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Obtaining hosting for your website can be a difficult task to undertake on your own. There are hundreds of providers and everyone of them seems to offer different services and pricing structures. Often, there websites delve deep into the technical aspects of their service without effectively explaining what these aspects mean for the website owner. They also often offer alluring pricing structures for limited time to get you to sign up, only to raise the prices significantly later.
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Inclement Weather Policy
With today's threat of snow, I wanted to remind everyone of our policy for closing due to inclement weather.
The safety of our dancers, their families, and our instructors is our first priority. If we close due to weather, I will post it on our website, our Facebook page, and also on our outgoing voicemail message. Any classes you might miss for weather may be made up.
Everyone stay warm and safe out there!
Posted on November 12, 2013, in Uncategorized. Bookmark the permalink. Leave a comment.

subset: commoncrawl


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Protect the Dandenongs: 2 Storeys not Tall Stories
This petition had 989 supporters
All visitors to the township of Upper Ferntree Gully (UFTG) enjoy unobstructed views to the beautiful surrounding hills and ridgelines.
Mandatory 8.5 metre building height limits are needed to preserve these views by ensuring that any future development is appropriate and considers the town's unique setting.
We urgently need your help to formally request the Planning Minister to intervene and approve Amendment C141 to the Knox Planning Scheme, with ALL the recommendations of the independent Planning Panel.
The community has worked with council staff for two years to develop and implement an amendment to the Knox Planning Scheme that will guide the future growth and development of the activity centre in UFTG, and also protect it from inappropriate development, this is known as Amendment C141.
Some councillors have been inexplicably determined in their attempts to modify the C141 Amendment against community wishes and against the Planning Panel recommendations. These councillors wanted 12 metre building heights plus roof form. If implemented the councillors plans would obscure views of the hills and ridgelines from many viewpoints though-out UFTG.
An independent Planning Panel Hearing was held to consider ALL of the available evidence to properly consider the C141 Amendment. After very careful consideration this State appointed panel of planning experts produced a report which recommended 8.5 metre mandatory heights through-out the commercial centre of UFTG, and they provided proper justification for their decision.
Mandatory 8.5 metre building heights in the UFTG commercial zone will satisfy ALL of the relevant planning strategies and ALL of the relevant zone and overlay controls. This is what the community wants and this is what the independent Planning Panel recommends.
But a group of councillors have turned their back on 2 years of constructive engagement with the community, turned their backs on $400,000 of hard work by the council's planning staff, and turned their back on the recommendations of the independent Planning Panel...all without providing a single supportable FACT to justify their position in supporting 12 metre building heights. Now they have abandoned the C141 Amendment because THEY want control over what is built.
We formally request that the Hon Richard Wynne, Minister for Planning exercise his power of intervention and approve the C141 Amendment with all of the independent Planning Panel recommendations.
To the Legislative Council of Victoria
This Petition of Residents of Victoria,
draws to the attention of the House, the independent assessment and recommendations of Knox City Council Amendment C141 Upper Gully Strategic Plan, by Planning Panels Victoria.
Attention is also drawn to the community's grave concern that after two years of extensive consultation and expenditure of public funds in excess of $400,000, Council officers, Council legal representatives and professional consultants, AGREED with the Knox Community and the Panel that in order to protect the iconic Gateway to the Dandenong Ranges and protect the vistas for future generations, MANDATORY height controls were required.
The Panel agreed with the community that a maximum mandatory height limit of not more than 8.5metres (2 storeys) in the Upper Ferntree Gully Activity Centre should be embedded into the Knox planning scheme. The regional significance of the Dandenong Ranges foothills is demonstrated by existing policy that DIRECTS that urban consolidation objectives MUST NOT OUTWEIGH the environmental and landscape objectives, recognising the Foothills metropolitan landscape significance by maintaining uninterrupted view lines and ensuring that buildings sit below the dominant tree canopy.
Knox Councillors have resolved to ABANDON Amendment C141 WITHOUT DUE CAUSE and revert to discretionary height controls.
We draw attention to the fact that this would place Upper Ferntree Gully, the Gateway to the Dandenongs, as the ONLY ACTIVITY CENTRE in the Knox Foothills without MANDATORY maximum building height controls.
The petitioners therefore request that the Government INTERVENE on behalf of the community and approve Amendment C141 with the MANDATORY maximum building height controls of 8.5M as recommended by the independent panel.
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David Fagan needs your help with "Legislative Council of Victoria: Protect the Dandenong Ranges: 2 Storeys not Tall Stories". Join David and 988 supporters today.
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Celebration Europe II
August 18, 2013 in Guest Blogs, Star Wars by GuestBlogs
A guest blog by Hevy782
So every year or so there's a big Star Wars Celebration that makes younger fans beg their parents to take them and older fans beg their employer for a pay rise.
I was one of the lucky ones who got to go to a Celebration this year and there was never a dull moment, even while waiting in line thanks to Angry Bird Star Wars.
But anyway, the panels were great and I got to go to a lot of them. At the behind the scenes stage I went to the Clone Wars panel and a fair bit of news came out of that (no new clip though, they just repeated the Yoda one from Star Wars Weekends). We got to see Cad Bane's new ship (yes, that means a Bounty Hunter arc is on the way) and a Sith Temple. Tusken Raiders will appear along with a chief. Also, Ex-Chancellor Valorum will appear too and will still be on Coruscant.
We also got a look at arcs we won't be seeing like a Wookie arc on with some cool new Clone Troopers and we would have gotten to see the lower depths of Kassyyk's forests which can be very dangerous. Also there was to be a Ventress arc which she would have grown hair in and her story would've gotten very dramatic.
We got a fair bit of news about Star Wars Rebels along with some pictures of what the show will probably look like. It's similar to Clone Wars only less angular and very much like Ralph's concepts for the original movies. I'm quite looking forward to it and I even got to ask Dave whether we'll see Han and Chewwy on a smuggling run, he simply replied that I'll have to wait and see and gave me an awesome TV shirt.
The experience overall was a great one but it was a bit crowded, especially on the Saturday. So to sum up the weekend it was great fun with a lot of awesome people dedicated to Star Wars.


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Noise reduction
What features would you like to see in Pixelmator Pro?
2018-12-06 20:08:52
Im sure its been posted a number of times already, but actually noise reduction would be fantastic.
2018-12-08 19:33:08
I look forward to that ... hopefully sooner rather than later this
2018-12-09 13:17:04
Please make it sooner and do it right
Please Sign In to post


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A General Introduction to Psychoanalysis
- $3.99
- $3.99
Publisher Description
Development of psychoanalysis:
Charcot demonstrates hypnosis on a "hysterical" patient, "Blanche" (Blanche Wittmann). Charcot questioned his own work on hysteria towards the end of his life.
In October 1885, Freud went to Paris on a fellowship to study with Jean-Martin Charcot, a renowned neurologist who was conducting scientific research into hypnosis. He was later to recall the experience of this stay as catalytic in turning him toward the practice of medical psychopathology and away from a less financially promising career in neurology research. Charcot specialized in the study of hysteria and susceptibility to hypnosis, which he frequently demonstrated with patients on stage in front of an audience.
In this Illustrated psychology series, our the first book volume includes that Freud's eventually establishes in the course of his clinical practice that a more consistent and effective pattern of symptom relief could be achieved, without recourse to hypnosis, by encouraging patients to talk freely about whatever ideas or memories occurred to them. In addition to this procedure, which he called "free association", Freud found that patient's dreams could be fruitfully analyzed to reveal the complex structuring of unconscious material and to demonstrate the psychic action of repression which underlay symptom formation. By 1896, Freud had abandoned hypnosis and was using the term "psychoanalysis" to refer to his new clinical method and the theories on which it was based...
Illustrated by Murat Ukray, Copyright by E-Kitap Projesi
Sigmund Freud (Born Sigismund Schlomo Freud; (1856 – 1939) was an Austrian neurologist who became known as the founding father of psychoanalysis.


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Returns number of days from first date to second date.
DateDiffDays(from_date, to_date)
|MDX expression that returns a date.
|MDX expression that returns a date.
Following example calculates how many days has the issue been in current status.
DateDiffDays([Measures].[Issue status updated date], Now())
Example bellow will return how many issues, that have been open 14 to 30 days ago from now, are still due.
NonZero( Count( Filter( Descendants([Issue].CurrentMember, [Issue].[Issue]), [Measures].[Issues due] > 0 AND DateDiffDays([Issue].CurrentMember.get('Created at'), Now()) >= 14 AND DateDiffDays([Issue].CurrentMember.get('Created at'), Now()) < 30 )))
See also
- The above is an example how to use the DateDiffDays function. Note that more efficient way of calculating issues due in various age intervals would be to use the Age intervals dimension.
- Function DateDiffWorkdays which returns number of working days between two dates.


text: Does Google work with Cookies and Web Storage? Cookies are small fractions of space that sites use to store user-specific info in user browsers. So that servers would know that a returning user is not a new one. That's how you remain logged in after you leave a website and come back later. Cookies is the link between your previous and next sessions. Web storage is cookies evolved. Cookies have lots of tecnical issues we're not gonna discuss now, but Web storage aims to fix them. Why would it matter in SEO? As you may know, developers tend to choose the shortest way to implement the functionality ordered by business. Even though employers now tend to look for developers who know about SEO, it doesn't help. They still wouldn't consider SEO during the development. Cookie-based redirection. A french user hits the site, the site determines the IP geolocation and redirects the user to the /fr/ version, setting something like "loc=fr" in cookies. Now if this user tries to hit any non /fr/ page, they will be redirected to the proper /fr/ page unless they change the language manually, in which case their cookie will be overwritten with the new value. And the redirections continue. Doesn't look very well from the UX/UI perspective, but it works ok. The problems start when Google hits the site. Since Google uses cookies, it gets all the effect normal users do. And so when Google tries to index other language pages, it gets redirected to the previous page, indicating non existence of other pages to Google. But does Google use cookies or doesn't? Let's experiment. Does Google use Cookies? To test it we will have a simple JS snippet that sets a cookie and then checks if the cookie is set. If it's set, the code will inject some hardly related text in a span below (if you use cookies, you will see it): G webmastertools hangouts And they discussed it recently, revealing the fact that G carries cookies through one crawling session, but not between the sessions, which is exactly what you would expect from G. Okay, now that we left the cookie-based output in that h3, we can experiment with the web storage a little. Does Google use Web Storage? The approach will be similar: we'll have a tiny bit of JS that sets it on the fly and then checks if it's set. Below: We'll wait till it's indexed though. Ok, now it's indexed and ranking. As expected. Results Googlebot uses both cookies and web-storage.


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I want to eat...
Collection by Bridgette Duplantis| Experimental Mommy| Blogger & Entrepreneur • Last updated 7 weeks ago
A collection of mouth watering #recipes that I must make now! #recipe #maindish
14 Delicious Weight Watchers Air Fryer Recipes
14 Delicious Air Fryer Recipes with Weight Watchers Points! Ok I have to admit it - Whole 30 is probably not for me. It was great to try it but I think I am a weight watchers girl at heart. The thing I like the most about Weight Watchers is that it's easy! You…
The Best Gluten Free Mini Crab Cakes [Air Fryer | Stove top] - Confessions of a Fit Foodie
I make a double batch of the BEST gluten free mini crab cakes every holiday season and they really couldn't be easier!
Best Skinny Chicken Parmesan (Air Fryer)
This is the best chicken parmesan with a crispy coating, topped with marinara sauce, melted mozzarella cheese and Parmesan cheese! The secret to making super
Craving Restaurant Flavor?
Discover Hellmann's full product line of great tasting Mayonnaises, Spreads, and Dressings. Try all of our varieties and flavors!
Honey Garlic Butter Chicken Tenders for Clean Eating Meal Prep!
These Chicken Tenders are ABSOLUTELY DIVINE! Sweet and Buttery...Golden Brown Crispy outer while staying nice and Tender-Juicy inside! ???? I suggest cooking up
Hawaiian Garlic Shrimp - Ev's Eats
Juicy prawns cooked in a garlicky buttery sauce, this Hawaiian Garlic Shrimp is just like the shrimp trucks you'd find in Hawaii.
Hawaiian Shrimp
Hawaiian Shrimp is an easy garlic butter shrimp tossed in an succulent garlic sauce. The perfect appetizer or light meal! Hawaiian Garlic Shrimp is so quick and easy! Especially if you love garlic. Enjoy it
Slow Cooker Shredded Mexican Chicken (Paleo, Whole30)
This slow cooker shredded Mexican chicken is easy to make and full of flavor! Just dump the ingredients in the crockpot or instant pot, and make tender juicy chicken for tacos, burritos, or salads.
Easy Rotisserie Chicken and Stuffing Casserole
Rotisserie Chicken and Stuffing Casserole, This casserole is very pure, it's a winter dish that can be made easily. This dish excites everyone's appetite and you will feel perfect delicacy.
Cream Cheese and Herb Stuffed Chicken - Emily Bites
This Cream Cheese and Herb Stuffed Chicken is an easy, low carb dinner you'll love! Just 307 calories or 7 Green, 4 Blue or 4 Purple myWW SmartPoints each!
Ricotta Stuffed Chicken Bake - Emily Bites
This easy, filling Ricotta Stuffed Chicken Bake makes for a tasty weeknight meal! Just 345 calories or 7 Green, 4 Blue or 4 Purple SmartPoints per serving!
Ham and Cheese Sliders - Recipes for Parties
Ham and Cheese Sliders are a delicious, easy and cheesy recipe for parties. Made with honey ham and swiss cheese, they're perfect for any crowd!
Pumpkin Spice Waffles - Lovely Little Kitchen
Made with pure pumpkin puree and coconut oil, these waffles are moist, fluffy and ready for maple syrup!
Pumpkin French Toast Sticks Recipe | Lil' Luna
These Pumpkin French Toast Sticks are so quick and easy to make, there's no reason not to try these delicious french toast sticks! Each bite is filled with cinnamon, sugar, & just the right amount of pumpkin!
Mini Sub Rolls Back to School Lunch Ideas - Simply Today Life
Create this easy Mini Sub Rolls Back to School Lunch Ideas kids will love! Mini Sub Rolls with Sunflower Butter, Hazelnut, and Fruit.


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Video: A Conversation on the Economic and Political Outlook for Latin America at #LABC19
Friday, March 1, 2019
AS/COA President and CEO Susan Segal moderated a conversation between two central bank policy heavyweights on the economic integration of Latin America. ... Play Video
Video: A Conversation with Colombian President Iván Duque
Thursday, February 14, 2019
"It was my moral duty to denounce that dictator [Nicolás Maduro]," said Duque at an event in Washington, DC, regarding the crisis in neighboring Venezuela. ... Play Video


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OBJECTIVE: In September 2011, an established pediatric asthma pathway at a tertiary care children's hospital underwent significant revision. Modifications included simplification of the visual layout, addition of evidence-based recommendations regarding medication use, and implementation of standardized admission criteria. The objective of this study was to determine the impact of the modified asthma pathway on pathway adherence, percentage of patients receiving evidence-based care, length of stay, and cost.
METHODS: Cases were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Data were analyzed for 24 months before and after pathway modification. Statistical process control was used to examine changes in processes of care, and interrupted time series was used to examine outcome measures, including length of stay and cost in the premodification and postmodification periods.
RESULTS: A total of 5584 patients were included (2928 premodification; 2656 postmodification). Pathway adherence was high (79%–88%) throughout the study period. The percentage of patients receiving evidence-based care improved after pathway modification, and the results were sustained for 2 years. There was also improved efficiency, with a 30-minute (10%) decrease in emergency department length of stay for patients admitted with asthma (P = .006). There was a nominal (<10%) increase in costs of asthma care for patients in the emergency department (P = .04) and no change for those admitted to the hospital.
CONCLUSIONS: Modification of an existing pediatric asthma pathway led to sustained improvement in provision of evidence-based care and patient flow without adversely affecting costs. Our results suggest that continuous re-evaluation of established clinical pathways can lead to changes in provider practices and improvements in patient care.
- emergency department
- interrupted time series
- length of stay
- quality improvement
- statistical process control
Asthma is the most common chronic illness in children. It accounts for >600 000 emergency department (ED) visits and 155 000 hospitalizations annually, making it a leading cause of pediatric hospitalizations in the United States.1 Reported admission rates for children treated in EDs for asthma exacerbations are as high as 53%.2–13 Evidence-based recommendations for acute asthma management developed by the National Heart, Lung and Blood Institute have been shown to improve acute asthma care.14–16 Unfortunately, there is often poor provider adherence to these recommendations, and the quality of asthma care suffers.17–19
Asthma is the leading ED diagnosis resulting in hospital admission at our freestanding children's hospital. Because children with asthma comprise a significant proportion of the patients we see, improving asthma care brings us closer to the goal of providing high-quality care for all patients. Our institution first implemented an ED and inpatient clinical pathway for asthma in 2002. As with any improvement initiative, re-evaluation is critical; repeated Plan-Do-Study-Act cycles resulted in modifications to our asthma pathway over time. In 2010, review of monthly quality metrics revealed opportunities for improvement in the care of patients treated on both the ED and inpatient asthma pathways (Table 1).
Numerous quality improvement (QI) studies demonstrate that implementation of clinical pathways can improve outcomes for common pediatric conditions such as asthma,21–25 pneumonia,26–31 and sepsis.32 Often, the importance of institutional support and provider adherence to pathway recommendations are emphasized as key drivers of success. Because use of the asthma pathway was part of our institutional culture for >10 years, and baseline provider adherence to the pathway and electronic order set was high (∼80%), we assumed modification of the preexisting pathway and order sets would be an effective means for improving targeted outcomes for patients with asthma.
The aim of the present project was to determine the impact of a modified asthma pathway and order sets on the percentage of patients receiving evidence-based care and on the efficiency of care provided.
The setting of the present study was a tertiary, university-affiliated, 323-bed pediatric hospital with a dedicated pediatric ED (43 000 annual visits). Since 2002, the institution has used a clinical effectiveness team to develop clinical standard work pathways for common conditions. Clinical standard work is an evidence-based approach to management of particular patient populations or diagnoses. Clinical pathways are designed as flowcharts or algorithms to guide provider decision-making and offer education to learners on the evidence behind the recommendations. These pathways are linked to diagnosis-specific electronic order sets. Each pathway has up to 2 physician owners who serve as content experts and who also lead the development, implementation, and evaluation of the pathway. Specific process, outcome, and balancing measures are identified for each pathway a priori and are evaluated on a monthly basis with run charts. Currently, 67 clinical standard work pathways have been implemented at our institution. Pathways are formally reviewed on a quarterly basis to ensure that they remain consistent with current medical literature and national guidelines.
The clinical effectiveness team worked with a multidisciplinary stakeholder group to update our clinical pathway for children presenting with asthma exacerbations. This group included physicians and nurses from the ED and inpatient units as well as respiratory therapists, pharmacists, and information technology specialists.
Pathway modification began with a literature review of Embase, PubMed, and national guideline clearinghouses. Using a standardized process, the team of clinicians (physician pathway owners) rated the quality of the evidence and generated a series of recommendations. When possible, the method of the Grading of Recommendations, Assessment, Development and Evaluations Working Group was used. Evidence was first assessed as to whether it was from a randomized trial or cohort study. The rating was then adjusted in the following manner33: Quality ratings were downgraded if we found that studies had serious limitations, had inconsistent results, had evidence that did not directly address clinical questions, had imprecise estimates, or if we observed substantial publication bias. Quality ratings were upgraded if we concluded that study effect sizes were large; if confounding likely resulted in underreporting the magnitude of the effect; or if a dose–response gradient was evident. When evidence was not available from the literature, recommendations were made based on local expert consensus. The team used these recommendations to modify the organizational layout and content of the multiphase pathway (ED and inpatient) and electronic order sets.
The modifications were approved during a series of meetings and subsequently built into the electronic medical record. The modified asthma pathway and electronic order sets were launched on September 5, 2011. As with previous versions of the pathway, the modified version used the Respiratory Clinical Score to guide treatment (Supplemental Fig 7). Similar to other scoring tools, the Respiratory Clinical Score is based on respiratory rate, retractions, dyspnea, and auscultation; it has a maximum score of 12. This instrument has demonstrated good interobserver agreement between physicians, nurses, and respiratory therapists.34
In addition to organizational changes such as renaming the order sets to make them easier to find and use, the pathway was modified to target specific opportunities for improvement (Table 1). For example, there were updates to the medical literature with respect to magnesium sulfate35–45 and ipratropium bromide46–52 that had yet to be put into practice at our institution. In other cases, we had specific local metrics to target for improvement such as ED length of stay (LOS) for admitted patients with asthma and steroid prescribing patterns at the time of hospital discharge. For example, before the pathway modification, patients were often discharged from the hospital with prescriptions to complete a 2-day course of dexamethasone, similar to our practice in the ED, rather than 5 to 10 days of prednisone or prednisolone.14
Implementation of the modified pathway was led by the ED and inpatient physician pathway owners as well as respiratory therapy and clinical nursing specialists. Multiple strategies were used to support uptake and adherence. For 2 weeks before implementation, the pathway modifications were discussed at ED and inpatient provider meetings. E-mail notifications (including to physician and nurse job aids) were sent. In addition, a mandatory Web-based training module was distributed. This training was required for all ED and inpatient providers. It described all pathway modifications and included a knowledge assessment with a required minimum passing score. Finally, laminated copies of the pathway were placed outside patient rooms and in provider work areas to ensure visibility and access.
Study of the Intervention
The goal of this QI study was to assess outcomes before and after implementation of the modified asthma pathway and electronic order sets. To ensure providers were using the pathway and order sets when indicated, we monitored the percentage of eligible asthma patients each month with an asthma order set activated.
Process, outcome, and balancing measures were considered in this analysis (Table 1). Process measures were selected to reflect the evidence-based modifications made to the pathway and order sets. Outcome measures included LOS for both ED-only and admitted patients and were selected to determine the efficiency of care provided. Balancing measures were selected to monitor and identify any unintended consequences of modifying the asthma pathway. For example, the overall proportion of asthma admissions was monitored because 1 modification was the addition of objective admission criteria to the ED phase of our pathway; a change in the proportion of patients admitted, particularly in conjunction with a change in unplanned returns, could signal inappropriate admission thresholds. Furthermore, unplanned returns to the ED and inpatient units were very low at baseline (<1%); an elevation might signal inappropriate discharge from the ED or inadequate steroid course for patients who were discharged from the hospital.
Cost data were obtained from hospital administrative records. Costs were inflation-adjusted to 2013 US dollars by using the medical care component of the Consumer Price Index.53 Because cost data are typically left-skewed with a few very high observations that can bias mean estimates, the top 1% of costs were truncated and assigned the value for the 99th percentile.
Data were analyzed for 24 months before and after modification of our asthma pathway (September 2009–September 2013). Eligible children were those who presented to our ED with an asthma exacerbation from September 1, 2009, to October 1, 2013, aged 1 to 18 years, and eligible for the asthma pathway. Eligibility for pathway use included having a primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code associated with asthma (493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, and 493.92). Exclusion criteria included acute illness such as pneumonia, bronchiolitis, or croup; chronic conditions such as cystic fibrosis and restrictive lung disease; congenital and acquired heart disease; airway issues such as vocal cord paralysis, tracheomalacia, and tracheostomy dependence; immune disorders; sickle cell anemia; and medically complex children defined as those classified as having complex chronic disease according to the Pediatric Medical Complexity Algorithm.54
Descriptive statistics were used to compare demographic characteristics of the premodification and postmodification groups. Statistical process control (SPC) was used to analyze process measures.55,56All control charts were created by using the QI Charts 2.0 add-on for Microsoft Excel (Process Improvement Products, Austin, TX).
For outcome measures (LOS and cost), interrupted time series (ITS) analysis was conducted by using segmented linear regression models. This analytic technique fits a separate regression line with different intercepts and slopes to the data points in each time period (before and after pathway modification) and then statistically compares the 2 intercepts and the 2 slopes based on the Wald t test.57
Ethical Considerations
This study was approved under expedited review by our institution's internal review board.
A total of 5584 patients met eligibility criteria during the 4-year study period. There were no statistically significant differences between the premodification and postmodification groups with regard to age, sex, race/ethnicity, and insurance type (Table 2).
Process Measures
Provider adherence to the asthma pathway was high throughout the study period. We did note special cause with a shift of 8 points above the centerline immediately after pathway modification, bringing the percentage of patients with asthma with an activated order set to ∼90% (Fig 1). The population of patients who were eligible for intravenous magnesium was relatively small; therefore, data for this measure were subgrouped according to quarter to improve statistical power. An increase was noted in the percentage of eligible patients with asthma receiving intravenous magnesium in the ED, with a shift in the centerline on the SPC chart after pathway modification from a baseline of 8% to 63% (Fig 2). As mentioned earlier, review of the medical literature affirmed the utility of ipratropium bromide only in the ED; therefore, we sought to decrease inpatient use of this medication. Through pathway modification and order set changes, we decreased our inpatient ipratropium bromide use from a baseline of 73% to 4% (Fig 3). Similarly, we noted improvement and special cause variation in the percentage of patients receiving appropriate steroid prescriptions at the time of hospital discharge from a baseline of 19% to 88% (Fig 4). All SPC results were sustained for the entirety of the 2-year postmodification period.
Outcome Measures
Results from our ITS analysis demonstrated a clinically and statistically significant decrease in ED LOS for admitted patients by ∼30 minutes. This decrease is likely a reflection of the admission criteria added to the pathway after 1 hour of treatment in the ED as we saw a similar decrease in the time to provider bed request.20 ED LOS did not change for patients who were discharged (Fig 5). Inpatient LOS did not change significantly after the pathway modification (Fig 6).
Balancing Measures
The percentage of patients admitted with asthma remained stable (∼30%), with the exception of a 4-month period of increase not temporally associated with the modification and thought to be related to poor local air quality due to wildfires (Supplemental Fig 8).20 Unplanned returns to the ED and inpatient units were rare events at baseline (<1% of patients), and thus changes were monitored by using T charts. We observed no sustained changes in this measure over the 4-year study period (Supplemental Fig 9). Finally, costs of care for asthma were measured for both ED-only and admitted patients. A statistically significant difference was found in the intercept for costs among those discharged from the ED ($59; P = .04), although that increase was small, representing <10% of total costs in each period. There were marginal, but not statistically significant, differences in the slopes for costs of care for ED-only patients between the premodification and postmodification groups (P = .08) (Supplemental Fig 10).
In this study, SPC and ITS analyses were used to examine the relationship between modification of a well-established clinical pathway for asthma and provision of evidence-based care, efficiency (LOS), and cost in both the ED and inpatient settings in a single freestanding tertiary care pediatric hospital. We found that pathway modification, including order set redesign and provider education, improved provider adherence and subsequent delivery of evidence-based care in both the ED and inpatient settings. Furthermore, the modified pathway was associated with improved patient throughput in the ED for admitted patients, with no significant changes in overall admissions or unplanned readmissions. Importantly, our analysis included 4 years of data, and the results were sustained for the duration of the 2-year postmodification period.
In this analysis of costs, the postperiod slope had a P value of 0.08, which may suggest a marginal increase in costs for ED-only patients. This small ($2/month) difference may have been driven by the adoption of electronic respiratory therapy charge sheets during this time period, which increased our ability to charge for provided services. Future research should assess the slope over a longer time period to assess whether this change was driven by billing or another driver of costs.
QI strategies, including care standardization through clinical pathways, improve outcomes and processes of care for asthma, at least in the short term in outpatient23 and inpatient24 settings. There is a gap in the literature regarding how to achieve provider buy-in and maintain adherence or if results can be sustained over long periods of time. A recent study by Nkoy et al25 showed sustained improvements in 8 asthma quality measures over a 5-year period after implementation of an evidence-based care process model at a pediatric tertiary care hospital; the group then disseminated the model to 7 community hospitals, with similar improvements. Our study adds to this knowledge base, demonstrating that utilization of Plan-Do-Study-Act cycles to modify well-established asthma clinical pathways is a successful approach for producing ongoing improvements in provider practice and patient outcomes that are similarly sustained over time. This outcome suggests that well-designed clinical pathways might not only be effective in acute management of pediatric illness but can be successfully modified over time to incorporate new evidence as it is produced, an important characteristic in a rapidly changing health care milieu.
Our study has limitations. First, patients were identified for analysis primarily by using International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis codes; thus, there may have been misclassification, but we expect any bias to be similar in the premodification and postmodification periods. We further refined our patient population by applying the Pediatric Medical Complexity Algorithm54 to ensure that children with medical complexity who were ineligible for the asthma pathway were not included in the analysis.
A second limitation is that we used the Respiratory Clinical Score34 rather than more widely used tools.58–66 Although this tool has features similar to these other well-established instruments, it is not identical, and this difference potentially limits the generalizability of our results to institutions in which other scoring systems are used.
Finally, our institution was an early adopter of care standardization and has had infrastructure in place to implement and modify clinical pathways since 2002. Over time, our culture has shifted such that providers are familiar with use of clinical pathways and electronic order sets. This infrastructure and level of provider buy-in may limit generalizability of our intervention to other institutions. We suspect that similarities in contextual factors (eg, QI leadership, culture, capability, staff motivation) between institutions as delineated in the Model for Understanding Success in Quality may be a critical factor in repeated success.67
Modification of a well-established clinical pathway and electronic order set for ED and inpatient management of asthma led to immediate and sustained improvements in provision of evidence-based care and efficiency without significantly affecting costs across the continuum of care at a freestanding pediatric hospital. These findings suggest that clinical pathways can be successfully modified and implemented when new evidence becomes available, and continuous re-evaluation and modification may be an effective method for improving care over time. Contextual factors, including institutional culture and leadership support for such interventions, are important considerations for implementation success and long-term sustainability.
- Accepted June 30, 2016.
- Address correspondence to Lori Rutman, MD, MPH, Division of Pediatric Emergency Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105. E-mail: lori.rutman{at}seattlechildrens.org
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Funding for this project was provided by the Seattle Children's Hospital Clinical Effectiveness Program.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- Copyright © 2016 by the American Academy of Pediatrics


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We invite you to stay up-to-date with the latest news and views from our CEO, Lizz Reay.
You can also follow her on Twitter: @NBMPHNceo
Our Well-Being Grants program officially launched in January 2019 and funded community-led initiatives that supported the mental health, well-being and resilience of farming communities affected by drought. These grants were funded through the Federal Government's 'Empowering Our Communities' (EOC) initiative.
We welcome Federal Government's announcement yesterday of $76 million for mental health support in response to the current bushfire crisis.
Bushfires have directly impacted our region, particularly in the areas of Lithgow and the Hawkesbury, with early indications that as many as 100 houses may have been lost, with possibly a further 40 damaged and over 300 other structures destroyed or damaged.
On Wednesday I was thrilled to officially launch the NewAccess program for the Lithgow and Hawkesbury communities.
Developed by Beyond Blue, and provided by Marathon Health, NewAccess is an early intervention self-referral program for people 16 years and over who may be going through tough times.
Our Well-Being Grants to Support Farming Communities help build on existing strong community networks so that people have the skills to support each other and have the best opportunity to thrive.
I'm excited to announce four more of our Well-Being Grants to Support Farming Communities recipients that have been successful in the Lithgow region. Capertee Valley Landcare Incorporated, Lithgow Area Women's Shed, Lithgow Information & Neighbourhood Centre and Trybal Productions.
Last month I wrote about the announcement by the Federal Government of funding to commission a new headspace outreach service in Lithgow in mid-2018.
While we work to establish this new service, it's important that youth in the area who are already experiencing psychological distress, can access the support they need.
As a result, we have established an interim measure that allows young Lithgow residents aged between 12 to 25 years old, who hold a current Centrelink issued Health Care Card, to access up to 12 sessions of free or low cost ($10) psychological services through a referral from their GP.
Today I was delighted to attend an event in Lithgow with the Federal Member for Calare, Andrew Gee, who announced on behalf of the Federal Government additional funding to help support youth anxiety and depression.
I am passionate about improving the health of our local communities and mental health continues to be a high priority for our region.
As part of the package announced today, our PHN will receive funding to commission an outreach headspace service in Lithgow in mid-2018. I am thrilled that Lithgow will receive this much needed funding boost to help address the high rates of youth mental health in the area.
I am a real advocate of health screening programs. Statistics confirm that screening plays a key role in reducing mortality rates through the early detection and treatment of cancer.
In short, cancer screening saves lives and is a priority in our region, as we have communities with some of the lowest screening rates in Australia.


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President's Message January 2007
I have this theory that if one person can go out of their way to show compassion then it will start a chain reaction of the same. - Rachel Scott
Rachel Scott was the first person killed at Columbine High School on April 20, 1999. Her acts of kindness and compassion coupled with the contents of her six diaries have become the foundation for one of the most life-changing school programs in America - Rachel's Challenge.
I viewed the Rachel's challenge program at Hackettstown High School this past month with my daughters. It was run by Rachel Scott's father, Darrell. It was one of the most emotional programs I have ever attended. For anyone involved in a school, I would recommend that you bring up this program to your administrators and bring Mr. Scott in to your school to speak.
The program that he brings is one of simple kindness to other human beings. In my opinion, that is what religion is all about to me. All of the rituals and rites that we as Jews perform, as well as all of the other religions of the world, are to prepare you to do one thing, do unto others as you would have them do to you.
Do you see people for who they really are? Can you see through the facades that we all employ and see the real person behind the facade? Do you see that a simple hello, or thank you, or even just a smile can turn a person's whole day around? The next time you are feeling sad or lonely, instead of thinking about what you need, try smiling at another person. They will usually smile back, and if you start a chain reaction of smiles, how many people'slives can you make better? It doesn't take a Herculean effort to engage in this challenge. It just takes the desire to want to make some one else's life a little better.
May you all have a HEALTHY New Year and may you make a difference in someone's life.
I love each and every one of you and we need all of you at the temple to be involved in our community.


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NFL: Surprising Miami Dolphins in Up Hill Climb
- Updated: July 24, 2017
DAVIE, Fla. — The Miami Dolphins surprised everyone last season by turning a 1-4 start into a six-game winning streak, a 10-6 record, and their first playoff appearance since 2008. Now the question is whether they can build on that momentum.
Las Vegas doesn't think so. It set the over/under for Dolphins victories at 7.5.
The Dolphins strongly disagree with Vegas, largely because of the culture change ushered in by second-year head coach Adam Gase.
As Miami enters training camp there's an almost tangible sense of confidence and optimism in the building and on the field, and that optimistic tone is led by Gase.
For one thing, all indications are that quarterback Ryan Tannehill, who missed the final three regular season games and the wild card game due to two sprained ligaments in his left knee, is full speed ahead for the start of training camp.
Tannehill participated in OTAs (Organized Team Activities) and mini-camp wearing a brace on his left knee, a practice that will continue for the foreseeable future. But Tannehill came out of offseason workouts strong and is ready to go full speed from Day One of training camp.
But beyond that, players think Gase's main tenet of accountability transformed Miami into a playoff team last season, and they saw what can happen, are excited about the future and how they could become even better in 2017.
"If it's on the field, off the field, sleeping better, eating better, whatever it is to make yourself even better than we were last year," Pro Bowl defensive end Cam Wake said, "Each man has to do that, and if we do that individually and collectively, I think that's how we make it happen."
Miami has gone over its deficiencies to the point of exhaustion – run defense (30th in NFL), total defense (29th), third-down offense (25th), total offense (24th), etc…
The Dolphins return many of the same players who were part of creating those rankings. They return nine starters on offense and eight on defense.
But the Dolphins are banking on Gase's policy of accountability to lead to better performance on the field.
In short, hard work is in, slacking/stepping out of line is out, and accountability, for everyone, is at a premium.
Players saw that when Gase opted to leave running back Jay Ajayi at home for the opener at Seattle after Ajayi reportedly reacted poorly to the news Arian Foster would start. It continued when Gase cut offensive linemen Billy Turner, Dallas Thomas and Jamil Douglas for under-performing, and then demoted defensive end Mario Williams and cornerback Byron Maxwell for the same reason.
The Dolphins think players respected Gase's culture change and responded by playing better.
"He's a great head coach," Pro Bowl defensive tackle Ndamukong Suh said, "and I think he's only going to continue to get better because he has that mentality."
Many, Vegas included, might argue the Dolphins caught lightning in a bottle last season, that they can't repeat that unexpected performance by returning many of those same players.
The Dolphins think otherwise. They think Gase's policy of accountability will make them better.
Even Gase isn't above the credo. During the offseason he publicly admitted he made a mistake early last season by putting defensive end Cam Wake, who was recovering from an Achilles injury, on a snap count.
Wake, who ended the season with 11.5 sacks and earned a Pro Bowl berth, was limited to pass rushing situations. His elevation to fulltime starter eventually made the Dolphins a better defense.
"That just makes us evaluate ourselves that much tougher, that much harder," veteran right guard Jermon Bushrod said. "So, when your head coach can take accountability like that, then it's just a trickle-down effect. We're professionals, and that's just how it needs to be so you can fight to win."
MIAMI NOTES: Pro Bowl center Mike Pouncey will have his left hip examined next week and hopes to be cleared to join his teammates for the start of training camp. Pouncey, the anchor of the offensive line since 2011, has not practiced since November, missing all but five games last season due to the hip injury. Pouncey will get the hip examined one more time before the start of camp when the first practice begins July 27. The 27-year-old Pouncey has suffered no setbacks with his hip rehabilitation since going on injured reserve in December and both the player and the team are "confident" the exam will yield positive findings, those familiar with the situation told Armando Salguero of the Miami Herald. The Dolphins hope the findings by doctors means Pouncey could avoid going on the physically unable to perform list at the start of camp. Pouncey sustained the injury in a 2016 preseason game and missed the first four games of the season. The 6-foot-5, 300-pound Pouncey has not played a 16-game season since 2012, his second year in the NFL. He has required surgery on both hips


text: You can run everywhere at any time, it's diverse and affordable for everyone. It shapes our character and gives us freedom, it broadens our horizon and teaches us about ourselves and the world. In this book philosophers, journalists, athletes and writers tell about friendship, nature, pain and pleasure. So it's not only the runners clothes that let you shine – as they do on the book cover – but also your body and mind.


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LASA has provided a comprehensive submission to Minister for Aged Care Ken Wyatt and the Department of Health in response to the Review of the National Aged Care Quality Regulatory Processes (the Carnell Paterson Report) which was finalised in October 2017.
LASA CEO Sean Rooney said the review is an important opportunity to reflect on what works well in the aged care quality system and where there are areas for improvement.
"Our industry was horrified to learn of the abuses revealed at the Oakden Older Persons Mental Health facility in South Australia. As an industry and a society we must work together to ensure that this never happens again."
Mr Rooney said the shared interests across older Australians and their families, age services providers, government policy-makers and regulators, in ensuring Australia's age services system is safe, fair and sustainable, provides a platform for collaboration to consider the recommendations put forward in the Review.
"Any resultant changes from the Review should be carefully designed, taking into account the detailed issues noted for each recommendation in LASA's submission," Mr Rooney said.
"Collectively, we need to translate the report's findings and recommendations into appropriate actions and outcomes that will address identified shortcomings and contribute to continuous improvement and community confidence."
LASA also notes that any recommendations and associated changes must be:
- considered in the context of the ongoing reform agenda
- consistent with the underpinning principles of the reform agenda and acknowledge the Aged Care Sector Committee's 'roadmap' and the NACA 'blueprint'
- considered alongside existing work underway with regards to the Single Quality Framework, quality indicators, and consumer reporting initiatives
- be rigorously assessed with regards to intent, cost, logistics and regulatory impact for providers/consumers/ governments.
Mr Rooney said there is a view that a key contributing factor to issues at the Oakden facility was not the Accreditation Principles or processes per se, but rather inadequacies in the their application by the agencies involved.
"It is comforting to know Australia's current aged care quality framework is resulting in the overwhelming majority of Australians in aged care and their families receiving high quality care, support and services that meet the most stringent national standards," Mr Rooney said.
"We need an accreditation system that assures the community of the safety, wellbeing and quality of life for older Australians living in residential aged care."


text: All the stylish wearers would wish to have leggings ideally because it has become very trendy and modren now a day. This glorious white unisex velous sleepsuit and hat is absolutely right choice for kids fashionable wearing even at their sleep time. Primark has launched it along with all handsome features available for kids.


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When cooks in the ancient Indus River civilization prepared their meals 4000 years ago, the results may not have been much different from what you might order today in an Indian restaurant. Recent studies presented at the meeting found a surprisingly diverse Indus diet that incorporated spices such as ginger and turmeric, beans such as lentils and mung, grains such as rice and millet, and even bananas. An explosion in food-related studies, thanks to both new tools and new interest in rural villages, provides exciting clues to day-to-day life in the Indus, experts says.


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Join Top Pro Jim Schmelzer as he uses two different Westcott Reflectors to discuss basic studio lighting fundamentals. During part three of this five part series, Jim explains how to properly use reflectors indoors. The angle of the reflector is very important. To best illuminate a subject with a reflector, the reflector should be held or placed parallel with the light source. To achieve maximum light reflection, often necessary when shooting from a distance, silver reflectors offer the most reflective surface. When shooting close to a subject, white reflectors are often used for a soft light reflection that will not wash out the subject. Placement of the reflector is also key. Proper, attractive lighting is achieved when reflecting light onto the front of the subject's face. Jim also suggests never using a gold reflector indoors, because this will create inconsistent light temperature by warming shadows.
Jim Schmelzer is an award-winning photographer, lecturer and trainer focusing in high school senior portraits and weddings. He is a Master Craftsman Photographer and holds a Master's Degree with Wedding and Portrait Photographers International. He has also been a technical representative and lighting adviser for F.J. Westcott for over 25 years.
These Westcott Reflectors fold to 1/3 their open size for easy transport and storage. The Illuminator reflectors are offered in a wide variety of colors, combinations, and sizes. The frames are double riveted to last a lifetime and the rectangular shape offers a large surface area. The frames also offer a lifetime warranty.
Westcott Lighting Gear in Action
Illuminator 42" Sunlight/Silver Reflector1408
Illuminator 42" Sunlight/Silver Reflector1408
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Author(s): Sally Bedell Smith
The first major biography of Prince Charles in more than two decades, with new insights into his family and his two marriages, from the bestselling author of Elizabeth the Queen. Drawing on extensive access to the Royal Family's inner circle, Sally Bedell Smith delivers unprecedented insights into Prince Charles, a man who possesses a fiercely independent spirit, and yet has spent his life in waiting for the ultimate role. Beginning with his lonely childhood, Smith details his intellectual quests, his entrepreneurial pursuits, and his love affairs, from the tragedy of his marriage to Diana to his eventual reunion with Camilla, as well as his relationship with the next generation of royals, including Will, Kate, Harry, and his beloved grandchildren. As this sweeping biography shows, Prince Charles is more complicated and compelling than we knew, until now. "For all we know about Prince Charles, there is so much we didn't know - until now." - Tom Brokaw
Prince Charles is an eighteenth-century gentleman with a twenty-first-century mission. His love of tradition combines with an outlook that can be bracingly avant garde. Sally Bedell Smith captures his contradictions and his convictions in this fascinating book that is not just about a man who would be king, but also about the duties that come with privilege. -- Walter Isaacson For all we know about Prince Charles, there is so much we didn't know until now. Sally Bedell Smith has given us a complete and compelling portrait of the man in the shadow of the throne. It's all here, from the back stairs of the palaces to the front pages of the tabs. Read all about it! -- Tom Brokaw No one writes about life at the top with more panache than Sally Bedell Smith. Her Prince Charles is a delicious blend of glamour and grandeur, jealousy and rivalry, greatness and human foible. Smith writes with wisdom and sympathy and a sharp and knowing eye about the struggles and maturation of the man who would be King. -- Evan Thomas This great biography is an indispensable guide for anyone eager to understand Prince Charles and the British monarchy in the twentieth and twenty-first centuries. What an achievement, what work went into it, and all of it presented with such ease. It is so fair, while suggesting so much. -- Peggy Noonan
Sally Bedell Smith is the author of the bestselling biographies of Diana, Princess of Wales, John and Jacqueline Kennedy, Bill and Hillary Clinton, Pamela Churchill Harriman and Bill Paley. A contributing editor at Vanity Fairsince 1996, she previously worked at Time and The New York Times, where she was a cultural news reporter. Sally is the mother of three children and lives in Washington, D.C. with her husband, Stephen.


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The National Cancer Institute (NCI), part of the National Institutes of Health, today announced funding for a major component of its $104 million, five-year Clinical Proteomic Technologies Initiative for Cancer (CPTI). Awards totaling $35.5 million over five years will establish a collaborative network of five Clinical Proteomic Technology Assessment for Cancer (CPTAC) teams. Each of these teams will bring complementary expertise to assess the full spectrum of measurement technologies for proteins and peptides relevant to clinical cancer research and practice. Proteomics is the study of the structure and function of proteins, including the way they work and interact with each other inside cells; a peptide is any compound consisting of two or more amino acids, which are the building blocks of proteins.
CPTAC will guide and provide resources to the broader cancer research community. The network's collaborative efforts will enable researchers conducting cancer-related protein research at different laboratories, to use proteomic technologies and methodologies to directly compare and analyze their work. In current cancer proteomic research, standardized technologies and methodologies are critically needed in order to more effectively discover and validate proteins and peptides relevant to cancer, or "biomarkers." This should lead in turn to improved diagnostics, therapies and even prevention.
"Emerging proteomic technologies have potential to improve cancer diagnostics and treatment, but we must carefully, consistently, and systematically examine them at every major step in the measurement process, in order to realize their full potential," said NCI Director John E. Niederhuber, M.D.
CPTAC awardees were chosen based, in part, on the broad expertise of their proteomic research teams and their familiarity with and regular use of a wide range of proteomic technologies. These five CPTAC teams define a cross-institutional and multidisciplinar
Contact: NCI Media Relations Branch
NIH/National Cancer Institute


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Classic Picture Books Pack x 6
Where should you start with reading? Here's our tip: start with the classics. Books so timeless and joyful they'll get you hooked on stories from the very start. Bursting with humour, colour and wonderful plots and characters, these glorious favourites will make you fall headlong in love with books. (Just like every little person should.) Books are fun. Books are surprising. Books help you discover your world. Books are your friends in tough times. And with stories like these to make you smile and open up your imagination, you'll find out RIGHT NOW how special books are. Make the most of your precious reading time!
- Classics old and new from a host of top authors
- Contains five full-size favourites and one mini book
- Ideal for sharing at home and building literacy
- A great way to awaken a child's love of books


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Chinese website and new director for Modern Water
UK forward-osmosis specialist Modern Water plc has recently appointed William Harvey as its director of strategy and new business development for its Membrane Processes division as well as its electrocoagulation products.On 11 January 2013, the company also announced the launch of a new Chinese website for its products.
Harvey joins Modern Water from GE Water where he was global sales director. While working for Ionics Inc and GE Water, he acquired a wealth of knowledge across multiple technological products for industrial high-purity water, seawater desalination, water reuse and zero-liquid discharge applications.
He specialises in marketing new technologies, the outsourcing of industrial water projects, municipal public private partnerships, new market development, water technology valuation and global business strategy.
The new website www.modernwater.cn comes just weeks after Modern Water signed a framework agreement with Hangzhou Development Center of Water Treatment Technology Co Ltd, which will allow both organisations to jointly identify and develop projects in China, including seawater desalination plants and other water-related opportunities.
© Faversham House Group Ltd 2013. Water. desalination + reuse news articles may be copied or forwarded for individual use only. No other reproduction or distribution is permitted without prior written consent.


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22 Jan Our Favorite Looks Right Now
Just like everyone else we are obsessed with pinning! Our boards our stacked with ideas, inspiration and fun things we want in our homes! These are our favorite looks, but clearly many of you are loving these ideas too.
Modern Mosaic Tile: There are so many reasons to love this gray and white tile. First gray is by far the up and coming neutral color in homes. From paints, cabinetry and flooring there isn't many places we haven't seen this color. Second it is just enough of a statement piece in the bathroom to draw your attention. For the most part this is a pretty simple design with an added element of a beautiful floor.
Statement Light Fixtures: If you want to be bold, then what better time to do it then with a light fixture. For the most part this kitchen is your standard kitchen with modern clean lines and a traditional element. The pendant lights fit very well, because they still stay true to the traditional element of the space, but tie in the modern design. You can't help but appreciate the bold choice when it came to choosing these light fixtures.
Brass and Gold: These two colors are up and coming for 2016. You will see a lot more copper, gold and brass hardware in homes. This pallet is a perfect combination of many of the colors that have become popular in homes.
Stand Alone Tubs: Many of our bathroom remodels are asking for stand alone tubs. Gone are the days of a bathtub in the corner or mounted to the wall. People want to utilize the additional space and create a better flow in the space. We can tell the by likes this photo has got that most people are on the same page as us with this one!
Transitional Kitchen: We can't say enough about this look. We can draw a lot of inspiration from here. From the various two toned cabinets, to the perfect use of gold. The clean lines in this kitchen make it a popular style for most home owners!
These are just some of many items we have on our pinterest page. Make sure you are following us to get access to our latest inspiration!


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6164 Garside Road
Nanaimo, BC V9T 6H9
- Single Family Home
- Status: Sold
- Square Ft.: 1494
- Property Size: 5167 sq ft
- Year: 2005
- Floors: Mixed
- Heating: Forced Air
- Heating Type: Natural Gas
- Shopping Nearby
- Quiet Area
- Recreation Nearby
- Parks nearby
This Lakeside Estates 3- bedroom, 2 bath, open concept home is sure to appeal. Featuring hardwood floors, an inviting entry and a spacious kitchen. The large partially covered deck off the dining room is an ideal entertaining space looking out over the level backyard and green space beyond. The double garage and extra deep crawl space is bonus storage space for those seasonal items. This home is close to Brannen Lake and the Parkway path for walking, running or cycling while being only minutes from all the North Nanaimo amenities. Be sure to view this bright, inviting home. It is sure to impress.
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Trump fails to recognise his gift to Queen, Melania comes to his rescue
Trump was shown a pewter horse that he gave as a gift when they met in July 2018, and was asked whether he recognized it.world Updated: Jun 04, 2019 16:22 IST
US President Donald Trump was rescued by his wife Melania from an embarrassing situation when he failed to recognize a statue at Buckingham Palace that he had gifted to Queen Elizabeth Il last year.
Trump was shown a pewter horse that he gave as a gift when they met in July 2018, and was asked whether he recognized it. Looking a bit puzzled, he replied "no", the Independent reported.
First Lady Melania quickly came to his rescue, saying: "I think we gave that to the Queen."
He had given the thoroughbred statue in polished pewter on his visit to Windsor.
It happened as the Queen was showing the President and his wife around an exhibition at the palace picture gallery of American artefacts on Monday.
Among the items she showed them were a display of golfing memorabilia and a draft copy of a telegram from George VI to US General Dwight Eisenhower after the D-Day invasion of France.
Earlier, Trump was pictured giving the Queen an unusual handshake as they met at the start of his state visit.
The President appeared to grasp only the monarch's fingers in his fist as he was welcomed to the Palace.
(This story has been published from a wire agency feed without modifications to the text. Only the headline has been changed.)


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Incredible Builders: Choosing the right Contractor for your Kitchen Project
It can seem like a monumental task to pick the right General Contractor (GC) when you are considering an update to your kitchen. Every home owner has different decorating tastes. Styles, and color pallets.Having worked the Incredible Builders, Inc.booth at various Home Builders shows over the last couple of years, home owners have asked a lot of question about their specific kitchen project. Here is a glossary of some ideas that you should consider to get starting on the planning:
- Does thecompany offer you a free estimate so that you can plan your budget?
- Does the company have a design person on staff to guide you in the selection of your cabinets, countertops, flooring, appliances, colors and layout to complement the new design?
- Do they have available software so that can show you a visual concept of yournew design?
- What material grades do they work with i.e. cabinets, countertops, tiles, floors?
- If you want to remove a wall, dothey have the capabilities for removing it and installing any necessary beams?
- Do they take care of getting the permits and meeting with the village inspector?
- Are they bonded to work in the village and meet the insurance requirements?
- Is a project manager assigned to your project and do they provide and follow strict schedules?
- What type of warranty is provided for the product and services that they provide?
- Are references of other satisfied customers available?
- Is their pricing competitive?
- What rating does the Better Business Bureau give the Contractor? An "A+" rating isthe best rating. Are there any complaints and were they resolved?
- Is your General Contractor a NARI Certified Remodeler.
So take all this into your decision process when you are picking that contractor. Don't make a hasty decision based on price along. Factor in all the consideration above before you make your final decision. Make sure that you will be comfortable working with the general contractor you select.
Incredible Builders has all ofthe items mentioned above covered. Regarding quality of work and professionalism, Incredible Builders, Inc is "A+" rated with the Better Business Bureau and has 5-star reviews on Google, Facebook, and Yelp and is a NARI Certified Remodeler. So why not call us to discuss your next project and our capabilities.


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INS recognise that the COVID-19 pandemic is a public health emergency. All measures will be taken to follow public health directions to keep everyone safe which includes the cleaning and disinfecting of all our surfaces and adhering to the Four Square metre rule applying to gatherings, events and venues under public health orders
Have your IT training hosted from our fully equipped and comfortable computer rooms based in Surry Hills location.
INS has excellent facilities which can be hired on a weekly, daily, or a half day basis at very competitive rates. Rooms are fully air conditioned and set up in a way to provide your participants with maximum comfort.
Included in hire:
- Technical infrastructure and equipment
- A choice of computers of various specifications
- On-site reception and technical support (M-F)
- High-speed internet connection
- Free Wi-Fi access
- Mobile flip chart stands (Flip chart paper can be provided at an additional cost)
- Complimentary tea/coffee/biscuit
- Kitchen/Breakout option
Optional Extras:
- Administration support services (M-F)
- Facilitator services
- Concierge service for after hours and weekends
Fully equipped computer rooms are available at negotiable prices.
Contact us today to discuss your individual event requirements on: 1800 467 000 or 9119 6000.
Location details
We are located within minutes of public transport, a few minutes from Museum train station as well as numerous bus options.
INS Career Management
Level 5, 1 Oxford Street,
Surry Hills NSW 2010
Phone: 1800 467 000 or 02 9119 6000
- 2 mins walk from Museum Station
- 13 mins walk from Central Station
- 2 mins walk to bus stops
- Numerous cafes and food courts close-by
Here are some testimonials received from clients:


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Billing Questions
For your own security and protection, SplendorAllure.com will pre-authorize the full amount of your purchase plus applicable sales tax and shipping to verify your billing address and credit card information. The pre-authorization will drop off from your account within 1-7 business days depending on your financial institution. SplendorAllure.com will collect payment and post the actual amount of the purchase only when your order is shipped from our warehouse.
If you have any questions about billing or charges to your account, please contact us immediately.
Order Status & Modifying Orders
Before you place your order, you can view the contents and the total amount in your shopping basket.
If you wish to change, refund or cancel your order, you are allowed to do so only before your item has been shipped. Once we have sent out your shipping confirmation email, we no longer have the ability to make changes or to cancel the order.


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Rosa 'Olympiad'
Hybrid Tea Rose
Photo courtesy of Prides Corner Farm
- Vigorous
- Blooms heavy
- Bright color
Blooms all Season
Cut Flower/ Foliage
Fertilize Often
Full Sun
Attracts Butterflies
Homeowner Growing and Maintenance Tips:
Roses grow best in full sun and in well drained soil. Keep well watered first season after planting to establish a good root system. Roses will flower and grow best when fertilized several times during the growing season. Prune dead wood and to maintain shape of the bush. Removing spent flowers will promote additional blossoms. Putting a heavy layer of mulch of compost on the base of the plant in late fall will help protect the bush's roots throughout the winter.
Climbing roses need their canes to be trained on the trellis or support you wish.
Height: 4-5 ft
Spread: 2-3 ft
Price Level 1: $24.99 ea.~#3
Bloom Color: Red
Zone: 5
Additional Characteristics & Attributes:
- Blooms all Season
- Cut Flower/ Foliage
- Vigorous
- Fertilize Often
- Full Sun
- Upright
Foliage Color:
- Dark Green
Season of Interest (Flowering):
- Summer
Attracts Wildlife:
- Attracts Pollinators
- Attracts Hummingbirds
- Attracts Butterflies
Soil Moisture:
- Average Water


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(Reuters) – Miner Anglo American Plc expects an incremental rise in production between 2018 and 2021 and costs to fall, its chief executive officer said on Tuesday.
Chief Executive Officer Mark Cutifani said the company, which has mining operations in Southern Africa, North and South America and Australia, expects 2018 production to be 2 percent higher than its previous forecast.
The miner sees a 3 percent rise in production in 2019 and a further 5 percent boost in both 2020 and 2021.


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The Holy Family Marble Statue - Life Size! - MS-1328
The Holy Family Marble Statue - Life Size! Carved from 100 percent natural solid marble!
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Italian Marble Surround - MFP-2008
Italian Marble Surround custom made to your required specs. Shown in a beautiful italian marble.
Dimensions: H: 65.5" W: 78" D: 16.5" View Colors Call Us!
Luxurious Antique Style Overmantel - MFP-2037
Luxurious Antique Style Overmantel in cream marble.
Dimensions: H: 144" W: 95" D: 24" View Colors Call Us!
Antiqued Marble Coat of Arms Wall Relief - MS-1319
Antiqued Marble Coat of Arms Wall Relief. This fine architectural marble coat of arms was custom designed for a clients upscale home in San Juan. Contact us today for a quote for your home. We supply the entire Globe 24, 7!
Dimensions: H: 28" W: 24" D: 24" View Colors Call Us!
Italian Calacatta French Marble Fireplace Surround - MFP-2009
Italian Calacatta French Marble Fireplace Surround. Carved from a stunning calacatta italian marble. Contact our US based showroom today for in stock options or customize to your required size and stone type. International Shipping Daily. 866.860.1710.
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Italian Limestone Keystone Wall Relief - MS-1320
Italian Limestone Keystone Wall Relief carved from 100 percent natural solid italian quarried limestone. We can design according to your architectural plans. Contact our experienced staff for an estimate at 1.866.860.1710. International delivery daily.
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Majestic Travertine Fountain - MF-1863
Majestic Travertine Fountain shown installed with optional commercial grade stainless steel water jets and submersible lighting. Contact our fountain experts today 1.866.860.1710.
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Tuscany Villa Marble Mantel - MFP-2028
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Transitional Cream Mantel in Solid Marble
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Transitional Marble Table features light cream marble with beautiful beveling throughout.
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This charming old world marble wall fountain features Antique Gray Bacchus marble wall fountain.
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Ultra Light Cream Mantel - MFP-2089
Ultra Light Cream Mantel featuring ornate hand carved detail throughout. A super luxurious french style marble fireplace. Available as shown for limited time only.
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After many years as the Metabolic Doc, I've realized the care I'm providing is best described as a new sub-specialty of Internal Medicine: Testosteronology. You can still call me the Metabolic Doc, but moving forward my focus is on Testosteronology.
While caring for thousands of men on testosterone and anabolic steroids I've learned a lot about how other medical specialists prescribe testosterone. I've found that no other specialty offers comprehensive and personalized medical services for men on androgens.
Testosteronology is distinct from Endocrinology and Urology: Testosteronology is more specific than Endocrinology, which deals with all hormones in men and women. And it is different from Urology, also known as genitourinary surgery, which focuses on the mechanics of the genitals and does not consider the cardiovascular implications of androgens.
With this name change, my medical practice provides the same specialized medical services for men: Testosterone Replacement Therapy, Anabolic Recovery Medicine, and Cardio-Metabolic Men's Health – focusing on aggressive prevention of cardiovascular disease, quality of life, and prostate health.
Aside from the logo change, you'll find most of the site is the same - at least for now. Stay tuned for some updates coming soon!
Stay Strong and Healthy,
Dr. O
Thomas O'Connor, MD


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When I first lost my mom, I didn't know if I was allowed to go out. Continue reading "If I'm Grieving, Can I Still Drink?"
Processing Grief is a Personal Preference: How I Figured Out the Way I Process Grief.
Have you heard of the term brain fog? It's that feeling when you should be perfectly fine, you're just going about your day, and WHAM. Your brain has gone all soft and fuzzy and you want to fall asleep right where you're at and all the energy in your body has disappeared. Your reflexes are slow. This is totally normal and people feel it all the time when they're tired or they've had a long day- whatever. Continue reading "Processing Grief is a Personal Preference: How I Figured Out the Way I Process Grief."


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Bankruptcy rates spiked during the 2008 recession and many were pretty judgmental toward the millions who couldn't afford to pay their bills.
But Suze Orman says bankruptcy is the better option over burying your head in the sand. "When somebody really doesn't have money to pay their bills then they should claim bankruptcy and face it right on and start all over again," says Orman.
Many people heeded this advice over the past five years. In 2008, bankruptcy filings jumped 32 percent to 1.1 million and in 2012 the filings jumped to 1.3 million. However, in June 2013, the U.S. courts reported filings closer to the early recession era at around 1.1 million.
Record-breaking filings have some at odds with Orman's advice. "Many gripe when I tell someone to claim bankruptcy," says Orman. "But what if you've got all this credit card debt, mortgage debt and car loans, and you just stop paying all these things because you just don't have the money?" asks Orman of her naysayers.
She points out that there's really not much difference and the alternative to filing may be far worse.
"If creditors sue and win they have the legal authority to garnish wages or put liens on your home," says Orman.
She says it's better to take "the legal route that is claiming bankruptcy, to let your creditors know that you really can't afford to pay it."
Check out more valuable information about Guam's Laws and working with
Mark Williams, Guam's Best Lawyer, on Dededo Law Office's websites: www.guamlegal.com www.bankruptcylawyerguam.com www.injurylawyerguam.com


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Friday Email: 15 March 2019
Every Friday morning our lead analyst Mark Riding sends out his weekly run-down and upcoming events in the investor calendar, like this one:
The FTSE 100 has had a pretty good week as Brexit dominated and culminated on Thursday with Parliament voting by a large majority to seek an extension to Article 50.
The past week continued to be busy with plenty of companies reporting to the market and declaring their dividends.
Next week is still reasonably busy with some big companies reporting including John Wood, Antofagasta, Kingfisher and Next.
Going ex-dividend this coming Thursday with yields in excess of 2% we have Crest Nicholson (5.5%), Hammerson (3.9%), Phoenix Group (3.4%), RBS (4.1% - 1.3% ordinary and 2.8% special), OneSavings Bank (2.6%), Blackrock World Mining trust (2.5%), Dominos Pizza (2.4%), Meggitt (2.2%) and Segro for 2%.
The Friday email is delivered to over 20,000 subscriber's every week, and remains a widely read run-down of recent events and what investors can expect in the week ahead written by our chief analyst Mark Riding.
It's included as part of the free DividendMax trial.
Read next: 08 March 2019
The FTSE 100 is unchanged on the week. It was again a very busy week as the reporting season continues. The dividend picture has been very resilient with a few specials thrown in; including one this morning from Bodycote. There was also the promise of a special dividend from Greggs with their next set of results (interims) and Cobham expects to return to the dividend list in 2019, albeit in a small way with 1p promised.
— Interested in a free trial? —


text: HONEYHONEYwith RYAN JOSEPH ANDERSON Tuesday, June 9, 2015 at 7:30pm$12.0018+Venue: First Avenue7th St Entry Info TabsPerformersPerformer: HONEYHONEY WEBSITEFACEBOOKTWITTERYOUTUBEPerhaps sometime in the early 90's Ben Jaffe and Suzanne Santo passed each other on a turnpike or east coast beltway in transit on a family road trip getaway. Perhaps their families stopped at the same Maryland welcome center and 9 year old Ben and Suzanne stared at the same bag of cheezits in a vending machine, turned to each other and said, "Hey homey, let's meet up in Los Angeles in ten years and start a folk band that will turn into a folk rock band that will turn into a full throttle rock all the way band." Read more about HONEYHONEY Special GuestsSpecial Guests: RYAN JOSEPH ANDERSON WEBSITEFACEBOOKTWITTERINSTAGRAMNashville (by way of Chicago) troubadour Ryan Joseph Anderson paid his rock n' roll dues as the bandleader for roots outfit Go Long Mule, guitar slinger for garage-rockers Rambos, and as a producer, sessions man, and touring musician for a variety of artists. His influences as a songwriter range from country blues to psychedelic folk. Read more about RYAN JOSEPH ANDERSON


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LISTEN: SuperM Drops New Track "One (Monster & Infinity)" Ahead Of New "Super One" Album
SF9 Announces February Comeback And First Mini-Album Release
Rookie group SF9 is preparing for their comeback!
On January 23rd midnight KST, the group announced their comeback via their broadcast of the V Live app. In addition, a teaser image was released on the Twitter account of their label.
According to the image, their first mini-album will be entitled Burning Sensation and is set to be released on February 6th. The title track is called "Roar." In a cute nod to the group, the tire tracks going across the image of the poster are made up of the repeated use of the word SF9.
Also according to the image, something entitled "The Process of Burning Sensation" will also drop on January 25th at midnight, but there was no further explanation as to what that meant.
Check out the teaser image below! Are you excited to hear the group's first mini-album?
#SF9 First Mini Album 『#Burning_Sensation』 Comeback Poster Open
>Release 170206
>The Process of Burning Sensation 170125#에스에프나인 #부르릉 #ROAR pic.twitter.com/mCJ8Dot0qx
— FNC Ent. (@FNC_ENT) January 23, 2017
Media: FNC Entertainment


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Welfare secretary Iain Duncan Smith has instructed officials to "look again" at how the "bedroom tax" will affect disabled people, the BBC has been told. Under the plans, social housing tenants' benefits will reduce if their home has one or more spare bedrooms. But charities have told the government that couples who could not share a bedroom because of a disability would be unfairly penalised.
Mr Duncan Smith said he understood the concerns. He said he had has "already issued an instruction" to officials at the Department of Work and Pensions saying, "let's look at this again". On Thursday, the chief executives of seven charities – Carers UK, MS Society, Mencap, Macmillan Cancer Support, Disability Rights UK, Carers Trust and Contact a Family – wrote an open letter to Chancellor George Osborne and Mr Duncan Smith. In it they expressed their concerns about the impact of the new policy on disabled people and families caring for disabled family members.
Heléna Herklots, chief executive of Carers UK said the changes would hit families for whom an extra bedroom was essential. "If you care full-time for a severely ill or disabled partner, their condition may mean a separate room for you to sleep is vital. Disabled children often cannot share with their brothers or sisters," she said.
"Hitting carers and disabled people with extra costs for this essential accommodation, or forcing them to move is simply wrong."
The charity said government figures showed the tax would affect 420,000 people. It said its analysis showed extra funding from government to provide "discretionary payments" to families hit by the policy would only protect 10% of the disabled people affected.
Under the government's so-called "size criteria", families will be assessed for the number of bedrooms they actually need. The change affects council tenants, and those renting from housing associations, of working age who receive housing benefit. It does not affect claimants who rent in the private sector. Tenants in social housing will have their benefit reduced by 14% if they have a spare bedroom or 25% if they have two or more extra rooms.
Source: BBC NEWS
Link: http://www.bbc.co.uk/news/uk-21541400
21st February 2013


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25 October 2018
As a communications professional, I'm always on the lookout for events to attend where I can learn something new and network with other like-minded business people to help build my contacts within the industry.
When I came across the Comms Event hosted by the National Housing Federation, this ticked all the boxes, especially when the guest speakers were announced as this is always a deciding factor when choosing a worthwhile conference.
The Comms Event has high profile speakers from a broad range of backgrounds in marketing and communications, covering everything from crisis communications to digital marketing. The event also helps to address issues facing the sector such as mergers, engagement and transformation. Having recently been through a merger the 2018 event really helped us shape our plan when communicating the rationale for change and how internal communications can help steady the business during the change period.
The Comms Event is always a high priority on our team's calendar for the year. It provides the right balance of networking and learning, with key takeaways to implement into a communications strategy. Highlights for me from the 2018 event were Amanda Coleman, Head of Corporate Communications at Greater Manchester Police who addressed the communications during the Manchester Arena attack. Wow… just wow! Jenni Field, Chair/ Director of CIPR Inside shared her expertise on internal communications and how it needs a seat at the table. I also enjoyed the seminar on digital marketing, as this is my particular area of expertise, and was blown away by Andrew Davis who is clearly a digital marketing genius. He explained how to make the customer the hero of the story.
There was some great insight from other keynote speakers such as Ed Fitzhugh from the Behavioural Insights team on how to communicate more effectively, and James Green from the National Housing Federation on innovation and the future of communications. Penny Haslam, a former BBC journalist was the chair of the event and kept the momentum going, as well as sharing what it is that journalists are actually looking for.
While someone from my team goes every year, 2018 was the first time I attended the event and it really delivered in terms of content and networking. Having the time to catch up with other communications professionals and bounce ideas off each other is a great way to work collaboratively, both across the sector and with the National Housing Federation.
It was through networking that I got the opportunity to join the advisory board for the Comms Event 2019, so I'm sharing my ideas and thoughts to help make next year's event bigger and better.
Tanya Edwards
Tanya Edwards is Communications Specialist at Jigsaw Homes Group, based in the North West.