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R.M. Palmer
Tuesday, March 11, 2014
R.M. Palmer Cake Batter Cup
The R.M. Palmer Giant Cake Batter Cup answers a need no one has addressed before. It's a fake chocolate cup filled with a solid oil-based confection that emulates raw cake.
The wrapper is pink and the launch of the product coincides with spring, so I'm going to call it an Easter candy even though there are no rabbits on the package, just a couple of pasty kids in chef's hats making some sort of bowl of batter.
It weighs a quarter of a pound, which is giant compared to the mini foil wrapped peanut butter cups R.M. Palmer usually makes, but it's not as large as the half pound peanut butter cups that Reese's sells in pairs around Christmas. But this isn't peanut butter, where most of us think more is better. This is cake batter, which is pretty much a room temperature cookie dough smoothie.
The cup is huge, at a quarter of a pound, it's the size of a small saucer and weighs, well, four ounces. This is not R.M. Palmer's first attempt at a quarter pound cup, they make a passable Peanut Butter Cup version. The package says that it's two servings, but that's a staggering thought when I looked at the ingredients:
The chocolate flavored coating looks like bad chocolate, but that's about the only thing that it succeeds at. There are no chocolate notes in it, it has no chocolate texture, it's filled with sugar, milk by-products and oils. The filling isn't like the Russell Stover cake fillings, there's no flour in there; it's just more oil and sugar and fake vanilla.
I've never been much for eating cake batter, so the idea of a candy that re-creates this is not up my alley. Add to that, vanilla cake is the least interesting kind of cake. Why would I want to eat that batter? Spice cake, lemon pound cake, devil's food ... these are interesting. Vanilla cake batter is not.
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POSTED BY Cybele AT 12:18 pm Candy • Review • Easter • R.M. Palmer • Kosher • Mockolate • 3-Unappealing • United States • Walgreen's •
Friday, November 15, 2013
R.M. Palmer Candy Cane Cups
I'm not usually a fan of R.M. Palmer candies (I can't call their the vast majority of their products chocolate with any accuracy) but I do appreciate their packaging and design. I browsed their new Christmas offerings a few weeks ago and was actually excited by just the name of their R.M. Palmer Candy Cane Cups. Luckily at only $1.00 at the 99 Cent Only Store, the risk was low and possible rewards were high.
They kind of lost me at the description on the ribbon on the front of the package: Your Two Favorites ... Candy Cane Crunch in a Chocolaty Shell. I happen to know a lot of undiscerning people, but I can't think of any of them that would call anything "chocolaty" their favorite thing. They might eat it pretty happily ... but most folks prefer the real stuff.
The ingredients include a lot of sugar and partially hydrogenated oils ... I'm not sure what will happen to these if the FDA bans artificial trans fats, though the nutrition panel lists that a serving of 4 cups contains 65% of your RDA of saturated fat, it doesn't actually show any trans fats (though if it's less than .5 grams, they can say there's 0).
The cups are nicely designed. The foil is clean red & white stripes and easy to identify if you were to put them in a candy dish. The cup is a nice size, could be one bit or two small ones. (I always like to look inside.)
They smell quite pepperminty. The chocolate coating is oily but does have a melt-in-your-mouth quality because of all the tropical oils. It has a light cocoa note to it, but it's barely discernible. The filling is firm but also has a melty but slightly grainy quality. There are little bits of peppermint candy in it that give a slight crunch and texture.
I was prepared to hate these, but it's a great idea and though not executed with premium ingredients, they're still passable. Now ... let's see some real chocolate companies do better.
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POSTED BY Cybele AT 1:34 pm Candy • Review • Christmas • R.M. Palmer • Kosher • Mints • Mockolate • 6-Tempting • United States • 99 Cent Only Store •
Monday, December 5, 2011
RM Palmer Giant 1/4 Lb. Peanut Butter Cup
R.M. Palmer makes charming and cheap candy for the holidays. Their Christmas candies are never as appealing as their Easter goods but I was intrigued by their new RM Palmer Giant 1/4 Peanut Butter Cup.
Giant candy is pretty common as a holiday gift, especially as a stocking stuffer or Secret Santa item. This one isn't quite as amazing as the Snickers Slice n' Share or 1 Lb Reese's Peanut Butter Cup, but it's certainly affordable at only $1.00.
The package is simple. There were two designs, the red wrapper I picked out features an elf on a snowboard. There's a green version that had a Santa on it.
The packaging is spare, it's just a plastic sleeve, there's no cardboard tray or even a fluted cup. However, this was more than sufficient, my cup came out the wrapper looking nearly flawless.
Like nearly all R.M. Palmer candies, this is a very nicely made product. The mold is well designed and attractive. The large cup has some attractive design details, including a little inset bevel and texture on the bottom of cup. The fluting is crisp and the mockolate coating is shiny.
The cup is three and a half inches in diameter and just a smidge over a half an inch thick. The package says that it's four servings, which would be one ounce each. It'd be pretty easy to divide this up, it cuts easily with even a butter knife. However, one ounce is a rather small portion for candy. The typical is about 1.5 (which is what a pair of Reese's Peanut Butter Cups are).
The first ingredient on the list is sugar, which I fully expected. The second is partially hydrogenated vegetable oil made from palm kernel and/or palm oil. It's pretty widely known now that partially hydrogenated oils contain trans fats. And trans fats need to be reported on the nutrition facts panel. However, if it's less than a half a gram of trans fat, it can be listed as zero. So it's entirely possible that a "truer serving size" of 1.5 ounces would have a measurable amount of trans fat. Or it could be that RM Palmer figured that people could quarter things easily but probably couldn't cut them into 3/8 as easily. (Well, you'd just cut it into 8 pieces and take a serving of three of those, but I don't think they'd be structurally sound.)
The cup smells good, like sweet peanut butter. The bite is soft and the peanut butter is smooth. It's an odd cup, I was fully willing to hate it based on the ingredients. However, the peanut butter center is really good. It's soft but not greasy, smooth but not quite silky. There's a slight coolness to both the mockolate and the peanut butter on the tongue. The flavor of the peanut butter center is sweet, not quite as salty or crumbly/dry as a Reese's, it's more like eating peanut butter cookie dough.
For kids or the not-too-picky, it's a fun little treat. It's far from gourmet, but it fits in as affordable and over-the-top little gift.
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POSTED BY Cybele AT 1:14 pm Candy • Review • Christmas • R.M. Palmer • Kosher • Mockolate • Peanuts • 5-Pleasant • United States • Rite Aid •
Thursday, December 23, 2010
RM Palmer Peppermint Patties
I've often made fun of R.M. Palmer as a maker of horrible candy. I do my best though to keep an open mind whenever I approach a candy from them that I've never had. Sometimes I'm rewarded.
I picked up their Peppermint Patties since they were on display as a "great value" at RiteAid. It was only $1.00 for a 5 ounce bag of individually wrapped patties. Each little pattie is about 1.5 inches in diameter.
They're molded instead of enrobed, which is kind of odd. (More like the Russell Stover version I mentioned last week in construction than the Haviland.) The molding has ripples on it to make them look liked they've been enrobed, but it's easy to tell around the edge that they're made in a mold. (And they look nothing like the image on the package, which I seem to have lost.)
The big difference between these and most other peppermint patties is the coating. This is not chocolate, it's mockolate. The first ingredient on the list is sugar and the second is partially hydrogenated vegetable oil (palm kernel, coconut and/or palm oil). It's really evident upon biting into them. The coating has a decent melt and the whole thing has a cool and fresh minty scent. The cocoa flavors are just that, plain old cocoa, like I'm eating that paste that you make with water and hot cocoa mix, not actual chocolate. The minty center is creamy and smooth and has a very subtle flavor, almost like peppermint bubble gum instead of a strong breath mint style.
Since there's more coating than filling, these are very high on the calorie count for a peppermint pattie. York Peppermint Patties are about 115 calories per ounce, which is great for a product that contains real chocolate. These clock in at 152 calories per ounce. For that you can have an actual chocolate truffle (sure, it'll cost more) and enjoy the real fats instead of this partially hydrogenated artery clogging crud.
They're not horrible, they're just not that good. I don't plan on finishing the bag.
Related Candies
POSTED BY Cybele AT 1:48 pm Candy • Review • R.M. Palmer • Kosher • Mints • Mockolate • 5-Pleasant • United States • Rite Aid •
Tuesday, March 30, 2010
RM Palmer My Little Bunny
Lately The Man and I have been searching for a new dog. As we've visited quite a few pounds and rescue organizations it's startling to see how many rabbits there are. Rabbits are great pets, but too many of them are taken home by families that don't know what's involved with their care. Easter is a prime impulse season for pet rabbits (and chicks & ducks) so there's an organization called Make Mine Chocolate that urges people to reconsider live animal gifts and instead keep the pet decisions out of the Easter basket. So make your Easter basket pet a chocolate one.
I am always drawn to RM Palmer's package and product design. Their products go downhill after that, but how could I resist this cute little chocolate bunny in a little hutch? It plays on a kid's desire to nurture without resorting to anthropomorphism.
The My Little Bunny is actually a fun little teaching toy. It's a bit more realistic that the regular seated bunny or cartoon style one carrying a basket. This one is about the size of a little baby bunny or a dwarf. It comes in a small box shaped and designed like a carrying hutch with simulated chicken wire on the plastic window. I picked the blue wood-grained box version, but there's a pink one as well. Also, I think the rabbits come in different colors, I only saw tan ones at the store.
The foil design makes the bunny look a little bit stylized with its vague smile, but for the most part it's very bunny-like in the crouched position on all fours. The box is far larger than the candy, which is a good thing for a pet, though kind of wasteful as far as packaging. (The bunny is 5 inches long and 3 inches high, the box is 6.5 inches long and four inches high.)
I liked the little box and thought a clever or motivated child might enjoy making use of it to keep a small stuffed animal or other light toys. Unfortunately it's poorly designed. The little tab in the top that tucks in comes undone when the little carrying handle is used, even when the box is empty. A little tape will fix that (that's the way it comes in the store), but a bit more thought would have made this far more useful with probably no extra work or weight in the packaging.
There's a web page just for the My Little Bunny where kids can download an adoption certificate or play games.
The candy itself is subpar. I've had the chocolate flavored rabbit before which looked completely fake, like some sort of vinyl dog toy. This one looks like chocolate and is called chocolatey n' smooth crisp n' crunchy candy which I figure is a Nestle Crunch simulation.
Since there are no easily accessible ears, I just smashed the hollow bunny instead.
It smells like caramel and chocolate cake, not actual chocolate. The ingredients are sugar, partially hydrogenated vegetable oil (Palm Kernel and/or Palm Oil), whey, lactose, crisp rice, cocoa, skim milk, soy lecithin and vanillin. My goodness, cocoa is really far down on that list. On top of that look at the second ingredient, palm oil. Nestle has being going through a huge issue recently for not moving to sustainable palm oil - that campaign has targeted the KitKat bar, which uses a little dash of the stuff, for most RM Palmer products it's a major component. It's short sighted to encourage kids to "adopt" a chocolate bunny instead of a real one but then not use sustainable ingredients in the product itself. (Save a bunny, trash a rainforest?)
The flavor is sweet, the texture is grainy and there aren't nearly enough crisped rice bits to make each bite crunchy. The cocoa notes are like cardboard and there's a greasy film on the roof of my mouth by the time I finished three bites.
Blech. At least I can wrap what's left back up in the foil and put it back in the little box and look at it instead.
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POSTED BY Cybele AT 9:05 am
Friday, October 30, 2009
Brach's Peanut Butter and Caramel Pumpkins
I was happy to see that Brach's was expanding its Halloween offerings beyond candy corn. I love peanut butter and chocolate and though nothing really compares to the Reese's products, a little foil wrapped sphere sounded good.
Brach's Peanut Butter Pumpkins say they're Rich Chocolaty Pumpkin With a Peanut Butter Center. There's a companion product, the Brach's Caramel Pumpkins. They're both sold in 9.25 ounce bags and I was a little surprised to see that they weren't even real chocolate. (The real shock came later, as you'll see.)
The foil on the pumpkins comes in two different "faces", one on each side of the sphere. There's a happy one with its teeth missing (shown) and then on the other side is a triangle-eyed one. It's an impressive look when they're piled in a bowl. Each is one inch in diameter.
The foil is easy to peel off. At first I though mine were dented, but it turns out there's a little divot in each where they're molded. (But they are easy to dent as well.) The chocolaty ball inside doesn't have any imprints on it, it's just a sphere with a slight texture to it (like a miniature basketball).
The smell like wonderfully fresh roasted peanuts.
Biting into it, it depended on the temperature what the filling was like. When I first got these it was quite hot, so the ambient temperature was over 80 degrees and the peanut butter center was gooey and slick. It was quite nice, not quite a meltaway, but definitely a whole different experience from the dry and crumbly Reese's peanut butter. When the weather cooled and I tried them again the peanut butter was firmer, a bit more dry but still quite smooth. The roast of the peanuts is dark with a slight bitterness to them. It's salty and satisfying.
The coating is mockolate. Unlike mockolate products created by Hershey's, these don't have a trace of cocoa butter at all in them, It's all partially hydrogenated palm kernel or palm oil. It's quite cool on the tongue and has a bit of a greasy melt. It lacks all chocolate power, it's more of a cardboard version of chocolate flavor. When it's all chewed together it's not as noticeable, but nibbled off separately it's quite bad.
The Brach's Caramel Pumpkins were even less appealing. (Well, the one thing they had going for them was 20 fewer calories per serving, but of course lacking all the nutrition that the peanuts provide.)
The foil wrapping is gold instead of orange but still has the same faces & green stem for hair.
They smell like butter flavoring and sugar.
The bite is similar, the chocolate-flavored-coating tastes grainier and of course lacks true chocolate flavor. The caramel filling is interesting, it's a little like a pudding - sweet but not actually cloying. It's smooth and not quite flowing but not stiff enough to be chewy.
The whole thing was a dreadful mess.
The worst part though was if you look closely at the photo above you'll notice a tiny little logo on the sphere. It's the R.M. Palmer logo.
These are just the R.M. Palmer Creepy Peepers! And Creepy Peepers are cheap - usually about a buck for a 6 ounce bag, these Brach's things are over $3.00 a bag in stores.
I just don't get it. Brach's used to distinguish itself from the bagged candy as being just a little better ... this repackaging of something most of us wouldn't dare touch is pretty creepy. I hope Brach's gets its act together and goes back to its core value of quality candy.
If you like these, well, skip the Brach's middle man and just get the R.M. Palmer. They sell them year round in sports shapes (I think that's the basketball texture).
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POSTED BY Cybele AT 9:35 am
Monday, October 12, 2009
Cookies 'n' Creme Showdown
At the Walgreen's I noticed a new set of bars far down on the bottom shelf in the candy aisle. They're simply called 3 for $1 Buck (which seems redundant, three for one dollar buck bar?). They're Proudly manufactured in the USA by R.M. Palmer. I picked out one of each and today I thought I'd do a head to head comparison between one of them, called Cookies 'n' Creme.
Of course the best known Cookies 'n' Creme bar is made by Hershey's. It was introduced in 1994 and for a long time was made with real cocoa butter so it was a white chocolate product. Now it's made with a white confection so a good item to do a match up with the Palmer version.
Each bar is a white confection (a mix of vegetable oils, milk & sugar) studded with chocolate cookie bits ... the whole effect is like Oreos in ice cream at room temperature.
Ingredients for Hershey's Cookies 'n' Creme (1.55 ounce)
Ingredients for R.M. Palmer 3 for $1 Buck Bar Cookies 'n' Creme (1.45 ounce)
The Hershey's bar is formatted just like the regular Hershey's Milk Chocolate. 12 rectangles make it easy to snap & share. The ingredients aren't quite as good as the pure white chocolate they used to use, but this is still a distinctive bar of decent quality.
It smells quite a bit like ice cream. The melt is rather smooth and cloyingly sweet. The cookie bits are jam packed in there, you can see from the flipside view that they're little cookie pellets so there aren't a lot of little crumbs, just real crunch & toasty chocolate flavor. It has a good bit of salt to it (110mg) so it helps the vanilla and chocolate flavors pop.
The Palmer version is a nice long, domed format. It's a little lighter in color compared to the Hershey's version. Even though it weights a tenth of an ounce less it has the same number of calories (220) and one more gram of fat (12 g).
It's immediately sweet, but has a good, cool melt on the tongue. I didn't get as much in the way of milky flavors from it but a fun fake vanilla that reminded me of taffy. There really weren't that many cookie bits, which was disappointing, especially since I figured those were the cheapest ingredient in the whole thing.
Overall it was far too sweet, even statistically I can tell: Hershey's has 19 g of sugars & Palmer has 24 g ... and remember, Palmer's is smaller.
There's really no comparison, the Hershey's is a well rounded white confection with a dark chocolate cookie crunch. The Palmer is just a cheap sweet and fatty imitation. If the Palmer price tag is too much of a temptation, wait until the Hershey's come on sale.
They're both Kosher and both made in the USA.
Related Candies
POSTED BY Cybele AT 11:15 am
Monday, March 2, 2009
R.M. Palmer Quax - The Yummy Ducky
I will start by saying that I'm a sucker.
I bought another molded Palmer Easter item. (A product which I generally consider a biodegradable decoration, not actually meant to be eaten.)
I have to hand it to R.M. Palmer. They do a great job of keeping their prices low and their designs contemporary.
Quax: The Yummy Ducky pretty much had me with the packaging. (It certainly wasn't the description of Hollow Milk Flavored Candy Duck that sold me.) It looks just like a bathtub rubber ducky. But it was also on sale for only a dollar.
Quax is a bit smaller than the average toy duck. He's about 3 inches from beak to tail and three inches high.
He's well molded, with a seam through his head and down his sides. (I would have thought it would be constructed with mirror-image sides, but this way presents a flawless face.)
He sounds like plastic, looks like plastic but thankfully smells like an Easter basket. (Mmm, vanillin.)
The ingredients are what I'd expect from Palmer:
The packaging seems a bit excessive for such a tiny candy toy - it's 4 inches wide and 6 inches tall. But it does have a little to and from tag area on the back for gifting.
After a certain point though, I just had to know ... would it float?
So I got out a bowl of water and plopped my Yummy Ducky friend into it.
Sure enough, he floats. He floats just fine. But he's not balanced, so try as I might, I couldn't get him to bob like a duck should, upright (or even tail up like a feeding duck might). Instead he did the duck equivalent of belly up and rested on his side. What this duck needs is a keel. Or feet. Then I think we might have something, an edible decoration for a punch bowl.
At this point I was pretty happy with my one buck purchase. It was cute, it smelled better than some vinyl toy and provided at least 800 words for my review without even cracking it open.
But I have to actually eat some, don't I?
So I bit off the top of his skull.
The milk flavored candy has a very strong vanilla flavor with a little bit of dairy/dried milk going on. It's incredibly sweet, actually throat searing.
It's not that bad! Since it's not trying to be actual chocolate, it succeeds at being better than plastic. I don't plan on finishing it, but it was a fun little novelty item. It might even be amusing if they made them in a few sizes. You know, because they're really not for eating, just decoration.
For those of you who for some reason now want to watch Ernie sing Rubber Duckie, here it is on YouTube.
Related Candies
POSTED BY Cybele AT 8:29 am
Meticulously photographed and documented reviews of candy from around the world. And the occasional other sweet adventures. Open your mouth, expand your mind.


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After how amazing all of the performances on last night's episode of Dancing With the Stars were, it was pretty much impossible to predict what would happen on tonight's results show.
All five contestants definitely deserved to be in the finals, but after tonight's double elimination, two of them have officially danced their last dance -- unless of course ABC winds up doing another All-Stars season down the road.
But regardless of who made it to next week's final round, it's pretty clear who is the biggest winner overall. Because Kelly Monaco will take away something this season that is way more important than the mirror ball trophy.
Um, duh -- she found herself one heck-of-a-hunk-of-a-man in Val Chmerkovskiy.
I don't care if Kelly has a boyfriend, and I don't care that he's been sitting in the audience in agony each week watching her steamy and undeniable chemistry with Val. (Hello awkward.)
Kelly and Val are so damn hot together that even fans like me who are watching the show from the comfort of our own living rooms can feel the fire between them -- and that's not something that most people find every day. A lot of us will go an entire lifetime without experiencing that kind of passion, so even if Kelly loses in next week's finals, it's okay, because she's really already won.
Yes, I said "next week's finals," and yes -- Kelly and Val secured themselves a spot.
As for who they'll be competing against for the title? Well, the ladies have it this time around, as Shawn Johnson and Melissa Rycroft also made it through.
While it's kind of sad to see Apolo Ohno and Emmitt Smith go home, having a final of just ladies should make the competition especially interesting and even more cut throat.
Are you happy with who wound up in the DWTS finals? Who do you think will win?
Image via ABC

subset: commoncrawl


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PotterCast LiveStream Recording Thursday, September 9
Sep 08, 2010
Join PotterCast this Thursday, September 9th at 11:30 AM PST (2:30 PM EST), for a live recording of our Harry Potter podcast. Taking place right here on LiveStream, you can listen in, give us your thoughts in the live chat, and keep up with our PotterCast twitter all on one page. Be sure to check "Attending" on the Facebook invite page via this link.
In addition to this, share with us what you would like to hear on this episode of PotterCast by joining the pre-show planning right here. On this page you can see what we're planning for this episode and share with us more about what you'd like to hear on the show.
See you there!


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Update – Saturday Afternoon Motorcycle Crash Victim Identified [AUDIO]
UPDATE - Monday, April 1, 7:45 a.m.
Missoula County Sheriff's department spokesman Jason Johnson has released the name of the victim of Saturday afternoon's motorcycle crash near Lolo. Johnson says 31 year-old Frank Schwindt died of blunt force trauma to the head and back. Johnson said Schwindt was not wearing a helmet when his motorcycle went off the road and tumbled into a ditch.
The Montana Highway Patrol reports that a 31 year-old man from Florence was killed Saturday afternoon not far from Lolo.
Trooper Richard Salois said that the unidentified man lost control on old U.S. Highway 93 not far from Trader Brothers at about 1 p.m. and left the road, went into a ditch and tumbled over several times.
Salois said the man was not wearing a helmet, and was pronounced dead after being transported to Missoula's St. Patrick Hospital. The victim's name has not been released pending notification of his family.
Montana Highway Patrol Dispatcher


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VANCOUVER, BC - Vancouver Whitecaps FC announced today that the club has recalled centre back Carlyle Mitchell for Saturday's Major League Soccer (MLS) match against Portland Timbers at BC Place. Mitchell has been on loan at North American Soccer League (NASL) club FC Edmonton since March and will return on loan following this weekend's match.
Tickets: http://ow.ly/l6uSm
"With our team having had a very busy schedule of late and with Johnny Leveron suspended for this match, we felt it was a good time to call Carlyle back into the team," said Whitecaps FC head coach Martin Rennie. "He has been doing quite well with Edmonton, so we're pleased to have him available this weekend."
Mitchell, 25, has played every minute for FC Edmonton so far during their NASL season, starting all six matches for a total of 540 minutes. His contributions have helped Edmonton to a tie for second place in the league standings.
The 6-foot-2 defender joined Whitecaps FC on September 14, 2011, after starting his professional career in his home country with Joe Public FC in the Trinidad and Tobago Professional Football League. In two seasons in Vancouver, Mitchell has started five MLS regular season matches.
Tickets start at just $20 per seat plus tax and are available at all Ticketmaster Ticket Centres, online at ticketmaster.ca/whitecaps, or Charge-by-Phone at 1.855.6.GO-CAPS (1.855.646.2277). Season tickets start at only $275 and student season tickets at only $174. For more information visit www.whitecapsfc.com/tickets.


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Some Favorites from the ABC Kids Expo
I wanted to share more of my finds with you from the ABC Kids Expo - from some of our favorite, tried-and-true companies to some exciting newcomers. Click through to read about them…
1. I was smitten with these Farm Animals as a play object for kids. They are very stable and strong yet lightweight - it's a mystery. Shown here in primary colors, they also come in chic cowhide and faux fur in neutral colors. Farm Animals are a product of the Netherlands and the company is looking for a U.S. distributor. I, for one, sure hope they find one!
2. Remember our post about Getting More Out of Your Coffee Table? Jennifer DeLonge is on the same wavelength with these tables and benches sized for little ones. Use them as activity and snack tables in a playroom or bedroom or put one into double service as your coffee table in the living room.
3. Nurseryworks debuted a new bunk bed which I liked not just for its style but for its sturdiness. I know a lot of parents worry about bunk beds, but this one is solid as a rock and the cube shelving is a storage bonus.
4. Skip Hop is bringing its popular Zoo friends to bibs. Not only are they irresistibly cute, they roll up into little bundles (see it hanging there under the bee bib?) for ultra portability and use in restaurants or in the park. It's the kind of small innovation that we applaud for making our lives just a tiny bit easier.
5. Boon Inc's /k sets the modern design standard in this little niche so I was very pleased to see that they'll be offering it in a larger size (Lawn) and a sleek silver/white version.
We'll let you know when these products are for sale - we hope you enjoyed this sneak peek!
(Images: Carrie McBride)


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All others please contact customer support for further information.
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We want to make your buying experience with AMEDS.com as pleasant and as satisfying as possible. We do however; realize that problems can occur therefore the following procedures have been put in place to assist you.
Damage or Errors in Shipping
If your order is damaged (not usable) in shipping or if you received the wrong product, we will replace the item or items as rapidly as possible at no charge. Please follow these instructions:
- E-mail us at email@example.com and include:
- The invoice number from your order
- The catalog number you wish to return
- A brief explanation
- You will receive a response from us no later than the next business day explaining how and when a replacement will arrive.
- After 30 days, returns will not be honored.
Change Your Mind?
If you receive a product and wish to return it for any reason, we will honor your request under the following conditions:
- Health and Safety concerns preclude us from accepting most bathroom aids / hygiene products, opened packages of disposable and reusable incontinence products, all bedding and personal apparel products.
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Please follow these instructions if you have an eligible return:
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- The invoice number from your order
- The catalog number you wish to return
- A brief explanation
- You will receive a response from us with in 1-2 business days. If your return is eligible, we will give you a Return Authorization Number (RA#) and instructions for your return and credit.
- After we receive the returned item in an eligible condition, we will credit your account less a 15% restocking charge + freight. Please allow 30 business days for a credit to be issued.
- After 30 days returns will not be honored.
To Cancel an Order
We pride ourselves on getting your requested items to you as rapidly as possible. After an order is placed it is sent electronically to one of 21 large distribution centers throughout the US to be picked, packed and shipped to itÕs required destination. This entire process (from order to ship) can take from 30 minuets to 3 hours depending on the time of day. It is for this reason we are unable to guarantee the cancellation of any item or order.
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- Call toll free 866-802-6337. If the office is closed, please leave a message with your name, order # and phone # for contact.
- Email firstname.lastname@example.com. Include your order # in the subject line as well as your name, order # and phone # in body of the email.
You will receive email notification of the cancellation ASAP.
If you do not receive email notification - Your order has not been canceled or your request has not been received.
Once notified of your request, we will do our best to honor your wishes and stop the order. In the event we are unable to stop or cancel your order, it will become a return and subject to the terms and conditions stated under "Change Your Mind" in our Return Policy above.
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Shopping on the Internet is fast becoming a much larger part of the total retail sales in the US and will continue to grow. Subsequently this rapid growth is well justified because shopping online is rapid, efficient, cost effective and allows the purchaser to comparison shop and have choices that would be impossible to find in a "bricks and mortar" store.
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Here is what the Safe Shopping Network says about their scoring and testing: "High quality web sites earn high scores because they are owned by business people who care about quality. The web sites listed in the Safe Shopping Network have been tested by us to help you decide which ones you should shop at. You can see each web site's scores by looking at the bars on the right side of each web site listing. Higher bars mean higher scores and higher scores mean these merchants are working hard to earn your trust. We take the trouble to test and score each web site for you. This provides you with objective information from an objective source."
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We endeavor to bring you the most accurate, up-to-date, and complete information concerning the products sold on our website. Our staff is committed to assisting our customers to the best of our ability. However, we cannot make guarantees or warranties that are out of our control. We cannot guarantee that the site is error-free, and warrant that the site will be uninterrupted at all times. We have no control over information, content and services provided by third party sites that links to or from AMeds.com with or without our permission. Thus, we cannot be held responsible and are not liable for results obtained from the use of information provided at AMeds.com and sites associated with it. Use of the information provided on the site is at the customer's own risk.
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text:
Announcers were great this year.The guy that sang the national anthem was good also,i think i recognized that voice.The racers like getting recognized from the tower.I appreciate you guys talking about teachers and all the years that i have taught auto tech.The race between Kerry and myself both teachers for a long time was a blast.I think that Larry jr should give up racing and announce .We had a good time thinks for putting on a good race.
General Racing Discussion Area
Moderator: opnwhl23
3 posts • Page 1 of 1
Re: Announcers
paul, fletcher, and dustin did a great job this year.....i snuck up there a few times during the weekend, great job on the national anthem as always paul, i look forward to that every year. oldtimer, dont think i will give up the wheel for the mic anytime soon!!!!!!
78 malibu
540 bb cchevy
2008 no-e track champ
78 malibu
540 bb cchevy
2008 no-e track champ
Re: Announcers
A BIG THANKS ALSO to those in the tower to the pits for everyones help and support during the week-end. It was my first time to race in 35years. SPECIAL THANKS to TONY PHILLIPS and the STAN NEWBERRYS for getting me to even be able to race and Jason Brown, Casy Campbell, Eric Perry, Greg McKennys help. Met lots of new people and friends!!. Kenny McDanials may be called OLD-TIMER but dont let him tell you he is slow at the tree. I do agree with Kenny that Larry Hunt Jr. would be better off in the announcers booth, that would give everyone else a better chance of winning!!! CONGRATS to all the WINNERS and THANKS AGAIN!!! KERRY
3 posts • Page 1 of 1
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Improving your health since 2000
60 Gummies
1 Gummy(s)
Vitamin Friends Propolis & Echinacea Vegetarian Gummies Berry Flavor - 60 Gummies
Vitamin Friends Propolis and Echinacea supports healthy immune systems. Vitamin Friends Propolis and Echinacea includes a Vitamin Friends sticker inside! Vitamin Friends Propolis and Echinacea is nut, trans, gluten, gelatin, wheat, corn and egg free. Vitamin Friends Propolis and Echinacea is suitable for vegetarians and for people with lactose intolerances. Vitamin Friends Propolis and Echinacea does not contain preservatives, artificial color, artificial flavor or artificial sweeteners.
Why Propolis and Echinacea?
Propolis is produced naturally in beehives, this anti-biotic protects bees from disease and infection. Comprised of several vitamins and minerals, propolis acts as an effective anti-bacterial, anesthetic and healing aid. Offering numerous human health benefits, propolis has been administered for centuries.
Echinacea is known to be an effective immune system stimulant and possesses many anti-bacterial properties and is a common choice in the treatment of colds, sore throats and the flu.
Why Pectin?
As a soluble dietary fiber known for its many health benefits, pectin can lower serum cholesterol, particularly LDL, improve insulin resistance, relieve diarrhea and act as a detoxicant. Pectin also acts as a regulator and protectant of the gastrointestinal tract. In addition, pectin stimulates the immune system and acts as an anti-ulcer and antinephrotic agent. Furthermore, pectin helps prevent surges in blood glucose levels by promoting saeity and possibly by reducing the glucose uptake rate after consumption of glycaemic (available) carbohydrates. Pectin may also reduce the risk of heart disease, gallstones and is good for people with diabetes.
Propolis is the resinous substance collected by bees from the leaf buds and bark of trees, especially poplar and conifer trees. Bees use the propolis along with beeswax to construct their hives.
Where is it found?
Propolis is available in liquid extract form as well as in capsules and tablets. Topical creams and sprays containing propolis are also available, but whether they closely resemble topical propolis products used in research is unclear.
Parts Used and Where Grown
Echinacea is a wildflower native to North America. While echinacea continues to grow and is harvested from the wild, the majority used for herbal supplements comes from cultivated plants. The root and/or the above-ground part of the plant during the flowering growth phase are used in herbal medicine.
Historical or Traditional Use
Echinacea was used by Native Americans for a variety of conditions, including venomous bites and other external wounds. It was introduced into U.S. medical practice in 1887 and was touted for use in conditions ranging from colds to syphilis. Modern research started in the 1930s in Germany.
About Vitamin Friends
Located in Los Angeles, California this limited-liability company (LLC) has made the well-being of kids its priority. Only the highest quality natural and herbal supplements are used to create this incredibly beneficial line of kid`s vitamins. To this end, Vitamin Friends is directly responsible for enhancing the lifestyles and improving the quality of life for kids throughout the world.
In every community of the country, families are suffering with preventable chronic diseases. Occurrences of heart disease, stroke, diabetes and arthritis, to name a few, have increased at a taggering pace.America`s children and teens appear to be headed in the same direction. Unrestricted diet, non-nourishing meals, rampant snacking, junk foods and the lack of parental guidance and education are major contributors to this preventable dilemma.Furthermore, considering that America is the most advanced country on the planet and the population is faced with these current health challenges, one can only imagine the state of children`s health throughout the rest of the world.
Research and development of vitamins and dietary supplements over the last two decades have provided information that can improve children`s health and increase their state of well being. Of course, some diseases and conditions are unavoidable and unaffected by dietary supplements, vitamins, or life style changes. However, science has shown that proper nutrition, an active daily life, and appropriate vitamins and nutritional supplements will promote and improve the general health and well being of our children. Parents want supplements and vitamins that perform. Nothing less, they do the research, they consider the health and well-being of their kids, they compare quality and price and then they turn to Vitamin Friends!
Vitamin Friends uses only the highest quality ingredients available. They offer a wide variety of products that deliver long-lasting results and they taste so good that your kids will beg for them! Their products are 100% Natural, Gluten Free, Nut free, Wheat free, Eggs & Corn free, have no artificial colors or artificial flavors, have no preservatives and some are even sugar free. Plus, their gummies are made with Pectin instead of gelatin so they won`t stick to kid`s teeth!
Vitmain Friends` motto is: "As parents, it is our responsibility to teach our children the benefits of a healthy nutritious diet supplemented with vitamins, minerals and regular exercise."
|Vitamin Friends Propolis & Echinacea Vegetarian Gummies Berry Flavor - 60 Gummies
|Ingredients: Water, Natural Sugar Cane, Glucose, Citrus Pectin, Citric Acid, Natural Flavors, Black Carrot Extract


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With Hip Street's Keyboard Case for iPhone 4 and 4S, BlackBerry devotees have nothing on Apple fans.
There are so many good iPhone cases on the market, but when it comes to our ongoing Mobile Accessory of the Week feature, there can be only one! This week, it's a case that'll finally get BlackBerry users to leave iPhone users alone.
With Hip Street's KeyBoard Case for iPhone 4 and iPhone 4S, Apple devotees can finally experience the ease of texting and typing that BlackBerry adherents are always harping on about.
Most of the the time, KeyBoard Case looks like your mild-mannered, everyday smartphone case, with a black satin-finish backing and attractive metallic accent around the edge. But when times call for a lengthy text or full email rather than a line or two, the BlueTooth-enabled, full Qwerty keyboard slides out for serious typing jobs.
But the integration of a full and super-handy keyboard in no way interferes with the way you'd normally use your iPhone. With a cutout design, the touchscreen is completely unencumbered and the case itself doesn't add very much bulk to your iPhone either.
Because it's BluTooth-enabled, you do have to charge the Hip Street Keyboard Case via USB cable, but a good 2 to 3 hours of charging should last you a few days. And you can always turn off the keyboard with a switch whenever it's not in use to conserve battery power.
Over all, it's a well made, sleek-looking case and an invaluable tool for anyone who tends to use their iPhone heavily for texts and emails. And that makes it our top pick for mobile accessory of the week.


text: Intermap Technologies Inc. 20140213 DSM_n6800w15445P.tif 1 Digital Elevation Model Digital Surface Models Core Product Version: 4.4.1, Edit Rule Version: 3.4 Englewood, CO Intermap Technologies Inc. Intermap's DEM products are 3D raster datasets with elevations captured at 5-meter postings or every 5 meters. They are generated using Intermap's STAR technology (Interferometric Synthetic Aperture Radar), which is mounted to an aircraft. The Digital Surface Model (DSM) products represent the first reflective surface illuminated by the radar. Accuracy statements are based on unobstructed areas of moderately sloped terrain. Diminished accuracies are to be expected in areas of extreme terrain and dense vegetation. The DSM is stored as a contiguous dataset spanning continental land masses where we have captured data. It is available in specific areas of interest or in 15-minute by 15-minute tile areas. For more detailed information, refer to Intermap's Product Handbook at http://www.intermap.com/Portals/0/doc/Brochures/INTERMAP_Product_Handbook.pdf. The DSMs are used as a fundamental layer of information in 3D geospatial analysis and spatial information Decision Support Systems (DSS). Typical applications include 3D visualization and line-of-sight applications. In conjunction with the DTM, applications include transmission corridor planning, forestry analysis applications, biomass studies, and other related applications. A number of the priority layers of spatial information recognized by the National Spatial Data Infrastructure may be derived from Intermap Technologies' DEMs including elevation, shoreline delineation, hydrography, slope, and aspect layers. 20130805 20130821 The above dates refer to the time of field data acquisition and therefore reflect ground conditions at that time. Complete Ongoing -154.765994 -154.486651 68.254058 67.995911 MEL_Scientific-Engineering_Field_Thesaurus Elevation Cartography Geodesy Geography Hypsography Mapping Photogrammetry Stereophotogrammetry Topography Radar Interferometric Remote Sensing SAR DEM DTM DSM ORI INSAR IFSAR IFSARE GEOSAR height None Alaska USA MEL_Environmental_Domain_Thesaurus Terrain Earth Surface Ground First 2013 August Purchase End User License Agreement Intermap Technologies Inc. Data Archive Manager mailing address 8310 South Valley Highway, Suite 400 Englewood CO 80112-5847 USA (303) 708-0955 (303) 708-0952 email@example.com This data was produced by Intermap Technologies Inc. This data is delivered on interoperable media with metadata. The data set was developed on a Microsoft Windows system using Intermap's propriatory Interferometric Editing System (IES). Calculation of the digital elevation model is described in the Intermap Technologies Core Product Handbook User's Guide. http://www.intermap.com/Portals/0/doc/Brochures/INTERMAP_Product_Handbook.pdf None None All data products are 2 meters RMSE or better in areas of unobstructed flat ground. 1 meter RMSE or better in unobstructed areas of unobstructed flat ground. The NEXTMap DSM data products are derived using Intermap Technologies' STAR-3 airborne Interferometric SAR data acquisition system. The data for this tile was captured at 25200 feet above mean sea level with a primary look direction of West and the swaths with IDs 26, 32, 36, 76, 77, 144, 145, 146 and 204. Small areas of missing data are interpolated using a continuous curvature spline over non-data areas. In larger areas of missing data, Intermap's proprietary editing process utilizes ancillary elevation data from secondary sources to fill the areas of missing data. Most incidents of missing data are due to radar shadow and layover in high-relief areas such as mountainous regions and highly developed urban areas and correspond to the look direction of the radar. Bodies of water are assigned an elevation which corresponds to the shoreline at the time the data was captured. Areas of null data are assigned the value -10000. 20140116 Raster Grid Cell 5690 2291 Albers Conical Equal Area 55.0 65.0 -154.0 50.0 0.0 0.0 coordinate pair 5 5 meters NAD83 CORS96 EPOCH 2003.00 GRS80 6378137.0 298.257222101 NAVD88(Geoid09) 0.01 meters Implicit coordinate 32-bit image The DEM is a 32 bit image on a 15-minute by 15-minute (lat/long) grid. The origin of the post is center center. http://www.intermap.com/Portals/0/doc/Brochures/INTERMAP_Product_Handbook.pdf Elevation value per grid cell. Height of the geoid, relative to mean sea level. http://www.intermap.com/Portals/0/doc/Brochures/INTERMAP_Product_Handbook.pdf 556.30 2202.85 meters 0.01 Project Area: Alaska, Mission Number: 4706 http://www.intermap.com/Portals/0/doc/Brochures/INTERMAP_Product_Handbook.pdf 20140213 Intermap Technologies Inc. Data Archive Manager mailing address 8310 South Valley Highway, Suite 400 Englewood CO 80112-5815 USA (303) 708-0955 (303) 708-0952 firstname.lastname@example.com FGDC Content Standards for Digital Geospatial Metadata FGDC-STD-001-1998


text:
Anne Paxton
June 2013—It might be a legacy of the economic downturn. Perhaps it is the prospect of increased capitation under health care reform. Or it could be the stunning price tags of some new tests on the clinical laboratory test menu. Whatever the cause, health systems across the country are increasingly moving beyond education and retrospective review to more specific, targeted, prospective controls on test utilization.
One of the most dramatic factors driving the trend is the number of new proprietary and genetic tests with four-figure prices. The $60 to $70 billion cost of clinical and anatomic pathology laboratory tests—which makes up four percent of the total U.S. health care tab—is on pace to double in three or four years. And ballooning molecular and genetic testing outlays are a major reason.
Partly as a result, traditionally modest laboratory costs are collectively starting to form a flashing amber light on the health care system dashboard, drawing the same kind of attention to test ordering that radiologists have long known in diagnostic imaging. "When a test costs $200, it's a different scenario than when a test costs $5,000," says Curtis A. Hanson, MD, professor of laboratory medicine and pathology at Mayo Clinic, Rochester, Minn.
At Mayo, for example, pressure from above and below recently made test utilization management a priority, Dr. Hanson says. "In hematopathology, starting three or four years ago, we were seeing a lot of requests for testing from clinicians that just didn't make sense. It reflected both a gap in knowledge and a problem with our processes that didn't encourage the right kind of testing."
Then, about two years ago, Mayo as a whole started grappling with finding that sweet spot of controlling expenses and providing quality care, he says, and asking how it could use all its resources most effectively. "Mayo started questioning whether physicians were ordering the right tests, and were we really getting the right clinical return from our laboratory testing dollars." Test utilization became part of a general program of "practice optimization."
His Department of Laboratory Medicine and Pathology chose to pursue a four-pronged approach to test utilization. "One is developing a test formulary. The second is reducing unnecessary testing in hospital patients. Third, implementing algorithm and guideline testing across the practice, whether that be low-volume, high-cost tests that can be honed by pathologists or genetic counselors, or algorithms for cascade testing that a clinician may order on a higher scale. And finally, reducing blood product utilization, obviously a high-cost area for all kinds of practices."
Mayo shies from using the term "formulary," but is now forming a committee to categorize tests according to whether they need review, Dr. Hanson says. Algorithm or guideline testing, however, has already had a measurable impact on utilization in hematopathology, where the emphasis has been on chromosome analysis, FISH testing, and a variety of molecular testing. ("Lab teams up to curb unneeded testing," CAP TODAY, December 2012.)
"We're finding the algorithms are helping, most definitely." Having pathologists who are willing and able to work with their clinical colleagues in establishing the algorithm and guideline approaches has been an important feature of Mayo's test utilization program, he adds.
But there is still an art to medicine, Dr. Hanson cautions, and when one of his clinical colleagues at Mayo wants a test, in certain situations the laboratory will still agree to it even if it's thought to be unnecessary. "I think standardization attempts have typically failed when people follow algorithms and guidelines like standard operating procedures that must be followed every single time. Standardization must be considered all the time, but not necessarily used all the time. In medicine, you really need to think about the usual patient versus the special patient. For the most part, the usual or routine patient accounts for 80 percent of what we do. Physicians tend to remember the 20 percent because that's where 80 percent of their effort goes. But standardization needs to focus on the 80 percent—the usual."
"It's easy to point fingers at clinicians and say why are you ordering all this stuff?" But it's impossible for clinicians to know all the performance and clinical characteristics of all the tests they are going to order, Dr. Hanson notes. "When clinicians see a patient, they have a differential list of possible diagnoses in their head and they think diagnosis A is the most likely, but they feel compelled to do the testing to rule out diseases B, C, and D in this process."
"They may have to draw blood at that point in time because it may be the only time they have the opportunity. They can't go back once they start treating or if the patient doesn't come back to the office, so if they don't order all the testing then, they may have missed their chance." Clinicians may have no choice but to order excess testing, if the lab doesn't have a process in place that allows sequential testing. So laboratories are part of the "problem"—and the solution.
There is another important benefit to test utilization management, in Dr. Hanson's view. "Our genetic and molecular tests are growing rapidly and we need to keep our hands around that kind of expense. But that overall cost is still a small percent of the total. What I've seen by doing this utilization management in the lab is that it helps lead the change of culture across the entire practice of how you can practice more effective and efficient medicine."
As the health care system gets more into value-based payment, he adds, "If we can't show value for what we do, then labs will just get further commoditized. And we'll be the last person around the table to get reimbursed. When you start pushing habits of effectively choosing the right test for patients in institutions, it begins to raise more global questions as far as utilization of other health care resources. And that's how we can provide leadership within our practices."
Based on research at his institution, Seattle Children's Hospital, Michael Astion, MD, PhD, says utilization is a central problem in laboratory medicine. "In practice, you come to realize that the biggest errors in laboratory medicine that harm patients are doctors ordering the wrong tests, doctors misinterpreting laboratory results, and doctors failing to retrieve lab tests they've ordered," says Dr. Astion, division chief of laboratory medicine at Seattle Children's and professor of laboratory medicine at the University of Washington.
In research funded by the insurance industry, Seattle Children's has looked at databases of millions of people who have had lab tests. "We've been able to analyze what tests they've had, how frequently, the medical necessity codes attached. And there are certain things you can see very easily," he says. There are seven domains of abuse—some easy to detect, others not so easy.
For example, some clinicians order IgG allergy testing, a test with no evidence base to justify it but with CPT codes listed for it and some insurers paying for it. "That's the low hanging fruit, where there is complete waste." Other tests may be ordered flatly against guidelines, such as a PSA test for 90-year-olds on a well-patient screen, or an ANA test on 2.5 percent of patients in a database, even though lupus and related systemic rheumatic diseases occur in maybe five people in a thousand.
"So there is a lot of testing for low-prevalence disease," Dr. Astion says. In part, patients themselves drive this over-testing because they Google their symptoms and many different diseases, both common and uncommon, come up. "That's why thyroid testing is so overdone now. It's one of the most popular tests in America because every conceivable symptom is related to thyroid."
Fee-for-service medical labs still have tremendous incentives to promote over-testing in ambulatory patients because more testing equals more money, and many physicians simply think more is better. "Some [labs] try to offer these gigantic panels as part of the special services they provide. For example, physicians are supposed to screen for cardiovascular disease risk, right? But some get talked into ordering much larger panels, 10 times the price of a standard lipid panel, and the labs make it part of their marketing strategy that they do much more comprehensive testing."
Similarly, instead of a focused workup after taking a detailed exposure history of six, 10, or 12 allergens, a doctor may order 25 to 100 allergens—most of which will be meaningless and some of which will produce false-positives.
Because of reimbursement through DRGs, "we've had a big motivation to decrease testing in the inpatient setting for a long time," Dr. Astion notes. Most places have eliminated the use of CK-MB for myocardial infarction except in special cases, for example, and use troponin instead. But various techniques are available for managing utilization apart from just taking a test off the menu.
"You can make something hard to order, say, by requiring three or four button clicks for CK-MB while troponin pops right up. You can just not allow people to order a test, or you can put it under management and require active review by a pathologist or specialist. For example, you can restrict the privileges of primary care practitioners so they can't order special very expensive genetic tests; only a geneticist would be allowed to order them."
Utilization "report cards" can also be useful, Dr. Astion says. "You can give feedback to physicians about their orders relative to their peers and relative to guidelines. That's very effective. And with electronic reminders on the CPOE [computerized physician order entry], when you order certain things you might get a message saying, 'That's an unusual order. Here's what is recommended.'"
The test-ordering system can include decision support options, which the physician can click to receive an ICU template, or care pathway, for a condition or disease. "In our system we call them 'power plans,' where you click on a few buttons and the template includes all the orders commonly needed. Then you can see how if it's not on that plan, it's not likely to get ordered."
Generally, Dr. Astion says, "you make it hard to order things you don't want, and easy to order things you do want. You make it easy to turn off standing orders on patients and hard to turn them on, because they're rarely useful. You put in detection systems to detect duplicate orders."
Seattle Children's program may be best known for putting genetic tests under a utilization management plan, he says. "Any genetic test above $1,000 has to be reviewed and approved, and we have a process for that. It's screened by a genetic counselor, an employee of the laboratory, for medical necessity, and that counselor works with the clinicians to move the order forward or modify it, usually in a downward direction. We find 25 percent of the time under this system, either the doctor cancels or modifies it downward."
The system was developed because of patient complaints about their out-of-pocket expenses for genetic tests, Dr. Astion adds. "In the old days, when tests were less expensive and insurance coverage was better, you just ordered tests and patients usually did not speak up about the costs. Now, the physician may say, 'I don't think this test is going to change the child's diagnosis or treatment but it may give you an answer on exactly the genetic problem your kid has,' and the parent can make a more informed decision. If, because of limited insurance coverage, it's going to cost $1,000 out-of-pocket, do they really want that test?"
Evidence-based medicine has steadily become a much more routine part of practice, Dr. Astion says. "There is a change happening. With standard clinical care pathways, when a patient comes in with a known syndrome or relatively uncomplicated cases of most common problems—for example, a patient admitted for diabetic ketoacidosis—they're put on a care pathway that everybody agrees to. They get certain tests, certain imaging, certain medication protocols or admission to the CICU, whatever it is, but all doctors have to follow that care pathway, and if they're going off it, there has to be good reason for it."
Paradoxically, a remarkable outcome of doing standard work is that you gather less data, he says. "Essentially there have never been more lab tests available, for example, and there have never been fewer recommended for screening. Twenty-five years ago, you were going to a doctor and they would do a big chemistry panel for sure, but not now. We used to image the majority of patients with back pain and now we image very few. It's the quality of information that the clinical standard work makes you focus on. "
The incentives to do utilization management are, if anything, even stronger with send-out tests, Dr. Astion says. "Even though we pass the charge through to patients and mark it up, we often do not get back what we've had to pay. For example, I have to pay one diagnostics company $2,000 on average and I might recover $1,300, because they might have a patent and my insurance company won't pay that. In the case of Children's, half of our patients are on Medicaid, so I'm going to get somewhere between zero and $50. So we just don't recover our costs."
Seattle Children's focuses on the more expensive send-out tests, which tend to be rare tests. "And because they're rare, physicians make more mistakes with them because they're not ordering them every day. In addition, they are less likely to be retrieved; they take a long time to come back so you forget about them in your list of things you think the patient has."
Preventing repetition of genetic tests is another productive measure, Dr. Astion says. Even if a genetic test was done seven years ago, it usually shouldn't be repeated, because the result won't change. But it's difficult for most doctors to look back that far in a detailed medical record. Now, "we're taking a deeper dive in the EMR," he says. "It takes time but it's worth it. On average, we save $437 per requisition under utilization management. Even though you're canceling 11 percent and modifying 14 percent, the one you cancel might be a $3,000 test, so that pays for the 75 percent that go through."
Clinicians need to understand that the laboratory has gotten a pass from insurance companies because it's not as big a driver of health care costs, Dr. Astion believes. "But once you have a $1,000 test, lab tests become expensive items, like radiology scans which have been under utilization review a long time. Insurance companies start to take notice and so does the hospital. And that's what is happening and the reason why people are talking about lab utilization."
The Seattle Children's Hospital program has been rolled out nationally and picked up as a toolkit by other children's hospitals, under the name "Pediatric Laboratory Utilization Guidance Service," Dr. Astion says, noting that more information can be found at www.schplugs.org. "It's basically to help children's hospitals or the pediatric component of any health system order tests better on kids."
Focused attention to utilization will be a key component of the $5 million that the clinical laboratory at Intermountain Healthcare intends to save over the next five years, as part of an ambitious cost-cutting effort across the health system, says Stephen Mikkelsen, MS, MT(ASCP), laboratory services operations director of the Salt Lake City health system. But Intermountain is not opting for red flags or straight-up ordering curbs. Rather, Mikkelsen describes a low-key, persuasion-based model for getting physicians to see the merits of managing utilization.
Mikkelsen works with every clinical program at Intermountain to scrutinize test use, and he finds plenty of room for improvement. The current recommendations for prenatal testing of the American College of Obstetricians and Gynecologists, for example, "are quite a lot more limited than what doctors are ordering," Mikkelsen says. "We looked across the system and the ordering patterns were all over the map, so I met with the clinical program director and asked why."
"We're starting to have more and more conversations with doctors about their panels, versus just being this place in the basement that sends back results."
The laboratory is not a gatekeeper, Mikkelsen stresses. "There's no way the laboratory can tell doctors what they may or may not order. If you just come up and say, 'This is what ACOG recommends,' that doesn't work. But what we can do, with evidence-based medicine, is have them look at the tests ordered and see how they have affected their patients' outcomes post-delivery. You share it. You say, 'This is what we're seeing, here's what your colleagues are doing.' If you can show the tests were ordered but had no effect on outcomes, you can help doctors draw the conclusions you want with just the data."
The laboratory achieved even wider impact by meeting with the cardiology department about the older, nonspecific cardiac markers. "You can pull patient charts for the last several years and review the data and see the old markers aren't clinically relevant," he says, adding that the cardiology department has agreed to no longer order CK-MB and CK. Mikkelsen estimates the system will save $1.2 million this year by eliminating just those two tests. Using similar retrospective peer reviews, providing surgeons with comparative data showing how much blood they were ordering versus their colleagues' orders, last year Intermountain saved $460,000 in blood products.
Intermountain has already made a name for itself in cost-effectiveness, with its quality improvement program cited in the Institute of Medicine's 2012 report "Best Care at Lower Cost," Mikkelsen says, and Brent James, MD, executive director of Intermountain's Institute for Health Care Delivery Research, has helped hospitals nationwide shift their focus to outcomes. "He has a course that people attend from all over the country, to learn how to look at their existing processes and how to improve them using evidence-based medicine."
The laboratory, Mikkelsen believes, can bring a fresh set of eyes to test ordering and help clinicians make a course correction. Sometimes a few simple questions are enough for the laboratory to have a dramatic impact. After a patient walked into Mikkelsen's corporate office with a concern about how to pay for the 92 tests her doctor had ordered for her, Mikkelsen asked her permission to get the doctor on the phone. He found out the physician wasn't sure what he was looking for and ordered some of everything to see if a result would be abnormal.
"So we walked through what he was trying to rule in and rule out, and we got the test order down to just a few tests." The next day the doctor called back. "He said, 'That was a really valuable conversation to have. There are a lot of these tests and I'm not sure what we should be ordering. It never dawned on me that we could call you or somebody in the lab and have this conversation.'"
For its first test of whether prospective actions to intervene at the time of ordering could reduce overuse of tests, the Veterans Affairs Connecticut Healthcare System decided to focus on the 18,000 to 20,000 tests a year it sends out to reference laboratories, says Christopher A. Tormey, MD, assistant professor of laboratory medicine, Yale University School of Medicine, the major academic affiliate of VA Connecticut.
The VA took a two-tiered approach to send-outs: prospective auditing and a prospective laboratory formulary. "In the last two or three years, we've been experimenting with taking two or three tests out of the test menu, and working with our specialized clinicians in oncology and other services to drill down and make sure there's a second set of eyes looking at the test request before it goes out the door," Dr. Tormey says.
For some tests, the VA pathology and laboratory medicine service obtained administrative approval for test cancellation, typically based on evidence that test results would have no impact on patients. The most common policy-based cancellation was methylmalonic acid, used to evaluate patients with questionable vitamin B12 deficiency, but only useful for "gray area" cases, not for most patients.
Other tests were placed on the formulary and made orderable only by a special process. For example, "Our No. 1 test that we were sending out was vitamin D screening, and we were getting clinicians who were unsure which test to order and were ordering both options on the test menu: vit D 1,25 OH in addition to vit D 25 OH. So we essentially made vit D 1,25 OH a test that can be ordered only in consultation with laboratory medicine or endocrinology, and that saved a lot of unnecessary testing." Send-outs of vit D 1,25 OH have dropped to fewer than 20 per year, with no complaints from primary care physicians, Dr. Tormey notes.
An algorithm-driven review helped stem another high-volume send-out: hereditary hemochromatosis genetic testing, generally a $209 test. "Many clinicians will test for mutations in HFE in a 'knee jerk' fashion," Dr. Tormey says, "often based on slightly abnormal iron studies, increased hemoglobin/hematocrit, or even mildly abnormal liver enzyme tests." The laboratory used a literature review to develop an algorithm (see page 80) to first test for transferrin saturation, to see whether the patient meets criteria for having an iron overload. "That was another place where we were able to streamline this broad-based testing that gets done for patients with questionable or unknown diagnoses."
Clinician response has been positive, Dr. Tormey says. "We might call and say we were reading the note and didn't quite understand why they were ordering test X. And nine-tenths of the time we end up getting a very reasonable person on the phone saying, 'I didn't realize this test was ordered,' or 'We have more information and totally agree the test is no longer necessary.' It's a minority of the time where somebody is upset or flatly refuses to cancel the test or consider an alternative."
The overall cost savings of the prospective audits and formulary programs have been impressive. The system saved an estimated $90,000 to $100,000 per year from reviews and algorithms. That does not include the savings from tests the formularies prevented, and from prevention of "chart viruses" secondary to inappropriate tests (where bad data or a mistaken diagnosis attaches to a patient's EMR), which are more difficult to estimate.
VA Connecticut plans to expand its test utilization controls on three fronts: reducing duplicate orders for send-out and in-house testing, expanding algorithmic approaches to lower-volume but higher-cost tests, and expanding the lab subspecialty formulary model for other high-priced tests. "One of the beauties of the VA system from a test utilization standpoint is that we have had an outstanding electronic medical record in place since the mid 1990s and it puts a great deal of patient data at our fingertips," Dr. Tormey says.
"If we can figure out that a genetic test was done on a patient eight or nine years ago, then we can cancel an order of that same test. Right now, our system is not going to tell an ordering provider that such a test has already been done unless they specifically query for the lab result, so we would like to develop a clinician feedback system to notify them, first that a test has been done, and second, ask whether they want to do it again."
The benefits would extend not only to molecular tests but also to tests like CBCs, Dr. Tormey says. "How many CBCs are really necessary over the course of one admission? On a single patient-by-patient basis it probably doesn't make a big difference, but if you can cut your overall CBCs by a third by knocking out unnecessary duplicate testing, there can be a real cost savings."
Laboratories that want to expand their test utilization controls don't need the resources of the VA, however. Reference labs such as ARUP in Utah as well as the Mayo Clinic have developed algorithms that are open to the general public and are ready-made starter solutions for laboratories needing to manage test use. "A middle-sized nonacademic hospital could very easily start with these algorithms on the ARUP or Mayo Web sites, and slowly but surely start to target some of these tests," Dr. Tormey says.
Control of costs is only one of the payoffs, he says. "The benefit of utilization review is getting better results for patients by preventing send-outs that are probably not necessary and, in some cases, provide information harmful to patient care because of bad data. It's great that we're able to control costs or reduce phlebotomies and lower the bottom line of our send-outs. But ultimately, preventing unnecessary or incorrectly ordered tests that can lead to problematic treatments for patients is the most important aspect." The monetary benefits are certainly important, he says. "But they're of secondary importance to improving clinical care for our patients."
Anne Paxton is a writer in Seattle.


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White Chocolate Cheesecake
100g plain sweet biscuits
50g butter, melted
250ml (1 cup) cream
250g cream cheese
250g mascarpone cheese
125g (1/2 cup) caster sugar
500g white chocolate, melted
Passionfruit pulp
Process the biscuits in a food processor until they look like breadcrumbs. Add the melted butter, process briefly, then tip the mixture into a 20cm (8 inch) springform tin lined with a disc of baking paper. Press firmly into the base of the tin, then place in the fridge until needed.
Using electric beaters, whisk the cream, cream cheese, mascarpone, sugar & chocolate together until smooth. Pour onto the biscuit base & put back in the fridge for at least 3 hours or overnight. Serve drizzled with passionfruit pulp & cut into wedges.


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Brand Label: Frederic Malle
ITEM MOVED TO ARCHIVE: On September 19, 2017 1:24 pm, Fashion Stylist Online noted this item may be out of stock at Saks Fifth Avenue because it was not referenced in their latest online catalog. If this item is out of stock at Saks Fifth Avenue, you may be able to find similar fashions sold there or elsewhere on our Frederic Malle Designer Brand Directory.
Available for Purchase Online at Saks Fifth Avenue for $50.00Pin It
Under the soft caress of milk, water and Musc Ravageur perfume, your skin becomes irresistible. Having caused a scandal when the perfume first appeared in 2000, Musc Ravageur is now celebrated, in all its sensuousness, as the Sistine Chapel of the Amber Oriental tradition.
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This item was published for sale online by Saks Fifth Avenue on September 19, 2017 12:26 pm and last updated by us September 19, 2017 1:24 pm.
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Ed Murray, Mayor
SUBJECT: Seattle's web site named best in country
Vinh Tang, (206)684-8804
Dana Robinson Slote (206) 615-0061
Kristen Glundberg-Prosser (206) 386-0049
Seattle's web site named best in country
Data.Seattle.Gov wins award for leading open data effort
SEATTLE - Mayor Mike McGinn announced today that Seattle.Gov has been named the country's best city web portal for an unprecedented third time. The award for Best of the Web in the city category comes from the Center for Digital Government.
Data.Seattle.Gov was also named a Digital Government Achievement winner in the Government-to-citizen category. Data.Seattle.Gov increases access to datasets generated by various departments of Seattle city government, including building permits, crime statistics, and Neighborhood Matching Fund grants.
"A core value of my administration is open and effective government," said Mayor Mike McGinn. "And we are supporting that value in many ways, including town halls, public performance measurements for city departments, providing online data, and providing user friendly services to all our users on our city website. I congratulate our Department of Information Technology on receiving this award for best city web portal in America."
City Councilmember Bruce Harrell, who chairs the Energy, Technology and Civil Rights Committee, said, "In 2009, our Committee announced initiatives designed to empower the public and enhance transparency. We identified the need to migrate our city system to one that releases city data in an open format that is more readable and favorable to programming. We are very pleased to see the results and we will continue this commitment in 2012."
In making the award, evaluators called out Seattle's use of blogging and social media.
"CityLink blogs not only enable transparency, but this content is also pushed to RSS feeds and widgets so content is fresh," one judge said. "Many sites have blogs, but they don't allow public comments," added a judge. "This defeats the purpose of a blog. Seattle does it right."
"The goal of every government website is to provide online services and information to constituents," said Cathilea Robinett, executive director of the Center for Digital Government. "However, this year's winners have taken the power of the Web to the next level - combining clear communication, design aesthetic and easy navigation."
In its 16th year, Best of the Web (BOW) recognizes outstanding government portals and websites based on innovation, functionality and efficiency. The Digital Government Achievement Awards (DGAA) highlight outstanding agency and department websites and applications. The Center for Digital Government is a national research and advisory institute on information technology policies and best practices in state and local government. The Center is a division of e.Republic, a national publishing, event and research company focused on smart media for public sector innovation.
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Hartsville, S.C. – The Lady Cobras basketball team nearly knocked off their second first place team, as the Mount Olive Trojans narrow escaped defeat with an 85-81 win over Coker on Thursday night in women's collegiate basketball.
With the win, Mount Olive moves to 19-3 overall, and 15-2 in the conference, while extending their winning streak to 13 games, with their last loss coming to Coker on January 5. The Lady Cobras drop to 9-13 overall, and 8-9 in the conference.
It was a fast paced, tight match-up, which saw 13 lead changes and nine ties throughout the forty minutes of play. Coker went to the lock room after the first half with a five point lead, but that quickly dwindled behind the stellar performance of Jasmine Whitby and Tomecka Prichard, as they combined for 43 of the Lady Trojans points.
Coker found themselves within striking distance as the final seconds ticked off the clock and senior Jessica Hayes (Beaufort, SC) went to charity stripe with just 7.5 seconds left, with the Lady Cobras down by two. Unfortunately, for Hayes she was unable to make either free throw and Rashonda Speed of Mount Olive came down with the second rebound, forcing Coker to foul. But, like a seasoned veteran, Speed nailed both free throws and put the game out of Coker's reach.
Henna Koponen (Vantaa, Finald) had a career night, dropping in 34 points and grabbing 15 rebounds for the double-double. Following her countrywoman, was Lotta Aaltonen (Rauma, Finland) with 17 points and five rebounds, while Hayes had 10 points and grabbed four rebounds.
For Mount Olive, Whitby had 23 points and six rebounds, while Prichard and 20 points and six rebounds. Also scoring in double figures were Brittney Robich and Shequanta McGee with 17 and 14 points respectively.
Coker and Mount Olive both return to action on Saturday, with Coker traveling to Pfeiffer for a 5:30 p.m. tip-off and Mount Olive travels to Lees-McRae for a 2:00 p.m. tip-off.


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All News Releases By Date
EPA Recognizes Shop-Rite of Roxborough as #1 Grocer with Food Recovery Challenge Award on America Recycles Day
Release Date: 11/15/2013
Contact Information: Terri A. White 215-814-5523 / email@example.com
PHILADELPHIA -- (Nov. 15, 2013) The U.S. Environmental Protection Agency's national Sustainable Materials Management Program recognized Shop-Rite of Roxborough as part of the agency's Food Recovery Challenge. The store, part of the Brown Family Shop-Rite group, placed first nationally in the FRC data-driven award category for grocers. Based on 2012 reporting data, Shop-Rite of Roxborough achieved the highest percent increase in food waste prevention and recycling comparing 2012 data to 2011 in the FRC's grocers sector.
"By committing to donate food and to compost food waste, Shoprite of Roxborough is serving as a significant environmental steward" said Shawn M. Garvin, EPA's Mid-Atlantic Regional Administrator. "As a result of their efforts, Shop-Rite of Roxborough diverted food waste while providing nutritious meals to members of the local community in need. Food not suitable for consumption was recycled into a nutrient-rich soil supplement which will nourish crops and landscaping, thereby reducing the use of fertilizers, pesticides and water."
More than 36 million tons of food waste was generated in 2011, 96 percent of which was thrown away into landfills and incinerators. Food in landfills decomposes rapidly and generates methane, a potent greenhouse gas. Conversely one-in-six Americans are in need of food, not knowing where their next meal will come from.
"I am proud of our achievements, not only in reducing our waste through our food donations, but how this practice assists our local communities," states David Deets, Director of Store Development and Sustainability. "Supermarkets are very large facilities that run 24/7, which can take a toll on the environment," said Jeff Brown, President & CEO of Brown's Super Stores. "We empower our employees to critically examine how we can reduce supermarkets' carbon footprint and work toward a brighter, more sustainable future."
The Food Recovery Challenge encourages grocers and organizations to donate and divert as much of their excess food as possible. Organizations that join EPA's challenge find that they can save money on disposal costs while helping to feed families in need and protect the environment by reducing greenhouse gas emissions.
For more information on the Food Recovery Challenge, go to: www.epa.gov/foodrecovery challenge
Search this collection of releases | or search all news releases
View selected historical press releases from 1970 to 1998 in the EPA History website.


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This test looks for a protein called albumin in a urine sample.
See also:
How the test is performed
You will usually be asked to give a small sample of urine while at your doctors office.
Rarely, you may have to collect all of your urine at home. This may be for 4 hours, overnight, or 24 hours. To do this, you will use a container with a cap. You will get this from your doctor. You may also need to have blood tests to look for kidney damage.
How to prepare for the test
No special preparation is necessary for this test.
Why the test is performed
Anyone with diabetes should have this test yearly. The test checks for signs of early
People with diabetes have a higher risk of kidney damage. In the early stages of kidney problems, you may have no other symptoms. Even other blood tests may be normal.
Your doctor will want to see if you have any kidney damage before it has become very bad. This helps you get treatment before the problem gets worse. People with severe kidney damage may need dialysis. They may even need a new kidney.
Normal Values
Normally, albumin stays in the body. Little or no albumin shows up in the urine.
A result of less than 30 micrograms per milligram of creatinine (mcg/mg) is normal. This means that your kidneys are most likely working well.
Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your test results.
The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.
What abnormal results mean
If the test finds a high level of albumin in your urine, your doctor may repeat the test.
Abnormal results may mean your kidneys are starting to get damaged. But the damage may not yet be bad. There are two ways you may see abnormal results reported:
- Range of 20 - 200 ug/min
- Range of 30 - 300 mg/24 hours
You will need more tests must be done to confirm a problem. The test will also show how bad any kidney damage may be.
Most often the problem is caused by
What the risks are
There are no risks with providing a urine sample.
Special considerations
Healthy people may have higher levels after exercise. People who are
If you have diabetes, make sure you are following your diet.Take your insulin or other drugs the right way. Control your blood pressure. You also need to be more physically active to prevent more damage.
American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2011 Jan;35 Suppl 1:S11-63.
Inzucchi SE, Sherwin RS. Type 1 diabetes mellitus. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 236.
Inzucchi SE, Sherwin RS. Type 2 diabetes mellitus. In:Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 237.
Review Date:
Reviewed By:
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.