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Teri Sernett stood frozen in fear in the living room of the east St. Paul home.
Her patient, an elderly quadriplegic man she had just met, gasped for air, his throat blocked and his eyes rolled back. Nothing in Sernett's one hour of training as a personal care attendant had prepared her for this.
Fearing the man was about to die, Sernett fumbled with a nearby suctioning machine. She had never used one, but she turned it on and inserted a long plastic tube deep into his throat.
"I was absolutely petrified," she said. "I had a man's life in my hands and had no idea of what to do."
Each day, thousands of home-based caregivers such as Sernett are thrust into similar life-and-death situations with little training and virtually no direct supervision. They perform a dizzying array of complex medical tasks — from inserting feeding tubes and cleaning infections to monitoring intravenous fluids — that once were provided only in hospitals or nursing homes by medical professionals.
Many say they feel overwhelmed and unqualified as they struggle to help patients with serious illnesses and disabilities.
In Minnesota, where more than 100,000 care assistants serve some 36,000 vulnerable patients, all it takes to be certified as a home caregiver is a brief online quiz with questions such as, "When talking to a 911 operator, do not hang up. True or false?"
Of more than two dozen personal care attendants interviewed by the Star Tribune in the past two months, only one had received more than an hour's training from their agencies. Many said they appealed to their agencies for more training and oversight but were told that state payments were too low to cover the expense.
Isolated and left to fend for themselves, many home caregivers say they have no choice but to violate rules designed to protect vulnerable adults. In interviews, unlicensed personal care attendants said they routinely sterilize wounds, administer powerful prescription drugs and even inject medications into patients' veins — even though such tasks are prohibited under the state-funded personal care assistant program.
Often, their employers don't know the risks they undertake because the caregivers are largely unsupervised.
The same pattern plays out across the country. Despite a decade of explosive growth in the $95 billion home-health industry, which is swelling to meet the demands of an aging population, there are no federal standards for the training, credentials and supervision of personal care attendants.
In Minnesota, state law requires personal care agencies to check directly on patients and their caregivers every four months. But some agencies neglect that law, letting years go by before visiting patients, according to some caregivers and county officials.
Personal care agencies are also required by law to employ a "qualified professional," such as a registered nurse or licensed social worker, who can train and oversee caregivers.
But at larger agencies, these professionals sometimes oversee hundreds of patients, and their house visits often amount to cursory scans of patient care plans, caregivers say.
The Minnesota Department of Human Services, which oversees care for vulnerable populations, has one full-time staff member on its home care team dedicated to service quality, including patient safety, to oversee hundreds of care agencies.
This person is supported by six other staff who do ongoing quality reviews.
When mistakes happen, complaints to state and county agencies sometimes go unreported or unheeded, enabling negligent caregivers to avoid sanctions while moving from one home-health agency to the next, say county officials and caregivers.
"It's like we don't exist," said Jennie Pechia, a personal care assistant from Cambridge. "You can be in a patient's home for a year, providing life-and-death medical care, before a nurse even pops in to check on you."
Now, to the dismay of some patient care advocates, the state is proposing changes that could loosen its already limited oversight of the state's massive personal care assistant program, which last year cost Minnesota more than $600 million.
"We, as a society, have really dropped the ball," said Lance Hegland, who has muscular dystrophy and is co-chairman of a state council for monitoring care for people with disabilities. "We have asked people to care for their loved ones in their own homes but haven't given them the skills and the resources to accomplish that with dignity."
'Stuck in the middle'
For years, state lawmakers and local officials have voiced concerns about the lack of oversight. In one review of the system, the legislative auditor found that just 57 percent of patients received the visits from qualified professionals required by state law. Even when the required visits occur, the auditor found, the actual supervision was modest. One-third of those who qualified for professional supervision received less than half an hour per month, the auditor found.
The result is that many caregivers rely on ailing clients for instructions, even though the clients can have disabilities that make it difficult for them to speak.
Some caregivers around the state say they often feel pressured to perform complicated procedures, such as injecting drugs and cleaning surgical wounds, even though such tasks are considered skilled nursing care and are not allowed for a personal care assistant under the state program.
"If someone needs an injection of insulin or a painkiller, you can't always say, 'No,' or , 'Just wait for a professional,' " said Shawntel Harry, a home caregiver from St. Paul's East Side. "You give it to them or they suffer or they die. That's the situation we're left in day after day."
To technically comply with state Medicaid rules, some caregivers say they administer drugs to people with disabilities by placing the pills in a patient's hand and then lifting the hand to the patient's mouth.
Melva Munoz, a personal care assistant from Hopkins, said she was encouraged by her former employer to use this technique, known as "hand-over-hand" assistance, to give painkillers and other drugs to patients when a nurse was not available.
"The agencies don't want to pay for the professionals, but they also want to cover their own tails," Munoz said. "The caregiver is stuck in the middle."
Oversight lacking
Home care agencies say state rules actually discourage more active supervision by medical professionals.
Patients are allotted up to 24 hours of worker supervision and training annually from a licensed professional under the state personal care assistance program. To qualify for more time, providers must show that the worker needs more supervision or training — a process that is time-consuming and often fruitless, providers say.
"Lack of supervision is the elephant in the living room," said Shelly Elkington, owner of Avenues for Care, a personal care agency based in Montevideo. "There needs to be more eyes and ears in people's homes … but no one wants to pay for it."
State authorities have resisted periodic efforts to expand regulation by licensing personal care agencies and their workers. Reformers proposed licensing in 1991, and again in 1997, when the program was about a third its current size. But the high cost of implementing the reforms proved an insurmountable barrier; legislators never appropriated funds so no action took effect.
The result is that unlicensed personal care assistants are not subject to the same routine inspections as nursing homes, assisted-living centers and other state-licensed facilities. Patients and relatives who complain about negligent or abusive care find themselves referred to county governments, which say they lack the resources to investigate home-care agencies.
Jerry Kerber, inspector general for the Department of Human Services, said the state-funded personal care program was "always intended to be more of an informal kind of service."
"You could put more heavy regulation over the top of it, but then you'd take away some of that consumer direction, some of that flexibility that comes with it," Kerber said. "There is a balance there."
Neglect and a death
With home caregivers asked to perform more complex and risky tasks, the absence of training and supervision has sometimes led to fatal results.
Lisa Lassen is still haunted by the pained cries of her father, as an infection from a foot wound spread through his body, consuming his organs. "I will never forget his moaning and yelling for as long as I live," Lassen said.
The worst part, said Lassen, is living with the belief that his death two years ago was "completely avoidable.''
Her father, Kenneth Ell, a retired railroad worker with diabetes and early dementia, developed a foot infection soon after entering St. John Home Care, a small group home that employed personal care attendants. The Ell family chose the home, in a neighborhood of Minnetonka, in part because it seemed more intimate than a nursing facility and advertised "specialized diabetic care" and "wound and foot care" on its website.
In sworn testimony, a former personal care attendant at the home described a chaotic atmosphere. The caregiver, Jessica Crawford, said she watched as a staff member reused hypodermic needles for injecting insulin into diabetic residents, and said her training consisted of being told to watch some videos. The group home's owner, a nurse, visited "maybe once in a blue moon," she said.
"Most of the employees didn't know what they were doing or didn't carry through with their jobs correctly," Crawford, who no longer works at the home, said in sworn testimony.
Lassen said staff failed to detect obvious signs that her father had a serious infection. He had difficulty walking, complained of foot pain and became increasingly lethargic, Lassen said. When a laboratory report revealed that Ell had an elevated white blood cell count, indicating an infection, she said three-and-a-half days passed before the staff sent the lab report to a physician's clinic.
By the time Ell was admitted to a hospital, it was too late. The infection had spread so rapidly that, after his lower right leg was amputated, he died of multi-system organ failure. His 89-year-old mother was so overcome with grief that she threw herself on his lifeless body as it lay sprawled on the hospital bed.
The Minnesota Department of Health investigated Ell's death last year and found that the group home had failed to appropriately treat the client's diabetes and follow up on the lab report. The facility was cited for neglect.
"It makes me so incredibly mad," said Lassen, who lives in Grand Rapids, Minn., and coordinates a day program for children with developmental disabilities. "I believe 100 percent that my father would still be alive today had he been treated by licensed and trained professionals."
Mopelola Akinloye, owner of St. John Home, did not return repeated calls from the Star Tribune seeking comment on the case and the state's findings about it. However, in court documents, Akinloye and the group home referred to the allegation that Ell received care from incompetent staff as "baseless."
It argued that, during Ell's stay, St. John Home employed two nurses and several nurses' aides, and that all of the staff were trained. Akinloye, a registered nurse, said in sworn testimony that she looked at Ell's foot every day and notified his physician when he complained of foot pain. A nurse at the facility also denied in sworn testimony that she reused needles to administer insulin to Ell or any other patient at the home. In court documents, Akinloye and the home also argue that Ell's death may have been caused by conditions predating his foot infection. At the time of Ell's admission to the home, he was diagnosed with chronic heart failure and kidney disease, among other ailments. A day before Ell's death, a doctor who cared for Ell wrote on medical notes that he could not determine the cause of his infection.
Workload more demanding
The type of work demanded of home caregivers has changed dramatically in the past two decades.
Hospitals, under pressure from insurance companies to reduce costs, are releasing more patients while they are still sick or recovering, effectively shifting the burden of medical care to the home. Caregivers have had to master the operation of respiratory ventilators, intravenous feeding tubes and home dialysis, while responding to medical complications such as wound infections and low oxygen levels.
More than 80 percent of home caregivers provide nursing care, while more than 50 percent provide help with highly complex medical tasks, according to a survey of 1,926 home care workers who cared for adult Medicaid recipients in three states.
"The burdens placed on [home caregivers] have never been greater," said Dr. Kevin Mahoney, director of the National Resource Center for Participant-Directed Services at Boston College.
Between medical tasks, caregivers are often expected to do laundry, cook meals and perform other household chores for their clients. In Minnesota, attendants providing overnight care describe sleeping on living-room floors with air mattresses because no spare bed is available, and getting phone calls at all hours of the day from clients who need advice or just someone to talk to.
Job takes physical toll
On a hot July afternoon, sweat poured down Debra Howze's face as the personal care attendant rushed from one errand to the next. Between house visits, Howze picked up prescription drugs for a client at a pharmacy and did two loads of wash at a laundromat, carting a client's dirty clothing in the back seat of her car. "I could make the same money waitressing and not have to put up with all this," Howze, of north Minneapolis, said as she stopped at a CVS Pharmacy drive-through window. "Everything is hurry, hurry, hurry."
The work is also physically demanding, as many caregivers must push, pull and lift disabled patients on a daily basis. In 2012, the average home health aide missed 14 days of work from injuries and illnesses, 55 percent more than all occupations nationally, according to the Bureau of Labor Statistics. Their median wage: $10 an hour.
For some personal care attendants, the strain can be too much.
Mona Ali of Burnsville, a personal care attendant, said she was asked to care for an elderly woman who depended on a ventilator machine and an intravenous feeding tube. Ali said she received no training on the equipment before being sent to the woman's home. Instead, a nurse with her personal care agency left a handwritten note at the foot of the patient's bed, instructing Ali to change the IV bag every two hours.
And if the red light on the ventilator stopped blinking? Call 911.
"I kept thinking, 'What if I end up killing this person?' " Ali said. "I could not understand why this woman was not receiving care from a skilled nurse."
Sernett said she has not seen a licensed supervisor in more than four years working as a personal care attendant for a severely disabled client. Yet Sernett, 50, performs a wide range of complicated medical tasks that, if not done correctly, could prove fatal.
On a recent weekday morning her client, Gary Jarvis, a 67-year-old former truck driver and stroke victim, had just awakened and was gagging on the mucus that had collected in his throat overnight. His face had turned red and the veins on his neck bulged as he gasped for air.
Calmly, Sernett inserted a clear plastic tube into his tracheostomy, a permanent opening in his neck connected to a respirator, and drained the excess phlegm. Moments later, she rolled his 190-pound body over so she could wipe his bottom with sterile gloves and clean a reddened sore on his lower back. Then she injected a syringe full of pink Milk of Magnesia into the feeding tube attached to his intestines.
For these and countless other tasks, Sernett said she received "absolutely no training" from the home care agency that employs her. Sernett said she learned how to suction a tracheostomy and administer a feeding tube from the patient's wife, Linda Jarvis, 66, who has no formal medical training and learned how to perform the tasks only by watching the hospital nurses who treated her husband after his stroke 14 years ago.
"This ought to be illegal," Sernett said, as she cleaned the skin around the man's feeding tube with a cotton swab and a washcloth. "I find it completely outrageous that a man's life rests in the hands of people who are completely unsupervised and untrained."
The living room of the couple's East St. Paul home resembles an emergency room, with piles of sterile bandages and more than $50,000 in medical equipment surrounding a hospital-style bed. There are only a few signs of the comforts of home: a wooden crucifix above his bed, a collection of model trucks, and the faint sound of country music from a nearby stereo.
Six months from now, Sernett will no longer be able to care for Jarvis after five years. She will graduate from nursing school and Medical Assistance will no longer pay for her services. "I really love Gary, so it makes me so sad that I can't stay with him as a nurse," said Sernett, her eyes tearing up. "He should be getting skilled nursing care every day because his needs are so technical."
Empowering consumers
Soon, families across Minnesota who depend on personal care assistance could have more control over their own home care and how state funds are spent. Like other states, Minnesota is shifting to a new, "consumer-directed" model of care that would give patients the authority to hire and fire their own personal care assistants and to pay them directly. Instead of relying on the state to pay caregivers, participants could receive monthly cash grants to spend as they see fit on home care.
Families who highly value a caregiver could encourage the person to stay by paying more than the $9 to $10 an hour now offered by many home health companies. Others could use the cash grants to pay for equipment, such as grab bars in bathrooms, which would enable them to live more comfortably at home.
The proposed changes, which must still be approved by federal authorities, could also greatly reduce financial waste. Currently, hundreds of individual home care agencies handle their own payroll and taxes, even though many of the agencies employ just a few caregivers. In the future, people could bypass the agencies and these administrative tasks would be handled by several large state contractors. The resulting savings from consolidating overhead costs likely would free more money for patient care, some disability advocates say.
"This is about consumer empowerment," said Steve Larson, senior policy director for Arc of Minnesota, which serves people with developmental disabilities. "We really feel that quality will improve and people's lives will be better if they have more control over their own care."
Still, some county officials and providers worry that the new program will end the requirement that patients receive home visits by a nurse or other qualified professional. In many cases, these visits are the only professional help that a caregiver receives — and one of the few ways for a provider to know if an elderly or disabled client is receiving adequate care, say county officials.
To Lassen, the balance already has shifted too far away from clear government oversight. During a recent trip to her father's grave in Aberdeen, S.D., with her 4-year-old son, Joel, Lassen said she is still tortured by guilt over his death.
She regrets not asking more questions when she discovered her father alone and disheveled in the dark basement of the group home. She regrets not asking staff why no one had shaved or showered him for what seemed like days; and why he grimaced in pain as he walked to the dinner table to eat the banana cream pie she brought for him.
As family surrounded the open casket at his funeral, Lassen slipped a small, handwritten note into the breast pocket of her father's suit. "I wanted him to know how sorry I was that he had to go through so much pain," said Lassen, as she wiped away tears. "My fear is that, if nothing changes, it will happen again to someone else."
Staff writer Glenn Howatt contributed to this report.
Twitter: @chrisserres


text:
A Niko-Niko Kasuri Child's Kimono: Toddler Size
December 22, 2012
This very wonderful, very worn, very small cotton kimono measures 21″ x 20″ or 53.25 cm x 50.75 cm. It dates from approximately the 1930s.
The kimono is hand stitched from a commercially produced kasuri or ikat cotton called Niko-Niko. This kind of faux-kasuri is really faux: the cloth was commercially printed to mimic the look of true kasuri cloth. This kind of cotton was very popular in Japan in the 1930s.
The image on this kimono is just charming. It seems that the cloth is imprinted with a repeating design of pigeons and chrysanthemums. The scale of the print in proportion to the very small kimono is delightful to see.
The collar area and a patch on the back of this tiny robe are of actual, hand woven kasuri cotton, and this contrast is very subtle and beautiful.
Seeing this very small kimono in person is endearing: it is so small, it is so well-worn, it is so shabby that we know that the child who wore this kimono was certainly not of means. We can also speculate that the child had few other garments, if any.
A really charming piece of children's clothing from old Japan.
In: Tags: kasuri - Comments closed

subset: commoncrawl


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The big day has arrived – we're here in New York City and elsewhere around the world to officially launch BlackBerry 10! You've had sneak peeks, glimpses into the functionality, and preview demonstrations, but today we launch the full package. It's my pleasure to introduce you to the first two BlackBerry 10 smartphones, the BlackBerry Z10 and the BlackBerry Q10.
[ YouTube link for mobile viewing ]
The BlackBerry 10 platform is designed to enable you to be successful in your work. The barriers between applications that slow you down have been removed, allowing you to flow through your apps, information, and communication with speed. And while you're at it, the platform learns how you work to intelligently filter, prioritize, organize, and predict what you need. Communicate your ideas and experiences rapidly, and rest easy with the peace of mind that BlackBerry security gives you.
The new BlackBerry 10 smartphones have been designed to connect you to those around you and to allow you to truly take your work and personal life mobile. We're very excited to unveil what we've been working on and to provide all of the details from our launch events around the world.
Check out the videos below to learn more about the BlackBerry Z10 and BlackBerry Q10 smartphones:
[ YouTube link for mobile viewing ]
[ YouTube link for mobile viewing ]
We've got a lot more to say about BlackBerry 10 and the features, apps, and value that it adds to your business. Stay tuned to the Inside BlackBerry for Business Blog for details on top business apps, accessories for life on the move, the re-designed Documents To Go, exciting new features of BlackBerry Messenger, and more.
Can't wait to get your hands on a BlackBerry Z10 or BlackBerry Q10 smartphone? Tell us why in the comments!


text:
It took me a long time to get to Heaven "˜n Eggs, an all day breakfast place that everyone had been either telling or asking me about. I did make it to their first branch in Tomas Morato way back in May, but was unable to eat there when the server told me, "Ma'am, you're next behind a party of 30. Would you mind waiting?"
That I did, but I don't mind driving the distance when it comes to food, and I was planning on going back anyway. So it was a nice surprise when Heaven n' Eggs opened up a branch in Glorietta. Since weekends are all about heavy breakfasts and eating things I don't normally get to eat during the week, I hied over there on a Saturday morning with my Bin and Boo. We got there just a little after 9 and soon, there was a waiting line.
This is a place where the seats are swings and the servers wear wings. (Huh, say that again?) Seriously, it takes some getting used to "" the seats in the middle are swings which really sway back and forth. There are "more normal" tables and chairs along the sides and towards the back of the restaurant. The servers, both men and women, wear t-shirts in an adorable sky blue with the words, "˜I am your angel' on the front, and white tulle wings pinned at the back. Cute, not kitschy. The restaurant itself is done up in yellow light, all luminous and bright. It really looks and feels like a fine day in there.
Of course I just had to snag a table with a swing, so taken was I with its uniqueness. The table is a bit far from the swing, so I had to pull the table closer to me, which was great for me, but inconvenient for my Bin. We ended up having a semi tug-of-war with our little table. Boo gave up on the swing and opted for a high chair.
Of course after you're done taking in the ambience, you zero in on the food. The usual suspects include pancakes, waffles, and eggs, which you can have done six ways: scrambled, egg white omelet, sunny-side up, over-easy, poached, and baked. There are soups, pasta dishes, salads, sandwiches, and Filipino rice dishes, of which the Angus Tapa and Eggs is supremely popular. Heavier dishes include pork chops and eggs, and steak with eggs. There's also a complete line of coffee and tea drinks, soft drinks, milkshakes, and flavored sodas (P50-P65), which come from a true-blue soda fountain machine.
I'm a sucker for eggs Benedict, so I ordered the Bagel Benedict (P175): cream cheese smeared on a garlic bagel topped with a thick slice of ham and a poached egg slathered with Hollandaise sauce. I was incredibly happy with it, although I had to laugh at the wedge of orange that came with it. It almost seemed like an after thought that proceeds the ingestion of all that fat; my "healthy food for the day," if you will. (Think: munching on a 1-pound bag of M&M's and washing it down with a Coke Light).
We also ordered classic waffles (P90), which looked a bit lonely: just a scoop of whipped butter sitting in the middle. But the waffles were good "" somewhat soft with just a hint of crunch. (I don't like crunchy waffles). Heaven "˜n Eggs believes in choices, which is always laudable in my book, hence, four kinds of syrup to go with your food: coconut, peach, pineapple, and ever-reliable maple. There's also a small container of blueberry preserves. I particularly liked the coconut syrup — I'm one of those coconut-loving people, but if you think coconut has a texture similar to day-old cuticles, then leave it alone.
A good breakfast is never complete without a steaming cuppa hot choco. Heaven "˜ Eggs offers the native tsokolate, which wasn't available when I was around, so I settled for the Cloud 9 (P65). Smooth and sweet, it goes down the hatch very well, and the generous dollop of whipped cream helps it along beautifully.
My Bin and Boo shared the Manila spare ribs with java rice, a thick hunk of pork heavily glazed with BBQ sauce. Delicious it was, save for the layer of thick fat which was sliced off easily enough.
This may be the first and last time I will ever finish a meal by swaying back and forth on a swing. As I sat there rocking gently watching my Bin and Boo arguing over the last two spoonfuls of java rice, I patted my stomach and thought, "Yeah, heaven could be a lot like this."
Heaven "˜n Eggs
last updated April 27, 2006
G/F CKB Bldg.
Tomas Morato corner Sct. Rallos
Quezon City
1/F Glorietta 4
Ayala Center, Makati
Open 7 am "" 12 midnight
1/F Market! Market!
Taguig, Metro Manila


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Cape May
What you need to know before you go
Cape May is for the seafood lovers and the fishermen, the nature tourists, and the beachcombers. The surrounding waters are peppered with pods of dolphins and humpback whales. Oyster bars as well as fish fries and American surf and turf all hide behind stately Georgian verandas and the town's Victorian façades.
That's all balanced by the indelible natural side of things. You'll spy out rare migrating species in the Bird Observatory, feel the Atlantic salt-spray on the city beaches, sample organic wines in Willow Creek, and hit the dunes and wetlands of Cape May Point State Park.
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- McAlester, OK - 74501
- Tahlequah, OK - 74464
- Bixby, OK - 74008
- Siloam Springs, AR - 72761
- Collinsville, OK - 74021
- Jenks, OK - 74037
- Okmulgee, OK - 74447
- Pryor, OK - 74361
- Greenwood, AR - 72936
- Sallisaw, OK - 74955
- Coweta, OK - 74429
- Wagoner, OK - 74467
- Skiatook, OK - 74070
- Alma, AR - 72921
- Stilwell, OK - 74960
- Muldrow, OK - 74948
- Lowell, AR - 72745
- Glenpool, OK - 74033
- Poteau, OK - 74953
- Centerton, AR - 72719
- Henryetta, OK - 74437
- Checotah, OK - 74426
- Fort Gibson, OK - 74434
- Eufaula, OK - 74432
- Booneville, AR - 72927
- Catoosa, OK - 74015
- Prairie Grove, AR - 72753
- Farmington, AR - 72730
- Mounds, OK - 74047
- Waldron, AR - 72958
- Gentry, AR - 72734
- Stigler, OK - 74462
- Inola, OK - 74036
- Locust Grove, OK - 74352
- West Fork, AR - 72774
- Spiro, OK - 74959
- Wilburton, OK - 74578
- Elkins, AR - 72727
- Heavener, OK - 74937
- Lavaca, AR - 72941
- Colcord, OK - 74338
- Hulbert, OK - 74441
- Sperry, OK - 74073
- Lincoln, AR - 72744
- Haskell, OK - 74436
- Westville, OK - 74965
- Chouteau, OK - 74337
- Salina, OK - 74365
- Barling, AR - 72923


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text:
Grapeape02 necesitaba un nuevo diseño de logotipo y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 36 diseños de 13 diseñadores freelance.
ManageLife (site) and ManageMoney (First Product)
We are an established service based company launching a new venture - a series of boxed DVD training products available for purchase online and in retail stores. The website name will be ManageLife.com.au and our first training product, an 8 DVD set training package will be ManageMoney. After ManageMoney we will launch ManageProperty, ManageRelationships, ManageStress, ManageHealth - etc.
25-55 year olds seeking to improve their lifestyle, financial position and health. It is a very successful existing market. We are seeking to find a place among other successful competitors in the field.
We are seeking two very similar logo's - ManageLife (for the website) and ManageMoney (first DVD product). We believe the 'Manage' piece of the logo should remain constant with the 'Life' and 'Money' piece changing to suit the product (and perhaps employing a small associative image?)
The bold logos need to convey a quality, contemporary educational product.
The successful designer will have the opportunity to provide artwork for the DVD the DVD outer retail box (slicks) and the website among other promotional products. It would be highly regarded if some initial feedback is given on these items.
We require the logos on both lighter and darker backgrounds.
There are no pre-existing materials.
Descubre cómo funciona un concurso de diseño u obtén más información sobre nuestros servicios de diseño de logo.


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U.S. economy added 165K jobs in April
(MoneyWatch) It could've been worse. The Labor Department said Friday that employers added 165,000 jobs in April, topping last month's weak labor growth although still short of the kind of expansion required to quickly reduce unemployment.
The unemployment rate ticked down to 7.5 percent, from 7.6 percent the previous month, and is now at a four-year low. The government also revised upward job numbers for the previous two months, putting the payroll gain at 138,000 for March and 332,000 for February.
Although the number of Americans who are out of work remained at 11.7 million, a mark of the stubbornly slow recovery since the recession officially ended in mid-2009, unemployment has fallen by 673,000 since January.
The firmer labor market, which topped consensus economic forecasts for April of 140,000 new jobs, will allay some fears that the economy was set to nosedive. Investors also appeared cheered by the news, sending stocks into record territory.
"All things considered, 165,000 isn't the biggest monthly gain in payrolls you'll every see, but it's enough to assuage concerns that the economy had stalled again," said Paul Ashworth, chief U.S. economist with Capital Economics, in a research note.
After picking up in the third quarter of last year, economic growth has weakened in recent months. Gross domestic product -- the value of all goods and services produced in the U.S. -- fell
to 0.4 percent in the fourth quarter of 2012, down from 3.1 percent in
the third quarter.
The economy has continued to leak air this year.
Growth in the January-to-April period was 2.5 percent, below consensus forecasts that had predicted at least 3 percent growth.
The biggest restraint on growth is largely self-inflicted -- namely, the massive government spending cuts that took effect in March after Congress failed to reach a fiscal deal and a January hike in payroll taxes. Only the twin engines of housing, as home prices continue to rebound, and consumer spending have kept the recovery trudging forward. Most economists now expect overall growth for the year of 2 percent to 2.5 percent.
As the economy faltered, so has job-creation. Even with the upward revision, the number of jobs hatched in March was below the average gains of 236,000 new positions in the previous three months. The new labor data also show a significant drop in the average number of hours employees work each week, to 34.4 hours. That is a sign of weakening demand and could make employers reluctant to hire.
Other recent data have pointed to a slowdown, or "spring swoon," as some experts have dubbed the seasonal slump that has dogged the recovery over the last three years. U.S. manufacturers sharply reduced their hiring last month amid softening demand for goods, industry figures show.
- Lack of jobs pushes 4.4 million out of work force
- U.S. economic growth disappoints
- Are the U.S. and European economies decoupling?
More worrying, in an economy where roughly 70 percent of economy activity is driven by consumer spending, is that Americans may be feeling the pinch of higher payroll taxes and are starting to count their pennies. Total consumer spending in the first quarter rose a robust 3.2 percent, but it fell significantly in March from the previous month.
Major economies around the globe also are losing steam, creating a further drag on growth in the U.S. Demand in China is weakening, business surveys showed this week. Europe, a major trading partner for the U.S., faces a deepening depression. Unemployment in the region has hit a record 12.1 percent, with "core" eurozone economies like Germany and France feeling the effects of the downturn.
The economic news isn't all grim. Healthy consumption has boosted key sectors. Retailers added 29,000 jobs in April, while leisure companies grew by 43,000, the Labor Department said. The number of Americans applying for jobless benefits also has fallen to a five-year low, while unemployment is receding in most larger U.S. cities. Inflation remains tame. A boom in oil production also bodes well for energy prices.
In another sign that could be a prelude to stronger hiring, growth in worker productivity -- a measure of how much work employees do per hour -- slowed in the first quarter. That's a good sign. If the economy were to strengthen in the months ahead, that could spur employers to bring in more workers to handle the stronger demand.
"We're making slow and steady progress, with the emphasis on slow," said Ed Yardeni, head of institutional investor advisory Yardeni Research. "It's frustrating, and it must be frustrating for the Fed.... housing is OK and consumers are spending, but the economy is growing at a subpar pace."
The Federal Reserve said Wednesday that the job market has shown "some improvement" in recent months, while acknowledging that unemployment remains high.
Winding up two days of meetings this week, the central bank showed no indications that is planning to curb its policy of "quantitative easing," or large purchases of Treasury and mortgage bonds, anytime soon. The Fed said it expects economic activity to proceed at a moderate pace for now and for the jobless rate to decline gradually.
As it has underlined in previous months, the Fed said it is prepared to either step up or reduce its bond purchases as economic conditions warrant. Some experts think the Fed will begin withdrawing this stimulus by year-end.
"We continue to expect that officials will start to scale down net purchases later this year, although growth will have to start improving again first -- helped by the ongoing easing of financial conditions and some fading of fiscal drag in the second half of the year," said Jim O'Sullivan, chief U.S. economist with High Frequency Economics, in a research note before the release of the latest job numbers. "For now, officials are highlighting the possibility that purchases could be scaled up as well as down."
As Fed officials have repeatedly emphasized, however, and as history has shown, monetary policy alone can't restore the economy. As the feeblest recovery in U.S. history slogs into its fourth year, Congress must take the lead.


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Please note: if you require a transfer from / to the airport, then a valid mobile telephone number and flight arrival time / details are required at the time of booking. If these details are not advised the transfer cannot be arranged.


text:
- Vintage-inspired top
- Beautiful delicate floral cram and blush print
- Pretty little buttons and lace
- Great length
- Relaxed loose fit
- True to size
- Material: Viscose
- Model: 170cm wears a size 8
Her Top Shop Returns/Exchange PolicyYou can return full priced items for Store Credit or Exchange within 14 days of purchase, on change of mind. Sale items can not be returned for exchange or store credit on change of mind.
Store credits valid for 12 months.
No refund on change of mind.
How to Make a ReturnPlease email email@example.com the details and reason for return.Post your item to 295 Flinders Street, Townsville City, QLD, 4810You will be responsible for paying for your own shipping costs for returning your item, shipping costs are non-refundable
Her Top Shop will accept a return if the item is:Sent back within 14 days of receiving your parcel. Item MUST be new and unworn with all original tags attached, does not have make-up, tan marks, smell of perfume, deodorant or washing powder.
Additional non-returnable items:Gift cards
Please Note: In compliance with Australian Consumer Law, HER TOP SHOP is not required to provide a refund or exchange if you make a wrong selection, need a different size or change your mind. This includes payments made via ZIPPAY and AFTERPAY. We will inspect all return items upon receipt and returns which fail to comply with the above will be sent back.Her Top Shop Shipping RatesFree standard shipping on orders over $100Standard shipping $10.00 (5-7 business days)Express shipping $15.00 (1-3 business days)


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Gov. Jerry Brown announced his spending plan Monday, calling for $12.5 billion in spending reductions to address California's $28 billion deficit.
"These cuts will be painful, requiring sacrifice from every sector of the state, but we have no choice," Brown said in a statement posted on his website. "For 10 years, we've had budget gimmicks and tricks that pushed us deep into debt. We must now return California to fiscal responsibility and get our state on the road to economic recovery and job growth"
As for revenue, his proposal calls for an election in June. Voters will be asked to continue income and sales taxes, and the Vehicle License Fee rate for five years.
U.S. & World
Money from the sales tax and vehicle license fee will be given to local governments, Brown said.
Department of Finance: Governor's Budget
- K-12 will be spared from cuts, according to a statement from the governor's office.
- $12.5 billion in spending reductions, including $1.7 billion to Medi-Cal, $1.5 billion to California's welfare-to-work program, $750 million to the Department of Developmental Services, $500 million to the University of California, $500 million to California State University, and $308 million for a 10 percent reduction in take-home pay for state employees not currently covered under collective bargaining
- Brown has said he will seek to fundamentally restructure state government, shifting a host of responsibilities from the state to counties and cities.
- He wants to cut staff in state agencies and streamline government, starting with his own office, where he said Friday he was eliminating cabinet secretaries, closing offices and cutting communications staff.
- He will ask voters to extend temporary increases to income, sales and vehicle taxes to help fill the gap.
Just two years ago, voters rejected an extension of the taxes as part of a package of ballot measures promoted by Gov. Arnold Schwarzenegger and lawmakers.
"Without decisive action, the state's severe budget problems will persist, threatening economic recovery, job growth, public education and the quality of life in California," Brown said. "The adoption of this budget will position the state to lead the country as it slowly recovers from the Great Recession."
Brown said during his campaign he would not raise taxes without voter approval, which will be sought in the June election.
The plan requires support from Republicans, and it also assumes the state Legislature would pass a spending plan by March. Recent budget debates that have continued into the fall.


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Law Faculty
Pamela Frasch
Associate Dean of the Animal Law Program and Founder of the Center for Animal Law Studies
- Nina Johnson
Erskine B. Wood Hall
Ms. Frasch is Associate Dean of the Animal Law Program and Founder of the Center for Animal Law Studies (CALS). CALS is an academic animal law program with a focus on research, scholarship, and experiential education. CALS is dedicated to:
- Training law students and lawyers for careers as leaders in Animal Law and public policy;
- Conducting, supporting, and promoting rigorous, independent legal research that advances the field of Animal Law; and
- Developing innovative recommendations and legal strategies relating to Animal Law within administrative, legislative, litigation and other settings.
Previously, Ms. Frasch served as general counsel for the Animal Legal Defense Fund (ALDF), a national nonprofit animal protection law organization that seeks to protect the lives and advance the interests of animals through the legal system. In 1996, Ms. Frasch created the ALDF Criminal Justice Program which has since assisted law enforcement and animal advocates in investigating and prosecuting thousands of animal abuse and neglect cases nationwide.
In addition to her duties with CALS, Ms. Frasch is co-author of the premier American legal casebook in the field, Animal Law: Cases and Materials now in its fourth edition (Carolina Academic Press, 2010) and used in most animal law courses being taught in the United States. She is also co-author, with Professor Kathy Hessler among others, of Animal Law in a Nutshell (Thomson West, 2011). She has taught survey and advanced courses in animal law at Lewis & Clark Law School since 1998.
Ms. Frasch is a frequent speaker and guest lecturer on issues of animal law and is the principal author of Oregon's first felony anti-cruelty law. She has authored or co-authored a number of articles and book chapters in the field, and has been recognized by the Humane Society of the United States and the Oregon Humane Society for her contributions.
Prior to focusing her practice on animal law, Ms. Frasch specialized in labor and employment law at Littler Mendelson and Hanson, Bridgett, in San Francisco and employee benefits law at Stoel Rives in Portland, Oregon. She is a member of the California and Oregon State Bars.
Specialty Areas & Course Descriptions
- Animal Law Fundamentals
- Companion Animal Law
- Advanced Animal Law Seminar
- Center for Animal Law Studies (CALS)
- Food Law
Academic Credentials
- JD, 1984, William Mitchell College of Law
- BA, 1980, University of Minnesota
Separately Published Works
- ANIMAL LAW IN A NUTSHELL (Thomson West, 2011) (co-authored with Professor Kathy Hessler, Sonia S. Waisman and Sarah Kutil).
- ANIMAL LAW, CASES AND MATERIALS (Carolina Academic Press, 4th Ed., 2010) (co-authored with Sonia S. Waisman and Bruce A. Wagman).
- ANIMAL LAW (Carolina Academic Press, 2000) (co-authored with Sonia S. Waisman, Bruce A. Wagman and Scott Beckstead).
Works Published as Part of a Collection
- The Future of Animal Law: Moving Beyond Preaching to the Choir, 60 J. LEGAL ED. 209 (2010) (co-authored with Megan Senatori).
The Unequal Treatment of Animals by Species and Practice in the United States: A Moral and Legal Dilemma(with Dr. Hollie Lund), published in:
- L'animal Dans la Spirale des Besoins de L'humain, (in French) (M. Lachance (dir.)), Cowansville, Éditions Yvon Blais, 2010, p.15.
- Revista Brasileira de Direito Animal (in Portuguese) (Heron José de Santana Gordilo, Luciano Rocha Santana, Tagore Trajano de Almeida Silva, Coordenação) Ano 4, Número 5, 2010, p. 11.
- Crime, Restoration and Responsibility, Research Project Report No. 185, Chiba University Graduate School of Humanities and Social Sciences (in Japanese) (From the proceedings of the Japanese Association of Legal Philosophy) (I. Shimazu, ed.) 2010, p. 45.
- Criminal Law, in LITIGATING ANIMAL LAW DISPUTES (ABA Publishing, J. Schaffner and J. Fershtman, eds.) (2009) (co-authored with Dana Campbell).
- The Impact of Improved Anti-Cruelty Laws in the Investigation, Prosecution and Sentencing of Abusers, in THE INTERNATIONAL HANDBOOK OF THEORY, RESEARCH AND APPLICATION ON ANIMAL ABUSE AND CRUELTY (Purdue University Press, F. Ascione, ed.) (2008).
- Addressing Animal Abuse: The Complementary Roles of Religion, Secular Ethics and the Law, 8 JOURNAL OF ANIMAL-HUMAN STUDIES 311 (2000).
- Recognizing, Investigating and Prosecuting Animal Cruelty, in GUIDEBOOK FOR VETERINARIANS (American Humane Association (2000)).
- State Animal Anti-Cruelty Statutes: An Overview, 5 ANIMAL L. 69 (1999) (co-authored with Stephan K. Otto, Kristen M. Olsen, Paul A. Ernest).


text:
In this topic, you'll find
strategies for quitting smoking and staying smoke-free. Find where you want to
go now:
Maybe you have already
taken your last puff or are ready to quit today. That's
great. This information will help you keep your resolve to kick the habit
for good.
Or maybe you want to plan ahead
before you quit. How ready are you to quit? To find out, use the
Interactive Tool: Are You Ready to Quit Smoking?
It's okay if you aren't ready now. But you may
want to quit at some point. So keep learning and preparing yourself. Many
smokers do quit. You can too.
Think about why you want to quit. Maybe you want to protect your heart and
your health and live longer. Or maybe you want to be a good role model for your
kids or spend your money on something besides cigarettes. Your reason for
wanting to change is important. If your reason comes from you—and not someone
else—it will be easier for you to try to quit for good.
Find out how smoking can affect you:
Quitting smoking is hard. Some people who have quit say that it was the hardest thing they have ever done. But many people like you have been able to quit smoking. And you don't have to do it alone. Ask your family, friends, and doctor to help you. Get what you need to help you quit for good.
After you quit, try not to smoke at all—not even one
puff. Prevent a slip (smoking one or two cigarettes) or relapse (returning to
regular smoking) by avoiding smoking triggers, at least at first. These
triggers can include alcohol and stress. Don't keep cigarettes in your house or
car. If you do slip, stay calm. Remind yourself that you have a
plan, and think about how hard you've worked to quit for good.
Quitting is hard because
your body depends on the nicotine in tobacco. Giving it up is more than
just kicking a bad habit. Your body has to stop
craving the nicotine. Nicotine gum, lozenges, patches,
and other medicines can help reduce the cravings without the harmful effects of
You also have to change
your habits. You may not even think about smoking. You just do it. You may
smoke when you are stressed. Or maybe you have a cigarette
with coffee. Before you quit, think of new ways to handle these things. For
example, call a friend or practice deep breathing when you feel stressed. Try
chewing sugarless gum instead of smoking. Go for a walk when you have a break
at work. Stay around nonsmokers.
You are likely to crave cigarettes and may feel grouchy, restless, or sad
for the first 2 to 3 weeks after you quit. It may be hard to focus on tasks.
Or you may have trouble sleeping and want to eat more. But you won't feel bad
forever, and medicine can help. Using medicines and products like nicotine gum
or patches can help with cravings and make it easier to resist smoking.
You may worry about gaining
weight after you stop smoking. Don't let this stop you. If you do gain weight, you can focus on losing it after you have successfully quit smoking.
You can take steps to
lower your chance of gaining weight:
Use quit-smoking medicines or nicotine replacement. They may make gaining weight less likely while you are quitting smoking.
Most people quit
and restart many times before they stop smoking for
good. If you start smoking again after you quit,
don't give up. Each time you quit, even if it is just for a short time, you get
closer to your long-term goal.
Remind yourself that by quitting
you may avoid serious health problems and live longer. Remember your reasons
for quitting. Maybe you want to protect your heart and your health and live
Each time you quit, you learn more about what helps and
what gets in the way. Think about why you started smoking again and about what you will do differently next time. If you tried to quit without medicines or a program,
think about trying them next time. Medicines and nicotine replacement (gum,
patches, lozenges) can double your chances of
success.1 And using medicines and counseling is even more effective. You can do it!
Deciding to quit:
How to quit:
Ongoing concerns:
Health Tools help you make wise health decisions or take action to improve your health.
Most people don't think about when
or why they smoke. They just do it. But knowing when and why you smoke can help
you choose the quitting strategy that is most likely to work. Perhaps you
Use this
form to find your reasons(What is a PDF document?) for smoking.
One Woman's Story:
"I went to nursing school, and
it [smoking] was the thing to do." Smoking helped relieve the stress.-Nancy, 54
Read more about Nancy and how she quit smoking.
children and teens use cigarettes, cigars, and smokeless tobacco because their
friends do. Movies and TV shows can make smoking seem attractive.
Teens, especially girls, often use smoking to try to control their
Teens may think that smoking is a way to look more mature,
independent, and self-confident to their peers. They may smoke to rebel against
their parents. But most teens do not know how addictive cigarettes are. If your child smokes, it might help to talk with him or her
about some of the
reasons to stop smoking. If you smoke or have quit,
talk with your teen about how hard it can be to quit after you've started
Children and teens are more likely to smoke if their
parents smoke. And they are more likely to quit if their parents quit.
When you're craving
tobacco, it's hard to focus on quitting. Preparing yourself before you quit can
help. Before you quit, get ready for a life without nicotine.
One Man's Story:
Planning was key to
John's success. "The [stop-smoking] class taught me how to get ready to quit."-John, 39
Read more about John and how he quit smoking.
What would
motivate you to quit smoking? Think about it. It's important to have your own
reasons for quitting.
Use this self-test to help you discover what
motivate you to quit smoking(What is a PDF document?).
healthy is a common reason to want to quit smoking. Or maybe you want to feel
more in control of your life, instead of feeling controlled by tobacco.
Teens may have other reasons to quit smoking.
Talk to your family and friends about quitting.
Their support might help you decide to quit.
What worries you about
smoking? Make a list. Talk about it with your doctor. You may worry about:
It was throat pain that helped
Nate give up smoking for good. Dealing with a sore throat all the time just
wasn't worth it anymore. "In the end, I made up my mind and quit."-Nate, 27
Read more about Nate and how he quit smoking.
What do you gain by
quitting? You can:
Possible roadblock
What you need to know
Cravings and
nicotine withdrawal.
Symptoms include feeling grouchy or depressed and having trouble sleeping or
Here are some things that can
Failure in the past
If you weren't able to quit in
the past, don't lose hope. Studies show that each time you try to quit, you
will be stronger and will have learned more about what helps and what makes it
Most people try to quit many times before they can quit for good.
Weight gain
You may gain some weight when
you stop smoking. Don't try to avoid this by going on a strict diet at the same
time. This will make it even harder to stop smoking.
You can take
steps to lower your chance of gaining weight:
Depression or nervousness
Medicines and counseling can
help treat nervousness or depression. Talk to your doctor.
Lack of support
Support can improve your
chances of quitting. Look for people who have stopped smoking, or seek out
those family and friends who support your goal to quit. Online and phone
support can also help:
Living with or being around
someone who smokes
It would be easier for you to
quit if those around you didn't smoke. Discuss quitting together. If this isn't an option, talk to the
person(s) about not smoking around you. When you can, avoid places where others are smoking.
If you enjoy smoking when you drink alcohol, you may need to give up alcohol when you quit smoking, at least for a while.
Stress can lead to smoking, but smoking doesn't really make stress go away.
To control stress, learn what
causes your stress and how to change the way you react. For suggestions, see the topic
Stress Management.
Missing your
smoking habits or not being able to avoid smoking
Assess your tobacco use(What is a PDF document?) to discover your smoking triggers. For some people,
morning coffee and going out with friends are common
smoking triggers.
Teen issues, such as fitting in
with the crowd and dealing with stress
Fresher-smelling clothes and
breath are just a few
reasons for teens to quit smoking. They may actually
improve their chances of fitting in. Also, feeling good physically may help
teens deal with stress in healthier ways than by smoking.
If you
have depression or
anxiety, talk to your doctor before you quit smoking. He or she may have helpful ideas on which medicines may work best for you to quit smoking.
Smoking can also affect the level of certain medicines in your
blood. If you take medicines for a health problem, talk with your doctor before
you quit smoking to see whether you should change the dose of any of your
When it comes to
quitting smoking, some people find it helpful to plan ahead. Others don't. Do
what works for you. If you are ready to quit right now,
see the section
Ready to Quit Today?
If you prefer to
plan ahead, start by asking yourself some questions. Are you a goal-setter? How
confident do you feel that you will succeed at giving up smoking? Asking
yourself these questions is one way to prepare yourself for quitting.
Your reason for wanting to
quit is important. Maybe you want to protect your heart and your health and
live longer. Or maybe you want to spend your money on something besides
cigarettes. If your reason comes from you—and not someone else—it will be
easier for you to try to quit for good.
After you know
your reasons for wanting to quit, use the U.S. Surgeon General's five keys to
quitting: get ready, get support, learn new skills and behaviors, get and use
medicine, and be prepared for relapse.
Contact your doctor or local health
department to learn about medicines and to find out what kinds of help are
available in your area for people who want to quit smoking. Telephone helplines operated by your state can also help you find information and support for
quitting smoking.
Check with your insurance provider to find out
if medicines and counseling are covered under your health plan. Your employer
may also help pay the cost of a quit-smoking program or provide help to pay for
medicines, even
over-the-counter ones.
Here are some
other ways to get ready to quit smoking:
You will have a better chance of quitting successfully
if you have help and support from your family, friends, and coworkers.
Others sources of support include:
You can also find online support along with
quit-smoking programs that you can attend. People who use telephone, group, or one-on-one
counseling are much more likely to stop smoking than people who try to quit on their own.
If a partner or friend is quitting, you can help.
Since you won't
be smoking, decide what you are going to do instead. Make a plan to:
The U.S. Food and Drug
Administration (FDA) has approved several medicines to help people quit
smoking. You will double your chances of quitting even
if medicine is the only treatment you use to quit. Your odds get even better
when you combine medicine and other quit strategies, such as
You won't have to take
medicines forever—just for as long as it takes to help you quit. Your employer
or health plan may help pay the cost of a quit-smoking program or provide help
to pay for medicines. And remember that no matter how much it costs to buy
medicines to help you stop smoking, it's still less than the
cost of smoking.
The first-choice
medicines are:2
Remember, taking
medicines and using telephone or in-person counseling or a quit-smoking program
at the same time greatly increases your chances of success.
Most people are not
successful the first few times they try to quit smoking. If you start smoking
again, don't feel bad about yourself. A slip or relapse is just a sign that you
need to change your approach to quitting. Make a list of things you learned. And think about when you want to try again, such as next week, next month, or
next spring. Or you don't have to wait. If you're still motivated to quit, you
can try again as soon as you want.
You might get some ideas for
things you can do differently by looking at "Prepare for roadblocks"
in the section
Thinking About Quitting? Maybe you can try something
new next time, such as a new medicine or program. You might try combining
tools, such as counseling and medicine. Keep trying, and don't be fooled into
thinking that smoking "light" cigarettes will help. They do not make smoking
If you slip or smoke a little, don't give up. Talk to someone who has quit smoking, or to a counselor, to get ideas of what to do. If you are taking medicine or using nicotine replacement, keep doing so unless you go back to regular smoking.
Quitting smoking is hard, but it
can be done. To stay motivated, keep reminding yourself why you want to quit
smoking. Make a list of your reasons to quit and the benefits you expect from
quitting. Put your list of reasons on your bedroom dresser, in your wallet, or
on the refrigerator. Review it whenever you are struggling with the quitting
process. Add to your list whenever another reason or benefit occurs to you.
See the topic
Quick Tips: What to Do When You Crave Nicotine.
If you have tried to quit smoking before, remember that most people try
to quit many times before they are successful. Don't give up.
Nancy hit upon a key that
helped her quit for good. "Finally what woke me up—after 3 years of failure—was
the realization of what happened when I relapsed. ... I quit drinking not
because alcohol scares me, but because when I drink, I want to smoke."-Nancy, 54
Congratulations! You are
taking a big step. You are ready to quit today. It's exciting. But it can also
be scary. If you're not quite ready yet, but you think
you will be soon, see the section
Thinking About Quitting?
If you've been
planning to quit, you may already know that when you stop smoking, you may not
feel so great at first. Some people feel grouchy and have headaches or
cravings. The good news is that these things are at their worst in the first 2
to 3 weeks after you quit, although they can last longer. And there are things that can help.
If you
decided to quit today but haven't planned ahead, don't
worry. Here are some things to consider to help you succeed:
Using nicotine replacement products
and/or medicine doubles your chances of
quitting.1 When you quit
smoking, your body craves the nicotine that it was used to getting when you
smoked. But the nicotine isn't the harmful part of smoking or chewing. It's all
the other things in tobacco that are bad for you, such as tar and carbon monoxide. Nicotine from medicine is absorbed so slowly and at such low levels that it is rarely addictive.
Support can
help you through the stress of losing this part of your life. Your doctor can prescribe medicines that can get you through withdrawal. And he or she can help you plan the best way to use nicotine replacement products. Friends and
family can provide shoulders to lean on, and they can encourage you to stay
smoke-free. They can help distract you when you want to smoke, and they can
understand when you're a bit grouchy.
People who use telephone, group, or one-on-one
counseling are much more likely to stop smoking. Experienced counselors have practical ideas that can help you succeed. Here
are some ways to get support:
If you quit
today but haven't planned ahead, now is a good time to plan your quit strategy.
Think of problems or barriers you have faced. And think of ways to reward
yourself for reaching specific milestones. Write out your
personal action plan(What is a PDF document?).
For more
information, see the
Planning Your Strategy to Quit section of this topic.
You are taking
an important step to improve your life. Make sure that you know your reasons
for quitting smoking. The most common reason to quit is to live longer. It's a
gift you can give yourself and your family.
You're not alone in going back
to smoking. Most people who quit try many times before they quit for
Don't feel bad about yourself. A
relapse is just a sign that you need to try a different approach to quitting
smoking. If you tried to quit without medicines or a program, think about
trying them next time. Medicines and nicotine replacement (gum, patches,
lozenges) can double your chances of success.1 And using medicines and counseling is even more effective.
Think about what made you start smoking again.
Maybe you couldn't handle the cravings. Or maybe you didn't have enough support
from family or friends. Maybe something stressful happened that triggered the
urge to smoke, and then you couldn't stop.
Whatever it was,
remember that help is here when you are ready to try again. You might want to
Thinking About Quitting? or
Planning Your Strategy to Quit in this topic.
Nate's struggle to
quit was a constant cycle of attempts and relapses. It was hard on his
"It seemed like trying just made it more difficult
to quit. I felt like a failure every day."-Nate, 27
Read more about Nate and how he quit for good.
To quit smoking, you have to learn how to deal with your cravings and temptations to smoke. But staying smoke-free involves learning how to think and act like a nonsmoker.
Many people who are able to make it through those first tough weeks without smoking run into trouble about 3 to 4 weeks after they quit. Surprisingly, this is just about the time when physical cravings have stopped. And yet—people often go back to smoking. Why does this happen? Some researchers found that staying smoke-free may depend on how well someone has been able to start seeing himself or herself as a nonsmoker.3
Many of the changes you feel when
you first quit smoking don't feel good.
Nicotine withdrawal can
make you feel grouchy, hungry, and nervous. You may have trouble sleeping or
concentrating. These symptoms can last for a few days to several weeks. But
they do go away, especially if you take medicine. You may struggle with
changing your
smoking habits and rituals. This is a lot to deal
with, but keep at it. You will feel better.
The following tips may help you in the first few weeks:
To stay smoke-free, you will have to make it past a second big challenge. This will come about 3 to 4 weeks after you quit, when you notice that your physical cravings are almost gone. Making it past this second big challenge will depend on how well you have been able to start thinking and acting like a nonsmoker. You will be able to enjoy and value a smoke-free lifestyle when you:3
There are many ways you can make positive changes in your life, such as starting an exercise program or
learning how to manage stress.
If you're reading this, you may be
thinking about quitting smoking or making a plan to quit. Or maybe you have
already tried to quit a few times. You probably already know that smoking is
bad for your health and that quitting will reduce your risk of getting a
disease related to smoking, such as heart or lung disease.
If you continue to smoke, there is a 1 out of 2 chance that you will die earlier because of smoking. Smokers, on average, die 13 to 14 years sooner than people like them who are not smokers.4 If you quit, most of your risk for having a heart attack or getting cancer goes away. The sooner you quit, the more you reduce your risks.
Everyone who uses tobacco would benefit from quitting. When you quit
smoking—no matter how old you are—you will decrease your risk of:
Nancy was working as a nurse
and was exposed to someone who had a bad case of pneumonia. As a precaution,
Nancy was checked for pneumonia. The X-ray revealed that she didn't have
pneumonia—but her lungs did show early signs of emphysema. "It scared the
daylights out of me. ... I really made myself focus on the future of my life. I
want to be skiing when I'm 70. I don't want an oxygen tank."-Nancy, 54
In addition to reducing your risk of diseases in the
future, you will notice some benefits right away after you stop smoking. Your
shortness of breath, energy, and asthma symptoms will likely get better within the first
2 to 4 weeks after you quit. (But don't be surprised if you cough more in the
first week after you quit, as your lungs try to clear themselves.)
There are other benefits to quitting:
Natural, low-tar, and low-nicotine "light" cigarettes are
not any safer to smoke than regular cigarettes. Do not be misled into thinking
that these products are any better for you. They are not.
You can get cancers of the throat and mouth from using
cigars, pipes, or chewing tobacco.
Avoiding diseases caused
by smoking and being in control of your life are good
reasons for teens to quit.
If you are a teen and you smoke, chew tobacco, or use snuff, you
probably already know that tobacco is bad for you. If you are like most teens,
you intend to quit at some point, but you may not feel it's very important to
quit now. But the longer you use tobacco, the greater your risk for becoming
addicted to it. After you're hooked, it's even harder to quit.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
The American Lung Association provides programs of
education, community service, and advocacy. Some of the topics available
include asthma, tobacco control, emphysema, infectious disease, asbestos, carbon monoxide, radon,
and ozone.
website provides resources for quitting smoking and tobacco prevention, including information for children, teens, researchers, and scientists.
There are also reports from the Centers for Disease Control and Prevention (CDC), fact sheets, a publications catalog, a smoking and health resource library, and other materials, such as buttons, calendars, and eCards.
This is also the location for the State Tobacco Activities Tracking and Evaluation (STATE) System.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
This organization provides information for the public on
drugs. It contains information about how certain drugs affect the brain.
The toll-free number is a single access point to the National
Network of Tobacco Cessation Quitlines. Callers are automatically routed to a
state-run quitline, if one exists in their area. If there is no state-run
quitline, callers are routed to the National Cancer Institute (NCI) quitline,
where they may receive help with quitting smoking, informational materials, and
referrals to other resources.
This website provides free information and
professional assistance to help support people who are trying to quit smoking.
The information provided is for both the immediate and long-term needs of
people who are trying to quit and for friends and family who care about them.
This website includes an online guide to
quitting smoking, local and state telephone quitlines, the National Cancer
Institute's national telephone quitline and instant messaging service, and
publications that can be ordered or downloaded and printed. There is also a link to women.smokefree.gov, which has more resources for women who want to quit smoking.
CitationsStead LF, et al. (2008). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (1).Fiore MC, et al. (2000). Clinical Practice Guideline: Treating Tobacco Use and Dependence. Rockville, MD: U.S. Department of Health and Human Services. Also available online: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf.Segan CJ, et al. (2006). The challenge of embracing a smoke-free lifestyle: A neglected area in smoking cessation programs. Health Education Research, 23(1).American Cancer Society (2010). Prevention and Early Detection: Guide to Quitting Smoking. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Healthy/StayAwayfromTobacco/GuidetoQuittingSmoking/index.Sunday SR, Folan P (2004). Smoking in adolescence: What a clinician can do to help. In VC Reichert et al., eds, Medical Clinics of North America, 88(6): 1495–1515. Philadelphia: Saunders.Other Works ConsultedAmerican Cancer Society (2009). Child and teen tobacco use. Available online: http://www.cancer.org/docroot/PED/content/PED_10_2X_Child_and_Teen_Tobacco_Use.asp.Benowitz NL, Brunetta PG (2010). Smoking hazards and cessation. In R Mason et al., eds., Murray and Nadel's Textbook of Respiratory Medicine, 5th ed., vol. 1, pp. 968–984. Philadelphia: Saunders.Flouris AD, Oikonomou DN (2010). Electronic cigarettes: Miracle or menace? BMJ, 340: c311.Hughes JR (2009). Nicotine-related disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1353–1360. Philadelphia: Lippincott Williams and Wilkins.National Institute of Diabetes and Digestive and Kidney Diseases (2010). You Can Control Your Weight as You Quit Smoking (NIH Publication No. 03-4159). Bethesda, MD: Weight-Control Information Network. Also available online: http://win.niddk.nih.gov/publications/smoking.htm.National Institutes of Health (2010). Tobacco addiction: Fact sheet. Available online: http://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=119&key=T#T.U.S. Department of Health and Human Services (2010). Cardiovascular diseases. In How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General, chap. 6. Atlanta: U.S. Department of Health and Human Services. Also available online: http://www.surgeongeneral.gov/library/tobaccosmoke/report/index.html.U.S. Department of Health and Human Services (2010). Cardiovascular diseases. In How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General, chap. 6. Atlanta: U.S. Department of Health and Human Services. Also available online: http://www.surgeongeneral.gov/library/tobaccosmoke/report/index.html.U.S. Preventive Services Task Force (2009). Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac2.htm.Yamin CK, et al. (2010). E-cigarettes: A rapidly growing Internet phenomenon.
Annals of Internal Medicine, 153(9): 607–609.
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Last Revised:
November 12, 2012
Healthwise Staff
Medical Review:
Adam Husney, MD - Family Medicine
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
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IT Gal necesitaba un nuevo diseño de logotipo y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 187 diseños de 34 diseñadores freelance.
Lender Vault is in need of a logo for use on the website, business cards and as an icon other websites. The logo should include the name of the company "Lender Vault" and any image should be subtle so that the word mark itself stands out. Despite our request, we also welcome any inspired ideas for the logo that we may not have considered.
Lender Vault
Lender Vault is a web based service that allows the general public to access a database of Canadian banks and lenders. It houses up to the minute information and allows end users to create a customized search to find the appropriate lender who suits their needs. It was created to help simplify what can be a complicated process.
The look and feel of the website will be modern, clean, and simple -- though we want to be perceived as professional, a non intimidating presence is our goal.
Our target audience are members of the general pubic who are buying or selling homes and looking for a mortgage.
- A contemporary, modern, clean and simple look
- The use of any image should be subtle
- Image can be perhaps of a lock, a safe/vault, maybe even a play of vault being like a "pole vault", an old fashioned rendering of a key
- Professional non-intimidating look and feel
- Sans Serif Typography
- Orange and Grey colors used in the word (one color per word)
- TM needs to be tagged on to the word
- Lower Case typography with a capitalized L and V
- An image that overpowers the name of the company
- An intimidating look and feel
Descubre cómo funciona un concurso de diseño u obtén más información sobre nuestros servicios de diseño de logo.


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Editor At Large and creative consultant for Vogue Japan, Anna Dello Russo, has never been a wallflower when it comes to fashion and is known for donning attention-grabbing looks right off the runway – often with micro-mini hemlines. This week, at the Autumn/Winter 2011 menswear shows in Milan, Dello Russo turned heads as usual, taking her cues from the boys wearing statement-making tuxedos, complete with bow ties and the occasional top hat.
image, left, via teampeterstigter.com; image, right, via stockholm streetstyle
Among Dello Russo's many takes on menswear this week was a sleek black tuxedo from DSquared's Spring/Summer 2011 collection, and a sharp shouldered Balmain jacket with gold buttons paired with a pink gingham bow tie, accessorized with a bold Prada Spring/Summer 2011 fox fur stole that got tFS forum members talking. Mikeijames commented that "people wondered how women would wear those neon fox stoles at Prada," to which kingchic responded: "Exactly. This is how its done. I gasped at first glance." ilaughead agreed: "Naturally [Anna Dello Russo would] be the one to pull one off perfectly."
image, left, via zimbio.com; image, right, via catchinginstants.com
Dello Russo displayed her take on white tie attire in this Comme des Garcons and Dior Homme ensemble with a top hat and sash fit for royalty at the Fendi O' party on January 17. She wore Comme des Garcons again (this time with a silver bow-tie and pink cummerbund) while strolling the streets of Milan with Vogue Nippon colleague Viviana Volpicella.
image, left, via teampeterstigter.com; image, right, via bryanboy.com
The Vogue Nippon team of Volpicella and Aurora Sansone flanked Dello Russo as she, once again, sported Balmain and Dior Homme. Forum member FashionPower thought "she looks amazing in that jacket." At the Prada show, Dello Russo ditched her requisite heels and complemented the style of her Yohji Yamamoto suit with a pair of decidedly more masculine Church's shoes.
Will Dello Russo continue with this streak of menswear-inspired looks in Paris? Only time will tell, but I'm guessing she's already missing her miniskirts.


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Surveying Equipment
Opti-cal Survey Equipment has been supplying precision measurement technology to surveyors for the past decade, and with service and distribution partnerships with Leica Geosystems, FARO Technologies and SPX Radiodetection, we are fast becoming the number one choice in the UK and Ireland for survey professionals to source their instrumentation.
Whether you are looking for Lasers and Levels, Total Stations, GPS kit or state-of-the-art 3D Laser Scanners, you will find it all here.
Leica iCON iCR80 Robotic Total Station
With its 'eye' on the job the iCR80 focuses on only the users target. With ATRplus you can layout more points per day - the most robust automated-aiming, lock and re-lock technology on the market.Learn MoreCall For Price


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Quackenbush rejoins bullpen; Ambriz DFA'd
SAN DIEGO -- Another day, another new pitcher on the roster for the Padres, who on Thursday recalled right-hander Kevin Quackenbush and designated pitcher Hector Ambriz for assignment.
Ambriz was added to the roster Wednesday to give the Padres a fresh arm after a pair of extra-inning games. He allowed one earned run in two innings of an 8-0 loss to the Royals on Wednesday.
The Padres designated Ambriz for assignment because the rules -- optional assignment waivers -- prohibit them from optioning him back to Triple-A El Paso.
If the right-hander clears waivers, the Padres hope to retain Ambriz, who had a 1.62 ERA in 14 games for El Paso.
This is Quackenbush's second stint with the Padres, and it figures to be longer than his first -- one game. The Padres added Quackenbush to the roster on April 25. He allowed two runs in 1 2/3 innings in his lone appearance that day and was optioned back to El Paso two days later.
In the interim, Quackenbush tossed 4 1/3 scoreless innings for El Paso. Overall this season, his ERA is 1.26 in 13 games for the Chihuahuas.
There will be another roster move coming Saturday when the Padres are expected to activate Chase Headley from the disabled list. Outfielder Carlos Quentin won't likely be too far behind Headley, which means the Padres have two moves to make in the coming days.


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Looking to improve your listening and speaking skills in Spanish?
Watch these authentic street interviews (with Spanish and English subtitles) and practise!
Easy Languages is an international video project that aims to help people learn languages through authentic street interviews. The videos also showcase the street culture of the participating partner countries, through its portrayal of typical, everyday situations. Episodes focus on different topics, and are produced at various locations around the globe. Every Easy Languages video is subtitled in its local language and in English — a valuable feature for learners of all levels.
Check out Learning English / French / German / Italian / Chinese / Japanese from the Streets!


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12 of the most enduring pop classic songs are included in this collection perfect for budding instrumentalists.
Classic Pop Songs features online access to audio demonstration and great-sounding backing tracks for download or streaming to help you hear how the song should sound.
Songs include Bridge over Troubled Water • Candle in the Wind • Dust in the Wind • Every Breath You Take • Fire and Rain • Good Vibrations • Have I Told You Lately • Heaven • Lean on Me • She's Always a Woman • Tears in Heaven and With a Little Help from My Friends.


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Something Chilly This Way Comes
Building off the famous line from Shakespeare's Macbeth (and inserting a bit of creativity too), you may wish to snuggle up to a nice cauldron (or perhaps more reasonably, a fireplace) for the next couple days as temperatures are not expected to be all that warm. Remember those 70s and 80s we had in the past week and a half...yeah, you can pretty much kiss those goodbye at this point as fall has truly taken the helm.
So instead, we're going to be waking up with temps in the mid to upper 30s and low to mid 40s across the region with highs struggling to make it into the mid to upper 50s for Northwest Arkansas and only into the low to mid 60s for the River Valley. So all the sunshine you'll see will be what we'll call deceptively...or dare I say, wickedly nice since the temperatures outside will not likely reflect the abundant sunshine.
On the plus side, Sunday will be a tad milder, with temps back in the 60s for NWAR and low 70s for the River Valley. But our next big cool down approaches into Wednesday, which could end up being our first freeze for spots around Fayetteville by that morning and highs for the day only in the mid 50s for NWAR and around 60° for Fort Smith and the River Valley.
So bundle up and may your cauldron boil and bubble to help keep you warm!
Brad Carl
40/29 Weekend Morning Meteorologist


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Without yet experiencing the city's first significant snowfall, the Fisher Theatre in downtown Detroit, Michigan eloquently glistened as it welcomed back to its stage the hit Broadway musical "Jersey Boys – The Story of Frankie Valli and The Four Seasons". Within a 'Motown minute', the Tony, Grammy and Olivier Award Winning Best Musical rediscovered the city's passion for live theatre performances. With the original Hitsville U.S.A. building located hauntingly nearby, the collective sounds of The Four Tops, The Supremes and The Temptations seemed to still somehow resonate through the slight chill in the evening air.
Scored brilliantly by Bob Gaudio along with lyricist Bob Crewe, the documentary-style musical follows the rags-to-riches tale of how four New Jersey youths propelled themselves through a relentless music industry. This Italian-American quartet from Newark known as The Four Seasons, surprisingly overcame life's misfortunes and released a slew of #1 songs in the early 60's to become one of the greatest pop music sensations in history. Unblemished by the powerful British Invasion of 1964, the group catapulted to stardom as a result of a hand-shake musical agreement between Gaudio and Valli.
Opening on Broadway's August Wilson Theatre to critical acclaim in November of 2005, "Jersey Boys" continues to break house records as it "doo-wops" its way through North America supporting its US national tour. With six other current productions running in New York, Las Vegas, London, Australia, Singapore and South Africa, "Jersey Boys" again made its way to Detroit and is currently performing throughout the holiday season from December 12, 2012 to January 6, 2013.
Passionate in its delivery, its four key characters easily related to the Baby Boomer Generation in attendance. John Gardiner convincingly captured the essence of founding Four Seasons member Tommy DeVito as his brawny, rebellious spirit dominated the stage. Occasionally comical, his love for women and gambling eventually lead him to the bitter hands of the mob who forced his departure from the group as the remaining members struggled to pay down his acquired debt.
Nick Cosgrove portrayed the often shy and unsure Frankie Valli whose high tenor voice charmed a nation. His failed relationship attempts did not diminish his quest to chase 'the song', as his unmistakeable falsetto gripped the attention of gifted songwriter/ keyboardist Bob Gaudio, movingly played by Miles Jacoby. With their bond now permanently sealed, an enraged and resentful DeVito continued down his road to nearly bankrupting the band.
Returning cast member Michael Lomenda supplied the low baritone voice of Nick Massi who began singing pop songs under a street lamp alongside Valli and DeVito. Coining himself as the "Ringo" of the group, Massi was responsible for shaping the vocal arrangements which set The Four Seasons' style of harmony apart from other pop groups of their era. Strikingly impressive was Lomenda's ability to mock intricate bass lines while singing harmony and moving to highly synchronized and complicated choreography.
The show was energetic and fast-paced. We were captivated throughout Spring, Summer, Winter and Fall; the four acts which allowed a brief intermission at its midpoint. The audience was delighted as they witnessed the birth of the group's classics "Big Girls Don't Cry", "Walk Like A Man", "Sherry" and the unforgettable "Can't Take My Eyes Off You". This was by far the highlight of the evening. To not only hear, but to understand the creation of a soundtrack for a generation was every fan's dream. Dazzling the crowd further was the band's cleverly re-enacted performance on The Ed Sullivan Show where live video scenes hovered alongside actual footage from their historic appearance in 1962. With the show's finale of the band's induction into The Rock & Roll Hall of Fame, the four original members ultimately reunited and independently reflected on their cavalcade of life events which lead them through their rise to stardom. "You ask four guys, you get four different answers", the musical beckons.
With another stellar cast and production, "Jersey Boys" will no doubt continue its reign over the Metro Detroit area as a Motor City favourite for years to come. So relive the sound of the 60's while it still resonates inside the walls of the beautiful Fisher Theatre and all its splendour. "Oh, What a Night" you'll have indeed!


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curious1 necesitaba un nuevo diseño de impreso o envases y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 33 diseños de 12 diseñadores freelance.
PlentyofGefilteFish.com (PoGF)
Our small, fun company, Curious, works exclusively with companies whose products and services we use--and love--to help them to profitably extend their brands. We're currently pitching a project to one of the world's most popular dating websites, PlentyofFish (pof.com), to create a free Jewish dating website named PlentyofGefilteFish.com. With that said, we need a nicely designed sell sheet that will be used to pitch senior-level execs at Jewish organizations all over North America to partner with us in the project.
Senior-level executives at Jewish organizations like:
Hillel (http://www.hillel.org/about/default), The Jewish Federations of North America (http://www.jewishfederations.org/in…spx?page=1), JCC's of North America (http://www.jcca.org/), B'nai B'rith (http://www.bnaibrith.org/), and other similar Jewish organizations with significant membership of single/unmarried Jews.
Since we're targeting Jewish organizations, the colors should be blue and white (like the Israeli flag). It should also be formatted as a pdf.
If successful in our pitch, these organizations will encourage all of their single/unmarried members to set up profiles on PlentyofGefilteFish.com, so this sell-sheet will be used to sell them on the idea of PoGF. Since we would be partnering with PoF, our design should be similar to theirs: http://www.plentyoffish.com/. Also, it should be 'Google simple, Apple elegant': clean, crisp, refreshing, beautiful, engaging, eye-catching, and easy-to-read.
Here's the copy for the sell sheet:
Raise Money Effortlessly and Sustainably while Promoting Jewish Culture (headline)
PlentyofGefilteFIsh.com -- a new 100% free Jewish dating website (subheading)
Jewish Singles will Love It (headline)
Leverage one of the world's most popular websites -- 1.3 million daily active members
Turn-key, maintenance-free, no expense to you
Upside only -- we do all the work while you consistently earn a generous share of the revenue
Bubbie and Zadie Will Insist On It (headline)
Make it easy and fun for young Jews to be active and engaged (pun intended ;-) in Jewish culture
Deepen your relationship and extend your reach with the "Internet Generation"
Engage and develop future donors and leaders of your organization