Legislature changed the formula to one based mainly on real estate values. The law was changed in 1993, but only for new districts being created. They could use per-pupil costs, property value, or a combination of the two.
On Tuesday, the council hired Vito Gagliardi, of the Morristown, Morris County, law firm Porzio, Bromberg & Newman, to fight for the formula change. One of the strategies is to get the issue before a judge. Before that can be done, Gagliardi said, all other remedies must be exhausted, including asking for a referendum.
The referendum must be approved by a Board of Education that includes mostly members from Lower Township, and they are not likely to approve something that would cost their residents more money. The enrollment formula could greatly increase taxes for Lower Township residents.
"Seven members of the board reside in Lower Township. They're not going to want to conduct a referendum. And even if it did go to referendum, it won't pass. However, it's one of the steps we have to do," said Deputy Mayor Jack Wichterman.
The city fought the formula before, originally hiring Gagliardi in 2004. The lone Cape May representative on the board then, the late Bill Nelson, made a motion to bring it to referendum, but nobody would second the motion. West Cape May also pays a high per-pupil share, but even its lone representative on the board, William Towns, did not second the motion.
The city is hoping West Cape May's representative today, Kathy Elwell, will second the motion this time.
But it isn't even a sure thing that Cape May's representative, Gary Gilbert, will make the motion.
"This same attorney tried it before and it didn't work. I'd have to get some education on it before I decide. I'd like to know more about it," Gilbert said on Wednesday.
Elwell also recalled the previous attempt. She said she might second the motion, but if it doesn't do any good, "What is the point?"
"As I understand it, it's never going to happen. Even if the board passes it, it has to go to the taxpayers, and the people in Lower will never vote for it," Elwell said.
Board President Richard Hooyman recalled the last attempt being dropped after nobody would second the motion.
"It's not beneficial to the residents of Lower Township. Somebody would have to pick up the difference," Hooyman said.
The district, however, has pledged to help Gagliardi to assemble the information he needs to conduct a feasibility study, which council agreed to fund for $48,000 on Tuesday. A meeting is set up with district officials on Dec. 17.
"We'll provide the information we have to provide. We did it before," said Superintendent Jack Pfizenmayer.
Kerri Wright, an attorney working with Gagliardi, said if a referendum is approved, the board would develop the ballot question in consultation with the county's superintendent of schools.
If it is not approved, Wright said, the next step would be to ask for a referendum on dissolving the district or having Cape May leave it. Wright said the feasibility study will identify which remedy to exhaust next.
Wichterman said the city is willing to compromise by creating a funding formula that takes into account both enrollment and property values.
"There could be a compromise of one-third property values and two-thirds kids in school," said Wichterman said.
Contact Richard Degener:


text:
Dessert time! You know them times, random early evening when you're not really hungry but you suddenly have a craving for something sweet...but not too sweet. Yeah this was one of those evenings!
The perfect fix to this was homemade apple crumble where the crumble is slightly savoury but the filling just ties it all together with the sweetness, some may call this 'heaven'.
Well it was all done under 30 minutes (including baking time) so hey defo a quick recipe! Peep the full details below.
I even made a special sauce thing to drizzle on-top, chef or what! ;)
Prep time: 10 Mins
Cook time: 30 Mins
- 5 Medium peeled apples
- 1 Cup of Flour
- 1 Cup of Oats
- 1 Cup of Brown Sugar
- 1 Cup of Butter (Room Temperature)
- 1 Tablespoon of Cinnamon
- A Pinch of Salt
- Water
Video Recipe Below:
And there you have it, let me know if you try it out and how you find it!


text:
Sitter in San Antonio
Seeking temporary nanny position during Dec. 19-Januray 4th (time students are not in school) Profile Summary: Hello, Abby here, I am a former Biology teacher waiting to begin a job as a web developer starting in January. I am posting this listing aimed at a household that will have students out of school for the holiday but may need extra assistance OR will be at work and need someone to watch their children during this time. Qualifications: -Experienced teacher -Experience with variety of learning levels, personality types, ESL, GT, special needs (spec. MR, autism) -Patient -Cook -Clean -Valid DL -Owns vehicle -Task organized -Tutoring experience -Certified Texas Teacher -Passed federal clearance background check (clean record; legal, financial) Specifics: Pay: Day rate: to be determined/negotiable depending on hours and needs Hours: Available 5am-4:30pm (can negotiate for 5pm) Dates: These dates are specific due to a job starting January 11th Location: Would prefer someone inside loop 410.
Sitter Details
|Email Address
|Phone Number
|830-534-... Confirmed
|Provider Type
|Age Group
Toddler (1-3 years)
Early School Age (4-6 years)
Primary School Age (7-11 years)
Preteen/Teenager (12+ years)
Children's Crafts
School Pick-up and Drop-off
Pet Care
Light Meal Preparation
Light Housekeeping
Run Errands
Notes made here will only be seen by you. If you want to message the owner of this listing
More in San Antonio, Texas
Looking for Child Care jobs in San Antonio, TX?
Find available jobs in your city.
Featured Child Care Providers near San Antonio, TX


text:
Affordable wheelchair designed for kids
Children often have different needs to adults, but that difference isn't always catered for when it comes to disabled kids, who typically use the same equipment as older people. While Japan recently developed the Magic Carpet roving platform designed to give less mobile toddlers independence, the Wheelchairs of Hope project is now hoping to give kids access to a chair created especially for them.
Spotted another good idea???
Join our network and earn rewards


text:
News and comment on church closings and on modern Catholic life throughout the world. The practice of Catholic devotions as a remedy and in reparation will also be encouraged. If anyone has any news on any Catholic Church closures anywhere in the world, pictures and suggested links please feel free to e-mail. Also pay a visit to the extensive archives- also click on labels. Visit the Catholic Store to support Cathcon!
Wednesday, June 17, 2009
12 Million Rosaries! Crusaders now carry a weapon more effective than any sword!
at 19:05
NB Not an SSPX production but by someone who is closely associated.
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text:
Savage Dragon: The End. Issue 187-192.
Record details
- ISBN: 9781607069690 (electronic bk.)
- ISBN: 1607069695 (electronic bk.)
- Physical Description: 1 online resource
- Publisher: [United States] : Image Comics : 2014.
Content descriptions
|Restrictions on Access Note:
| Digital content provided by hoopla.
|Summary, etc.:
| Convicted of crimes he committed when he reverted to his Emperor Kurr persona, Dragon is locked up with the deadly villains he himself brought to justice. What follows isn't pretty.
|System Details Note:
| Mode of access: World Wide Web.
Search for related items by subject
|Electronic books.
Graphic novels.
Comic books, strips, etc.


text: Art is messy, and not just for creators like Jackson Pollock and Julia Child. From paint spatters to ink smears to handmade aioli, chaos is part of the creative process for most artists. But at the end of the day, the paintbrushes have to be washed, the nails cleaned, and the pans scoured. Domestic sinks struggle to accommodate many of the tools involved in artistic professions, and sanitation is always an issue. Thankfully, Worthington Direct created a new section of culinary equipment to satisfy all your artistic needs!


text:
Decision makers
- The Home Office
Let May Brown stay in the UK
Student May Brown, 19, faces being kicked out of the UK after her asylum plea was rejected.
May fled her native Nigeria aged 16 after seeing her father murdered and she herself being abused and threatened.
The college student is studying to become a barrister. She met and married her husband Michael, a former British soldier, in Weymouth, Dorset.
The pair are very much in love and had been busy making plans for the rest of their lives. That has been cruelly snatched away.
Recently May was told by immigration officials that her marriage was a sham and her asylum application had been rejected.
May said if she returned to her home country she feared she would be killed.
So great was her fear of persecution that a few days before she was told she was to be deported she attempted to take her own life and was rushed to hospital in a coma.
We, the undersigned, are calling on the government to allow May Brown to stay in the UK.
- home office
- The Home Office
Let May Brown stay in the UK
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text:
Question about 1989 Suzuki Swift
Have a new flasher unit to instal, cannot find the location of the old one. Where is it?
Vehicle is actually an Australian '89 Holden Barina but is just a rebadged Suzuki Swift
Posted by chalkyos on
Hi Chalky!
I'm not familiar with your vehicle but if it were me I would put the Hazard Warning lights on and listen/feel the small relays/boxes close to the fuse board I'm sure you'll find it that way.
Good Luck!
Paul 'W'
Onyer~EDson(:0) {#><U.K.
Oh! please rate my effort.
Posted on Jan 21, 2009
SOURCE: I have freestanding Series 8 dishwasher. Lately during the filling cycle water hammer is occurring. How can this be resolved
a 6ya expert can help you resolve that issue over the phone in a minute or two.
best thing about this new service is that you are never placed on hold and get to talk to real repairmen in the US.
the service is completely free and covers almost anything you can think of (from cars to computers, handyman, and even drones).
click here to download the app (for users in the US for now) and get all the help you need.
Posted on Jan 02, 2017
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text:
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"I told him that yes, I thought that I was pretty good. Ugg Bailey Button Boots On Sale " A lot of people distort reality, of course.Black Tall Ugg Boots Lesson learned. Eventually he would make people think they had to hold the antenna while standing on one foot or touching the top of the set. I wish parajumpers hadn't become the "in" brand in warm weather gear, but no matter, this is a high quality product and I'll get years of use out of it. I wouldn't always be. [Ugg Bailey Button Boots On Sale] Revamped with seasonal colors and prints, charms, and corduroy bows, the ever-popular Bailey Collection is crafted from signature Twinface sheepskin and adorned with collection-defining wooden logo button with elastic-band closure.
The guy who took the Blue Box actually gave Jobs a phone number and said he would try to pay for it if it worked.Cheap Sundance Ugg Boots And since Windows just copied the Mac, it's likely that no personal computer would have them." This helped fulfill the pledge his parents made when he was adopted. I ordered an XL Chateau Parka and it was huge. Occasionally Chrisann Brennan would come to visit. [Ugg Bailey Button Boots On Sale] It would become to the personal computer era something akin to what the Turk's Head coffeehouse was to the age of Dr.
"He lay thinking a few minutes, as he had done before,and then he spoke again. Ugg Snow Boots For Women We must start both with a price goal, and a set of abilities, and keep an eye on today's and the immediate future's technology. The house had two big bedrooms and two tiny ones. He had a vivid memory of sitting on the lawn of his house, when he was six or seven years old, telling the girl who lived across the street. [Ugg Snow Boots For Women] This style tends to run a size large.


text:
THIS RESTAURANT IS CLOSED Q, A Thai Bistro
10825 Ascan Ave. (Austin & Burns Sts.) Send to Phone
718-261-6599 | Make Restaurant Reservations
OpenLunch & Dinner daily
- Dress code: Casual
- Full bar
- Kid-friendly
- Romantic setting
* Click here for rating key
THIS RESTAURANT IS CLOSED Q, A Thai Bistro Restaurant Review: Soft lighting sets the mood at this low-key Thai eatery. The menu includes dishes such as Thai barbecue chicken marinated in plum chili sauce; crispy whole red snapper; and filet mignon au poivre with shiitake brandy reduction and rosemary new potatoes.
Find out which restaurants and chefs top the list of GAYOT's 2016 Annual Restaurant Awards.


text:
The Deal
- $117 for two I-Lipo sessions with whole-body vibration and a consultation ($750 value)
Healing Hands Spa
Signature Service: Customized massage and facials
Brands Used: Jan Marini, Pure Fiji, Jean DeArcel, Bio Elements, Biotone
Established: 1999
Reservations/Appointments: Required
Handicap Accessible: Yes
Parking: Parking lot
Minimum Age Requirement: 18
Beyond their extensive training and ability to customize treatments to suit each individual client, the specialists at Healing Hands Spa each possess another trait that sets them above: they simply love their jobs. Thus, they approach each treatment with enthusiasm, be it one of 10 signature facial treatments or an aura clearing. Reflexology, reiki, and raindrop therapy demonstrate the range of the massage menu, and pre-assembled spa packages give clients the opportunity to spend the whole day in the salon's healing and relaxing environs.


text:
Adults: Sunday Morning
How are classes arranged?
We have Sunday Morning Bible study classes for all adults. No matter your age or life stage we have something that would be a good fit for you. In deciding where to start attending a class we encourage you look at 3 factors: Your age(s), Your life stage, and Relationships with others.
Generally speaking most people want to find other people who are similar in life stage and age. Therefore most of our classes are arranged by ages. However, we do have some classes that are considered General Adults and open to all life stages, and ages. So we encourage you to visit a variety of classes until you find the one that fits you.
Sunday Morning Bible Study Classes & Locations (8:00 am)
Married 50+: Fellowship Hall D
Married 60+: Chapel
Sunday Morning Bible Study Classes & Locations (9:15 am)
Single 20s-30's: W104/106
Nearly Newlywed: South Hall C/D
Young Married A 20-'s Early 30's: W108/110
Young Married B 30's E234
Young Married C 20's - Early 30's: Fellowship Hall A
Median Families: W107/109
Married 30s-40's: E209/211
Married 40s: South Hall E/F
Married 40s: W103/105
Married 50s Plus+: Fellowship Hall C
Music: Music Suite
Women (All Ages): E217
Men (All Ages): Chapel
International: E162/164
Sunday Morning Bible Study Classes & Locations (10:45 am)
Married 60's Plus: Parlor
70+ Women: W104/106
Men (All Ages): W103/105
Women (All Ages): W107/109
Women (All Ages): E162
Single 50+: South Hall E/F


text:
There were five murders between Friday and Sunday.
Neighbors found the body of a Panamanian man, identified by the last name of Wilson, about 7 a.m. Friday, the Judicial Investigating organization said. The scene was in Valle la Estrella, Limón. The body was in a ditch alongside the road. Agents said the man had been stabbed in the neck.
Saturday judicial agents and Fuerza Pública officers caught up with a man suspected of killing a woman who rejected him. A homeowner found the body of the woman, an employee, when he returned to his residence in Liberia. The woman, identified by the last name of Sánchez, was 23 and died of multiple stab wounds, agents said.
A short time later they located in Barrio Moracia in Liberia the principal suspect, a man who had been rejected by the woman, agents said.
In Guararí, Heredia, gunmen shot down a 19-year-old man, identified by the last name of Carmona, while he still was inside his home, judicial agents said. The gunman or gunmen fired from the public street, agents added.
In Paraíso de Cartago late Saturday a 23-year-old man, identified by the last name of Gomez, died from a knife wound, agents said. He was wounded in a dispute and was pronounce dead on arrival at Hospital Max Peralta. A 19-year-old man, who also suffered a knife wound, was detained in the case at the same hospital.
In Upala two men suffered bullet wounds, one fatally, when they were riding on a motorcycle abut 6 p.m. Saturday. The gunfire came from another vehicle, agents said. Dead was a 58-year-old man with the last name of Tijerino. His 45-year-old companion was hospitalised.
Some individuals who suffered wounds were luckier.
About 2:30 a.m. Saturday a security guard from a fast food restaurant in Curridabat suffered a bullet wound to the back when he struggled with a man who had pulled a gun. Agents reported that the gunman tried to rob the guard of his cell telephone. The guard was treated at Hospital Calderón Guardia.
In Escazú a 24-year-old man with the last name of Alvarado, said he was walking along a public street about 8:30 p.m. when a man and a woman rushed at him from the bushes with the goal of robbing him.
The man suffered a wound in the subsequent struggle, and the assailants fled, said agents.
In another weekend death, a 64-year-old man with the last name of Pérez died when his bicycle was struck by a public bus in Barrio Nájera, Cariari de Pococí,
Judicial agents said that the passenger on a motorcycle died Sunday morning when the vehicle went out of control on the highway from San Isidro to Cajón de Pérez Zeledón. The man was identified by the last name of Rodríguez. He was 24, agents said, and appeared to have been riding the motorcycle without a helmet. He suffered head injuries.
The driver was not hurt seriously, agents said.
About 3:30 a.m. in Dulce Nombre de Tres Ríos a car carrying four persons went out of control. Dead was a 35-year-old man identified by the last name of Torres. The other occupants went to Hospital Calderón Guardia, said agents.
In Santa Ana early Saturday a 37-year-old man identified by the last name of Muñoz died when he was hit by a vehicle whose driver fled the scene.


text:
- Shed resistant-lint and fiber free
- Economical-washable and reusable
- Stand up to most commercially available solvents
- Nonabrasive and durable
- Resealable Bag
Revolutionize the way you clean and lubricate your firearms with Swab-its Firearm Cleaning Swabs. Bore-Sticks offer a easy way to clean your pistol's bore that is extremely effective.
Technical Information
Caliber: 9mm/.38 caliber
Handle Length: 8.5"
Quantity: 4


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After making the same mistakes as his predecessors, Madhu Kannan has quit BSE, saddling it with an expensive and inexperienced management team
On Tuesday, Madhu Kannan, Managing Director and CEO of the Bombay Stock Exchange (BSE) announced plans to quit and join the Tata Group. This was just a day after the Securities and Exchange Board of India (SEBI) announced the new policy framework for stock exchanges, depositories and clearing corporations. It may be a coincidence, but the timing of Kannan's decision seems to suggest he is throwing in the towel when his attempt to shake the National Stock Exchange's monopoly had clearly failed.
Mr Kannan, the hotshot imported from New York (he had worked at Merrill Lynch which imploded in 2008 and New York Stock Exchange before that) to turn around a sinking BSE has left it much weaker and more dangerously poised. BSE is saddled with a lop-sided pay structure and a deep divide between a tiny and extremely expensive top management team which has little expertise in running markets (far from turning around sinking bourses) and the rest of the staff. Mr Kannan has repeated the same mistakes of his predecessors, who quit under controversial circumstances and that too, by inflicting a much higher cost to the exchange.
BSE's shareholders, who are mainly brokers, watched silently in the hope that he would manage to list the exchange at a good valuation and give them a good exit price. Mr Kannan's expensive management team, comprising a number of US citizens (some of Indian origin), were expected to attract foreign institutional investors to invest. However, SEBI's new rule of pre-empting 25% of the profit every year is a big damper and worried shareholders and staff are beginning to ask questions. Interestingly, the BSE's average daily turnover was around Rs6,400 when Mr Kannan took over in 2009 and has shrunk to just Rs2,800 crore. Profits are also down, although the salaries of its top brass have sky-rocketed. This is probably something that Mr Kannan brought from the New York Stock Exchange (NYSE) and Merrill Lynch. Consider the messy trail Mr Kannan leaves behind:
This is BSE's third failed experiment with a SEBI-supervised / chosen professional management team. Strangely enough, this does not seem affect its "public interest directors" or its board. While there are many angry and unhappy shareholders and employees at the bourse, the exchange's board of directors seems to be unconcerned. BSE is set to sink further unless its true owners – the stock brokers who hold most of the shares – wake up and act collectively.
Around 42% of respondents in India surfed online to look for jobs in the last three months
A majority of Indians prefer to use the Internet for banking and other financial services than shopping online, shows a new survey. Almost 57% of Indian respondents using the Internet prefer to bank online and use other financial services due to hassle-free easy access and time-saving features of online banking, according to the survey conducted by research firm Ipsos.
Checking information on products and services online comes a close second at 53%, while 50% shop for products online. Around 42% of respondents in India surfed online to look for jobs in the last three months, the survey said.
"Online banking has made things much easier for the people and it saves a lot of time. It has eliminated the hassle of the traditional way of banking where one had to stand in the queue and fill up several forms," Ipsos India head (marketing communication) Biswarup Banerjee said.
Most of the banks in India have introduced customer-friendly online banking facility with advanced security features to protect customers against cybercrime.
"The easy registration process for net banking has improved customers' access to several banking products, increased customer loyalty, facilitated money transfer to any banks across India and has helped banks to attract new customers," he added.
The Indian results closely track the global trends as well. Conducted among 19,216 people from 24 countries, the survey showed banking and keeping track of finances, shopping and searching for jobs are the main tasks of Internet users around the globe.
Overall, 60% of people surveyed used the Web to check their bank account and other financial assets in the past 90 days, making it the most popular use of the internet, Ipsos said.
Globally, shopping was not too far behind at 48%, the survey showed, and 41% went online in search of a job. In terms of country preferences, almost 90% of the respondents in Sweden use e-banking. Online banking has also caught on in a big way in nations like France, Canada, Australia, Poland, South Africa and Belgium, the survey showed.
The Germans and British come on top for using online shopping with 74% of respondents in both countries having bought something online in the past three months. They are followed by 68% of respondents in Sweden, 65% in the US and 62% in South Korea.
While a section of agitating jewellers have called off the strike, jewellers associations from Mumbai will take the decision in a day or two
New Delhi: Bullion traders and jewellers on Friday called off their 21-day nationwide strike after meeting united Progressive Alliance (UPA) Chairperson Sonia Gandhi and Finance Minister Pranab Mukherjee who assured them that their demand for rollback of excise duty on unbranded jewellery would be considered.
"We have notified all our members to call off the agitation with immediate effect," Dinesh Jain, Director of Governing Board, All-India Gems and Jewellery Trade Federation, told PTI.
Most of the jewellery shops would open from Saturday, today being holiday on account of Good Friday.
Traders are estimated to have lost Rs20,000 crore due to the strike which began on 17th March after presentation of the Budget on the previous day.
Jewellers, however, threatened that strike would resume again if the proposal to levy excise duty of one per cent is not withdrawn in the Finance Bill, which is expected to come up before Parliament early next month.
"The strike has been suspended till 11th May, as the Finance Minister has assured us on a decision on rollback on excise duty and customs duty by first week of May," Mr Jain said.
Delhi-based All India Sarafa Association General Secretary Surendra Jain also said that their members have also agreed to suspend the strike.
Some of traders who met Mr Mukherjee, said the Finance Minister has assured them that their grievances with regard to levy of 1 per cent excise duty on unbranded jewellery would be addressed.
Before traders met Ms Gandhi, Congress General Secretary Janardhan Dwivedi said the party has asked the government to consider jewellers' demand sympathetically.
But, the Bombay Bullion Association President Prithviraj Kothari said, "We and other associations will meet tomorrow or day-after to decide whether to continue strike or open our shops."
Mumbai-based All India Gems and Jewellery Trade Federation also said that they would decide on the next course of action after consulting 153 affiliated associations.
Central Board of Excise and Customs (CBEC) Chairman SK Goel said that Mr Mukherjee has assured traders that he would address their concerns at the time of consideration of the Finance Bill 2012 in Parliament and "associations have agreed to withdraw the strike".
"We will decide on calling off strike... industry lost nearly Rs20,000 crore due to this strike and the government lost nearly Rs1,200 crore (in revenue)," All-India Gems and Jewellery Trade Federation Chairman Bachhraj Bamalwa said after meeting with the Finance Minister.
Meanwhile, Gem and Jewellery Export Promotion Council (GJEPC) Chairman Rajiv Jain welcomed the assurance given by the Finance Minister and appealed to all jewellers in the country to resume their day to day business operations as early as possible
"The Finance Minister also assured that the import duty imbalance for jewellery imported under Free Trade Agreement from Thailand and other issues faced by the gems and jewellery exporters due to recent announcements in the budget will be looked into," the GJEPC said in a statement.
On 16th March, a day before jewellers began their strike, gold prices in the national capital were ruling at Rs28,140 per ten grams. In Mumbai, gold rates stood Rs27,760 per ten grams.
India, the world's largest gold consumer, imported 967 tonnes of precious metal in 2011. Gold is the second biggest commodity imported after crude oil.


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He wore a faded San Francisco 49ers jacket from the glory days of the franchise, and had long, curly brown hair. His pubescent kid trailed him by about ten yards as they walked along the mountain road toward their car. I had my thumb out looking for a ride down the mountain—and less than a minute later he walked by with his skis on his shoulder and asked if I needed a lift. We threw our skis into the bed of his off-white '84 Dodge Ram, piled high with the debris one accumulates while living and skiing in the Montana mountains. In addition to the mighty hood ornament of the truck's namesake animal, I noticed some Sharpie on the breast of his jacket. He explained it was an autograph from Eddie DeBartolo—the legendary former owner of the football team, who has a house in the area.
In the car, he lit up a cigar, then put in a CD from a local band. They recently made it big; he knew the lead singer, a former heroin addict, he told me, from AA. Our 49ers man, he was a coke head, but it all started with the booze. Some people just can't drink like normal people, he said. His kid, a polite and easy-going 8th grader, sat in-between us on the truck's bench. He was visiting his old man from Plains, or some such flat and boring place you'll tend to find in other parts of this state. (The kid lamented the fact that cops now busted folks who jumped from the bridge into the local river.) Anyway, the kid wanted to live with his dad now, who resided right here in Whitefish, just ten minutes down the road from Whitefish Mountain Resort. It was easy to see why.
If you've been coming to Whitefish, near Glacier National Park in northwest Montana, for a long time (and I have, as I've been visiting my brother there for 12 years), it's easy to notice what's changed: The name Big Mountain Resort, the rowdy springtime furniture races, the AlpenGlow, and the ski school locker room with the 50-cent PBR dispenser, are all history. But the qualities that have stayed the same—its location, weather, skiing, charming Central Avenue, and characters like the aforementioned—continue to define this special place.
For visibility, give thanks for the abundance of tree skiing here, and to stay warm, keep skiing fast.
Whitefish is two and a half hours from St. Regis, where I-90, the nearest freeway, passes through. Flights to nearby Kalispell are pricey. The Amtrak stops here, but while a ride on the rail might make for a nice story, our nation's train operates as inefficiently as it probably did since the 1970 Rail Act initiated the service. (Once, while traveling from Whitefish to Portland, the train arrived half a day late, then the 11-hour ride turned into a 24-hour marathon. While stopped, Amtrak tried to placate its passengers by passing out buckets of KFC. A description of the ensuing smells would not be fit for publication.)
What I'm getting at is that this place is hard to get to. And once you're here, the skiing isn't for the feint of heart (say, for a Californian, for example). A thick fog can make you feel like you're lost in a murky dream, and the cold can make you want things you never thought you would—like insulated pants and those electronic boot warmers—and things I know I'll never have, like a beard, and general heartiness. For visibility, give thanks for the abundance of tree skiing here, and to stay warm, keep skiing fast.
Whitefish is one of the few original ski towns left in North America, with local businesses, lights, and wreaths lining Central Avenue. Every time I ask for the check at the Great Northern, I wonder if they have undercharged me. A microbrew there is still just $3, and on Tuesday, a 16-ounce can of Kokanee is just $2. Then there's the Bulldog, where you can order something called a Big Fucking Pitcher, and '80s Playboy pin-ups cover the walls of the men's and women's bathrooms, respectively.
As of January 6, it has snowed 151 inches at Whitefish Mountain Resort. The depth of snow at the summit is six feet. One night in late December, I walked from downtown, across the viaduct above the rail-yard, back to my brother's house. It was cold, and snowing so hard the town turned white, with a Christmas light tinge. I knew the following day would be one of those few special winter occasions that you look back on with a smile come spring.
Arriving at the hill while it was still dark, I lapped Chair 4 twice, jetting through the soft snow in-between pines, until the rest of the mountain opened. Connie's, a steep face through the trees that dumps skiers into the Hellroaring Basin, was skiing particularly well that day. As was East Rim to Haskel's, whose flat landings below a series of big boulders were soft enough to hit without much reservation. After a bell-to-bell day of skiing soft powder, few places in this world are better for running into old friends over beers than the dim, always crowded Bierstube. So that's where I went, until it was time to find a ride down the mountain.
The other night my brother sent a text of his backyard. Snow had swallowed his barbecue, which also had three feet of snow on top of it. It was dumping again in Whitefish.
Details, Details
Where to stay: At the Hibernation house, a short walk to the lifts, it costs $84 per person, per night, for a lift ticket, breakfast, lodging, and hot-tub access.
What's New: This season Whitefish installed the Flower Point Chair, which allows easier access to sustained, steep tree skiing on the back side.
By the numbers: Day ticket: $71; Average snowfall: 300 inches; Vertical: 2,353 feet; Terrain: 3,000 acres.


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Weston, Florida and Cypress Bay High school defensive end standout Jacob Lichtenstein has accumulated close to 30 offers. Jake recently made a decision to narrow that list of offers to five schools before he begins his summer visits.
Jake has enjoyed the recruiting process even though he felt at times that it has been nerve wracking. "This is a once in a lifetime decision for me. That is why I have narrowed my choices." The five schools on Jake's list are Georgia Tech, Cal, Kentucky, Pittsburghand Nebraska.
There are no plans for Jake to narrow the list any further. Jake could, however, change the top five after he completes his summer visits. "I've decided that by the end of the summer I'll be making my decision." Jake will be visiting more than just the five schools on his list. The schools on his list could change depending on what he sees on those visits.
What does Jake like about each of the five schools on his list?
Pittsburgh – "A great football town and I have family in that area. The staff is hard-working and it has rubbed off on the players. They are a team that has a bright future and they have a good football tradition."
Kentucky – "I loved my trip there. They showed me the plans for their future facilities and ones that they are building right now. I love the coaching staff and how they help the players."
Georgia Tech – "I love Coach (Buzz) Preston. We have formed a great relationship and the rest of the staff is great. I loved my trip there and the city of Atlanta is a great place. I love how Coach (Paul) Johnson works with companies to help the players get internships. They have a rich football tradition. I feel that Adam Gotsis and I have the same type of game. He's a great player and I am honored that many feel my play is similar to his. Not many schools can match their combination of football and academics."
Cal - Like Georgia Tech, they are a very good academic school and they've had real good success of late on the football field. Defensive line Coach (Fred) Tate and I get along well. I have set up a June 10th-11th visit to see them. Of the five teams on my list, Cal and Tech are great academically."
Nebraska – "They have a lot of resources to help a football player to do well on the field and then when it's time to get a good job. I really like the coaching staff and the team has made huge progress since they have joined the Big 10. They have a lot to offer a student-athlete."
The schools on Jake's list of five like him as a defensive end or possibly playing the three technique. Some of the other schools that have offered Jake like him as an offensive tackle or a tight end. "I would be happy to play any of the three. I just want to play and help my college team win."
Lichtenstein hasn't set up any visits other than the one to Cal. Jake does know that he'll be making return visits to Georgia Tech and Kentucky. "I want to talk to the coaching staffs and meet the current players and incoming freshmen."


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Restek Protocol Station
Designed for convenient wall mounting of high-purity gas regulators
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text: 10 Party Outfits From 7 Mix-and-Match Pieces Facebook Pinterest Twitter Print Mail Save Left Arrow Right Arrow Photo by Jens Mortensen You don't need a packed closet to get through a packed party calendar. Just a few festive items will keep you covered this holiday season and beyond. By Rebecca Daly Start Right Arrow Start


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Arrive Paris, France
Paris | Unrivaled Cultural Icon
Paris | Reflections on the Seine
Paris | Echoes of Napoleon
Paris to Meaux | Cruising the Marne
Meaux to Courtaron | Grand Riverside Chteau
Chteau-Thierry | Uncorking the Champagne Region
Cumières | A Taste of the Countryside
Condé-sur-Marne | Birthplace of Bubbly
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Strasbourg | Crossroads of France & Germany
Alsace | Wines of the Vosges Foothills
Versailles | Grand Legacy of Louis XIV
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Paris, Champagne & Alsace: Villages & Vineyards by Barge
After a grand tour of Paris, cruise the Marne River aboard a deluxe private barge, disembarking in the Champagne region for wine tastings, gourmet dining and château visits. Continue overland to Strasbourg, finishing with a tour of Musée Unterlinden in Alsace and a luxurious stay on the grounds of the Palace of Versailles.
Immerse yourself in three distinct regions, exploring iconic cities, cruising by barge and disembarking for shore excursions
Watch the idyllic scenery slip by as you cruise the Marne from Paris to the Champagne region
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In these and myriad other ways, Abercrombie & Kent consistently goes above and beyond the call of duty — and no A&K journey is complete without that extra, unexpected "and" that makes your experience unique and unforgettable. Choose from a Luxury Small Group Journey, the finest group travel experience in the world; a Connections Journey, which combines A&K's renowned service with unbeatable value; A Marco Polo Journey to an exotic locale or local festival; a private Signature Series itinerary; or a custom Tailor Made luxury journey created just for you. When it comes to discovering the world, the possibilities are endless.
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With expertise in not only luxury but culture, wildlife and history as well, Abercrombie & Kent reveals your destination with an authenticity beyond the reach of any other travel company.
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Running Time: 85 minutes
Released: 09/2009
Studio Name: White Ghetto
Description: These moms next door love to lick cooch and finger holes. Forget the opposite sex. They want someone who understands them inside and out. They want what only another woman can give tem.
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A standard in advanced flute repertoire, this brilliant showpiece is widely performed in contest and recital settings. Now, with this meticulously prepared accompaniment for winds, you can feature any
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