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Peritoneal Dialysis and In-Centre Haemodialysis: A Cost-Utility Analysis from a UK Payer Perspective
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With limited healthcare resources available, cost-effective provision of dialysis to patients with end-stage renal disease (ESRD) is important.
To assess the cost-effectiveness of varying levels of peritoneal dialysis (PD) use versus current practice among incident ESRD patients requiring dialysis.
A Markov model was developed to investigate the cost-effectiveness of increasing uptake of PD to 39 and 50 % versus current practice of 22 % PD from a UK National Health Service perspective for the year of 2013–2014. A scenario with 5 % PD was also considered. Sensitivity analyses were performed.
Five- and 10-year discounted total costs and quality-adjusted life years (QALYs) per patient for the current scenario (22 % PD) were £96,307 and 2.104, and £133,339 and 3.301, respectively. Use of PD in 39 % of patients resulted in 5- and 10-year total per-patient cost savings of £3,180 and £4,102 versus current usage alongside total per-patient QALY increases of 0.017 and 0.020. Use of PD in 50 % of patients resulted in 5- and 10-year per-patient cost savings of £5,238 and £6,758 versus current usage alongside per-patient QALY increases of 0.029 and 0.033. Thus, increasing use of PD was associated with marginally better outcomes and lower costs. Cost savings were driven by lower treatment costs and reduced transport requirements for PD versus haemodialysis. Reducing PD use was associated with higher costs and a small reduction in QALYs.
These findings suggest increasing PD use among incident dialysis patients would be cost-effective, associated with reduced costs and potential modest improvements in quality of life.
Key Points for Decision Makers
Increasing peritoneal dialysis (PD) usage among incident patients with end-stage renal disease (ESRD) requiring dialysis has the potential to result in significant cost savings.
The possible clinical benefits and improvements in patient quality of life associated with PD could also reduce the burden of disease to the patient.
Implementing the use of PD as a first choice dialysis modality among appropriate patients could be a positive step towards supporting the National Health Service (NHS) QIPP (Quality, Innovation, Productivity and Prevention) programme in its aims to reduce costs while improving the quality and delivery of patient care.
1 Introduction
People with end-stage renal disease (ESRD) require renal replacement therapy (RRT) in the form of dialysis or kidney transplant to sustain life. Due to ageing populations and increased risk factors such as diabetes mellitus and hypertension [1], the global prevalence of ESRD has been increasing and thus is a significant public health concern. In the European Union, the annual dialysis population growth rate in 2012 was approximately 2 % [2]. In the UK, approximately 55,000 adult patients received RRT in 2012 [3] with 6,891 commencing RRT [4]. The RRT population represents approximately 2 % of the total chronic kidney disease (CKD) population [5], but accounts for half of the estimated £1.45 billion spent by the English National Health Service (NHS) in 2009–2010 for care of CKD (approximately 1.3 % of total NHS spending for that year) [5].
The two main types of dialysis modality are haemodialysis (HD) and peritoneal dialysis (PD). PD is home-based, administered either by a cycler whilst asleep [automated PD (APD)] or manually [continuous ambulatory PD (CAPD)]. HD is usually administered in a hospital or satellite unit, three times per week, and sometimes at home. As a home-based therapy, PD is associated with fewer travel requirements, less exposure to hospital pathogens and improved patient control. Factors determining choice of modality include availability of options, clinical contraindications and, importantly, patient preference [6]. Although evidence suggests that 50 % of patients would choose PD where possible [7], the use of PD in the UK has been decreasing over the last decade [8, 9]. In 2012 in the UK, approximately 22 % of incident dialysis patients and 14 % of prevalent dialysis patients used PD [3, 4].
The National Institute for Health and Care Excellence (NICE) guidance for England and Wales, which is produced to support people in making informed decisions about RRT, recommends that PD should be considered as the first choice of dialysis modality in adult patients without significant associated comorbidities [6]. The guidance advises that offering PD where suitable gives patients more choice and flexibility and can lead to short-term survival benefit and improved preservation of residual renal function [10]. Currently, the UK NHS is undergoing an extensive overhaul; an integral part of this reform is the QIPP (Quality, Innovation, Productivity and Prevention) programme, which aims to improve quality and delivery of NHS care while reducing costs and achieve £20 billion of efficiency savings by 2015 [11]. A national costing report on the prevalent dialysis population published by NICE in 2011 suggests that annual savings of approximately £20 million could be made nationally if 39 % of dialysis patients were to receive PD [12]. It is believed that exploring which dialysis modality or modalities should be chosen to achieve best outcomes for incident ESRD patients is valuable.
This study aimed to determine the cost-effectiveness of varying levels of PD use versus current practice among incident dialysis patients to build on a similar analysis conducted by NICE among prevalent dialysis patients [10]. The 5- and 10-year cost-effectiveness, in terms of cost per quality-adjusted life-year (QALY), of increasing the proportion of incident patients on PD to 39 and 50 %, or of assuming only 5 % use of PD, compared with typical UK current practice [22 % PD, 78 % in-centre HD (ICHD) conventional] was investigated from the UK payer perspective.
2 Methods
A Markov model was developed to assess the relative cost-effectiveness of different dialysis modality distribution scenarios versus current practice. The model considers a hypothetical adult incident patient cohort with ESRD requiring dialysis and adopts a UK payer perspective. Costs and benefits are discounted at a rate of 3.5 % per annum in line with current UK Treasury guidance [13]. Total costs and QALYs per-patient and incremental cost-effectiveness ratios (ICERs) (expressed as cost per incremental QALY) over 5- and 10-year time horizons are estimated. Sensitivity analyses were conducted to test the robustness of our model conclusions.
2.1 Patient Distribution and Comparators
Default data for the reference scenario's modality distribution (22 % PD, 78 % ICHD conventional), representing UK current practice, were sourced from the UK Renal Registry 16th Annual Report [4]. The UK Renal Registry, which automatically collects data quarterly from UK renal unit databases, was selected as an independent source of data and analysis. The baseline distribution of PD is: 50 % CAPD and 50 % APD [3]. This breakdown is assumed to be consistent in all scenarios. Alternative scenarios to UK current practice included: Scenario 1, 39 % PD and 61 % ICHD conventional (39 % PD was used in the recent economic evaluation by NICE [10]); Scenario 2, 50 % PD, 50 % ICHD conventional (evidence suggests 50 % of patients would choose PD where possible [7] and some UK centres achieve this level of PD use [4]); Scenario 3, 5 % PD and 95 % ICHD conventional (chosen to see the effect of limited use of PD as seen in some UK centres [4]).
2.2 Model Structure
2.3 Model Inputs
2.3.1 Clinical Data
Clinical input data
Clinical parameter
Value (range)†
Parameter distribution‡
Data sources
HD exponential model intercept
1.98 (1.49–2.48)
ERA-EDTA survival data§ [17]
PD Weibull model intercept
1.92 (1.44–2.40)
PD Weibull scale
0.82 (0.62–1.03)
Hazard ratio to reflect an incident cohort
1.06 (0.80–1.33)
Adjusting life to its quality: baseline utility values for patients in all health states
ICHD conventional (hospital and satellite)
0.56 (0.49–0.62)
Liem [28]
HHD conventional
0.69 (0.52–0.86)
0.58 (0.50–0.67)
Liem [28]
Transplant and post-transplant
0.81 (0.72–0.90)
Liem [28]
Dialysis modality switching assumptions: 28-day probability of switching modalities (incident population): %
HD to PD
0–6 months
3.58 (2.69–4.48)
Johnson [54]
7–12 months
0.08 (0.06–0.10)
13–18 months
0.08 (0.06–0.10)
19+ months
0.08 (0.06–0.10)
PD to HD
0–6 months
Baxter UK hospital data
7–12 months
1.13 (0.85–1.41)
13–18 months
0.78 (0.58–0.97)
19+ months
0.31 (0.23–0.39)
ICHD to HHD
0–6 months
0.05 (0.04–0.06)
7–12 months
0.05 (0.04–0.06)
13–18 months
0.03 (0.02–0.04)
19+ months
HHD to ICHD
0–6 months
0.38 (0.29–0.48)
McFarlane [55]
7–12 months
0.38 (0.29–0.48)
13–18 months
0.38 (0.29–0.48)
19+ months
0.38 (0.29–0.48)
Dialysis complications: 28-day probability of all-cause hospitalisation: %
ICHD conventional (hospital and satellite)
Year one
7.05 (5.29–8.81)
FHN trial [31]
Subsequent years
4.86 (3.65–6.08)
Based on Arora [32]
HHD conventional
Year one
5.35 (4.01–6.68)
Rocco [56]
Subsequent years
3.68 (2.77–4.61)
Based on Arora [32]
All PD modalities
Year one and subsequent years
7.05 (5.29–8.81)
Breakdown of transplant type by donor: %
36 (27.0–45.0)
NHS Blood and Transplant Activity Report 2012/2013 [22]
Donor after brain death
39 (29.3–48.8)
Donor after cardiac death
25 (18.8–31.3)
Annual transplant probability: %
All patients
9 (7–11)
Annual graft failure probability by donor type
0.03 (0.03–0.04)
NHS Blood and Transplant Activity Report 2012/2013 [22]
Donor after brain death
0.06 (0.06–0.07)
Donor after cardiac death
0.08 (0.07–0.10)
Weighted average
Annual access failure probability: %
HD vascular access
10 (7.5–12.5)
Xue [33]
2.3.2 Survival
Survival was estimated based on data from the ERA-EDTA Annual Report 2009 [17], which relates to European incident patients on dialysis, and was used because the UK Renal Registry reports do not provide such detailed information on patient survival. The age and gender distribution of patients in the UK was found to be comparable to those in patients in the US and in other European countries based on data published by the USRDS (US) [18] and ERA-EDTA (Europe) [19] registries. It was therefore deemed appropriate to use European ERA-EDTA registry data to approximate the UK population in this analysis. The survival curves published in the ERA-EDTA report permit parametric modelling of survival, whereas the UK Renal Registry's summary statistics do not. Five-year survival curves for HD and PD patients were digitised and the data obtained converted into a patient-level data set and analysed in the statistical package, R [20]. Further information regarding the R survreg function is provided as Electronic Supplementary Material accompanying this article. In order to extrapolate PD and HD survival beyond 5 years, parametric survival models were fitted to the data. Since extrapolating the available 5-year HD and PD data beyond 10 years would cause more uncertainty and as a result be less reliable, it was assumed that there were no differences in mortality rates between modalities after 10 years. This is in line with the review paper by Chiu [21], which reported that 'virtually all the recent observational studies from different parts of the world consistently show that long-term survival of HD and PD patients is remarkably similar'. Average extrapolated mortality rates were used across all dialysis modalities beyond 10 years. Survival of patients post-transplant was modelled using 5-year summary survival data for the 2005–2007 transplant cohort from NHS blood and transplant's activity report for 2012/2013 [22].
2.3.3 Quality-of-Life
Dialysis modality has the potential to impact upon patients' quality-of-life (QoL). It has been reported that PD patients have less illness intrusion, better renal care and higher satisfaction, while HD patients have better staff and social interaction and less fear of isolation [23, 24, 25, 26, 27]. The model includes the utility of patients that varied between different dialysis modalities and between patients on dialysis and those receiving a kidney transplant. A systematic review and meta-analysis conducted by Liem [28] was used as the main source of utility values for the model; this was also used in NICE clinical guideline (CG) 125. The utility value assigned to patients receiving HHD was based on the combined approach of NICE CG 125 [6] and NHS CEP10063 [16]. The utility value assigned to ICHD conventional from the Liem study [28] was multiplied by a ratio of limited care HD to HD conventional utility scores taken from the study by de Wit [29] to estimate a utility value for conventional HHD.
2.3.4 Transition Probabilities
Patients may change dialysis modalities because of complications and changes in preference or living conditions. Estimated transition probabilities for the model are shown in Table 1. When patients change dialysis modality they are redistributed according to the baseline distribution of the modality to which they change. For example, if a patient moves from HD to PD, whether they move to APD or CAPD is dependent on how PD patients are distributed between these modalities at baseline (CAPD = 50 %; APD = 50 %). The probability of a patient staying in the same modality from one cycle to the next is taken to be equal to 1 minus the probability that they move. Following a transplant, all patients move to the post-transplant state where they stay until graft failure/death. If graft failure occurs, the patient's subsequent dialysis setting is dependent on the scenario's baseline patient distribution.
2.3.5 Dialysis Complications
Patients undergoing dialysis may experience complications. The model looks specifically at all-cause hospitalisations as an encompassing approach. Since no studies reporting all-cause hospitalisation probabilities in patients on PD in the UK were available, to be conservative, it was assumed that the rate was the same as for HD [30, 31] (Table 1). All-cause hospitalisation probabilities in subsequent years were calculated by applying a ratio of first-year to subsequent-year hospitalisation rates derived from the study by Arora [32]. In HD patients, hospitalisation rates in subsequent years are 30 % lower than in the first year, whereas for PD patients hospitalisations occur at the same rate in subsequent years as in the first year.
2.3.6 Cost Data
Cost input data
Value (range)†
Data sources
HD-related costs
Vascular access cost
£1,287 (£965–£1,609)
PbR tariff 2013–2014 [34]
ICHD cost per session
Catheter access
£121 (£92–£154)
PbR tariff 2013–2014 [34]
AV fistula/graft access
£152 (£115–£191)
Breakdown based on the target percentage set by the best practice tariff for 2013–2014 [60]
Home HD cost per week
£456 (£342–£570)
PbR tariff 2013–2014 [34]
HD conventional ESA cost
Dose (units/week)
6,306 (4,730–7,883)
Rao [61]
ESA cost per 1,000 units
£5.09 (£3.82–£6.36)
BNF No. 67 [35]
Cost per HD hospitalisation
£1,887 (£1,415–£2,359)
Event costs from the PbR tariff 2013–2014 [34]. Event numbers from the National Schedule of Reference Costs 2011–2012 [37]
PD-related costs
Peritoneal access costs (PD specific)
£1,233 (£854–£1,423)
PbR tariff 2013–2014 [34]
PD cost per day
£52 (£39–£65)
PbR tariff 2013–2014 [34]
£46 (£35–£58)
PD ESA cost (all sub-modalities)
Dose (units/week)
2,933 (2,200–3,666)
Rao [61]
ESA cost per 1,000 units
£5.09 (£3.82–£6.36)
BNF No. 67 [35]
Cost per PD hospitalisation
£1,504 (£1,128–£1,880)
Event costs from the PbR tariff 2013–2014 [34]. Event numbers from the National Schedule of Reference Costs 2011–2012 [37]
Overall (common) costs
Transplant cost
Donor after brain death
£19,804 (£14,853–£24,755)
National Schedule of Reference Costs 2012–2013 [42]
Donor after cardiac death
£16,580 (£12,435–£20,725)
Living donor
£18,640 (£13,980–£23,300)
Breakdown based on the NHS Blood and Transplant Activity Report for 2012–2013 [59]
Post-transplant medication costs
£11,137 (£8,352–£13,921)
NHS Kidney Care report [41]
Monitoring costs‡
Single professional
£132 (£99–£165)
PbR tariff 2013–2014 [34]
Multi professional
£247 (£185–£309)
Equal weighting assumed
Transport cost per visit
£44 (£33–£55)§
NHS Law on tariffs [38]
National Schedule of Reference Costs 2009–2010 [39]
National Schedule of Reference Costs 2010–2011 [62]
National Kidney Care Audit, Patient Transport Survey 2010 [40]
2.4 Cost-Effectiveness Analysis
For the base case analysis, three alternative scenarios with 39, 50 and 5 % PD respectively were compared with the current clinical practice of 22 %. In line with current UK Treasury guidance, future costs and benefits were discounted at an annual rate of 3.5 % [13]. The main outcome measure was the ICER, the cost per incremental QALY. Given the available survival data and in line with previous economic evaluations in ESRD [6, 43, 44], 5- and 10-year time horizons were presented as main results.
2.5 Sensitivity Analyses
One-way sensitivity analyses were performed to assess how sensitive results were to changes in model parameters. All model parameters were individually varied between a minimum and maximum value and their impact on model results recorded. Variables were altered according to published ranges (available for transplant graft failure rates [22], certain switching rate inputs [45] and utility values [28]) or by ±25 % for those variables without such information. The following parameters were analysed: all-cause hospitalisation rates, transition probabilities, survival parameters, costs, transplant and graft failure rates, and utilities. Parameter ranges are shown in Tables 1, 2. Results are presented in the form of a tornado diagram.
Probabilistic sensitivity analysis (PSA) was also conducted. In PSA, model parameters are assigned appropriate statistical distributions and are permitted to vary according to those distributions. Running a large number of simulations allows a more accurate assessment of the effect of parameter uncertainty on model results. Distributions assigned to parameters in the PSA are shown in Tables 1 and 2. PSA results are presented in the form of a cost-effectiveness plane scatter diagram and a cost-effectiveness acceptability curve (CEAC).
Further sensitivity analyses for different time horizons beyond 10 years, including 15, 20, 30 and 40 years, were also conducted to test the robustness of the model conclusions.
3 Results
Results of the effect of varying the proportion of incident patients on PD showing the total costs, QALYs per patient and the ICER
Total costs (£)
ICER (vs. reference scenario)
Reference scenario (5 years)
Scenario 1 (39 % PD)
Scenario 2 (50 % PD)
Scenario 3 (5 % PD)
Reference scenario (10 years)
Scenario 1 (39 % PD)
Scenario 2 (50 % PD)
Scenario 3 (5 % PD)
For the following time horizons, equal survival was assumed after 10 years
Reference scenario (15 years)
Scenario 1 (39 % PD)
Scenario 2 (50 % PD)
Scenario 3 (5 % PD)
Reference scenario (20 years)
Scenario 1 (39 % PD)
Scenario 2 (50 % PD)
Scenario 3 (5 % PD)
Reference scenario (30 years)
Scenario 1 (39 % PD)
Scenario 2 (50 % PD)
Scenario 3 (5 % PD)
Reference scenario (40 years)
Scenario 1 (39 % PD)
Scenario 2 (50 % PD)
Scenario 3 (5 % PD)
3.1 Sensitivity Analyses
4 Discussion
The results of this study suggest that increasing PD use among new patients with ESRD initiating dialysis from the current 22 % to either 39 or 50 % would be cost-effective, associated with reduced costs and modest improvements in health outcomes. Reducing PD use to 5 %, however, would result in higher costs and worse outcomes. The range of QALY differences observed in the sensitivity analyses reflects the clinical uncertainty surrounding the relative effectiveness of PD and HD; thus, dominance cannot be presumed. However, the cost savings associated with increasing PD use to 39 % of incident dialysis patients are such that one can be confident that it will be deemed cost-effective. Results were also considered for longer time horizons of 15, 20, 30 and 40 years and were found to be consistent with the results for 10 years.
These findings are consistent with prior studies on this topic. The cost-effectiveness analysis conducted by NICE analysed the prevalent population in order to determine whether the proportion of patients on PD should be increased in England and Wales [47]. Compared with the reference scenario (Hospital HD 47 %, Satellite HD 33 %, HHD 2 %, CAPD 14 %, APD 4 %), increasing PD use (Hospital HD 8.5 %, Satellite HD 49 %, HHD 9.5 %, CAPD 20 %, APD 13 %) resulted in reduced costs (reference scenario £130,234; PD scenario £120,200) and better QALYs (reference scenario 3.77; PD scenario 3.87) and was dominant at 10 years. It has been reported that increasing use of PD from current levels (approximately 15 %) to 39 % among prevalent patients is cost-effective and could realise annual savings of approximately £20 million nationally [12]. When the NICE scenario was tested as closely as possible in the current model using the prevalent population (data inputs not shown), it was found that increasing PD also resulted in reduced costs (reference scenario £138,606; PD scenario £132,969) and better QALYs (reference scenario 3.38; PD scenario 3.43) as well as a dominant ICER versus the reference scenario. However, the decision to focus on incident dialysis patients rather than prevalent dialysis patients is in response to the perceived benefits of starting incident patients on PD; these include improved early survival and better preservation of residual renal function [46, 48, 49].
Studies from other countries have also reported that increasing PD use in incident patients with ESRD requiring dialysis is cost-effective [45, 50, 51]. To the authors' knowledge, this is the only study that has looked at increasing the proportion of PD use among incident patients from the perspective of the UK NHS. Neil et al. used a budget impact analysis to estimate the country-specific, 5-year financial impact on total dialysis costs, assuming utilisation shifts from HD to PD in the prevalent population in two high-income, three upper-middle-income and three lower-middle-income countries [52]. This study found that increasing PD rates could be significantly cost-saving compared with HD in all the studied countries, including the UK.
The key strengths of the current analysis are first that the model structure was informed by previous economic evaluations in ESRD including the analysis conducted by NICE in relation to CG 125—peritoneal dialysis [10]. Second, model assumptions and inputs were validated at a clinical advisory board and with a UK-based nephrology key opinion leader who had been involved in both inpatient and outpatient NHS renal services and was involved in the NICE appraisals of HD and PD.
Although the best-available published evidence was used to model costs and benefits associated with increasing PD use among incident patients with ESRD requiring dialysis, the analysis has several limitations. First, some data may not be completely representative of current clinical practice in the UK, as some model inputs were derived from other countries where clinical practice might be different. Survival, for example, is based on European data in which UK patients represent 20 % of all incident patient counts [17]. In order to facilitate future research and economic evaluations in the UK, it would be very valuable to have more comprehensive UK-based clinical and epidemiological data, including long-term comparative survival data for PD vs. ICHD. Second, the current data are only applicable to adult patients who are suitable and willing candidates for PD. Patient suitability is based on NICE clinical guidelines. Third, to calculate the number of hospitalisations in subsequent years versus the first year, data from a study published by Arora in 2000 were used—more recent data were not identified [32]. This study suggested that the rate of hospitalisations in PD patients did not drop in subsequent years while in HD patients the rate dropped by 30 %. Since PD technology has improved significantly in the interim, the number of hospitalisations in PD patients may be overestimated. Thus, the results may be biased in favour of HD. Fourth, given the payer perspective of the analysis, indirect costs related to working days lost, direct out-of-pocket costs to patients and carers were not incorporated. Fifth, with regard to other medication costs, there is currently a lack of evidence demonstrating that these costs differ between the different treatment modalities within the UK. Finally, data availability did not permit the consideration of the relative clinical efficacy of APD versus CAPD. Therefore these conclusions relate to PD in general as conducted in the UK. This analysis does not advocate one kind of PD treatment over another.
The present study may have important implications for policymakers. As part of extensive healthcare reform in the UK, the QIPP programme aims to improve the quality and delivery of NHS care while making efficiency savings. For example, one aim is to "reduce expensive hospital admissions by: getting patients more involved in managing their own conditions; where possible treating more patients closer to home" [53]. The current results show that PD is associated with quality improvements and cost savings compared to conventional ICHD. The increased use of PD could make a significant contribution to the target of achieving £20 billion efficiency savings by 2015 while improving the quality of a patient-focussed health service.
In summary, this study suggests that using PD in line with NICE recommendations may be a cost-effective method of treating incident ESRD patients requiring dialysis. It is acknowledged also that there are some limitations associated with this analysis due to many of the model inputs being based on data not specifically relating to the UK. Additionally, the results of the PSA show that there is uncertainty regarding the clinical benefits of PD over other dialysis modalities. Further research is therefore warranted into the clinical comparative effectiveness of PD versus HD. However, this study suggests that, from a UK payer perspective, increasing the proportion of patients on PD could lead to cost reductions while also improving clinical outcomes and QoL, thus alleviating the burden to the patient. The results suggest that policies encouraging the use of PD as the first dialysis option would help support implementation of the NHS QIPP agenda and that quality of care could be improved with reduced resource use.
The authors thank Dr Andrew Buckland (Abacus International), Dr Andrea Ditchfield (Abacus International) and Dr Amanda Prowse for assistance in writing the article.
This study was funded by Baxter Healthcare Corp. Frank Xiaoqing Liu, Murat Arici and Usman Farooqui are paid employees of Baxter Healthcare Corp/Ltd. Catrin Treharne and Lydia Crowe are employees of Abacus International, a health outcomes consultancy commissioned by Baxter to conduct the economic analysis. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Author contributions
Catrin Treharne performed the economic model development, assisted with data collection and was involved in the manuscript development and review. Frank Xiaoqing Liu was responsible for the model structure design, contributed to data collection, reviewed and approved the economic model described in the manuscript, and was also involved in manuscript development and review. Murat Arici assisted in collection of cost data, reviewing data inputs and review of the manuscript. Lydia Crowe was involved in development of the economic model described in the manuscript and in the review of the manuscript. Usman Farooqui provided clinical data inputs and reviewed and commented the manuscript. All authors approved the final manuscript. The guarantor for the overall content of the manuscript is Frank Xiaoqing Liu.
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- 60.NHS Kidney Care. Frequently asked questions. payment by results (PbR)—Renal dialysis. Feb 2011. Available from http://webarchive.nationalarchives.gov.uk/20130504185629/http://kidneycare.nhs.uk/resources/?dispFolder=503#. Accessed Jan 2014.
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Copyright information
Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.


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360 Keweenaw is a project created by Julie and Christopher Rice of Exactly Done. We love to cook, travel, walk the slackline, play cribbage and enjoy old-school, wood-fired sauna. We share our life adventures with our four children, Rebecca (10), Nahlah (8), Hudson (6), and Daniel (4).
How can we serve you?

subset: commoncrawl


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Our client in Tallahassee is currently seeking an ERP Programmer/Analyst-CRM for a long term contract opportunity. Customer Relationship Management (CRM) Functional and Technical sub-team This position works with the Exchange Interface (XI) and Business Intelligence (Bl) team in data system operations, maintenance and management- Position Description: This position provides professional, technical level support in Customer Relationship Management (CRM), Exchange Interface (XI), and Business Intelligence (Bl). It provides vast and varied technical knowledge and experience in several modules of the SAP application. The goals of this multi-SAP module position are to:
- provide system upgrade Development know-how and expertise in preparation for CAMS Phase II
- perform Operations & Maintenance on the existing CRM and XI aspects of the System, including applying approved enhancements
- elicit, analyze, document, and ...
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Okla St. dominates Ark.-Pine Bluff
Seven second-half goals lift Cowgirls to 20th victory of season
STILLWATER, Okla. -- Oklahoma State's offense erupted for seven second-half goals as the Cowgirls opened play in the NCAA Women's Soccer Championship with a 9-1 rout of Arkansas-Pine Bluff Friday night at the Cowgirl Soccer Complex.
Six different Cowgirls scored as OSU tied a school record with its 20th win. Coach Colin Carmichael's squad is 20-1-2 on the season and advances to the second round of the NCAA tourney for the sixth consecutive year, where it will play the Notre Dame-Illinois winner Friday at 5 p.m. in Stillwater.
OSU went into halftime against the Golden Lions leading just 2-1, but the second 45 minutes was a different story as the Cowgirls scored three times in the first 6:35 after intermission and cruised to the win.
"We talked [at halftime] about that we weren't playing with the right intensity and came out with the wrong attitude," Carmichael said. "Arkansas-Pine Bluff came out very, very fired up and played really well in the first half; you have to give them a lot of credit. But we felt like we weren't playing with the right intensity, the right drive and the right focus. We addressed that at halftime, and obviously it got a little bit better in the second half.
"The second half was fantastic, it's what we hoped to do in the first. Pine-Bluff tired a little bit maybe, and it opened up a little more space for our team. We just were sharper, we were quicker and we played with more energy. We know next weekend we'll have to come out and play like we did in the second half."
OSU's nine goals tied for the fifth most in a single game in school history and were the most by a Cowgirl squad since 2006. OSU also racked up 44 shots in the match, which tied for the second-most in a game in program history.
Taylor Mathews led the scoring attack with two goals and three assists as the sophomore tied the single-game school record for assists. Elizabeth DeLozier and Annika Niemeier also had two goals apiece for the Cowgirls.
Mathews assisted on both of OSU's goals in the first half, and after a score by Melinda Mercado put the Cowgirls up 3-1 in the 51st minute, Mathews collected a pair of goals within a 42-second span to help put the game away.
The first goal came at the 51:35 mark when Mathews took a pass from Megan Marchesano and drilled a shot from 15-yards out that deflected off the post and bounced over the line. Less than a minute later, Mathews fired another shot into the back of the net to make the score 5-1.
"In the second half, Taylor ran the show -- she played in the center-mid and got on the ball and made things happen for us," Carmichael said. "That's what Taylor can do when she's on her game. She's a very creative player who can score goals and set up goals."


text:
Education and job complexity levels
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Volume (Year): 57 (2010)
Issue (Month): 4 (December)
Pages: 361-368
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- Coen Teulings & Thijs van Rens, 2008.
"Education, Growth, and Income Inequality,"
The Review of Economics and Statistics,
MIT Press, vol. 90(1), pages 89-104, February.
- Coen Teuling & Thijs van Rens, 2001. "Education, growth and income inequality," Economics Working Papers 942, Department of Economics and Business, Universitat Pompeu Fabra, revised Jul 2006.
- Coen N. Teulings & Thijs van Rens, 2002. "Education, Growth and Income Inequality," Tinbergen Institute Discussion Papers 02-001/3, Tinbergen Institute, revised 05 Mar 2003.
- Thijs van Rens, 2002. "Education, Growth and Income Inequality," CESifo Working Paper Series 653, CESifo Group Munich.
- Teulings, Coen N & van Rens, Thijs, 2003. "Education, Growth and Income Inequality," CEPR Discussion Papers 3863, C.E.P.R. Discussion Papers.
- Barbara Sianesi & John Van Reenen, 2003. "The Returns to Education: Macroeconomics," Journal of Economic Surveys, Wiley Blackwell, vol. 17(2), pages 157-200, 04.
- Pekkarinen, Tuomas, 2002. "Complexity, wages, and the O-ring production function: evidence from Finnish panel data," Labour Economics, Elsevier, vol. 9(4), pages 531-546, September.
- van Ophem, Hans & Hartog, Joop & Vijverberg, Wim P M, 1993. "Job Complexity and Wages," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 34(4), pages 853-872, November. Full references (including those not matched with items on IDEAS)
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text:
Electrical measuring instruments >> analog panel meters >> panel with round scale devices for harsh environments >> special devices
A device for measuring the temperature ER1621S-11 (ER1621S11, ER-1621-S-11, ER1621S-11 ER1621S11)
A device for measuring the temperature ER1621S-11 is designed to measure temperature.
Technical characteristics of the devices device for measuring the temperature ER1621S-11:
C - the primary transmitter termopraobrazovatel;
It consists of showing the device, additional devices MR1621P (C), the coupling device MH1621P (C) and switch MP1621P (C);
The manufacturer guarantees the quality of the instrument temperature measuring instrument ER1621S-11 technical requirements specifications, subject to the consumer the terms and conditions of storage, transportation, installation, operation, established specifications and operational documentation.
Photos: ER1621S-11 (ЭР1621С-11)


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"A Cry My Mother Never Heard"
"Truth is a healer, revealer, and deliverer"
by Takeia N. Murray
About the Book
30yr old single mother of 2, living with Sickle Cell Anemia, love my family to the fullest......... Taking life one day at a time.....
Features & Details
- Category Biographies & Memoirs
6×9 in, 15×23 cm
110 Pages
- Publish Date Jul 14, 2012
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About the Creator
Takeia Murray
Salisbury, Md
Pray you take my life as an eye opener......
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Men's Sports
Women's Sports
Men's Sports
Women's Sports
Dec. 1, 2006
PORTLAND, Ore. - Former University of Portland tennis star Roman Borvanov, who graduated from The Bluff in 2005, has seen a great deal of success on the professional tennis circuit this year, winning three titles and advancing to at least the quarterfinals in six other tournaments. His world ATP ranking is currently 400, up more than 500 spots from his 902 ranking on Januray 2, 2006.
"Roman is living a dream," head men's tennis coach Aaron Gross said. "He has gone from being an overlooked junior player in his home country of Moldova, to being a solid college player for UP, to being among the best men tennis players in the world. He is among the top 50 ranked American players in the world and will finish the year around 400 on the ATP computer."
Borvanov's most recent tournament victory came three weeks ago in Queretaro, Mexico, where he defeated Brazil's Rodrigo Grilli in straight sets to win the Mexico F20 Futures. He also won the Mexico F2 Futures in Mexico City and the Mexico F7 in Guadalajara. Last weekend, he advanced to the quarterfinals of the Puebla Challenger.
"This was my first full year on the circuit and I am pretty happy with my achievements," Borvanov said. "I started the year at 900 ATP and finishing it 400 ATP. I played 26 pro tournaments and 21 times I was playing in the main draw. I also played 2 money tournaments in Oregon and won both of them."
Borvanov also competed in the Davis Cup for his native country of Moldova, going 3-1 overall in singles play to help Moldova to victories over Andorra and Armenia before falling to Monaco and Bosnia-Herzegovina.
"Playing Davis Cup was a little bit similar to college team tennis but with the difference that there was much more pressure because I was representing the whole country," Borvanov said.
Even with his tremendous successes this year, Borvanov is aiming higher. He plans on including many more challenger tourmanents into his schedule in 2007 and has a goal of playing in the qualifiers for some of the ATP tour events as well as for the Grand Slam tournaments.
"When Roman first started out we were just hoping he would be able to get a world ranking," Gross said. "Now we are looking at the real possibility of him being able to compete in a Wimbledon or US Open type of event."
Borvanov also acts as in inspiration for Portland's current tennis players, proving that dedication and hard work can pay off at the next level.
"He is a motivation to all of our guys," Gross said. "They all see that the secret to his success has been a toughness and work ethic that is achievable by anyone if you want it bad enough. Roman is one of the few around that wants it that bad. Our guys see that and it gives them hope that they could have a chance to have success after college.
"He was invaluable to our program when he actually played here and continues to touch the program even when he is gone," Gross continued. "Whenever he wins an event the first thing he does is put on his UP Tennis shirt for the award ceremony. He means a lot to us."
© Copyright 2017 West Coast Conference. All Rights Reserved.


text:
What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you're getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you'd like help immediately, feel free to search for a similar question, or submit your question or concern.
Is it possible to use conditional logic to fill configurable list from another configurable list?Asked by leeanndumas on September 15, 2016 at 09:58 AM
I am using multiple configurable lists for a counting and claiming form.
I would like for the user to be able to enter participant information on the attendance list and have that same information be automatically entered on other configurable lists on the form.
In the same vein, I am trying to pass data from one matrix to the totals matrix at the bottom of the form, but it is not working.
JotForm Support
Unfortunately, none of those are possible. All framed widgets like the configurable list widget can't be auto-filled through condition or URL parameter due to its nature. These widgets are loaded inside an iframe container, it is considered to be a separate HTML document. So the data from within one iframe can't be passed to the fields inside another iframe element. The frame serves as the barrier between them and I think it's impossible to connect its data because that's just how iframe works by its nature.


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Sauteed Leeks and Carrots
Recipe by Dancer
From The Vegetarian 5-Ingredient Gourmet, by Nava Atlas. Leeks and carrots both have a natural sweetness that mingles nicely. This is a mild and pleasant side dish, good with pasta, potatoes, and soy dishes. We loved this dish.
Top Review by SuzTheQ
Wonderful side dish! I love carrots, and love this new way to prepare them. I didn't use the nutmeg (because I forgot) but will next time. Also, I added a sprinkle of garlic powder and small amount of agave at the end for a little sweetness. A definite keeper- thanks Dancer!
See Discussion:3 Reviews
Ingredients Nutrition
- 1 tablespoon light olive oil
- 1⁄4 cup dry white wine
- 3 medium leeks, white and palest green parts only, chopped and very well rinsed
- 4 large carrots, peeled and sliced
- 1 pinch nutmeg (optional)
- salt & freshly ground black pepper
Directions See How It's Made
- Heat the oil and wine in a wide skillet.
- Add the leeks and carrots, cover, and cook over medium-low heat, for about 8 to 10 minutes, or until tender-crisp.
- Uncover and sauté, stirring frequently, until the leeks and carrots begin to turn golden.
- Stir in the nutmeg, if desired, season with salt and pepper, and serve.


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I'm not saying it was the best home wedding ever. But I'm not saying it wasn't.
This is my salute to the Wedding Bosses. Our friends and guests pitched in mightily. They didn't just attend the wedding, they made it special. And they did it in the rain.
Don't miss "Cake Bosses," the little video at the very end.
Jesse was Chief Umbrella Boss for the march down the aisle.
There was a lot of work to do.
It's photogenic but a bit run down in the paint and landscape department. The Boss of All Wedding Bosses insisted we do some serious spiffing.
Spencer is Scaffold Boss. We named our lawnmower, "The Spencer," in his honor.
David is Paint Boss, Glazing Boss, and Look After His Dad Boss.
Todd and Emily are Yard Bosses. They recruited a team to rescue our exhausted front yard. It was like a barn raising. They joked and sang amusing songs. Now we have Emily's Garden and Todd's Garden. We are in the process of naming our trees after them: The Ben, The Mary Lou, The Wil.
They are all Bush Bosses. You may know that a cubic foot of soil weighs about 100 pounds. The bosses moved tons of our beloved clay.
The Groom is Tiller Boss AND Pressure Wash Boss.
They got it looking real good. Thanks to Paint Picker Boss, Helen Crawford.
Of course every front yard wedding needs a broken water pipe in the front yard. Plumbing Boss: M. Cary and Daughters to the rescue with same day service.
Friday's Rehearsal Bosses at scene of bonding.
Wedding day was a whirlwind of loving friends who wanted to help.
Candle Bosses.
Table Bosses.
Nail Boss.
Makeup Boss, Kristina Vancea.
Krista, Hair Boss.
Did I mention the rain? Jesse, Umbrella Boss AND Turf Boss, saved the day.
Quincy and John: father-son Tub Boss Team.
Abby Smith: Picture Boss
Abby Smith: Picture Boss AND one of many Good Cheer Bosses.
Cake Bosses. We had 8 home made wedding cakes.
(Missing: Next Morning Breakfast Bosses: Syd, Debbie, and Debbie.)
I'm not saying it was the best home wedding ever. But I'm not saying it wasn't.
Amazing Instagram Feeds for Sketching
12 minutes ago


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I asked this question a bit ago but really didn't get responses. I'm a guy and I really like fashion. One of the things I typically wear is girls super skinny jeans. I wear this since I like figure fitting clothes. With those jeans, I typically wear vans and nikes but something I've always liked the look of and wanted to try are riding boots and combat boots but I never knew if I really should. I'll point out now that I am NOT gay at all. I just happen to like certain fashionable things that a guy usually doesn't. I really tend to dress for myself and not for attention. I bought two pairs of riding boots and one pair of combat boots and have pictures of me wearing them below. Tell me what you think and if you have any opinions on what else I could wear with them that goes well, let me know! I think I look really good but that's my opinion.
Most Helpful Girl
Skinny jeans alone - girl's skinny jeans even more - make me think a guy is gay. Add to that boots that look effeminate and there's no suspicion in my mind he is ad least 70% gay...
I don't think you should ask people this - you wear what you want to wear.
The thing that puzzels me in those pics is that those pants look like leggings... And it just looks odd to me. Honestly.
All together.00|00|0


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Gold-glitter-snoball-fight y'all! *throws one*
Crossroads Director Harvey had to keep a set somewhat clean from gold-glitter in order to shoot this. Concept by RH Advertising. Post house Envy worked closely with Harvey in the studio, monitoring the blacked out set and gold glitter snowballs.
"It was a very messy shoot in that glitter covered everyone and everything," stated Harvey. "While technically challenging from various angles, we were able to come up with a number of techniques that simplified and sped up the process."
Client: Swatch Spot Title: Seasons Air Date: December 2009 Agency: RH Advertising CD: Franco Reda Client Director: Matthew Howells Client Support: Paula Chapman Weston Prod Company: Crossroads Director: Harvey Producer: Francesca Barnes EP: Carly Stone Telecine: Rushes Colorist: Simone Grattarola Post Production: Envy, London Lead VFX: Marcus Dryden Nuke: Olivia O'Neil VFX Support/Particle Generation: James Knopp 3D: Howard Bell Producer: Rachel Stones Music: Point Blank, London Composer: Eddie Yanez


text:
What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you're getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you'd like help immediately, feel free to search for a similar question, or submit your question or concern.
Contact form not sending emailsAsked by acjdesigns on August 20, 2015 at 03:06 AM
Hi I have setup 2 forms on your website and embedded them into my customers website however, they aren't sending the notification emails over to their email address?
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I have checked the mail log and see that emails are not being sent to your email *****@wine-factory.co.uk (email used in your form). Your email was on the bounce list because of the following reasons:Reason(s) : smtp; 554 4.4.7 Message expired: unable to deliver in 840 minutes.<421 4.4.0 Unable to lookup DNS for wine-factory.co.uk>
I have removed your email from the bounce but please check your DNS settings in your email also.
Do let us know if you need further assistance.
Thank you. Very strange as the email and website is fully functional.
Kind regards,
ACJ Designs
Web: www.acjdesigns.co.uk
Email: firstname.lastname@example.com
Tel: 01245 409656
JotForm Support
You are welcome. Is it working fine now?
It seems to be yes :). Is there a chance the test emails can be removed as I know it has monthly restrictions
Kind regards,
ACJ Designs
Web: www.acjdesigns.co.uk
Email: firstname.lastname@example.com
Tel: 01245 409656
There is not monthly limit on the emails you can send using a form or during testing of the email, the limit only applies to submissions submitted when using the form.
I have reduced you submission limit by 4 from 12 to 8


text:
Create a Video
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8 los freelancers están ofertando un promedio de ₹3727 para este trabajo.
My Company Video: https://youtu.be/u6KkPdo5y8Y Here By Some Sample Text Animations: https://youtu.be/NQx0aIUwUaM https://youtu.be/WgipxeuC6H4 https://youtu.be/7fuMUWYjHs4 https://youtu.be/e7fQp6i0 Más
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You can see my portfolio from know my working skill. For more info about my work we can chatting.


text: Body Hardener MangaManga | AnimeAnime Characteristics Name Body Hardener Type Nature User GaronOrco An unnamed set of rings (or armbands) that hardens one's body. Owned by Garon and Orco. Body Hardener as armbandsAdd a photo to this gallery Retrieved from "http://mar.wikia.com/wiki/Body_Hardener?oldid=7361" Ad blocker interference detected! Wikia is a free-to-use site that makes money from advertising. We have a modified experience for viewers using ad blockers Wikia is not accessible if you've made further modifications. Remove the custom ad blocker rule(s) and the page will load as expected. Categories: ÄRM Nature ARMs Add category Cancel Save


text:
Twitchy Tak (originally called "Dark Tak" or "Nega Tak") is the destructive, ferocious alter ego Tak develops in Tak-Zac Bug Gladiator. When Tak turns into Twitchy Tak, his skin turns dark black, grows claws and fangs, and glowing green eyes.
Twitchy Tak's melee attacks are twice stronger than normal Tak's and he is completly invincable.


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i have 2 graphic designers that are constantly working on the same files. we have a airport extreme and a 2tb drive connected as a network storage for them only.
the problem im having is that i hate macs and that these guys need the files to tell them if the other person is already working on that file so they don't spends hours working on something that the other one already had open. ive fooled around with the file locking features n all but it just doesnt seem to be working.
10 Replies
Apr 10, 2012 at 1:30 UTC
Sounds like you need a server. If you're more comfortable with Windows servers, consider a solution like Group Logic's Extreme-Z IP:
I hope that helps!
Apr 10, 2012 at 2:13 UTC
Brand Representative for Contronex - G Data Distributor
You could try just having them move the file to their computer until they are done then move it back. Or have a folder on the NAS called working where they can move it before they start working, then move it back when they are done. When the other person looked for it, they wouldn't see it and would know. Otherwise you would need a file check-in/out software it sounds like.
Apr 10, 2012 at 2:32 UTC
i just don't understand why mac wouldn't include an automatic read only attribute when the file is in use.
user friendly my butt haha
thanks for the ideas. kefob, i am going with your simple solution as a temporary fix until i can find something more suitable and automatic.
Apr 10, 2012 at 2:44 UTC
Brand Representative for Contronex - G Data Distributor
I was looking for a better solution, but there are not as many for Macs. I know that if you have a Mac server it will notice if a file on it is being accessed and will do a read-only designation, but you didn't mention having a Mac server.
The Macs may not be setup to write attributes to a network share like that. Usually it is something the NAS device or file server would do itself. Esp since Macs can save versions of files.
Apr 10, 2012 at 2:45 UTC
If there's only 2 users, can't one say to the other, "hey I'm using file 'foobar'"?
Apr 10, 2012 at 3:36 UTC
macfixer believe me that should have been the only fix from the beginning lol but it won't play out like that
Apr 10, 2012 at 3:57 UTC
What if you were to use a digital asset manager like Extensis Portfolio? A little overkill, but…
Apr 11, 2012 at 1:36 UTC
1st Post
Hey mate,
Had the same issue here with the Adobe suite, which I'm guessing is the same for you. Make sure that the .idlk files are being created when an .indd is opened.
idlk are the InDesign Lock files which prevent another user from opening the same file.
Also, make sure a / is not present in the idlk file when it is created.
If it's a filename like /~fhghlkg.idlk then you need to update your Adobe suite, not upgrade, update. Go to the help menu in InDesign and go to Updates. This was a bug in the Adobe suite. The / is a deliminater under certain file systems and means it can't find the idlk file on some operating systems.. which means you can open the file.
One you see a file like ~dfwelwg.idlk created when opening an indd, you shouldn't be able to open the same file on another users computer.
Apr 11, 2012 at 9:07 UTC
As was pointed out by Nigel the problem is most likely with the application software, not the OS. It's up to the application software to let the user know if the document being edited is read/write or read only (based on how the file was opened and the return code from the OS).
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


text:
ON the blocks under the Williamsburg Bridge in Brooklyn, which do not have a snappy moniker like ''Dumbo'' for those under the Manhattan Bridge, the night crawlers are seeking out Bembe.
A Brazilian-influenced dance club, Bembe is designed with worn honey-hued hardwood and richly colored fabrics that evoke places where winds smell of coconut, thousands of miles from the steel, bricks and concrete outside. Since the club opened a little over a year ago, it has built a following -- people from every part of New York who come by the cabful to dance the salsa and do the samba.
Micaela Nevaez, a model in her 20's with wavy black hair down to her hips, broke away from the salsa long enough to say why she comes to Bembe. The D.J.'s play the best music, she said. Gesturing to a dozen friends at a banquette in front of the D.J., she added, ''It makes you feel like you're at your own house.''
The heavy rosewood entrance door, made of a wine barrel salvaged from a kosher winery in New Jersey, is one of the many examples of found materials used to turn this 100-year-old former warehouse for shoes into a place to wear out the bottoms of them. This evening, two couples moved in a fluid, undulating salsa on the knotted wooden floorboards from barns upstate. Friends placed mojitos and caipirinhas on tables cut from railroad ties.
Downstairs, Corey Tatarczuk, 28, a petite artist who lives in Park Slope, showed off a brisk and articulated samba before a circle of four girlfriends. An outer ring of tall men looked on. Her friends picked the dance up haltingly with a few giggles, eventually growing stronger with the beat.Continue reading the main story
This was Ms. Tatarczuk's first visit to Bembe, and she said she was pleased to find a place to samba, adding: ''It really changes my opinion of Williamsburg. I felt like it was getting old.''
By 1:30 a.m., the D.J.'s took on a reggae riff and Kelvyn Perez gyrated his hips, sandwiched by two women. He finished off his beer and took a white-handled knife offered by the bartender. Mr. Perez wrapped his arms around the knife, explaining, ''I have to cut the cake; I'm not going to hurt anyone.''
He bounced through the crowd, stopping over a large birthday cake -- his -- with white frosting and blue letters that said, ''Life Is Too Short. Enjoy It!'' An hour later, all that was left was ''Life.''
Outside, as a vendor sold empanadas, a woman was trying to get back to Manhattan, asking the bouncer for a car service number. Dialing, she intoned out loud her Manhattan area code: 2-1-2. The bouncer corrected her: ''You're in 718now.''
81 South Sixth Street (Berry Street), Williamsburg, Brooklyn; (718) 387-5389.
GETTING IN -- Just walk in.
D.J. PICKS -- ''Cumbia Sobre el Rio'' by Celso Piña, ''Prototype'' by OutKast, ''De Camino a La Vereda'' by Buena Vista Social Club.
DRESS CODE -- Sexy tank tops and flowing blouses for the women; embroidered shirts and T-shirts for the men.
SIGHTINGS -- No one famous.
SIGNATURE DRINK -- Capeta (fresh coconut meat, coconut rum, the Brazilian herb guaraná, sweetened condensed milk and coconut milk), $5.Continue reading the main story


text:
"Excellent care in A&E"
About: Poole General Hospital / Accident and emergency Poole General Hospital Accident and emergency Poole BH15 2JB
Posted by Thankful Family (as ),
Today my daughter was admitted via A&E for suspected pulmonary embolus. We were so pleased with swift treatment, cleanliness, information, feedback including test results, & forward treatment.
We thank everyone from reception, porter, triage, Dr, nurses & kind gentleman who provided a cup of tea. ! We are lucky to live in this area which provides such wonderful service, upholds it's targets yet maintains holistic care AND kindness.
Please ensure our gratitude reaches them especially @ a time when many units in other hospitals receive criticism.
A&E must be particularly strained in view of the acute nature they work under BUT no-one seemed to show stress & all was calm.
Regards & thankyou.
Response from Poole General Hospital 3 years ago
Thank you for taking the time to provide us with feedback following your recent visit to our emergency department with your daughter. We are very pleased to note your comments relating to the care, kindness and treatment provided to your daughter by our staff. We will ensure that your comments are passed to the team within our emergency department – thank you once again. Kind regards Maria Bennett Patient Experience Facilitator
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We the board members of the Nat Gold Players would like to publicly thank the Plaza Hotel. The Nat Gold Players were in the middle of rehearsal for "Agnes of God" to be produced in mid-November, and our new youth group, Clearly Confused Productions, was in rehearsal for its first play to be produced in December when we lost access to our regular rehearsal space. The owners and managers of the Plaza Hotel stepped up and offered rehearsal space for both of the productions at no cost to our groups, and they have also offered space for the production of Agnes of God.
Thumbs up! SCHOLARSHIP FUNDS. Refinancing a bank loan to buy additional property can be a good deal, but in the case of the Highlands University Foundation, it was even better because it freed up more than $120,000 a year in student scholarship money. The foundation bought 1.25 acres of prime real estate next to its Rio Rancho campus, and in doing so, struck a favorable financing deal with the Bank of Las Vegas.
It was 1976, and Joseph M. Montoya was seeking his third term to the U.S. Senate. The quintessential politician, Montoya was becoming a powerful senator, and had served on the select Senate Watergate Committee which investigated the Nixon White House. (President Richard M. Nixon resigned from office Aug. 9, 1974, the only president in history to do so.)
I was amused by the list of all of the consequences that will, or might occur, as a result of the proposed low-flight training by the Air Force in the area.
Local activists were able to hustle 150 people to protest the Air Force plans for said training with such excuses that it will hurt our water supply, contaminate our land with spilled fuel and scare animals. Being stationed at a fighter base in a war zone during the Korean War, I'd rather have friendly low-flying aircraft over my head than enemy aircraft.
Several citizens have expressed their concern over funding for the ambulance service in Mora County. From experience I can tell you that oftentimes we concentrate on the wrong priorities when we apply for funding from the Legislature.
We ask for money for new buildings, and that's OK because we all like nice things. However, the buildings are going to be there long after we are dead and buried. We need to start paying more attention to the health and safety of our citizens. I know that the ambulance staff do their best, but we need to start looking at alternatives.
I agree with Robert Jeffress that religion should not be marginalized. Christians should depend and promote Christ's kingdom on earth. We have an obligation to love our neighbor. We cannot have one conscience in our private life and another in public.
The enemy of the poor is the enemy of God. We are not to make life hard for aliens.
Copyright © 2017
The Las Vegas Optic is your source for local news, sports, events, and information in San Miguel County and Las Vegas, NM, and the surrounding area.


text:
DailyTech went to Google
Fast Flip and took it for a spin. Basically, the site works as
a preview engine, publishing articles from several sources as PNG
format images, which you can scroll through via arrows on the left
and right of the frame. Like Google
News, both top stories and news by categories are offered.
the service indeed allows for fast reading, it has several major
annoyances. The first is that you have to click a link to get
the full story -- the Fast Flip only gives you a page-sized
screenshot of the story (how about a scroll option, Google?).
Second, you get less stories than Google News, both in terms of
number of articles, and sources (only select partners show up).
Finally, the switch lags just enough that it doesn't really feel
"fast" -- something that PC World's David Coursey also
The upsides are that if you just want to scan bits
of the story, you can often get the gist of the story from the
excerpt, in which case the service could, in theory, speed up your
read times. Another upside is that the ads are relatively
unobtrusive, with no ad-words present on the articles we
Google hopes to gain both advertising money and
greater control over advertising content with the new service.
For that reason they're giving their
partners -- TechCrunch, The New York Times, Fast Company and
Business Week (and others -- 39 in total, with DailyTech not
currently being a member) -- a share of the ad revenue from Fast Flip
ad clicks. In this respect, Google is placing itself as the
middleman for online news advertising, even more so than with Google
News. This is a deal with the devil, in a sense, for
publications as they may gain revenue, but they'll lose control of
advertising on at least part of their traffic.
Some aren't
very hot on Google Fast Flip. The aforementioned Mr. Coursey
comments, "Google's new Fast Flip news-er interface is a bit of
a puzzle. It doesn't seem very fast and also doesn't flip pages, but
slides them across the screen...Fast Flip has, for now, limited
itself to a fairly narrow set of partner publications. This will suck
if Fast Flip becomes the standard Google newsreader and the
publications you like aren't included."
At DailyTech
we're a bit more reserved about the new service. While it's no
Google News, it does have its strengths. And it seems unlikely
that the Google would kill Google News and replace it with Fast
Flip. Google Fast Flip is a fun toy to try out and see if it
helps your news reading -- try it yourself and draw your own


text:
Alan Rosen (Co-chair), John Allan (Co-chair), Tim Lambert, Tim Chen, Andrew McLachlan, Sam Stott, Kerin O'Halloran, Rod McKay, Timothy W, Aoife Davis, Michael Tam, Judith Mackson
Titia Sprague, David Kitching, John Feneley (NSW Mental Health Commissioner)
Danielle Keogh (Mental Health Commission of NSW)
Other attendees
Carlton Quartly (Mental Health Commission of NSW)
Scott Thompson (Mental Health Commission of NSW)
Catherine Montigny
1. Acknowledgements
Alan Rosen provided an Acknowledgement of Country and an Acknowledgement of People with Lived Experience of Mental Illness.
2. Welcome and apologies
Alan Rosen welcomed members. The apologies of John Feneley, Titia Sprague and David Kitching were accepted.
Members of the group introduced themselves and provided a brief background of their experience and interest in the area of pharmacotherapy.
3. Confirmation of agenda and declaration of interests
The Agenda was confirmed. Rod McKay declared that he is a member of the Expert Advisory Group for NSW Therapeutic Advisory Group's Mental Health QUM National Indicator Project.
No other declarations were made.
4. Terms of Reference, membership and roles
The following changes were requested to the terms of reference:
- the word 'patient' be changed to 'consumer' at point 2
- that 'carers' be included at point 4
- a 6th point be added that refers to, understanding variability in respect to medicines due to factors such as geographic ancestry, cultural diversity, interactions with social conditions and implications for training.
5. Commissioner update: Mental Health Commission of NSW
In the Commissioner's absence, Alan Rosen provided the group with a brief overview of the purpose of the Commission.
6. Commissioner update: Draft Strategic Plan for Mental Health in NSW
Carlton Quartly updated the group on the process that has been undertaken for development of the draft Strategic Plan for Mental Health in NSW.
7. Key issues and opportunities
There was discussion about the key issues and opportunities in the area of pharmacotherapy in Mental Health. Key themes included:
- That there is a need to humanise interactions through mental health care and this includes pharmacotherapy and pharmacy.
- Pharmacy needs to be grounded in principles of trauma informed care and recovery orientated practice.
- Consumer and carers require access to targeted and accessible information on medication.
- Training in mental health and the lack of pharmacists that specialise in mental health was noted as an issue.
- The need to identify issues and gaps in the area, but also to analyse why these gaps and issues have arisen. This analysis can then assist to determine solutions.
- Consumers and carers need to be educated on the questions to ask clinicians.
- There is a need for clinicians to value the lived experience of consumers and carers. An 'equal footing' is required in order for consumers and carers to feel confident when advocating for themselves.
- The potential for pharmacists to be part of the treatment team, and / or as part of the Partners in Recovery team.
- That medical students are no longer trained in pharmacotherapy.
- That for some consumers, in some settings and uses, opioid medication is viewed as chemical restraint.
- Any solution needs to be both consumer / carer focused and professional focused. Any divide here is to be avoided.
- The need for an evidence base.
- Polypharmacy can become a cycle of treating one condition, experiencing side effects, and then treating the side effects.
- Issues with adherence to medication.
- Clinicians, as regular practice, must routinely ask consumers about side effects.
- The concept of a 'key' mental health pharmacist in an area/LHD be nominated. Consumers could then have a trained contact for prescription filling and advice.
- Treatment plans should be transparent. This would then allow the pharmacist to be aware of the intended outcome the prescriber is hoping to achieve.
- The need for transitions of care to be better informed. Correspondence is currently infrequent and not detailed enough.
- Investment in ehealth is needed. Also better ways to share and gather data.
- The need to better understand non adherence to practice. There is plenty of evidence based guidelines but they fail to be properly implemented by clinicians.
- Medication is often seen as the simple solution by carers and families.
- GPs are not specialists and we need to consider how we support GPs to adopt better prescribing practice.
8. Actions
ACTION 2014.01: The Commission will develop a position paper which outlines the current issues and opportunities in NSW in relation to pharmacotherapy and contextualises this against best practice nationally and internationally. The Group will act as a reference point for the development of the position paper.
Next meeting
In accordance with the Terms of Reference the next meeting will take place in six months time. Out of session the group will continue to be consulted by the Commission on relevant matters.


text:
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Understanding How Analytics and Linear Review Can Coexist
The vast majority of legal teams are not implementing analytical tools in a way that can truly make a difference to alleviating their overall e-discovery burdens and growing expenses.
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Intellectual Ventures must have felt pretty confident when it launched its patent enforcement campaign against the nation's largest banks in 2013.
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A federal jury in San Jose returned a guilty verdict against a husband and wife team behind an operation, which bottled the fakes in an unsanitary San Diego warehouse and distributed them to wholesalers across the United States and Canada.
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Samsung Electronics Co. will not get an en banc do-over against Apple Inc.
Huawei Notches Win Over Samsung in Patent Skirmish
Huawei Technologies Co. has won an early skirmish in its smartphone patent war with Samsung Electronics Co.
Regulators Should Take the Driver's Seat of Autonomous Vehicles
As autonomous vehicles begin to see acceptance, regulators face questions of cybersecurity, ownership and infrastructure.
Dropbox Fends Off Trademark Threat
A federal judge in San Francisco has handed a victory to data storage company Dropbox Inc. and its lawyers at Wilson Sonsini Goodrich & Rosati in a fight with a Texas company that claimed it had trademark rights to the Dropbox name.
Sirius XM Radio Agrees to Settle Copyright Case With 60s Rock Band The Turtles
Sirius XM Radio Inc. has agreed to settle a closely watched copyright infringement case brought by two members of the 1960s band The Turtles that was set to go to trial on Tuesday in California.
Steady Through Storms at Abercrombie & Fitch
Between protecting Abercrombie's IP to reinvigorating the company's corporate governance policies, Bostrom has been busy at work leading the retail chain's legal department of more than 25 people.
Case Study: How Molson Coors' Lawyers Pulled Off a $12B M&A Deal Under the Gun
In early October, beer brewing giant Molson Coors Brewing Co. announced that it had completed a $12 billion acquisition of Chicago-based MillerCoors LLC, making Molson Coors the third-largest brewer in the world.


text:
On July 5, 2014, Gov. Andrew Cuomo signed a limited medical marijuana bill into law, which included several revisions he insisted upon. After 18 years of work, led by tireless Assemblyman Richard Gottfried, New York is now the 23rd state with an effective medical marijuana law.
The bill gives the state and Department of Health 18 months to enact regulations and install a patient and business infrastructure to allow for the cultivation and sale of medical marijuana to qualifying patients.
Registered organizations or "RO's" are companies, either for or not-for-profit organizations that the state will license to produce and dispense medical marijuana.
The state will not license more than 5 RO's, which can each operate 4 dispensaries (for a total of 20 dispensaries). The state can add more RO's if they determine a need for more.
So in order to do anything within the state, you'll have to first be licensed to Grow/Cultivate Medical Marijuana Legally in New York in order for you to be able to Open A Medical Marijuana Dispensary in New York.
To get ahead and be prepared for when the state will opens its program for licensing marijuana businesses, you should:


text:
Call of Duty: Black Ops II
You're browsing the GameFAQs Message Boards as a guest. Sign Up for free (or Log In if you already have an account) to be able to post messages, change how messages are displayed, and view media in posts.
- Boards
- Call of Duty: Black Ops II
- This whole ghost thing is out of hand, I might not get BO2
My K/D is around 2.0 while doing objectives heavily when I play those modes. But this new nerf to ghost doesn't effect me because as I said I am always moving from place to place and very strategic kind of blows away the point of me doing this ever if I can never hide from radar again... seeing that the new unlock level is 55! WHAT, so basically it is either prestige or completely revamp my entire loadouts I use every CoD ... so I don't know I am very furious why can't they just have it at an appropriate level and have it so you have to keep moving in order to not show up.
Seriously I plan ahead so I don't just run in and die, and now that is pretty much pointless seeing that now every can see everyone why not just have radar always on :/, I am sorry I am pretty upset.
Does anyone know if I can use tokens on perks to keep them through prestiges? I feel like now it is either have my 2.0 or higher (aiming for about 2.25-2.50 but seems impossible now) or to actually prestige...
Sometimes you get the coal mine, and sometimes you get the shaft.
Kovalchuk_ 4 years ago#2
because of one perk you won't buy the game?
chickenlard 4 years ago#3
SackBoi posted...
Seriously I use Ghost in EVERYTHING, not because I camp I never camp but I move very slickly and always and never run around a corner, I always creep.
Don't let the door hit you in the face. Bye
TrixtinFamer 4 years ago#4
I hear you dude it's clear trey wants nothing but 24/7 run and gun. I can get behind playing for the objective but there's more ways to do it than screaming like a loon diving head first with your trigger taped down.
Just keep up with these topics and trey will make the changes come patch time. Be so nice to finally have a game rebalanced on MY whim and fancy for once.
RepublicanThug 4 years ago#5
So if you hide in a corner to goto the bathroom or answer the door a red dot automatically pops up?
That seems kinda bogus
4 more years? Sigh.....
Use your token on it when you Prestige.
Loons do not scream... They call.
It is one perk that should be sort of end game content; Make it to 55 and then don't prestige. Now you have ghost and can enjoy your ghostesque tendencies.
Really,m it is a new game, just accept it for what it is.
The word multiplayer shouldn't be underlined in red with how influential the Video Game Industry is.
Gamertag: Surfertie
RepublicanThug posted...
So if you hide in a corner to goto the bathroom or answer the door a red dot automatically pops up?
If this is sarcasm you need to get help, this had nothing to do with my topic I said I am 100% okay with the changes and that I actually like them but not the fact it is a level 55 perk.
Sometimes you get the coal mine, and sometimes you get the shaft.
If you need ghost to get a higher K/D, you're not very good. The fact that not having ghost will completely cripple you is hilarious. This is why I love the changes Treyarch has made to ghost.
PSN: WingNut125
RepublicanThug 4 years ago#10
SackBoi posted...
RepublicanThug posted...So if you hide in a corner to goto the bathroom or answer the door a red dot automatically pops up?
It wasn't sarcasm it was a question. Thought that was obvious.
4 more years? Sigh.....
- Boards
- Call of Duty: Black Ops II
- This whole ghost thing is out of hand, I might not get BO2
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|"Gunnar Wagenknecht (JIRA)" <j...@apache.org>
|[jira] Updated: (LUCENE-1344) Make the Lucene jar an OSGi bundle
|Fri, 19 Sep 2008 08:30:44 GMT
[ https://issues.apache.org/jira/browse/LUCENE-1344?page=com.atlassian.jira.plugin.system.issuetabpanels:all-tabpanel ] Gunnar Wagenknecht updated LUCENE-1344: --------------------------------------- Attachment: LUCENE-1344.patch Michael, the attached patch adds the bundle license header for the source bundles. I also started to add descriptors for two more contrib jars (queries and xml parser). It gets a bit messy now because of split-packages, i.e. the queries jar exports the same package (org.apache.lucene.search) as Lucene core. This requires to add split packages headers to the manifests. Additional, the "-" (dash) is invalid so I had to override the default bundle symbolic name for the xml-query-parser jar. I use the package name. The OSGi JARs don't need to be uploaded somewhere. It's enough to just put them on the FTP mirrors next to the regular distribution. Nicholas, we generate different JARs for OSGi because I don't like to mix and match things. OSGi should be separated from Maven. They are different. For example, in OSGi it's a good practice to name the JAR like the bundle symbolic name and to include the version. Otherwise you'll run into problems because bundle repositories are usually not hierarchically organized like Maven repos. Michael, do we need a "-final" or "-dev" indicator on the JAR names and bundle versions? > Make the Lucene jar an OSGi bundle > ---------------------------------- > > Key: LUCENE-1344 > URL: https://issues.apache.org/jira/browse/LUCENE-1344 > Project: Lucene - Java > Issue Type: Improvement > Components: Build > Reporter: Nicolas Lalevée > Assignee: Michael McCandless > Attachments: LUCENE-1344-r679133.patch, LUCENE-1344-r690675.patch, LUCENE-1344-r690691.patch, LUCENE-1344-r696747.patch, LUCENE-1344.patch, LUCENE-1344.patch, LUCENE-1344.patch, LUCENE-1344.patch, LUCENE-1344.patch, MANIFEST.MF.diff > > > In order to use Lucene in an OSGi environment, some additional headers are needed in the manifest of the jar. As Lucene has no dependency, it is pretty straight forward and it ill be easy to maintain I think. -- This message is automatically generated by JIRA. - You can reply to this email to add a comment to the issue online. --------------------------------------------------------------------- To unsubscribe, e-mail: email@example.com For additional commands, e-mail: email@example.com
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Sunshine State Conference Release
SAINT LEO, Fla. – Saint Leo women's swimming freshman Annie Lindstrom was named the Sunshine State Conference Freshman of the Year following an impressive rookie season for the Lions.
Following her stellar season for the Lions, Lindstrom became the second Saint Leo swimmer to earn Freshman of the Year honors. Nicole Weber was named Freshman of the Year in 2014.
Individually, Lindstrom qualified for the NCAA Division II championships in the 50 Free, 100 Fly, and 100 Free during the 2016-17 season and finished top four in all three at the SSC Championship. At nationals, she finished 16th in the 50 Free, 23rd in the 100 Free, and 27th in the 100 Fly. In relays, the Kristianstad, Sweden product was part of four Saint Leo school records and the Lions' 200 Medley Relay that finished Top-8 at the national championship meet.
At the SSC Championships, Lindstrom finished fourth in the 50 Free with a time of 23.50 and added third-place finish in the 200 Medley Relay. She also finished third in the 100 Fly by swimming 55.53 and added another third place mark with a 3:48.56 time in the 400 Medley Relay. She also added a four place finish in the 100 Free, and in her highest finish at the SSC Meet, the freshman was part of the second-place 400 Free Relay squad that swam a time of 3:26.68.
For the latest news, updates, and information on the Saint Leo swim team, visit SaintLeoLions.com. Fans can also stay up-to-date on the latest Lions news by following Saint Leo Athletics on Facebook, Twitter, Instagram, and YouTube.


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