text:
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How to Use: Apply to freshly shaved face and neck. rub in circular motions untill fully absorbed
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subset: commoncrawl


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DIY Lip Balm
So last week I had a commerce assignment to create a mothers day product to sell at school. We were put into groups and given a budget of $10 to buy the… Read More
How To Get Stuff Done On The Weekend
It's Friday afternoon, you are all pumped for the weekend and all the stuff you can get done in the two whole days you have free from school! You get home… Read More
DIY Personalised Lunch Box
If you are like me, you probably don't have enough money to buy your lunch at school everyday. So you have to pack your own. I used to just take my food… Read More
Pretty School Books
Hello lovely people! I have finished my annual book covering project! Each year I cover my books differently before the beginning of a new year because it is one of the few… Read More
What's In my Pencil Case?
A while ago it was requested that I do a 'what's in my pencil case' post, and here it is! I figured that since I have just bought new stationery and school… Read More
Cake Mix Cookie Bars
Today I am going to share with you my FAVOURITE snack that I love to make! I found this recipe a while ago on pinterest and it looked super delicious so I… Read More
Friendship Gift
Recently I was thinking about how my friends and I sometimes have some tough days when we are pretty down in the dumps, and how much happiness it would bring if you… Read More


text:
Ste. Genevieve Garden Walk, 2017
In Ste. Genevieve -- tour private and public gardens
Plant Sale Sat. 9:00 a.m.; Sun. 10:00 a.m.
Sponsored by Ste. Genevieve Master Gardeners and University of Missouri Extension
$7 Individual; $6/Individual in groups of 5 or more
Children 12 and under free
Sunday, May 21, 2017
Contact:Ste. Genevieve Welcome Center
Phone: 1-800-373-7007
Share this Event:Email to a Friend
Save this Event:iCalendar vCalendar
Google Calendar
Yahoo! Calendar
Windows Live Calendar


text:
The Friends of Chichester Hospitals have generously supported CHR from
its inception in 1972. If you'd like to know more about the Friends'
work, please visit their web presence (soon to be re-vamped, so please
let us know if the link fails), click on the Friends' logo:
job got
in the way. Ken rejoined in 2003 doing the Friday TLC and
outside broadcasts. When it comes to knowledge
and interest in Folk Music, you will have to go a long
way to find a better presenter on Folk for All,
Pete Edgeler
Pete's voice can be heard at CHR on the twice-at-weekend's
Treble Top
Show and often standing in for
the occasional holidaying TLC presenter. He is a former Treasurer and
brings a lot of experience and music knowledge to CHR.
is CHR's longest-serving broadcaster. In fact some
people believe the CHR studio was built around him as it was an old
pram-store and Colin may well have been broadcasting from his pram at
St Richards in the early 70's! Colin has held many positions over the years, including Chair.
our most literate presenter, being a Scrabble
champion and crossword expert, Graham turns his
mind to all things stage and screen, presenting That's Entertainment on a Saturday
Richard Webster
An old hand who's strayed back into the fold to present Saturday's
Breakfast Show.
Rob Chalmers
Sarah has
been CHR's ward visiting coordinator and
co-presenter on Sunday evening's TLC. She's currently awaiting an opportunity to return to the air.
valued member of the OASIS team,
Alan has also been active in CHR
for over more than three decades and his
quiet approach to radio brings balance at the end of a hectic CHR day.
There are
very few popular music genres that Mike isn't
expert on - you may well find this out when you hear him getting the weekend going on a Saturday morning on CHR.
(Special) Constabulary duties are done, and when
away from the motorsports circuit, Gabriel leads the Monday TLC team.
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Egypt's Ruling Party Turns Down Membership Application from Opposition MP
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A top body at Egypt's ruling National Democratic Party (NDP) has rejected an application for membership submitted by a former opposition member of Parliament, according to the Cairo-based Al Gomhuria newspaper.
The paper said that Mohammad Fareed Hassanein, a deputy for the Tokh constituency, applied to join the NDP as a working member after he was sacked from his former party, the opposition Al Wafd.
Egypt's opposition parties are periodically torn by internal disputes that send the losers in search of new allies – Albawaba.com
© 2001 Al Bawaba (www.albawaba.com)
Top Headlines
- South Korean Rulers Blast Opposition Leader over Spy Cash Scandal
- Palestinian Opposition MP: We Need Arab Support, Not Summit
- Assassin of Tunisian opposition MP Belaid allegedly killed in police raid
- Muslim Brotherhood MPs Walk out from Egypt's Parliament Session
- Is this the end for Morsi? A breakdown of Egypt's June 30 protest


text:
▼now listening "Make You Feel My Love" by Adele ♫
I have just read a quote and then it got stuck in my head. the whole quote is "Live without pretending, love without depending, hear without defending, say without offending" (....or somewhat like that :p) the part that I love the most is "Love without depending". the fact is I dont know whether I love it or it slapped me since it got stuck in my head without any wynn coming over ;p
Love without depending, what was that? hahaha. no, seriously, I was asking what was that -_- all of a sudden I thought about what kind of love that I have, not just with him, I mean, whats the definition of love that I thought I knew. the right timing was, he forgot to reply my text for about 3 hours when those words still hangin around my clouds. I love him, right? was that an excuse for me to be mad if he didnt contact me as often as we did before? was that an excuse for me to be mad if he couldnt make it when I asked for his help? is that a love or is that a need?
if you love someone, you want to make him happy right? does this known logic make you automatically think that "if he loves me, he should do anything to make me happy. if he is my boyfriend, he is somewhat responsible for my happiness." then whats the point of loving each other if love becomes a burden in something called 'responsibility of happiness"?
I know, I am a crap because I feel that way, too. I mean, I notice how my dependance to him is. I want him to be available for me whenever we are close to each other and not separated, just like a payment for those months separated. and now............. I have a fight with my own self. my logic >< my heart. I mean, this thought makes me realize that he's not responsible for my happiness, it was my myself, from the very first start. like, I was happy before I met him, so I should be happy by myself either eventhough I am his now. but then, my heart says, I deserve his time, eh? I am his girlf, he could have his own world without me needing him physically whenever we are far, whats so wrong about asking for his presence only few months a year?
this fight dizzies me, not to be hyperbol but it does ._. should I make up my mind? should I learn to have that single person's mentality back again eventho I am taken? they said 'dont be in a relationship if you still have one person's mentality' but crap, love without defending? hahahahaha bitter truths' attack!
now listening "Set My World on Fire" by The Feeling ♫ || (do) you wanna be free but not alone (?)
or.... is it about finding someone who wants to be depended on? I'll know sooner or later :'▲
Monday, July 11, 2011
Love without depending
Posted by Medina Rachma Lea at 7:42 PM
1 comment:
I feel you mba Naraaa :') *hug* never meant to lecture, but when that happened to me, we talked it over and found a conclusion that yes, we do have our own lives, and that includes our relations with family, friends, etc. By then, we do acknowledge each necessity to mingle with them, and we do have the rights to do so.. I know it mite sound bitter, but yes, sometimes we do need to let him do his own business, his own will.ReplyDelete
Patience, and understanding.. :) *hug*
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text:
Keeping your house clean can feel like a never-ending task, much like convincing yourself you enjoy reading. Take a break with this Groupon.
Choose from Three Options
- $65 for carpet cleaning for two rooms and a hallway ($130 value)
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Click here to see available service areas.
Around the Clock Cleaning
Around the Clock Cleaning's professional crew tidies up the streets and interiors of the Raleigh-Durham metro area with commercial and residential cleaning services. When they're not busy cleaning newly finished construction sites and offices, these cleaners create spotless domiciles with carpet cleaning, power washing, and move-out cleaning services. They don't use harsh chemicals while scrubbing and sweeping—they clean only with environmentally friendly products.


text:
|"Armageddon over Dagenham through a sweet wrapper." My solution to owning a disc camera which couldn't take lens filters.
|Our cat Harley.
|The Statue of Peter Pan in Kensington Gardens.
|I live quite close to Jodrell Bank now, but I used to live in London. This was the first time I'd ever seen the dish, around 20 years ago on a train between Crew and Alderley Edge, and it blew me away. The photo doesn't do it justice.
|My lovely "woodland" garden back in London. I try not to think about what happened to it after I left.
|The barrel pond with my two Sarasa Comets, Levy and Bopp (sadly no more).
|In 2004 Cowparade came to town. There were about 160 cows so too many to put here. These are two of my favourites, Ravin' Rita
|and Mooer's Moomalade (You know when you've been Tango-ed!")
|Playing around with the effects on my phone in the Manchester Gallery. The shop.
|The stairs and lift.
|Manchester Central Library.
My favourite place after home.
|Ladybarn Park pretending to be a lake. It was very atmospheric and later I may add a tentacle or two coming out of the water.
|And you thought Cowparade was wierd! These giant pencils have been put at every school crossing.
|This pair are outside Cholton Library. And I wonder how much they cost the Council...
|This is Loomy, who I bought
last Christmas in Habitat.
He's weird and cute.
I think he might be a sloth.
|Fizzy Soap for Comic Relief
(Okay, I'll buy some more.
You can all stop chanting now.)


text:
Our CD
We currently have one CD available.
Our CD is available for NZ$15.00 plus postage. Please contact us here to arrange to purchase.
The music on this CD is a reflection of some of the finest Big Band charts and includes two works by local composers and arrangers. Thanks Bill is a tribute to the great Count Basie by Doug Caldwell, pianist, teacher and an icon in the New Zealand Jazz scene. And Yesterday's Bread is a whimsical number by Stu Buchanan.
The main recording was done in the Chapel of the Music Centre in Christchurch, New Zealand. Recorded by Peter Ratray and Tandem Recording. Produced by Iain Clark of Pan Promotions Ltd.
|1. The Opener
|C Strommen
|2. Almost Like Being in Love
|AJ Lerner/F Loewe
|3. Thanks Bill
|D Caldwell
|4. The Second Time Around
|S Cahn/J Van Heusen
|5. Hay Burner
|S Nestico
|6. Witchcraft
|C Leigh/C Colman
|4. The Second Time Around
|S Cahn/J Van Heusen
|7. Yesterday's Bread
|S Buchanan
|8. It Don't Mean a Thing if it Ain't Got That Swing
|D Ellington/I Mills
|9. I Left My Heart in San Francisco
|D Cross/G Cory
|10. I've Got You Under my Skin
|C Porter
|11. Take the A Train
|B Strayhorn & the Delta Rhythm Boys
|12. Theme from New York New York
|F Ebb/J Kander
|13. Mr Lucky
|H Mancini
|14. Queen Bee
|S Nestico


text:
Mar 8, 2013
Brazil's EBX Group and BTG Pactual have reached an agreement for the bank to provide the Eike Batista family of companies with financial...
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September 14, 2017 | Shanghai, China
LatinFinance returns to Shanghai for the 8th edition ... more
September 26, 2017 | New York, USA
The sheer size of Latin America's infrastructure needs, coupled ... more
Celebrating the stand-out institutions and transactions of the past year in this important ... more
October 5, 2017 | Playa del Carmen, Mexico
The Infrastructure and Sub-Sovereign Finance in Mexico Summit remains the ... more
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Argentina's provinces and municipalities are at the frontlines ... more
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text:
cRacKh0rN wrote:Thanks for all the tips fellas.
EOJ's guide is very good as it shows the A+B enemies. Do you all do a lot of A+B with Rosa? She is pretty tricky to use with lock shot imo. I find myself turning away from the enemy to do the lock shot. Is it even worth it on the level 1 bears?
Yes, but now I automatically face the wrong way when using lock shot I'm trying to play with folleta now, but its so different
cRacKh0rN wrote:Regarding fever mode, do you get an extra life bar when this has been achieved? Any other indicators?
Na, the counter, when you collect skulls, will be 10,000 & every enemy drops Crowns (which you leave to break up into skulls & slow the game to a crawl )


text:
Life is good
This style is currently unavailable.
- Life is good
- Approximately 28.5in from shoulder to hem
- Measurement was taken from a size medium and may vary slightly by size
- Design details: classic fit, garment washed for softness, rib at the neck and self-fabric taping from shoulder to shoulder, printed graphic
- 100% Cotton
- Machine wash
- Imported
- 10% of the retail sale of each purchase will be donated to The Life is good Playmakers. For more information about The Life is good Playmakers please visit www.Lifeisgood.com/Playmakers
- Imported
- See Details
- Style # 396165201


text:
Fabric Technician
5 days left
The Fabric Technician will be responsible for direction and effective reactive and planned preventative maintenance on a number of water systems with plumbing requirements as well as general carpenter / handyman tasks which is within competence skills as well as ability of onsite workshop and tools. Will be working as part of a Hard Services team, they will also be responsible for escort and overseeing of specialist sub- contractor support performing planned and reactive maintenance, and all other M&E work functions.
- Substantial intermediate experience working within M&E building maintenance.
- Substantial intermediate experience in a Manufacturing.
- Demonstrate experience & understanding of current Health & Safety.
- City & Guilds competencies
- Comprehensive building services knowledge in similar environments to a minimum of Joinery or Plumbing standards.
- Critical Environment Experience.
- Good Customer relationship skills.
- Working knowledge of "Permit to work" systems.
- Understand and interpret technical drawings/processes.
- Willingness to develop skills and take on additional responsibilities
Apply for Fabric Technician
Already uploaded your CV? Sign in to apply instantly


text:
Author has written 1 story for Days of Our Lives.Copyright © 2001 All rights reserved.
Please, do not use or display the whole or parts of my work without my permission. I have dedicated endless hours in brainstorm, then draft, then revision, and final, endeavoring not only to entertain, but also to inspire dialogue and understanding.
Thank you for your honor and integrity.
For more information about U.S. intellectual property laws, please contact the U.S. Copyright Office at the Library of Congress.
I am in no way affiliated with NBC Television, Days of Our Lives, or Corday Productions. I am merely an avid and loyal fan, who is a recovering and nearly penniless student. I make no money from my writing, which is the result of insomnia, repressed stress, and creative venting. Please contact me at email@example.com with concerns and/or questions about my work.


text:
There are a maximum of 60 Tropico 4 achievements (50 without DLC) worth 2,107 (1,250)
10,811 tracked gamers have this game, 1,042 have completed it (9.64%)
Buy now from the Microsoft Store
2,593 tracked gamers have this dlc pack, 1,238 have completed it (47.74%)
There are a maximum of 10 achievements worth 433 (250)
There are 2 reviews | Estimated completion: 8-10 hours
This walkthrough currently needs a new owner. Please post in this thread if you are interested in writing it.
Copyright © 2017 TrueGaming Network
Ltd, All Rights Reserved
Xbox, Xbox Live, and all other Xbox Live specific terms are registered trademarks of Microsoft Corp.
TrueAchievements is a proud member of the Xbox Community Developer Program
Concept, Design, Programming and Server Stuff by Rich Stone
aka TrueAchievement
Site version: 5.1.1, also available on Mobile


text:
Is Continuing Education Needed For Work Within Health Care Coding ? Deciding on healthcare html coding while profession might be ideal for many people because it is a lucrative way to earn an income that will not occur incorporated with all the typical stresses of an regular 9-5 work. In fact , on the other hand , deciding on a healthcare html coding profession can be settling on earn an income with adaptable some time to work from home advantages. Your problem remains even though : can be training essential for a profession in healthcare html coding ? The simple respond to this really is indeed. So that you can greater the occupations , it will be therapeutic for you to definitely find the necessary instruction required to understand the different ins and outs of healthcare html coding. One should be capable of understand and understand all there is to master regarding healthcare html coding. It is because a healthcare encoder manages setting specific requirements to several healthcare solutions and treatments to enable healthcare suppliers every single child bill for solutions rendered. This is why exactly why healthcare coders have been in need in the market. If there is a inclination for firm and luxuriate in administrative function , learning healthcare html coding will likely be easy for you. There are specific courses and trainings readily available for folks who want to learn your unique approaches found in healthcare html coding. However , not all of the free courses gives you the necessary qualifications necessary to move forward your career within this industry. It will however supply an individual with all the understanding to feed necessary examinations for you to become granted qualifications. You will see that proceeding further and committing some time to resources in to training for any healthcare html coding profession will need an individual far. After all , healthcare coders are needed by a number of corporations such as hospitals , healthcare centers and office buildings. If you've got the correct accreditation and accreditation just for this work after that more opportunities prove to you personally. The national school involving expert coders presents several types of qualifications after everyone has had the opportunity to feed his or her examinations. Every single accreditation can be nationally recognized and while you'll be able to nevertheless get yourself a healthcare html coding work with out these types of qualifications , the options for work are limited. If you are serious about a profession in healthcare html coding , it is best to take your examinations and get these types of qualifications. Most specific trainings that healthcare colleges provide for many who go with a profession in healthcare html coding are going to go ahead and take examinations given by your national school involving expert coders. For this purpose alone , it really is good to acquire more training. The national school involving expert coders presents step-by-step programmer accreditation to
prospects that pass a particular evaluation just for this. After transferring test and as a accredited step-by-step programmer , the person are able to be regarded for a number of renowned opportunities while healthcare encoder in various expert healthcare amenities , office buildings and centers. That kind of accreditation can be simple of course , if one wants , they can additionally go ahead and take other styles involving examinations provided by your national school involving expert coders. They have specialty credentials that could enable an individual for you to prove his or her knowledge inside their current focus or they even can utilize this to leap commence his or her healthcare html coding profession in a various kind of expertise totally. It actually is useful for you to pursue training essential for a profession in healthcare html coding because not only can the proper accreditation enable a larger selection of work alternatives , it will also available the entranceway so that you can manage to have got and deal with your own personal healthcare html coding organization. health insurance benefits
Published on May 14, 2012
free courses gives you the necessary qualifications necessary to move forward your career within this


text:
Family Health Navigator - Registered Nurse (RN)
Job ID: KNH-1018721 Description:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.
Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".
This position is responsible for discharge care coordination, episodic case management and pre-admission/post-discharge counseling for an acute condition. Provide education/local resource information and encourage member (self) education. Determine case complexity and consult with other internal departments as needed.
- Registered Nurse (RN) with current, active, unrestricted license in the state of operations (or reciprocity if applicable).
- 2 years clinical experience.
- 1 year health insurance/managed care experience.
- Knowledge of medical management policies and procedures.
- PC and database experience.
- Verbal and written communication skills.
- Customer service skills and interpersonal skills to discuss care with physicians, hospital staff and members.
- Ability and willingness to travel within assigned location. Possess transportation and current, valid driver's license for applicable state.
- Ability and willingness to provide coverage after hours on a call rotation.
- Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.
- 3 years recent clinical oncology experience.
- 3 or more years clinical experience.
- Familiarity with ancillary services including but not limited to Home Health Care (HHC) or Skilled Nursing Facility (SNF).
- Familiarity with Utilization Management/Case Management activities and standardized criteria sets.
- Bilingual English/Spanish.
Requirements: Expertise Nursing Job Type Full-Time Regular Location TX - Houston
Meet Some of HCSC's Employees
Allison M.
Internal Auditor
Allison audits operational and financial data throughout the business, helping to expose and mitigate risks, ensure compliance, and add value to HCSC's operations as a whole.
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text:
"Cheltenham Swinging Squares"
2016 Dancing Season
We are very pleased to report that six of our new dancers graduated on 29th July at Holy Apostles Church Hall and were presented with their certificates.
We had planned to have the graduation at Bob's garden party, but as the weather was rather less than ideal, we moved indoors.
Congratulations to Sandra, Theresa, Mike, Julie, Michael and Heather. We wish them many years of dancing pleasure. Our photo shows them together with our caller - Colin Pett.
To see reports on individual events, please slide your mouse cursor off the Reports menu item (top left) and then click on one of the listed events.
Our thanks to Phyllis and Peter Wright for the photo.
Our 60th Anniversary event
on 8th July 2017 was a great success.
Click here for more details and photographs.


text:
8 bedroom detached house for saleHigher Wraxall, Dorchester, Dorset, DT2
Under Offer £1,850,000
Do you like this property?
Call: 01202 024006
Property Description
Key features
- Grade II* Listed manor house
- 5 Reception rooms
- 8 bedrooms
- Self contained 2 bedroom cottage
- 1 Bedroom annexe
- Stable Block with Garaging
- Formal Gardens
- Swimming Pool and Tennis Court
- Paddock
Full description
Tenure: Freehold
A historic Grade II* Listed manor house with stable block, garden and grounds of about 7 acres located in a small hamlet surrounded by open countryside
Wraxall Manor is located in Higher Wraxall which is a small hamlet in West Dorset. Nearby villages of note include Rampisham, Cattistock. Evershot and Maiden Newton which between them have a variety of every day amenities including churches, shops, garages, public houses and at Maiden Newton a branch line station with a service between Weymouth and Bristol. Towns in the area include Beaminster, Bridport, the County Town of Dorchester, Sherborne and Yeovil, all of which have an excellent variety of shopping, educational and recreational facilities. Communications in the area include mainline railway services at Crewkerne, Dorchester, Sherborne and Yeovil with a regular service to London Waterloo. The A303 can be join ed to the north of Yeovil and the A35 to the south at Dorchester. Independent schools in the area include Perrott Hill at North Perrott, Sherborne School for Girls, Sherborne School for Boys and Sherborne Preparatory School as well as Leweston and a variety of state schools in the larger towns with primary schools in Maiden Newton and Evershot. Sporting facilities include water sports along the Dorset coast at Poole Harbour, Weymouth Bay and the Jurassic Coast as well as golf at Sherborne, Yeovil and West Bay and horse racing at Wincanton, Exeter and Bath.
Wraxall Manor dates mainly from the early 17th Century with later additions; some parts are considerably older. It has distinctive stone elevations under a slate roof with many stone mullion windows and a striking Jacobean front elevation. The property currently requires modernisation and has excellent spacious accommodation including 4 reception rooms, staircase hall, kitchen with Aga, garden room, 8 bedrooms, 4 bathrooms and shower room as well as a 2 bedroom integral flat known as Chapel Cottage and 1 bedroom annexe known as Squirrel Cottage. Features include good ceiling heights to the main reception rooms, many window seats, drawing room with panelled walls and Neo Classical style fireplace, stone fireplace in dining room, kitchen with Aga, galleried staircase hall and landing. The interior was remodelled in about 1905, possibly by the young Edward Lutyens. The gardens are another delightful feature being walled with many areas of lawn, well stocked flower and shrub beds as well as a swimming pool, All Weather tennis court, paddock and a detached stable block with garaging, stabling and clock tower.
Wraxall Manor as it is today is believed to date from circa 1630 although the manor itself is mentioned in the Doomsday Book where Wraxall is known as Brocheshale. The owner at that time was William Lawrence who inscribed his name on an internal mullion and was a distinguished Parliamentarian in the tome of Cromwell. Other owners have included John Stein who was a member of the Stein family of Whisky distillers and William Busk who established a cattle ranch in Texas and founded the remote town of Gouldbusk which still exists. During World War II the house was requisitioned by the Ministry of Defence and for a time occupied by 62 Commando who were known as the Small Scale Raiding Force, later the SAS. The house is also mentioned in Pevsner who describe it as being "an orderly and harmonious stone house of circa 1630, quite large but quite without idiosyncrasies."
Please see floor plans.
To the front of Wraxall Manor there is a semi circle with central lawn adjacent to which is a Stable Block with stone and brick elevations under a tiled roof and clock tower, central archway, storeroom with loft over, two garages with double doors and four loose boxes with dividers and iron railings and stone floor. The gardens are a delightful feature of the property being predominantly walled to provide a good degree of privacy and include areas of lawn interspersed with well stocked flower and shrub beds and borders as well as hedging and a good variety of mature trees. There is also a further area of parking and courtyard with adjacent outhouses including greenhouse and garden shed. Beyond the gardens is an All Weather tennis court and swimming pool as well as an area of paddock which is currently laid to pasture. The gardens provide fine views across the surrounding undulating countryside.
Fixtures and Fittings
All fixtures, fittings and garden statuary are excluded from the sale, although some may be available by separate negotiation.
Square Footage: 7,865 sq ft
Acreage: 7 Acres
From Dorchester take the A37 and turn left onto the A356 after Grimstone. Proceed along this road through Maiden Newton and when you reach the top of the hill take the turning on your right hand side which is signposted Wraxall. Continue along this lane and after passing through an area of woodland, you will find Wraxall Manor on your right hand side.
More information from this agent
To view this media, please visit the on-line version of this page at www.rightmove.co.uk/property-for-sale/property-61708499.html
Listing History
Nearest stations
- Maiden Newton (2.8 mi)
- Chetnole (4.5 mi)
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To view this property or request more details, contact:
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Standard geographic charges from landlines and mobiles apply and calls may be included in your telecom provider's call package.
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Objectives The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches.
Methods Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality.
Results The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease.
Conclusions The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Strengths and limitations of this study
This study provides a significant contribution to the existing evidence base as it is the first extensive investigation of the cost associated with overweight and obesity on the island of Ireland, enabling comparisons to be made across both jurisdictions.
The healthcare and lost productivity costs of overweight and obesity are examined in the study which further enhances the robust scope of the research.
Omitted from the analysis were several aspects of service where additional demand is likely to emerge as a result of overweight and obesity, that is, long-term care, social care, personal social services and dietician services. Costs that fall on the individual rather than the health service were also omitted. Owing to the absence of adequate reliable data on which to base estimates, the derived summary cost estimates are likely to be conservative.
The increasing prevalence of overweight and obesity in recent decades poses significant threats to the health and well-being of populations and represents a major challenge for health services. In a systematic analysis of data from 199 countries, it was estimated that 1.46 billion adults worldwide were overweight in 2008, of which 502 million were obese.1 Trends over the past 20 years in the USA suggest that the number of people in the highest body mass index (BMI) group is increasing faster than any other group. From 2000 to 2005, the estimated prevalence of obesity in the USA based on self-reported height and weight increased by 24%. However, the prevalence of morbid obesity (BMI >40 kg/m2) increased by 50% and the prevalence of a BMI of over 50 kg/m2 increased by 75%, during this period in the USA.2
In the Republic of Ireland (ROI), the 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland (SLÁN) provides estimates of BMI based on self-reported height and weight3 (Ireland refers to the ROI, while Northern Ireland (NI) refers to the Northern part of Ireland which is part of the UK, and the Island of Ireland refers to the whole) More than one-third of respondents (36%) were classified as overweight (43% of men and 28% of women) and 14% as obese (16% of men and 13% of women), while a measured subset showed the prevalence to be 39% overweight and 25% obese. More recent data on the prevalence of overweight and obesity in adults aged 50+ years in the ROI using measured BMI4 reported a prevalence of overweight of 47% in men and 40% in women, and a prevalence of obesity of 37% in men and 31% in women aged 50+ years. Results from the Health Survey for Northern Ireland 2011 have also revealed similar prevalence rates for NI with 36% of adults reported as overweight and 23% as obese.5
Overweight and obesity are implicated in the aetiology of a large number of medical conditions. They are associated with significantly increased risk of type II diabetes, cardiovascular disease, several cancers and a number of additional chronic conditions.6 The WHO has described chronic disease (mainly cardiovascular disease, diabetes, asthma and chronic obstructive pulmonary disease) as the 'leading threat to human health and development'.7 The WHO's project, the Global Burden of Disease, has estimated that chronic diseases are the largest contributor to mortality and disability in high-income countries and that by 2030, 89% of disability adjusted life years (DALYs) will be attributed to chronic conditions.7
Estimates of the economic burden of illness can provide useful information for priority setting, policy development, assessment of health technologies and investment in prevention and clinical services. Health systems worldwide are struggling to meet the challenge of increasing demand for healthcare and of increasing expense with diminishing resources. Cost of illness studies for major health risks such as overweight and obesity therefore have the potential to frame core policy issues in language that is tangible and accessible to policymakers. International cost of illness estimates of overweight and obesity have demonstrated substantial costs. The published estimates for the healthcare cost of increased BMI in the UK range from approximately £3.2 Billion to £4.2 Billion.8 ,9 These figures represent around 5% of the total healthcare spending in the UK for the years concerned. In similar studies, it has been estimated that in the USA between 4.8%10 and over 9%11 of total healthcare spending is due to overweight and obesity-related illness.
Few estimates exist for the costs associated with overweight and obesity for Ireland. The costs in terms of hospital inpatient stays only were estimated at €4.4 million in 1997, rising to €13.3 million in 2004.12 The National Taskforce on Obesity estimated that the direct healthcare cost of obesity in Ireland in 2002 was €70 million, and the indirect cost was €0.37 billion, giving a total cost of €0.4 billion.13 However, this estimate was based mainly on data from the UK, which were adjusted for Ireland, with limited data from the Irish Hospital Inpatient Enquiry (HIPE) database included. In NI, there is a relative paucity of cost data to help inform policy responses. Given Ireland's health service and population characteristics, it is difficult to reliably estimate the cost of illness by extrapolation from published international data. Furthermore, much of the previous literature focused only on healthcare costs of obesity, productivity costs being largely ignored. The aim of this paper is to provide a comprehensive estimate of the healthcare and productivity costs of overweight and obesity in the ROI and NI in 2009. Decomposing differences in cost on the two parts of the island would provide an interesting and useful exercise in, for example, investigating the impact on healthcare costs that differences in access to public services might have. As this was not the focus of this paper and mindful of constraints on space, we have chosen not to provide such an analysis here.
Materials and methods
We adopted a societal perspective (ie, that includes healthcare costs and lost productivity) in estimating the economic cost of overweight and obesity. We focused on estimating costs across four key categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. We used population attributable fractions (PAFs) calculated by age and gender and applied to national cost data analysis of hospital inpatient, day cases and also prescribing data in the ROI and NI. Similarly, PAFs were applied to social welfare (SW) data and to national mortality data to calculate the productivity costs due to absenteeism and premature mortality. There were no data availability for which general practitioner (GP) costs could be analysed from a top-down approach, so we based our estimates on work previously carried out by this group, using a bottom-up approach.14 ,15 Table 1 outlines the data sources used in this study.
Population attributable fractions
In this study, PAFs were calculated using the following formula which accounts for multiple levels of exposure:21
where PF1 is the fraction of the population in exposure level 1 (eg, overweight), RR1 is the relative risk of disease for exposure level 1, PF2 is the fraction of the population in exposure level 2 (eg, obese) and RR2 is the relative risk of disease for exposure level 2. All the PAFs used in these calculations were based on measured BMI prevalence rates, calculated from the measured subset of the SLÁN survey for the ROI and the 2010/2011 Health Survey Northern Ireland, and using RRs from the international literature as outlined in table 1. PAFs were calculated by the 5-year age group for ROI and the 10-year age groups for NI, separately for males and females for each condition including low back pain, osteoarthritis, coronary artery disease and stroke.
Healthcare utilisation
For hospital inpatient and day cases, PAFs of the specific overweight and obesity-related conditions were applied to the Hospital Inpatient Enquiry (HIPE) database for the ROI, and Hospital Inpatient Statistics (HIS) data for NI. HIPE in the ROI and HIS in NI are the primary sources of national data on discharges from acute hospitals and collect demographic, clinical and administrative data on discharges from and deaths in acute public hospitals nationally.i In both data sets, the diagnosis related groups (DRGs) are the cost groups for patient discharges, and for each condition they were summed by 5-year age group and gender. The PAFs for overweight and obesity-related conditions were applied to the summed DRGs to give the proportion of costs that could be attributed to overweight and obesity. The International Classification of Diseases (ICD) codes included in these analyses are outlined in table 2.
Our estimates of GP and outpatient costs for the ROI are based on published literature. Doherty et al15 used data from SLÁN 2007 to estimate the impact of overweight and obesity on GP service use and outpatient services. They provide a detailed description of the model used and the regression analyses performed. Briefly, they estimated the difference in the probability of individuals using their GP associated with elevated BMI, controlling for covariates and, based on this, estimated the impact of overweight and obesity on service use. This was then combined with the cost of the service, to estimate the additional cost associated with overweight and obesity. Estimates of average visit frequency for the adult population were taken from the Quarterly National Household Survey (QNHS) Q3 200722 and costs were taken from published sources in the literature; more details of these are given in Doherty et al15 In the base case analysis, the cost of a GP consultation was estimated at €50, of an inpatient episode at €503023 and of an outpatient visit at €139 (personal communication: Mark Connors Casemix unit, HSE). They calculated the cost of GP use associated with overweight and obesity as being €22 900 000.
For NI, we used data from the grey literature that used similar methodology for healthcare costs associated with GP use in NI.14 In that study, data from the 2010/2011 Health Survey Northern Ireland, which is similar to SLÁN in terms of the issues covered and is based on a representative sample of households, were used. The unit cost for a GP visit of £36 was taken from standard sources assuming all visits were to the GP surgery within office hours and lasted on average just over 11 min.24 Adjustment was made using purchasing power parity (PPP) for 2009 to express UK figures into their Irish equivalent for comparison purposes with the ROI. The cost with respect to increased BMI in the case of GP services was €7 411 564.
Drug costs
Drug cost data for the ROI were obtained from the Primary Care Reimbursement Service (PCRS) and from the Business Services Organisation (BSO) for NI, for the year 2009. The PCRS reimburses community drugs dispensed for those with medical cards (dependent on means test), with long-term chronic illnesses (dependent on diagnosis) and those on high-tech drugs, which three schemes together cover over 50% of the population's drug spend. They also reimburse drug payments in excess of €142 to private patients. The BSO manages prescribing data on behalf of the health service in NI, where all citizens have equal cover. The PAFs calculated were applied to the drug expenditure on drug categories of relevance including drugs used in the treatment of type II diabetes, cardiovascular conditions, aspirin and non-steroidal anti-inflammatory agents (reflecting treatments for osteoarthritis). Drug expenditure included a dispensing fee plus VAT where relevant.
Work absenteeism
Work absenteeism was calculated using social welfare (SW) data in both jurisdictions. However, the availability and quality of the available data were variable. In ROI, the Department of Social Protection runs three SW schemes which apply to individuals who are unable to work due to illness. One of these deals mainly with disabilities from birth, and was not relevant to the cost of obesity. The other two deal with short-term illnesses from work (the illness benefit scheme (IBS)) and longer term illness causing inability to work on a long-term basis (Invalidity Pension). Both of these schemes have data on work absences that could be related to overweight and obesity, but only data from one scheme (IBS) was available in electronic format. Therefore, we limited our analysis to this scheme.
Claims were assessed to determine if the principal medical condition linked to each claim was likely to be associated with overweight and obesity. The age group and gender-specific PAFs were applied to the duration of illness for each condition, and a productivity loss value was calculated by costing the length of the claim by gender and age group-specific mean total annual earnings for 2009. The IBS data set not only contains short-term claims but also many claims spanning the entire year, which were often found to be initiated long prior to 2009 (historical claims). These historical claims were found to have a large effect on the estimated productivity loss, and were therefore eliminated following the primary analysis, giving a truncated data set on which subsequent analyses were performed. Claims are not paid until after day 3 of sickness absence in about 90% of cases. Accordingly, 2.7 days (3 days×90%) were added to each claim. By applying PAFs for the relevant conditions, estimates of duration of illness were obtained and were taken as a proxy for lost productivity. Associated costs were estimated by applying average gross national wages for men and women to illness duration attributable to obesity and overweight. For NI, the number of individuals in receipt of a range of benefits was obtained from the Analytical Services Unit of the Department of Social Development (NI) for 2009 by ICD-10 code. Owing to the available data, it was not possible to estimate total duration of time off work (as was performed for the ROI). Therefore, the total amount of benefit payments made for overweight and obesity-related conditions was calculated. Using this information and data on weekly payment rates, the duration of absent days was calculated from which a productivity estimate could be made. It was not possible to eliminate long-term claims from this data set.
A PAF approach was used to estimate the productivity loss costs associated with benefits paid to individuals unable to work due to obesity-related illnesses. The human capital approach counts any hour not worked as an hour lost and takes the perspective of the patient. The friction cost approach takes the employer's perspective and counts only hours not worked up while the employee is being replaced. We estimated both for each jurisdiction. The use of average earnings to estimate lost productivity is open to question. Those who are overweight or obese may experience an earnings penalty related to unobserved characteristics and/or discrimination in the workplace. Rather than speculate as to the magnitude of such effects (and their differences between jurisdictions), we have used the average wage figure but caution as to the interpretation of results.
Premature mortality
Mortality data were obtained from the Irish Central Statistics Office (CSO) for the ROI and the Registrar General reports for NI covering a 3-year period from 2008 to 2010 inclusive. Deaths for the named conditions were weighted using years of potential life lost (YPLL) up to age 75, and also for all ages. Costs were based on the average income at the age of death, by age and sex, excluding deaths occurring in those under age 18. Thirty per cent of the pre-retirement income, reflecting an approximation of the state pension, was used for people in the 65+ age group. The estimated income at the time of death was used as the income and a discount rate of 4% was applied. All analyses were performed using R. Deaths were manually linked to the ICD-Code 10, described in table 2, which indicated the cause of death in the individual death records obtained from the CSO. For each death record, the relevant overweight and obesity prevalence, and the life expectancy from the most recent Life Tables, were linked by age and sex to the record. The relevant RRs and their upper and lower CIs were linked by cause of death and sex.
Bottom-up estimates were based on regression analyses in which a range of health and sociodemographic covariates featured in the estimated functions. The resultant cost estimates are based on conditional probabilities of adiposity and in consequence are to be interpreted as incremental costs of adiposity. Similarly, in respect of the top-down estimates of cost, PAFs are based on relative and not absolute risks of morbidity conditional on adiposity and can again be interpreted as incremental costs of adiposity. The two approaches are different, a fact we return to in our limitations section.
The issue regarding the use of average earnings notwithstanding valuing premature death in terms of lost productivity ignores the broader value to society beyond production that individuals make as members of families and social networks. While alternate approaches—for example using the value of a statistical life—may incorporate such elements, their precision is open to question. Moreover, as we have not sought to include monetary values associated with the disutility of obesity-related morbidity (pain, suffering and anxiety), an attempt to include them here could appear inconsistent.
Table 3 gives the individual results for each part of the analysis. The main drivers of healthcare costs due to drugs and hospital inpatient and day-case care are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver of productivity costs and for premature mortality the primary driver of productivity costs is coronary heart disease.
Healthcare utilisation
Hospital inpatient and day-case costs estimated using PAFs are presented in table 4. Costs for NI are presented in PPP 2009 Irish Euro for ease of comparison.
Sensitivity analysis was performed using the upper and lower bound PAFs, which were calculated using the CIs range for the associated relative risks.6 This gave a range of €125 686 873 to €216 025 571.
For NI, the PAFs used were calculated using NI-specific prevalence data for overweight and obesity. The total hospital inpatient and day-case cost attributable to overweight and obesity was €42 920 806 (with a range of €35 204 704—€54 942 260).
Drug costs
The cost of prescribed drugs in the ROI attributable to overweight and obesity is €234 441 904, which includes all dispensing and associated costs. This estimation is based on the PAF approach which was calculated by applying the overweight and obesity PAFs to the total cost of the drugs. Cardiovascular (CVD) drugs were found to be a major contributor to drug costs with CVD costs calculated at €142 761 929. Diabetes diagnostic kit costs were estimated to be €30 638 061 and were followed by type 2 diabetes mellitus (€17 620 890), non-steroidal anti-inflammatory drugs (NSAIDs; €13 884 944), aspirin (€11 220 201), antiobesity (€8 418 288), glucosamine (€5 276 736) and topical NSAID costs (€4 620 854).
The cost of prescribed drugs in NI attributable to overweight and obesity is €77 074 272. This figure was estimated using a similar PAF method used for the ROI whereby prescribing data from the BSO was combined with PAFs to estimate total costs. Cardiovascular (CVD) drugs were reported as a substantial source of prescribed drug cost (€38 916 053), followed by diabetes (€22 233 463) and diagnostic kits (€6 676 919).
Lost productivity
For the ROI, overweight and obesity-related conditions in 2009 resulted in 266 553 claims to the IBS, made by 202 246 claimants, of whom 57.4% were female and 42.6% male. The summed 2009 duration of illness/work absence was 34 322 years. PAFs were applied to the relevant conditions to estimate absolute years lost and the percentage of the 2009 illness duration total. The total duration of illness due to overweight and obesity for 2009 was estimated at 3117 years. Overweight and obesity-related illness benefit claims accounted for 9.08% of the summed 2009 duration of all illnesses. For the human capital approach, these durations were transformed through the application of age and gender appropriate 2009 earnings into the yearly productivity loss cost estimates. The estimated annual productivity loss costs in the ROI due to absenteeism related to overweight and obesity was €135 977 068 for 2009. Productivity losses for the ROI were also estimated using the friction cost approach. In this approach, claims longer than 90 days were capped, giving a friction cost estimate for productivity loss due to overweight and obesity-related conditions of €72 133 090 for 2009.
The estimated annual productivity loss costs in NI due to absenteeism related to overweight and obesity is €215 million using the Human Capital Approach and €74.4 million using the Friction Cost Approach.
Premature mortality
In the ROI, the estimated cost of life years lost due to obesity and overweight was calculated at a total of €853 070 261, of which €276 496 546 accounted for female deaths and €576 573 715 for male deaths. These figures are presented as income weighted years of potential life lost for all ages based on life expectancy. The total figure represents 9% of the total income-weighted years of life lost from 2007 to 2009 in the ROI. The estimated cost of life years lost to age 75 due to overweight and obesity was €684 747 065, of which €190 542 208 accounted for female deaths and €494 204 857 accounted for male deaths. The total figure represents 8.3% of the total income-weighted potential years of life lost from 2007 to 2009 in the ROI. The basic analysis used undiscounted years of life and weights these years of life using undiscounted income. As part of the sensitivity analysis, the effect of using different discount rates, 2%, 4%, 6%, 8% and 10%, was investigated. As expected, both the absolute number of years of life lost and the corresponding costs fall sharply. The figures are shown in table 5 below.
Using the Irish Department of Finance recommended discount rate of 4%, the total annual productivity loss cost estimated for the ROI, using measured BMI for prevalence rates, and only counting those who died aged 18–75 was €592 991 594.
For NI, the annual cost of premature mortality attributable to overweight and obesity was €147 417 113. By applying the upper and lower bound range relating to the range of RRs used in the analysis, the range calculated for costs is €107 022 854 to €186 486 711 million.
This is the first comprehensive study of the cost of overweight and obesity on the island of Ireland, which allows comparisons to be made across both jurisdictions. The study focused on estimating both the healthcare and productivity costs of overweight and obesity, and although it takes a primarily top-down approach, it also draws on bottom-up approaches. The cost of overweight and obesity in the ROI was €1.16 billion, and for NI it was €510 million. NI has a population of about one-third of the ROI. Their health system is part of the UK's National Health Service (NHS) in which care is delivered free at the point of use, while in the ROI a mixed system in which a greater role is afforded private medical insurance operates. If the systems were equivalent, that is, if healthcare was also free at the point of use in the ROI, one would expect a rise in demand, with increased costs, although the fact that healthcare is relatively price inelastic means that the increase in cost would be disproportionately less than the rise in demand. While the different systems might in part explain some of the differences in cost across the two jurisdictions—serving to stifle demand for services relative to that in NI and thereby deflate the cost estimation of the apparent differences—it may also relate to the use of PPP. PPP provides for the conversion of one currency to another based on the purchasing power of that currency domestically. As many of the services valued here are delivered free at the point of use, conversions based on specific comparisons, for example, of a GP consultation, were not possible. The use of general PPPs may in consequence not be ideal. If the exchange rate which was current at the time of the study was used, the cost for NI is reduced to €416 million.
While the results between the two jurisdictions were broadly along expected lines for healthcare costs, with respect to productivity costs the differences were somewhat greater than expected. This was mainly due to the amount and quality of data made available for the study of absenteeism. In the ROI, electronic data were only available for one of two relevant schemes, and so a proportion of the estimated costs was probably excluded. The data that were available were very detailed, and allowed for the number of sick days associated with overweight and obesity to be estimated with a reasonable degree of precision. Data for NI were at a much higher level, and the number of days had to be estimated. However, data for all relevant schemes were available. The crudeness of the estimates, however, meant that the estimates were much less likely to be precise. Therefore, the figure for absenteeism for the ROI can be considered an underestimate, and for NI, most likely a slight overestimate.
In the ROI, 38% of the total costs were healthcare costs, amounting to 2.7% of the total healthcare costs for that year. For NI, healthcare costs were 25% of the total and 2.8% of the total healthcare costs for 2009. These results are within the range commonly found in other European countries,25 although healthcare costs in the USA tend to be higher, up to 9% of healthcare spend.11
There are a number of limitations associated with our analyses. First, omitted from the analysis were several aspects of service where additional demand is likely to emerge as a result of needs related to obesity and overweight. Such services include long-term care, social care, personal social services and also dietician services. Also omitted from the analysis are costs that fall on the individual rather than the health service. The latter could include over-the-counter medicines purchased by the individual or costs related to the consumption of GP or hospital services, such as travel, and the copayment made for drugs by private patients. Also excluded are the costs of lost production in the self-employed, which are private rather than societal costs. In each case, the rationale for the omission of the service resulted from the absence of adequate reliable data on which to base estimates. Second, repeated cross-sectional surveys show us that the population BMI distribution is 'shifting to the right,' but the duration of obesity—the period that obese people are living with obesity—is probably also increasing and the cumulative risks of adverse health events may actually be higher than those we have used in our analyses (and the costs).26 ,27 The duration of obesity, however, is not captured in these cross-sectional surveys. Third, studies have shown that risk measures of central adiposity may better predict aspects of morbidity than BMI.28–30 While using alternate measures may have helped increase the precision of some of our estimates, BMI was the only measure of adiposity available to us. Fourth, for productivity losses due to premature mortality, the cost estimates reflect the wage rates in the ROI. There is considerable uncertainty in these estimates, reflecting the imprecision in estimates of population attributable fractions and the assumptions, approximations and simplifications inherent in this approach to estimating productivity losses.
Lastly, with respect to those elements where cost estimates were provided a number of simplifying assumptions were employed any of which are open to debate. For example, data constraints obliged the use of different methods—bottom-up and top-down—that are not directly comparable. In the top-down approach, simplifying assumptions were employed in respect, for example, of average earnings at the time of death, of the value of lost productivity among the retired, of the duration of absenteeism in NI, of the interval over which friction costs were calculated of discount rates used, etc. The use of lost output when valuing premature death as opposed, for example, to the value of a statistical life is similarly open to question. Similarly, in the bottom-up approach, alternative regression models and survey data may have resulted in alternative estimates of costs. In respect of both unobserved characteristics correlated with adiposity—for example, preferences for health or attitudes to risk—we acknowledge that we have not been able to take these into account in this study, and that the bias from such factors may well lead to an overestimate of the costs of obesity. While the precision of our estimates should in consequence be treated with some caution in the spirit of lighting a candle rather than simply cursing the dark, however, we contend that these estimates at a minimum help spark a debate in respect of costs and hopefully help to provoke a policy response.
The limitations notwithstanding, the paper provides the first comprehensive examination of the cost associated with obesity and overweight on the island of Ireland. On balance, the summary cost estimates are probably conservative, that is, likely to underestimate the true costs for the reasons detailed above. It quantifies the not insubstantial costs associated with overweight and obesity currently in both parts of Ireland. The upward trend in the prevalence of childhood and adult obesity indicates that these costs unchecked will increase over time. Given the drive in both jurisdictions to contain healthcare spending and increase productivity, it seems unlikely that current trends will be sustainable. Given this, evidence based prevention programmes must be set in place at all levels of society to tackle this in a coordinated and sustained fashion.
Lastly, this study was constrained by a lack of suitable longitudinal or cross-sectional data to allow for a reliable bottom-up estimate of costs. The top-down approach using PAFs may have resulted in some overestimation, as these costs are average costs, and also such calculations cannot rule out double counting of cases, where multiple comorbidities coexist. The pooling of two jurisdictions (as per the funding requirements) for this study provides useful comparisons across the jurisdictions, especially as there are differing healthcare systems.
The cost of overweight and obesity is substantial, multifaceted and likely to increase. This paper quantifies the avoidable costs attributable to overweight and obesity and should motivate policymakers to urgently consider evidence pertaining to overweight and obesity prevention strategies, and their cost-effectiveness, as part of the development of a coherent policy response.
Contributors AD, AC, ED, CO'N, TMcV, MRS, AS, KK, LS and JH were all involved in performing various parts of the study. AD wrote the manuscript. AD, AC, ED, CO'N, TMcV, MRS, AS, KK, SF, LS, FK, JH, KB and IJP assisted in writing, revising and reviewing the manuscript. IJP was the Principal Investigator on the overall study. He advised and assisted in the drafting and review of the manuscript. All authors read and approved the final manuscript.
Funding The work on this paper was funded by safefood (Ref Project 01-2010), and is part of a larger study on the cost of overweight and obesity on the island of Ireland.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
↵i HIPE data was analysed using the Health Atlas. Health Atlas Ireland is an open source application which enables web-based mapping of national health-related data.
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What will the Knicks look like this season?
Can Javale McGee improve enough to be a starter?
How do Dave and I watch NBA Games?
What is the latest in the Kyrie Irving Experience Situation?
How Does Carmelo Anthony fit into all of this?
Why has the free agent market dried up so quickly?
Coach Dave DuFour of the That Guy Basketball Podcast and a contributor to bballbreakdown.com joins Coach Nick for a new WEEKLY SHOW, where we answer questions submitted to us from the NBA Reddit page. We discuss topics like: Who Is Our Pick For MVP, What Do The Timberwolves Need To Do To Turn It Around, and Why Russ Would Be Better At Shooting Guard.
Big Wos of ESPN's True Hoop Network joins Coach Nick for a new take on the podcast: What You DON'T Want To Talk About In The NBA. We discuss why the Sixers and the Nets are teams on his list, and why Coach Nick doesn't want to talk about the Knicks offense anymore either


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Illustrations in Report Writing
Students create a short report using all the steps in the writing process including a bibliography. They explore different pictures that relate to their topic and download an image for the internet into their report. A helpful rubric is included and encouraged to give to students to help them successfully add all the elements to their report.
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Writing Portfolio: An Autobiography Assignment
An extensive portfolio project encourages your kids to reflect on their personalities with multiple writing assignments. From activities on extended metaphors to writing about an important day in their lives, kids explore the way they...
6th - 12th English Language Arts CCSS: Adaptable
501 Writing Prompts
Never again will you need to worry about coming up with a writing prompt! This packet contains, as it says, 501 prompts that are suitable for fourth graders on up. The prompts are paired into four categories (persuasive, expository,...
4th - 12th English Language Arts CCSS: Adaptable
Book Report Writing Template
Assist your class members with organization and content as they prepare to write book reports. They can use the template to prepare and draft the work. The template prompts pupils to include an introduction, information about the book, a...
6th - 8th English Language Arts CCSS: Adaptable
Super Sentences & Perfect Paragraphs
An extensive collection of lessons and activities includes many writing, grammar, and proofreading exercises. With templates and worksheets that cover several steps in the writing process, from sentence to paragraph to essay, this...
3rd - 6th English Language Arts CCSS: Adaptable
Writing with Wow Words and Building Vocabulary
There are some words out there that just make you say, "Wow!" Encourage your class to find and use these words in their writing to make their work more interesting and complex. This packet goes through the writing process, beginning with...
5th - 8th English Language Arts CCSS: Adaptable
Narrative Writing Unit
Each one of the learners in your class has a story to tell, so help them learn the most efficient and organized way to tell their tale. A thorough unit on narrative writing addresses the writing process, grammar, story structure,...
4th - 7th English Language Arts CCSS: Adaptable
New Review Writing About Literature Nature in the Writings of John Muir and Emily Dickinson
As an assessment of their skill in crafting a compare and contrast essay, class members read and compare the portrayals of nature in excerpts from naturalist John Muir's My First Summer in the Sierra and from poet Emily Dickinson's "The...
11th - 12th English Language Arts CCSS: Designed
Grades 9-10 Writing Module, Unit 1: Argument Writing
As an introduction to argument writing, groups examine two argument essays, observing how the writers state their claims and organize and support their ideas. Individuals then craft an argument essay, taking a position on the question of...
9th - 10th English Language Arts CCSS: Designed
Outlining and Organizing Made Easy
Outlining and organizing an essay are made easy with the help of Inspiration® graphic organizers. Specific directions and colorful graphics model for writers how to use the software to craft these key steps in the writing process....
7th - 12th English Language Arts CCSS: Designed
Persausive Writing
A unit on persuasive writing guides elementary learners through the writing process. The first part examines the elements of persuasive writing, including expressing an opinion, connecting ideas, using supporting facts, and writing...
3rd - 6th English Language Arts CCSS: Adaptable
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You know the story of Cora, the first county seat of Comanche County, as well as I do. You also know what the first courthouse of Comanche County looked like because the log structure still stands today. Oh, it doesn't stand in its old spot; it hasn't in decades. No, today the little courthouse that we call Old Cora stands in the southwest corner of the Comanche public square, an honored structure that becomes a photo op each and every day of the year because she has the distinction of being the oldest standing log courthouse in Texas, and tourists galore stop and visit her every year.
Of course, I don't want to leave you with the impression that Old Cora was referred to by name in the long ago days when she held the county records, not at all. Back then, she was simply the courthouse, and just as we here in the 21st century must "go to the courthouse" so was it with the people of the 19th century.
The photo that I have used today depicts the day that the town of Comanche moved Old Cora to its present location. Obviously, it caught my eye because of it historic significance, but then I looked a little closer. I simply do not remember that there was ever an Ellison's Furniture in what I still refer to as the old Durham Drug building. Of course, I was young and very busy, but I have no idea how I could not remember Ellison's.
If you remember anything about this day, about Old Cora at her other locations, or anything about the businesses located in Comanche at the time, please leave us your comments in the boxes below. That way we all can share in what you already know. Thanks!


text: On 11 May 2016, Wal Mart opened a new store on South Bryant in San Angelo. The Academy was asked to sing God Bless America during the ceremony. The academy also received a $500 dollar grant for which they had applied. At least one local news outlet covered the event. Click here to access the article on San Angelo Live!


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In collaboration with Amy McDaniel, of Dewdrops Photography, we have created the ultimate newborn Photoshop action set. Our amazing foundation actions give you the ability to soften your subject without losing any precious details. The Retouch Toolkit has been overhauled, is much more robust and creates extremely accurate skin tones. Plus, the artistic enhancements provide organic tones and mattes that compliment your images instead of over taking it. All these things combined, make this a must-have newborn set, the only one you'll ever need.
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Since 28 May, the diesel engines on the Maersk Invincible have been switched off. The rig is now running entirely on hydropower from the shore.
This was made possible because Maersk Invincible was built with this purpose in mind from its conception. The electrical power system was designed and prepared to be able to receive power from shore.
"The testing and commissioning of the high voltage shore-power installation has been thorough," says Christian Adamsen, Technical Section Leader on board the rig. "Maersk Invincible is now a clean hydropower rig since Sunday, when we made the change to shore-power supply."
At 11.000 volts, the high voltage shore-power supply is capable of supplying up to 10 megawatts, corresponding to the consumption of up to 20.000 households. The innovation not only means reduced emissions, but also a cost saving for customer Aker BP in fuel and maintenance.
It is Maersk Drilling's ambition to conduct sustainable and environmentally responsible operations, and it is our belief that this ensures a sound and viable business for the future.
"Maersk Drilling is pleased that we have been able to successfully implement this innovation with our client Aker BP and together become first movers in introducing shore power operation on jack-up drilling rigs," says Peder Norborg, Head of the XL-E Newbuilding Project with Maersk Drilling.
Another benefit of shore-power is a much quieter work environment for the crew, since the diesel engines were one of the main sources of noise.
"This will reduce emissions from the rig," says Christian Adamsen. "It will also reduce cost and time for maintenance on diesel engines and generators and give a better working environment in the engine rooms. Furthermore, the deck will be easier to keep clean since we won't have soot from the exhausts.
This will all be eliminated by running on shore-power."
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text: Buying a New Car Recently, I found myself in need of a new car. Some people are prone to buying the first shiny thing they see, but I'm more the type to thoroughly research every option and settle on something that offers form and function. […] Tags: drone, hubsan, safety, uav, yuneec|


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Li Guo
Contact Information
Dr. Guo's ongoing projects include, 1) a special issue "Women, Writing, and Visuality in Contemporary Chinese Literature and Film", co-edited with Dr. Geraldine Fiss (University of South California), for Frontiers of Literary Studies in China (Brill), forthcoming Summer 2016. 2) an invited chapter on Chinese folklore animation films from 1941 to 1965, in Chinese Film Historiography, a volume for Routledge AFI Film Readers Series edited by Dr. Jason McGrath (University of Minnesota). 3) a special issue "Animating Chinese Cinemas" co-edited with Dr. Jinying Li (University of Pittsburg) for Journal of Chinese Cinemas (Routledge) in spring 2017.


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Mr. and Mrs. Dennis Simas are proud to announce the engagement of their daughter Diana Simas of Seekonk to Robert Pacheco of Bristol. Diana is a graduate of Seekonk High School 2004. They are … more
9/19/16 09:19 AM | 666 views
Dr. & Mrs. Dom Indindoli of Plymouth announce the engagement of their son Dominick Indindoli to Ruth Votaw. Ruth, originally from Illinois has a son, Aidan, who is studying Engineering and German … more
7/5/16 | 831 views
Mr and Mrs Arnold & Filomena Tavares of Seekonk, MA announce the engagement of their daughter, Miss Katie Tavares to Mr. Edward Medeiros Jr. son of Mr and Mrs Edward & Lisa Medeiros Sr. of Seekonk, … more
8/12/14 10:12 AM | 2300 views
Stephanie Lagarto and Derek Rosata were married February 2, 2013 at St. Francis Xavier Church in East Providence RI. The reception was held at Johnson and Wales Inn in Seekonk MA. The maid of honor … more
2/28/13 02:28 PM | 3526 views
Kendra and Gary Prevost of Warwick, RI are proud to announce the birth of their daughter Ellie Ava, born April 26th at 6:13 AM at Woman & Infants Hospital. Ellie weighed 7lbs 14oz and was 21inches … more
9/17/12 09:17 AM | 1352 views
Michael and Jennifer Boisvert of Seekonk, Ma are overjoyed to announce the birth of their son Jake Steven, born on July 31st at Women and Infants Hospital. He was 8lbs 6oz and 21 inches. Jake is the … more
8/15/12 03:15 PM | 1894 views
Katie and Chris Tomlinson of Rumford,RI are happy to announce the birth of their daughter Emily Lynn, born on June 21st at Women and Infants Hospital. She was 6lbs. 15oz and 21inches long. She was … more
7/26/12 10:26 AM | 2973 views


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essential oils...
About the forums, what they're for, how to make best use, and how to get started.
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essential oils...
...wouldn't want to live without basic 3: tea tree, lemon, and lavender...but as an aromatherapist, the fun is in discovering new blends. plants are amazing and I never stop learning from them!
Re: essential oils...
so with you on that... plants spark my spirit like not much else can!
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Actress Lindsay Lohan was arrested in the wee hours Wednesday morning for leaving the scene of an accident. Lilo is accused of clipping a pedestrian in New York, but claims she had no idea she had hit someone.
Officers told TMZ
that Lindsay was parking her Porsche Cayenne and driving at a very low
speed near the Dream Hotel downtown when she allegedly struck a man in
his 30s.
The "Liz & Dick" star parked and entered the hotel just after
midnight and when she emerged around 2:30 AM police arrested her.
The 26-year-old was booked at the station and released without having
to pay bail. The victim was taken to the hospital, but reportedly had
no visible injuries.
The incident could cause major trouble for the star, who is on
probation. Friends of Lindsay's told TMZ that she didn't realize she had
hit someone and feels she may be the victim of a setup. Surveillance
video of the accident shows Lindsay drive past the man very slowly, but
it is unclear whether she clipped him. Afterward, he sprinted after the
actress, but didn't approach her as she entered the hotel.
Meanwhile, she reportedly looked unaware of the run-in as she got out
of her car and headed into the hotel.
The tapes also show Lilo left the
location a few minutes later, but then returned a short while after
Early reports claimed that a passenger in Lohan's car got out to
inspect the damages, but sources told TMZ that it simply isn't true.
Lindsay, whose driving habits have been compared with Amanda Bynes'
in recent weeks, slammed law enforcement on Monday for going easy on
Amanda. She wrote, "Why did I get put in jail and a nickelodeon star has
had NO punishment(s) so far? +"
After the accident, reports claimed the former child star was headed
to rehab, but a source close to Lindsay said it was "untrue."
As Lohan's latest legal woes play out in NYC, Lifetime is shifting
the spotlight to the actress' latest TV movie, "Liz & Dick.
Source: extratv.com
Your number one source for the latest celebrity news.
Wednesday, September 19, 2012
Lindsay Lohan Arrested in NYC: New Detail
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Review of the book Portrait Of Vengeance by Carrie Stuart Parks
I just read the best book. It was about a girl named Gwen who is a forensic artist for a police office who gets descriptions of people and m...
I really enjoyed this book. The prince is a boy with down syndrome and how he protects his family when no one else could. I will be giving t...
Source: Just Jared


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I am decided. I will try to become fully the silent watcher, rebuffing the internal voices for thirty minutes a day, possibly for the rest of my life. If there are no objections today will be the dry run and tomorrow will be challenge day one.
Preparatory work day five(An Individual Blog Post)
by Will Lomers | May 29, 2015 | 30 Day Meditation & Breathwork Challenge 2015 | 0 comments


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Note : Your Quotation Request will be directed to Teledyne Relays.
The CCP-37S from Teledyne Relays is a RF Switch with Frequency DC to 3 GHz, Insertion Loss 0.2 dB, Isolation 70 dB, P1dB 43 dBm, P1dB 20 W. Tags: Multi Configuration. More details for CCP-37S can be seen below.
1 MHz to 6 GHz, SP4T, Absorptive RF Switch
You can now find similar products from multiple companies on everything RF.