text:
Barkerbears-Wendy-Alice-Something By Wendy!
Barkerbears Very unique and whimsical teddybears,elephants,and other wonderful creations.Please visit wendys etsy shop at barkerbears.etsy.com Thanks Beary much. Wendy has also added her Something by Wendy line of cards and homemade something's....keep on coming back to see what creativity is hiding around the corner!!!
Tuesday, October 4, 2016
Barkerbears-Wendy-Alice-Something By Wendy!: Patti's Paw Prints: SMUDGE WELL LOVED BEAR
Sunday, October 18, 2015
Show time
We just had a wonderful show at the Saskatoon western Developement museum .
Thank you for all the support . Mandy Ross Art Studio,
Thank you for all the support . Mandy Ross Art Studio,
Sunday, May 31, 2015
Patti's Paw Prints: SMUDGE WELL LOVED BEAR
Patti's Paw Prints: SMUDGE WELL LOVED BEAR: Hi, it's a pleasure to introduce you to SMUDGE, he stands 8" and is made with very sparse distressed mohair. He is hand staine...
Thursday, May 21, 2015
Sunday, March 1, 2015
Tuesday, December 23, 2014
Sunday, April 13, 2014
Monday, March 17, 2014
Subscribe to: Posts (Atom)


text:
Lara's secret look
Farhan Akhtar insists on keeping Lara's look in Don 2 as secretive as possible.entertainment Updated: Dec 08, 2010 01:36 IST
Howdee doo, my darling donuts? I bring to you some of the most
nuggets from glamour
We've heard of film-makers being secretive about their projects to let anything leak out. But it looks like Farhan Akhtar takes the cake, bakery and all that, if this piece of information about his next movie,
Don 2
is to be believed. Sher Lock Holmes tells me that the film-maker is being very secretive about the look of the character Lara Dutta plays in his sequel
The Dutta girl is covered in a huge robe with a hood when she walks from her vanity van to the sets and takes it off only at the call of 'Lights!' from Akhtar. And the moment the nirdeshak declares 'Cut!', her staff rushes to cover her with the robe again.
Suna hai
, the film-maker has instructed this secrecy to ensure that no
clicks a picture of Lara in her exclusive look.
First Published: Dec 07, 2010 16:22 IST

subset: commoncrawl


text:
Canadian Journal of Gastroenterology
Volume 15, Issue 4, Pages 243-247
In vivo gluten challenge in coeliac disease
Gastroenterology Unit (Kcl), The Rayne Institute, St Thomas Hospital, London, UK
Received 3 August 1999; Accepted 6 August 1999
Copyright © 2001 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
In vivo gluten challenge has been used since the early 1950s to study the role of cereal fractions in celiac disease. While early studies relied on crude indicators of celiac toxicity, the advent of jejunal biopsy and sophisticated immunohistochemical techniques has allowed accurate studies to be performed. Studies to determine the nature of the cereal component that is toxic to patients with celiac disease have concentrated on wheat because of its nutritional importance. A number of in vitro studies indicated the presence of one or more celiac-activating epitopes with the N-terminus of the A-gliadin molecule. In vivo challenge with three synthetic peptides subsequently indicated the toxicity of a peptide corresponding to amino acids 31 to 49 of A-gliadin. In vivo gluten challenge is the gold standard for the assessment of celiac toxicity; however, jejunal biopsy is a relatively invasive procedure, thus, other methods have been investigated. Direct infusion of the rectum with gluten has been shown to result in an increase in mucosal intraepithelial lymphocytes, occurring only in celiac patients. This method has been used to study the celiac toxicity of gliadin subfractions. The in vitro technique of small intestinal biopsy organ culture is also a useful tool and appears to give the same results as in vivo challenge. The importance of tiny amounts of gliadin in the diet, such as that which occurs in wheat starch, has been studied by in vivo challenge; this technique has clarified the position of oats in the gluten-free diet. Several studies suggest that this cereal may be included in the diet of most adult celiac patients. Studies of the transport of gliadin across the enterocyte following ingestion or challenge suggest that gliadin may be metabolized by a different pathway in celiac disease. This could result in an abnormal presentation to the immune system, triggering a pathogenic rather than a tolerogenic response.


text:
Everybody desires to be ranked on top of the first page of Google search. Nonetheless a business or a brand needs to earn that right, and needs a committed strategy and attempt towards making sure this occurs. Getting the right SEO Harrold, Texas services can be the first step in ensuring you get the rankings you deserve. The gauntlet was thrown along with the sites have replied. At HudsonRiver SEO Services, we target at enhancing the visibility of the brand keeping in mind the algorithmic search and deliver high quality, targeted traffic to the website.
What is search engine optimization in Harrold, Texas?
This is the procedure of improved the visibility of a web site on organic, i.e. outstanding and natural search engine result pages. This entails using search engine friendly components in the site. A successful search engine optimization effort and Search Engine Optimization service would have carefully incorporate unique and important key words which the on-page optimization would help highlight for the algorithms that search engines use.
There are essentially two specific regions of search engine optimization.
On-page optimization - All these components must be geared towards making the website as user-friendly as possible.
This mostly refers to backlinks, i.e. the links pointing back towards the site which desires visibility from other important sites.
What's search engine optimization, is a question that may best be answered consequently - It is your greatest tool to get the most traction online and also to keep your search engine ranks high.
Harrold, Texas SEO Optimization Services
HudsonRiverSEO Services supplies the most in-depth array of SEO optimization services in the business. Here are some of the services we supply under Search Engine Optimization optimization services:
We provide detailed and effective link building while ensuring that there are not any bad links or contextually erroneous links.
We offer complete organic Search Engine Optimization services aimed to assemble a sustainable and natural growth pattern in the brand's on-line visibility.
We keep a keen eye on the analytics and create detailed reports regarding the same identifying tendencies and helping formulate future strategies.
We supply all important bookmarking services together with article, directory and classifieds entry to ensure your brand is being marketed across the digital board.
We supplied high quality content marketing and post writing services to ensure your brand has the one of the most useful and focus-catching content online.
Using Google Adwords, advertising forums like Bing advertisements, Yahoo ads and facebook promotion we also make sure that your brand is being promoted among the right demographic.
Hudson River SEO Services supply you the most comprehensive SEO optimization services, and organic Search Engine Optimization services inHarrold, Texas. To know more about our Search Engine Optimization services contact us now.


text:
This week's Courier Herald column:
As we go to the polls this week Georgians now know what it feels like to be a battleground state. We have seen national interests use Georgia's Governor's office and U.S. Senate seat become national proxies for a variety of interests. Ads from the major party candidates for these offices, as well as those from independent expenditure groups, have drowned out much of the rest of the debate.
Fighting for voters' attention are others further down the ballot. And one that deserves a bit of recognition from Georgians as part of the closing for the 2014 race is first term incumbent Agriculture Commissioner Gary Black.
Black won office four years ago to fill a position that had been occupied by the same person since the sixties. The former commissioner's grandson is now battling Black, the third of the Democrats' famous family ticket. Black, however, deserves the nod for brining the Georgia Department of Agriculture kicking and screaming into the 21st Century.
At the 2011 Georgia Republican Convention Black jokingly asked the delegates if they know of anyone that needed to buy a microfiche reader. In assessing his first year in office he used that imagery to explain that he had a bit of a technological curve to getting his office operating with the tools needed to meet contemporary challenges.
Black took over an office still reeling by a failure of inspections at Peanut Corporation of America. A national salmonella outbreak in 2008 and 2009 was caused by food from the company's Blakely plant, killing nine and sickening at least 700. Critics complained that Georgia was not adequately inspecting food processors, and that the state was not paying inspectors enough to do the job.
Black has raised the starting salary for Food safety and meat inspectors from $25,000 to $31,000, and fuel & measurement inspectors from $20,000 to $27,500. He noted that much of the increase was paid for reducing the prior turnover rate of more than 37%. He notes that it costs about $20,000 to train each of these workers, so reducing the turnover rate by paying market wages has helped attract and retain a better workforce.
Many of his other upgrades in systems and technology have been done "in house" with Department of Agriculture employees. He notes that phone lines installed for the Olympics were never utilized, but the department had been paying for them since 1996. Savings from waste such as this have been reinvested in upgrades.
The result? Black is doing more with less. His budget exclusive of employee health care costs is now $4 Million per year less than when he took office. And yet, he's raised employee pay and streamlined operations with new technologies. Efficiencies created in his licensing system alone have resulted in an additional million dollars in revenue collection, with faster processing of checks collected also increasing the office's cash management for taxpayers.
Stakeholders credit the office now being run with an open and collaborative atmosphere, with the overall image being "more professional" according to timber and blueberry grower Andy Stone.
Stone tells of Black becoming aware of the EPA's growing concern that blueberry producers may be encroaching on wetlands as they have rapidly added acreage. Blueberry farmers knew better, as they need high ground for their plants to thrive. Still, as Stone said "the difference between a hill and a pond can be about six inches in South Georgia", but rather than let the problem fester, Black met it head on.
He held a meeting with representatives of the EPA, Army Corps of Engineers, and various stakeholders within the blueberry growing community. By proactively discussing everyone's concerns in advance of any rulings or new regulations, everyone was able to avoid misunderstandings and avoided a needless protracted battle.
The result is that Georgia's environment remains protected, and that blueberries are now the state's largest crop for fruit production. It's a testament of getting folks to work together on the front end, rather than avoiding a problem until it became a bigger one.
Black is responsible for administering an agency that regulates Georgia's largest economic engine. He's as comfortable in an Atlanta boardroom as he is on any farm. And yet, it's fairly clear which one he prefers.
Gary Black's victory party won't be in a downtown Atlanta hotel. It's will be at the Harmony Grove farm in Commerce. The invite instructs that "barn doors open at 5pm". You'll have until 7pm Tuesday to vote for Black. He's someone that has unequivocally earned four more years.


text:
"GAZZMAN COULEUR...DON'T GET IT TWISTED just because" says..
GAZZMAN COULEUR....DON'T GET IT TWISTED bruh!!!!!! At least according to.....(Read Below)
*KOMPA MAGAZINE: With the CD being well received...do you still think GAZZMAN needs a young singer next to him...or NO?
SEXY BEEF: "If he's thinking LONGEVITY and BUSINESS then I would say YES."
- kompamagazine
- Site Admin
- Posts: 3964
- Joined: Thu Dec 10, 2015 12:05 am


text:
Tag Archives: death
Rise up!
Resurrection is also about going past the limiting beliefs we have about ourselves and situations. It is about possibility- of new life emerging in the most dire of circumstances. Once we purposely choose to be open resurrection rather than the circumstance or person that has crucified us, we change subconsciously and consciously. Continue reading
When Christmas is not so merry…
Suddenly, things came into focus: the piercing glitter of the Christmas tree, the mocking joy of the star lit in the window. Christmas had come and gone for the rest of the world but not for us. There was no meal, no feast, no exchange of symbols of love for the birth of the Christ child…At the joy of the journey to Bethlehem was a funeral procession. The reading of the Scripture was about being lifted up on eagle's wings, not the wings of angels at the manger. The hymns we sang were about Beulah Land not Bethlehem. The poems were of God's mansion with many rooms, not about crowded inns. Silent Night took on a whole new meaning. Jesus seemed so far away, either in a manger, on a cross or out of the tomb. Continue reading
What NOT to say to a grieving person
Humans have one thing in common: death. No one gets out of here alive. It's just a matter of how and when. I'm no stranger to death. My grandparents have all passed and my mother crossed over suddenly and far … Continue reading


text:
The One and Only: Mr. Carlson
September 28, 2017
Filed under Human Interest, Showcase
Hang on for a minute...we're trying to find some more stories you might like.
Email This Story
Everyone knows Mr. Carlson, the eighth-grade math teacher on team Ignite. His six years experience include three at Mayfield and before that, a stint at a local private high school–math for tenth and eleventh grade. He describes himself as a laid-back person that likes to joke around from time to time. And while his passion lies with math, his daily quirky Math Club announcements, signature curly ginger, and 4-D personality are what make heads turn in the hallways.
Before he went into teaching, Mr. Carlson graduated high school in 2004 from Mayfield High School and went on to study at John Carroll, Kent State, and Case Western University. He served four years on the Mayfield district school board before getting elected as a member on the Mayfield Board of Education. Since then, he has taught at two schools.
He says one thing drives him forward to keep teaching: "I love to see kids doing things that they'd thought they'd never be able to do. It's amazing."
He also added that he loves seeing kids happy when they finish something that thought was hard. The school he came from before was pretty strict, he reflected. And, he taught a group that wasn't the most academically inclined. So to see kids finally being happy, solving a problem, and trying something new that they thought they'd never get, brings joy to his heart.
Mr. Carlson starts the class off with a few math related questions, then goes over them for the first part of class. He makes a few jokes here and there and oftentimes makes fun of himself. He also stays after school to help kids on homework or in other areas that they don't understand. Additionally, he supervised the math club.
When kids are having trouble with a problem or a concept, he understands where we're coming from and doesn't judge. He feels he does a good job of remaining unbiased toward students and is willing to help anyone who comes in–adding that even though teachers can do their best to help a student, it can't work everyone.
Mr. Carlson explained that as a middle schooler, he was pretty awkward and a little self-conscious. After a few years, he became tired of being someone he was not; in high school he changed and stopped worrying about what others thought about him.
"I do weird things, it's not a show. I'm just being myself. I'm not going to treat someone differently just because they're different from me."
When Mr. Carlson isn't teaching, he likes reading books, but adds that he doesn't have as much timer to read as he'd like. In his younger years, he ran cross country. But that was only for a short time; he joked that he was the only one in the history of cross country to ever get a concussion.
He's quirky and whimsical, but that's what we like him for.
"I do weird things, it's not a show. I'm just being myself. I'm not going to treat someone differently just because they're different from me.""


text:
The eye can be analyzed with relative ease as to both its function and its structure. A practical examination consists of the ability to relocate the orbit and the response of the pupil to light and lodging.
The function of the eye might be tested in numerous methods. The client might be asked to identify illuminated letter or things of differing sizes on exactly what is called the Snellen chart.
Conversely, the evaluation of the structural part of the eye may be made in several methods. Tension within the eyeball is measured by a "tonometer." In particular illness, particularly in glaucoma, the stress in the eyeball is increased noticeably.
Nevertheless, it should be well remembered that a patient with an eye issue might have other problems too. Typically other physical conditions are main and impact the eye as a consequence. The look of the eye can alert the patient and the physician to problems in some disruptions of other parts of the body even before other signs provide themselves.
One's reliance on sight is emphasized when one faces a temporary or possible permanent loss of this vital sense. Thus, when restorative procedures are looked for, specific forms of vision correction such as contact lenses or eyeglasses are prescribed.
On the other hand, some individuals are troubled with the reality that they have actually some framed lenses or contact lenses in front of their eyes.
For this factor, advanced surgeries were developed to motivate reduced usage of contact lenses or glasses. Among which is the now popular LASIK eye surgical treatment.
Generally, LASIK eye surgical treatment is the short-term for "Laser-Assisted In Situ Keratomileusis." Like its tangible equivalent, LASIK eye surgical treatment is another kind of vision correction. Check This Out The only distinction is that with this type of surgical treatment, one's vision is remedied permanently.
With LASIK eye surgery, the refractive mistakes in the cornea are completely transformed. This can be done utilizing an "excimer laser."
The main function of this surgical treatment is to produce a threadlike, rounded "flap" in the cornea using a blade called "microkeratome." In a series of unfolding and laser processing, the cornea is finally reformed, enabling better the eye to direct more light into the retina.
Popularity vs. Disadvantages
Amidst the growing appeal of LASIK eye surgical treatment, there are still disadvantages that people should understand. Most likely, the primary reason that this kind of eye surgical treatment has ended up being well accepted is since the majority of its cases had actually achieved success.
However, in spite of its success, there are still some downsides. Here is the list:
1. It is an operation applied to the most delicate part of the eye
Since LASIK eye surgical treatment involves the operation of the retina, which is among the most delicate portions of the eye, many people state that the operation can be very risky.
To puts it simply, a basic mistake could practically trigger an individual's lifetime loss of sight. For this reason, it is very important to think about lots of aspects prior to choosing whether LASIK eye surgical treatment is the best restorative measure one has to undergo.
2. It is not a ideal treatment
LASIK eye surgical treatment may fix your vision however it does not always imply that it can offer you a ideal vision. Even if statistical reports reveal that 70% of the clients may have 20/20 vision, this does not necessarily suggest they have ideal vision as well.
Provided all these things, it can be deduced that, in spite of the appeal of the operation, LASIK may not always be the perfect eye surgical treatment the method many people view it
Alternatively, the examination of the structural part of the eye may be made in a number of methods. It must be well kept in mind that a client with an eye issue might have other problems. Frequently other physical conditions are main and impact the eye as a effect. The look of the eye can signal the client and the doctor to troubles in some disruptions of other parts of the body even prior to other symptoms provide themselves.
Like its concrete equivalent, LASIK eye surgery is another type of vision correction.
- 239 Visitors


text:
Yep, it is water marbling! Still perfecting the technique, but not bad for only my second time.
Somehow my pink looks orange and my purple looks a bit pink. I got a lot of complements on this, so I can't wait to try it again with different colors.
Here's my favorite one, of course it is on my right hand. This is my right thumb. Now on to all the other Tri girls


text:
|Shop by Language | Shop by Product Type | Shop by Country
|About Us | Contact Us | Order Status | Shopping Cart
|Culture & Tradition
|A Dictionary of Muslim Names
A Dictionary of Muslim Names
Buy now for $39.99
We ship worldwide. Bulk and academic discounts available -- contact us for pricing.
Ships in approximately 8 business days.
A dictionary giving meaning or bearing on Islamic heritage of the words, Arabic or Persian, which form parts of Muslim names.
Many Muslims with names that comprise Arabic or Persian words are unaware of their meaning or bearing on Islamic heritage, particularly if they are unfamiliar with these languages. It is important for parents and guardians to devote time to selecting suitable names for children by consulting authentic books on names and re-checking them. This dictionary simplifies this process.Throughout the world Muslims share similar names, be they in the Middle East, the Indian subcontinent, South East Asia or new migrants in the West. Hence, there is a growing interest in the study of Muslim names.
An important source of Muslim names consists of the ninety-nine attributes of Allah mentioned in the Quran and the hadith. According to Islamic belief, the relationship between man and his creator of that of servant and master, and therefore a Muslim feels gratified to be named as a servant of one of the attributes of Allah.More than a compilation of Muslim names, this dictionary is a reference work pertaining to the broad field of Islam. By way of illustration, the book gives references to Muslims who left their mark on history in different ages, in different fields, and in various parts of the world. For most people, a name appears more significant when it is identified as having been borne by an Imam, a Khalifa, a Mujahid, a Sultan, a saint, an author or a jurist who shaped the history of Islam.
2390 Crenshaw Blvd., #813, Torrance, CA 90501 USA Tel: 310-996-2300 Fax: 888-213-4042
About Us | Contact Us | Privacy Policy | Site Security | Help | Affiliate Program Browse: Languages | Product Types | Countries


text:
I can't get one of the best books I've read in recent memory out of my head. It is a very timely book. The descriptions and message fits where our culture is today. It helps me understand myself and others today. I more fully understand those whose views on what is important in life differ from my views. The book is The Road to Character by New York Times columnist and political commentator on the PBS Newshour, David Brooks.
Mr. Brooks describes two sets of virtues that we internalize as we strive for success and making our mark in the world. They are resume' virtues and eulogy virtues. The resume' virtues are those talents, skills, and accomplishments that we include on our job resume's, such as what we have accomplished, the awards we have received, or status in society. The eulogy virtues are those characteristics of us that are described at our funeral in a eulogy, such as patience, faithfulness, and friendship. As Brooks describes it, in the first stage of our adult life we strive for the resume' virtues and in the second sage of our life we focus on the eulogy virtues. It is important to know that these two stages do not have predetermined time spans, and in varying degrees we can have both stages occurring somewhat simultaneously.
The author describes these two stages as Adam I and Adam II in the beginning of the book. Then he uses nine chapters, focusing on nine individuals to show how these virtues play out. The descriptions of these individuals in history, their actions and virtues, kept me spellbound making it difficult to put down the book. After reading it I find more patience with those whose views and actions in life different significantly from mine. It's not so much, now, that they are wrong as it is that they are seeing and living their lives differently than I do.
The Road to Character has definite spiritual aspects to it, for various reasons we do not have the book in our inventory. It is available in your local independent bookstore, no doubt.


text:
SAVE THE DATE: Block Party October 7th
We are celebrating community residents and the grand opening of the All Bright Community Center with a block party next month. Come join us on Saturday, October 7th from 12:00-4:00PM between Spofford Road and Long Avenue. There will be music, games, food and more! We can't wait to see you there.


text:
Wednesday, May 28, 2008
Life as a Trainer
Wednesday, May 21, 2008
Na ostanoevkee-eh
Hello one and all!
Seriously where did the last week go?! I honestly had to sit for a second and wonder if I had already written about my birthday and what happened-was sooo long ago already!
Well you are prolly wondering about my companion. Her name is Cectpa "Razoomnaya" and she is from Rostov. On Wednesday we took an electreechka up to Rostov to drop off Cectpa G who is now serving in Krasnodar (my good ol' birth place) and there I got to say goodbye to Cectpa Malinina one last time 8(
As it turned out the new sister coming in was delayed in Germany for a few days so I worked with Cectpa Hesteranka (from Ukraine) for a few days in Rostov center. It was interesting experience and definitely made me happy for the slightly slower pace here in T-rog but at the same time people were still out on the streets etc. in the evening and about after 8 it's a ghost town here, so I guess there's perks on both sides.
I met up with Cectpa R. on Friday and we took a marshootka back here after she got set apart. We'll be together for about 2 weeks-til the end of May and then I will be with someone else. It has been good so far together. It's definitely made me grow in every way. I've had to really learn the city now and how to read our map and crazy marshootka/bus/tramvi map but now I feel confident in those abilities. I've had to even more so be an example in general-in the little things that I don't consider as especially missionary-like, but am reminded that she is more than just greenie, but in general doesn't know what to do-hasn't been in the MTC etc. so it's really teaching me patience and I've been trying to lead by example and encourage and compliment her for her efforts. She has a real desire for the work but it's cute cause sometimes she just doesn't know how to channel it but I feel like I will learn a lot from her energy and desire to be bold.
On the other hand I feel like I'll be really tired after this transfer cause just when I start to feel at home with someone and get in a groove with someone I'll be with someone else and have to re-tackle and relearn how to work with someone else cause really you can't teach different people in the same way....well, at least through example is always universal.
Mom and Grandparents and Eric, thank you so much for your birthday gifts/constant financial support and love. It's just further testimony to me that the Lord blesses us through one another which is just a further blessing because we learn in the process and continue to grow. Also thank you all for your well wishes etc. on my birthday and in general- I can't wait to get your letters etc and hear what is new with you.
Mom, I just realized that I didn't get an email from you listing what you got me and then I looked back and went further and saw the hiding P.S. (so sneaky) thanks so much they sound great. I'll prolly go to a second hand here sometime and find a new skirt or something-my grey one has a hole around where the zipper is and it's hard to zip it up which makes me very sad cause it's my favorite skirt but what can you do? It definitely won't last my mission that's for sure.
Anywho, I've had many humorous experiences so far in being the experienced one. For example, we were on a marshootka and I said: "on the stop" (na ostanoevkee-eh) and the driver said, what? I didn't hear and I repeated myself and then he said I didn't understand and then all the girls in the marshootka (maybe 5) all yelled "ON THE STOP!" at exactly the same time and I started to laugh and they did too. See? Lots of help all around 8) Today I asked a lady where a certain store was cause I forgot and right at that moment I found the store but the woman started talking to us because she heard my accent and she was an English teacher and gave us her address and told us to come over some time. Lots of little blessings that just make me so grateful for the Lord's help and support-It's amazing how much closer I feel to Him now that I'm in a leading role. Prolly because I'm praying every other minute in my head for help or guidance. I'm grateful for this opportunity and know it will help me become that much more of a tool in the Lord's hands.
I love you all and hope all is well with you! (ahem Steve, Eric, Mike)
Cectpa Richards
Wednesday, May 14, 2008
Senior companion!
I love the computers here-faster, even though every word I write has a little red line under it as if I spelled it wrong-grr.
But everything is going great so far here 8) I'm here to either pick up my mini-missionary or to stay here in Rostov for a couple of days with Cectpa Malinina's companion that she's leaving. (Apparently they don't know if the new sister will be here or not). Always a surprise on the Rostov mission -I really think all missionaries should have a pack of clothes for two days on them at all times, haha just kidding....but seriously.
Well the past few days have been really hard to feel like a missionary because in preparation for transfers it was kinda hard for my comp to focus on the work and she had to do things that took more time than I would have liked. Sigh, but the next transfer-our complete effectiveness and obedience is mainly dependent on me which I think will be a good thing -I'll just leave it as no question. I'm hoping that those I'll be with can understand basic English-always comforting to know that if I absolutely need to we can communicate fast, but we'll see. I have a feeling that I'll prolly be in T-rog for only one more transfer or maybe two. If it's only one than they are basically white-washing the area = sending two new sisters into the area since I'll be with non- missionaries this transfer, so it should be interesting to see what happens.
My birthday was great! For being on a mission I'd say it was up to R22 and F6 standards 8) So it was on a Monday so we went to district meeting at the branch and when we got there a little late and the door was locked I thought it a little strange and when we opened the door the lights were off and the elders were sitting in a semi circle around the door and sang happy birthday and gave me a candy bar that's called: Nestlé's Just for Men but they scratched out men and wrote sisters. It was cute and nice that they remembered. Then later when we came home to eat something the apartment was completely toilet-papered, every room and on my bed were chocolates, a rose, and random stuff and a sign saying happy birthday. I videoed it so don't worry-you'll see it all eventually. Apparently my comp gave them access some how-tricky tricky. The cake was of course great and it was a great day.
The boy we found that got baptized was very emotional when Cectpa G left today-he cried and cried. It makes me worry for next transfer because Cepta Mozley who taught him all the lessons is going home and I might be leaving too-it'll be water works for sure! Of course I'm nervous about finding my way where we need to be but who knows...maybe the Holy Ghost will help me get lost to somewhere where we need to be 8)
I'll just try my hardest and trust in the Lord and the guidance of the Holy Ghost. Seriously it feels like riding a bike without training wheels for the first time-awkward and you can just feel a fall coming, but I know everything will be fine. I think it mostly feels weird (more lonely) just because they're not actual missionaries, haven't had the same training etc, but it'll be a learning experience that's for sure.
Well I'll be sure to check at the office-I'm sure I have mail there and will take my last picture with Cectpa Malinina 8( It's so crazy...I wrote to President how I want to extend: jokingly (sort of) saying ya know, I can stay till March...or May....or June...you get the idea and he wrote back: June sounds good we'll talk later 8) So I think extending is definitely possible so I'd count on it (as far as getting visa stuff squared away) of course in this country-always good to get a start on this stuff early before another law changes or something 8)
Well I better go, but thank you all for the great phone call-these calls are always so weird for me cause I just want to be relaxed and chat=let the conversation flow naturally but everyone is trying to think of the important things that need to be said cause there is a time limit etc..."noo, shtoe dyelit?" that means, well what to do (phonetically spelled out for ya).
Well I love you all so much and will try extra hard this next transfer to do everything in my power to do what the Lord wants me to do and give all of my imperfect efforts and hope He makes something of them-it's prolly hard work for Him 8)
Love you all,
Cectpa Richards
Wednesday, May 7, 2008
Half way point
Well today was a fun P-day. We met the Rostov missionaries in a town between Taganrog and Rostov where there are a bunch of ruins-basically holes in the ground with some stones layed on top of each other (and to think I wanted to be an archaeologist!) But it was fun to see how many of us could fit in one particular hole-pretty deep too. Cectpa Malinina is leaving next Wednesday and today she and her companion came back with us to T-rog to work with us tonight and tomorrow a bit as one last time together 8(
Um, hahaha it's funny cause I'm not sure who said I would be a trainer-if I mentioned anything it was prolly that it could happen but seriously no one knows anything yet-we'll hear on Saturday so you'll hear on Sunday I guess. To be honest I'd prolly welcome and dread the opportunity but we'll see. The work is going ok, we really need to find some solid new investigators though...right now there's just some semi-lukewarm people who have the habit of saying, "Um, call back after the 26th, I'm really busy." Not very promising, but as always I'm trying to keep my efforts concentrated and energized.
The weather is really nice here and lots of flowers are blooming-though it's almost ALWAYS windy which means dirt blowing around everywhere. Mom, the shoes were around 20 dollars (25ish rubles=1$ last time I heard). I just got letters from Sara and Heather today-it's always fun to hear from them and how they are doing. It seems the pouch gets here exactly one month later since they sent it on April 7th.
Steve-happy bday stud! Glad to hear you had a great day-as it should be. I still remember all the great bday fun we had with R22 and F6 -I must say we can throw a mean party. Send a picture of the cake in the face if you can 8)
It's so great to hear about all the different friends and cousins serving on missions-lots of them are going stateside I notice. I heard that because of all of the of the church publicity in the states right now more will be called stateside-cool huh?! Spread the good word one and all!
It's hard to believe that I'll be 22 soon-shrug, age really is meaning less and less to me-just seems like another day, and on the mission it will be except of course we'll have American cake 8)
Well I think I will still be here in Taganrog-I'll be really surprised if I move from here and I don't want to 8) The only other places that I'll most likely serve in will be the two areas in Rostov and Volgograd. Of course you never know it's always possible to return to Krasnodar or something which would be really interesting to see the difference time makes.
Speaking of time.....I can NOT believe how FAST it is going. I can't even explain how crazy it is that half of my mission is over especially when only now am I starting to feel really effective and fully functioning. It seemed that I was in culture shock/ survival mode-just trying to get through each day; and that it flew past. Now I'm trying to dig in my heals and slow it all down cause I feel like I haven't done anything yet. Time can't start counting yet but as always-it always counts whether we are using it or not. I DEF want to stay and leave in March rather than January-there's no choice about that one, I will!
Well I better go, thanks for your love and support as always and don't be offended if I'm really lethargic on the phone-I never was a morning person 8)
Cectpa Richards


text:
Absolutely no atmosphere, as its in a shopping centre that is nearly empty. The voices from people are directly below and Echo upwards so you feel as if you're part of people's conversations. It is very out of the way and every time I have...More
Absolutely no atmosphere, as its in a shopping centre that is nearly empty. The voices from people are directly below and Echo upwards so you feel as if you're part of people's conversations. It is very out of the way and every time I have...More
Light, airy cafe style place, friendly young staff. We had scrambled eggs / bagles / salmon which was lovely and great value. It was a cold day and the location makes the place cold, but other than that it's got a nice feel to the...More
A hidden Gem!!Bar staff are great, and the cocktails are fantastic and cheap also!The problem is its a little off the main street so whenever I've been its never been very busy and it seems a massive shame!Lovely decor although the glass roof makes it...More
We stumbled upon this restaurant by accident. We've bought a house in Congleton to renovate and as we were looking for somewhere to have lunch, we walked through a tiny, rarely used arcade and spotted a restaurant menu chalkboard, and then looked up to see...More
Overall we had a quiet pleasant lunch. Food was amazing! Staff friendly and atmosphere was nice. You do have to go up to order no service is given. Good value for money. Excellent coffee
Husband and I called in for a cooked lunch so we could have a packed tea while travelling in the evening. As usual I wondered why we did not come more often. The café is in the glass roof-space of the shopping arcade replacing Congleton's...More
Hoping for a quick pub lunch we were redirected to Illucinos by the pub in the High Street as they didn't serve food. What looks like an unprepossessing venue in a rather small and quiet indoor shopping mall turned out to be an attractive, airy...More
Met some friends here for lunch and was pleasantly surprised. We had the mushroom soup which was homemade and delicious and the sandwiches were also good and great value. The only negative Would be it was a bit cold and we had to ask twice...More
Illuccinis is a friendly family owned & run business.Always good quality fresh produce are used in their home cooked specials.We eat there regularly & whatever we try its delicious.
Tried here as a change from the 'spoons and it worked out well. Very reasonable, cooked with care. Just the job.
TripAdvisor uses cookies to improve your site experience. Learn more or change your settings. By continuing, you consent to our cookies.


text:
We know how hectic corporate world is, so why take up this extra task on to your plate. Leave it to us and we will do the running around for you. Transforming your dream project into reality is our dream!
We help you to enjoy those special moments of life. We will handle your family function end to end giving you an opportunity to freak out and have fun!


text:
****Edited to add: Ah the Irony! This doll is now deceased. My in-law's dog, Abby, has the habit of eating our belongings. There is now a long list of things she's destroyed of Kenzie's: cups, Croc shoes, baby bag, etc. that have been ripped to shreds by this dog. Kenzalina suffered the same fate last night.
Original post:
Kenzalina (face)
Originally uploaded by mama's doodles.
Anyway... I've named the doll Kenzalina...which is the nickname that our old Nanny gave Kenzie. I've fashioned Kenzalina to be quite like Kenzie with the bright blue eyes...and blond piggie-tails. (OK, so I'm dreaming a bit with that mass of hair, but maybe someday my Kenzie will have long luscious hair too. :) She's wonky and fun, and she turned out really great. She now sits on a rocking chair in Kenzie's room. Kenzie said she's "OHhhhhH, pretty, pretty!"
And, after trying to upload this post through Blogger - oh, say 37 times...unsuccessfully -- I threw a temper tantrum and did it through flickr. I put two other shots (full body and backside view) on flickr, but I can't seem to get Blogger to upload ANY photos for me today. This doll was fashioned after the dolls made by Joybucket.org. It's my own take on her fabulous dolls, which seem to have skyrocketing price tags.
Labels: softie


text:
Apparel21 SalesNet for online wholesale ordering
Developed and customized E-commerce web application on apparel21
Me concernant
As a web designer and developer, my objective is to make a positive impact on clients, co-workers, and the Internet using my skills and experience to design compelling and attractive websites/Dsktop Applications.I've been programming custom web and desktop applications for nearly 11 years. More details on my actual programming experience below. Results-oriented systems developer with extensive experience in C#,ASP.NET,MVC3,Telerik,AJAX,JQuery,CSS,Web,Mobile,EFCode,MSSQL website-development, asp.net, c#, .net, css,html, photoshop, javascript, jquery, telerik, ajax, xhtml, xml, mysql, oracle-database, database-administration, database-modeling, database-programming, oracle-pl/sql, linq, html, project-management, mvc, sql, microsoft-sql-server. Expertise in custom web application development; client/project management; research and analysis. Proven technology problem-solver with excellent web application development, systems development, workflow, and trouble-shooting capabilities. Ambitious and confident self-starter with strong communication, trouble-shooting, presentation and planning and execution skills for web application development projects. Thrives in a fast-paced, goal-driven environment.


text:
18 Apr 2016
increase online presence original business names
There are many strategies used to increase online business. Link building, search engine marketing and website submission are a few of the important ones. Using these types of effective tactics properly, traffic to websites can be improved. To make sure success amidst the rigid competition on the internet, it is very important make certain that website appears on all the significant search engines and directories available online.
increase online presence original business names
Websites can be submitted both manually and automatically to search engines and directories. But most of the websites don't encourage automated submission. It can be an easy way to submit...


text:
Calligraphy Workshop
With Lucy Edmonds
Thurs 12th Oct 2017, 10.30-12.30pm
William Morris Tent
Come and spend a morning with Lucy Edmonds, founder of Quill London, developing your own unique style of creative lettering. Learn tips and tricks about inks, how to use a brush, and the many applications for your new skill. Designed for complete beginners, this workshop is the ideal way to learn the basics of this fast-growing trend.
Ticket includes pen set and a copy of the book Modern Calligraphy RRP £12.99


text:
Millennials: It is Ok: There is No Need to Rush in the Morning
Millennials who are driving in the morning, might often get caught up in the morning rush of where they need to go, whether it is work, dropping their children off at school or running errands.
Some might even take unsafe measures, and not realize that what they are doing is a danger to other drivers on the road they are on because they intend for the unsafe measure to go well and not become problematic.
It is important to remember however that there is no need to rush in the morning, especially if you are behind a vehicle that is going the speed limit on a road, or waiting for a car to turn onto a main road from a side road.
Millennials will get to where they need to go, only if they don't take shortcuts and drive on the right side of cars in the same lane that they, and the other car are in, or go around the car on left side that they are behind that is turning onto the main road, and that is turning in the same direction they are, whether it be, right or left.
If Millennials are late because of a slow driver, or other driving-related circumstance, then they can blame their delayed arrival on the traffic, and the slow cars that they are behind, and that are in front of them, and the car they are in on the road.
Slow vehicles in front of the ones that Millennials are behind, may be going at the speed they are going because they don't want to risk enduring the agony of a flat tire after going over potholes on roadways that they are driving on, that may need to be repaved because of holes in the pavement from it cracking, caving in and sinking into the ground because of the snow, and snow plows that plow snow during, and after snowstorms.
Better yet, Millennials may want to obey the rules of the road while driving, by driving the speed limit, and driving slow in case a car pulls out from a driveway, or other roadway near the road that they are driving on.
New Year's Resolutions about trying not to speed, may also be a case as to why Millennials might be driving slow, and obeying the rules of the road and the speed limit.
The most-high power of The Lord, God, Jesus Christ and not wanting to sin could also play a role. In addition: being religious or not, Millennials who choose to live life according to his word, might want to live their life the way that they see is right.
All in All: There is no need to rush in the morning Millennials. You will get to where you need to when you need to in the morning even if it is behind a slow car.


text:
I have a PhD and 2 years postdoc experience, but been out of the lab for 2 years.
I am having a hard time getting a post and all of the feedback I am getting from interviews is that my experience is not recent enough.
Does anyone know/have experience of getting up to date lab skills outside of employment?
I would happily pay for training courses, but they are all so expensive.
Thanks in advance.


text:
Discoms up pressure for steep tariff hike
Just weeks before the power regulator is to come out with a new tariff for electricity, the discoms increased their pressure for a steep tariff hike by voicing their demands at the national level before the apex electricity regulator and power producers.india Updated: Jul 17, 2011 23:06 IST
Just weeks before the power regulator is to come out with a new tariff for electricity, the discoms increased their pressure for a steep tariff hike by voicing their demands at the national level before the apex electricity regulator and power producers.
"If the regulator allows us to recover the Rs 2,000 crore of revenue gap of 2008-09 alone, the increase in tariff will be around 50%. The revenue gap of the subsequent years is even additional," Gopal Saxena, CEO of BSES Rajdhani told the 12th Regulators and Policymakers' Retreat in Goa in the presence of Central Electricity Regulatory Commission chairman Promod Deo and senior officials from various utilities in the power sector. "We can't go on like this. Between the three discoms, we stand under a combined debt of Rs 10,000 crore. Someone will have to do something immediately," the CEO of the capital's biggest discom said.
The annual conference was organised by the Independent Power Producers' Association of India, with the participation of senior officials from state utilities, public sector undertakings, Union Power Ministry and private sector.
Speaking openly for the first time about the regime of the former chairman of Delhi Electricity Regulatory Commission, who retired last year, Saxena said the then DERC chief had created a wrong perception about the discoms' profits.
"I may shout from the tallest buildings about how bad my situation is, but the regulator made one statement about a supposed cash surplus of Rs 3,577 crore and everyone bought it. This cost us dearly," he told a roomful of chairmen, secretaries and other officials from regulatory commissions across the country. No one from DERC had attended the gathering, though.
Explaining that the private discoms had vastly improved the quality of supply and brought down losses for the consumers in Delhi, Saxena said the achievements of privatization were not being appreciated. "Not a glimmer of appreciation for the good work we have done," he said.
As a relief to the discoms, Saxena's views found takers in most of the other senior bureaucrats in the power sector, both serving and retired.
SL Rao, former chairman of CERC said discoms needed to be able to recover their investments through tariff.
"If the tariff is not increased, how will the utilities remain viable?" he said.
Former member of Appellate Tribunal of Electricity HL Bajaj said, "Across the country since 2009, the discoms' costs have gone up by 7% while tariff has increased only by 5.2%."Several speakers said the countrywide revenue gap of discoms on account of non-revision of tariff was Rs 80,000 crore.
Open access at what cost?
The Delhi discom chief also said that if the regulator allowed open access (wherein consumers could buy power from any discom, and even from generators) then big commercial consumers like Delhi Airport and other power guzzlers might get cheaper power directly from generation companies.
"The big commercial buyers are the ones which allow me to cross-subsidise domestic consumers. If my big commercial consumers are gone, someone will have to make up for the lost revenue so I can continue to keep domestic tariff low. I am stuck with long-term power purchase agreements and that is costing me dearly," Saxena said.
(The correspondent was covering the conference at the invitation of the organizers)
First Published: Jul 17, 2011 23:00 IST


text:
We're raising money in memory of Cyrille Regis for Jason Roberts Foundation because he was a trustee and mentor for young people. Click here to donate.
- Return to articles / Nov 07, 2016 -
Disabled people are known as 'the world's largest minority'. And it's not by chance, the cost of living with a disability can increase household poverty, which means disability is not an issue limited to individuals. Exclusion and stigma, low incomes, and high costs of rehabilitation and care, all create a vicious circle that holds back not only individuals with impairments, but their families and children too.
Taking part in physical activity is important to all of us and for disabled people, an active lifestyle can significantly help improve their health and increase social interaction. The Jason Roberts Foundation's disability programme is providing sporting opportunities for disabled people in Brent.
The disability programme targets the Borough's most marginalised children and young people aged 12-25 years many of whom have learning and/or physical disabilities, mental health issues, and health conditions.
With funding from the John Lyon Charity and Peter Harrison Foundation, we have been able to meet with local schools, referral units and like-minded organisations in Brent, London, to ensure community ownership and develop greater community cohesion.
At the meetings, we have also discussed ongoing disability work and how we can build on the already existing partnerships to extensive our outreach work across Brent to engage a broad range of young people including those living with a disability.
The JRF have worked with SEN schools in the UK and Grenada since 2008, where we together with our delivery partners, The Golf Trust, Meadow School, Ark Academy and DASH, have engaged with young people through sport, including; golf, basketball, goalball, boccia, seated volleyball and football.
JRF engage, support and enable young people, through sport, to enjoy positive activities and develop valuable life skills including; teamwork, leadership, reliability, sportsmanship and will increase their confidence in order to achieve their own personal goals.
JRF's skilled youth workers and coaches engage with young people in a range of inclusive sports activities. The Foundation is very focused on sport, although it is important, it is the outcome of sport that is a key thing.
Recently our Academy football coach; Wilbert, attended a disability course provided by the Golf Trust and ILS Autism.
The course focused on how to teach people to play golf, it educates coaches how to deliver and set up sessions for people with autism.
Wilbert said: "The course was excellent, my daughter has autism so it was both personally and professionally wise very helpful.
"My hope is to work more within in the field of disabilities and sport, as I already have several disability badges, but this course covered more how to get young people with autism involved in sport.
"We talked about inclusion and looking at certain ways to make sport more accessible and engaging for young people with disabilities, this includes balance and coordination and how to excel at individual sports."


text:
Well, it looks like we're into yet another year – and with that comes hope-filled resolutions and goals.
And for creative minds all over the world, it also usually means more projects!
Some people start the new year off saying they are going to work out. Others spend less money, drink less soda, be more responsible.
I, however, took on another project: to take one photograph a day for the entire year. I tried this a couple of years back and failed pretty miserably. I got somewhere around day 50/365 and just.. stopped.
So, you consider this my public disclosure and I'll consider this my act of socially binding myself to the goal. ;]
A friend is trying to get through the p365, too so, I am hoping that between the two of us, we can keep each other going. I'm also trying to not take pictures of things I would normally post. For instance, this picture summarizes my night tonight perfectly – and I would definitely not normally post some Chinese food and water bottles.
But here we are – a night with Chinese food, water bottles, and a Grey's Anatomy marathon. =]


text:
Our Lady of Mt. Carmel Society is a non profit Italian American club on 8th Street in Verplanck, New York. It was established in 1922 by a handful of immigrants from Calabria, Italy, most of whom worked at the quarry in Verplanck. The Mt.Carmel Society has grown from that small group of men to a record number one hundred thirty-five members. We also have an active Ladies Auxiliary with over 30 members.
The mission of the Society of Our Lady of Mount Carmel is to support our community and neighbors through donations and charitable work while keeping the Italian tradition alive.
Throughout the year the Mt. Carmel Society holds several events such as Las Vegas Night, the annual Chubby Capicotti Memorial Golf Outing, dinners, clambakes, picnics and the annual Italian Feast - always the third weekend in July. The Feast is our main source of funding and we look forward to hosting it every year. We have the distinction of being the longest running Feast in the Hudson Valley. We are also the home of the World's Largest Tarntella!
President - Vinny Altieri
Vice President - Michael Letteri
Treasurer - Tony Palmisano
Secretary - Greg Brown
Feast Chair - Anthony Capicotti Jr.
Comptroller - Mike Grean
Board of Directors - Joe Bellizzi, Mike Carbone, Glenn Creeden, Joe Cosentino, Jim Serimarco, Vinny Tropiano, Joe Tropiano.
The Society of Our Lady of Mt.Carmel is a proud member of The Hudson Valley Gateway Chamber of Commerce.
Our Lady of Mount Carmel Society
"Supporting community &
preserving tradition Since 1919"
155 Highland Avenue, Verplanck, NY 10596
Marching towards 100 years!
OLMC Society
155 Highland Ave.
Verplanck, NY 10596


text:
This can be done in just a few steps.
You can visit:
Then in 3 simple steps.
1 – Select the file you want to be converted.
2 – Select your file output name.
3 – Input your email address.
Your converted documents will be emailed back to you.
For a video showing you how to do this please click below.
See the video provided by eHow


text:
|coreopsis beginning to bloom in sunny bed
My daisies and coreopsis share space with lilies, coneflowers, black-eyed susans (rudbeckia), liatris, phlox and monarda. All of these plants are sun lovers. Full sun is at a premium in my yard. So I require my sun-loving plants to get along and share space. I really like the kind of crazy quilt flower bed that results.
This is "Jethro Tull" coreopsis I got last year. I just couldn't resist. Why the name? Well, the petals are fluted and IT ROCKS!
As you probably noticed, the pink phlox pilosa is till blooming! It's happy to have the company of the daisies and coreopsis!
Make the most of your sunny areas. If you let those wildflowers spread, soon you will have a fiesta of flowers!
I am joining Gail at Clay and Limestone for Wildflower Wednesday.


text:
Dear Jonny, We Beg For Your Advice…
Dear Jonny,
Answer some (more) questions…
– Readers
Dear Readers,
"You don't have my IP address, so don't even pretend that you do. You're dead, motherfucker, You won't even see it coming."
– I can't wait. Shoot me? Stab me? Beat me to death with a large group of friends brandishing handsome, well-polished axes? You're either extraordinarily upset because I exposed your lack of manhood (a frustratingly easy task), or disturbed due to the fact that I made fun of the unashamedly whorish woman who sleeps next to you while wishing she was slithering atop me. Or…Did I insult your shamelessly bulimic, wondrously whorish sister (I sure hope so, kiddo; yum). Tell me more about the leaky bitch. Why, exactly, is she so comfortable with me railing your repugnant mother. God, I love the nasty, creamy goat (your mother). Have a swell day.
"I recently came across your awesome "We Were Bouncers" article
(http://www.shutupandlistentojon.com/commentary/the-real-roadhouse-we-were-bouncers/). It really does sound like that place was a hell hole. I just started bouncing myself, but at an upscale club with a relaxed clientele. No broken bottles slicing out eyeballs or any of the shit you had to deal with. But I did notice that there are ALWAYS huge brawls at the Denny's down the street after the club has shut down. Why do you think that is?"
– The Denny's confrontations of which you speak are generally a result of many not-so-interesting factors, such as: It's been a long night of aggressive posturing, boozing, and coking-up at various sketchy establishments. Foggy brains seek convenient nourishment from sugar and grease served by depressing people in a well-shined shithole filled with bad energy and lots of volatile come-downs. Somewhere in the mix a blabbering, emotionally adolescent jackass decides to stir up drama because it's his/her only talent. Insecure dimwit wankstas act on the drama because they're dim and insecure. Suddenly you're witnessing something like an urban Viking battle, minus the skill, motive, and strategy. That about sums it up.
"Ever since my older brother changed his major to literature he's turned into a pseudo-intellectual dickwad that favors quoting Henry David Thoreau while smoking a (retarded looking!) pipe and telling me how little I know about the world in general. He's also telling everyone that he plans to build a cabin (he can't build shit) deep in the woods to escape "the ravages of society." I'm beginning to hate him. What should I do?"
– Tell him that Thoreau's mother did his laundry while he was staying in the cabin, which, contrary to popular belief, was not deep in the wilderness but on the edge of town, less than two miles from the family home. That should shut him up. If it doesn't, you can always sneak some Salvia into his pipe, then slap him around while he's tripping his ass off.
"I tend to eat crunchy peanut butter and dill pickle sandwiches when I'm stressed out. Is that weird?"
– Not nearly as weird as the sandwich my ex-girlfriend's father used to eat on a regular basis while he was completely relaxed: Fried bologna and peach preserves piled high between two pieces of white bread, then dunked into buttermilk and drizzled with Hershey's chocolate syrup. Unsurprisingly, he had a fatal heart attack some years ago.
"My wife says she needs some time and space away from our four years of marriage because her inner child is craving new horizons. What does that mean?"
– It sounds like a gargantuan load of disgustingly narcissistic bullshit. In my mind, "inner child craving brand new horizons" = "inner whore craving brand new dick." She probably has her sights set on the t.v. repair guy, if she hasn't slept with him already, though she's obviously trying to pass everything off as a touchy-feely metaphor for an inherent need for personal growth. If I were you I'd tell her inner child to go die in a ditch, then have a few beers and possibly a nice Cuban cigar while insulting greasy strippers. There will be plenty of time to reflect on things down the road.
"What do you think of people who don't respect animals?"
– Humans are animals with laughably large egos which lead us to believe that we're more deserving than the undeniably innocent beings who exist on the lower end of the totem pole we've created to advertise our supposed superiority. Anyone who lacks respect for the rest of the life forms on this planet needs to be tossed into a large tank teaming with half-starved great white sharks surrounded by a plethora of pissed off electric eels. That should put everything into perspective quite nicely.
"Lethal injection or the firing squad?"
– Shoot me. I'm bored with poison.
– Jonny


text:
Individual Author Record
General Information
Name: Joan L. KellyPen Name: None Genre: Fiction Audience: Young Adult; Children; Born:
-- Joan L. Kelly on WorldCat -- http://www.worldcat.org/search?q=joan++l.++kelly
Illinois ConnectionKelly lived in Litchfield and now lives in Springfield, Illinois.
Biographical and Professional Information
Published Works
- Hiding the Stranger in Hickory Valley , Bezalel Books, 2008Hiding the Stranger on Baker Street , Bezalel Books, 2008Hiding the Stranger: The Journey Home , Bezalel Books, 2008Lonnie the Lizard Finds a Treasurer, Bezalel Books , 2007My Big Feet, Bezalel Books, 2007
Titles At Your Library
My Big Feet
ISBN: 0979497639 Bezalel Books. 2007
Joan L. Kelly's work is called "highly recommended for community library fiction collections" by Midwest Book Review. Her titles also include "Hiding the Stranger: The Trilogy" which is the recent recipient of the Catholic Writer's Guild Seal of Approval.
Book Description:
Rob Sanderson and his friends knew that they weren't part of the "popular" kids but that didn't stop them from accepting each other and facing life's challenges―even when those challenges involved intrigue and espionage! See how this group of misfits combines forces to find a way to outwit dangerous spies and save their new classmate and her family from imminent danger.
Character education can be painless―as evidenced by My Big Feet… Marilyn Missel, Associate Superintendent of Education Diocese of Springfield, IL
I am thrilled when a book such as My Big Feet comes along with its message of embracing each person as a unique individual… Lisa M. Hendey CatholicMom.com
Lonny The Lizard Finds A Treasure
ISBN: 097949768X Bezalel Books. 2007 Children will delight in the adventure of Lonny the Lizard as he discovers family treasures in the attic. Parents will delight in the tale as Lonny and his mom affirm that true treasures are those found within families and in helping others.
Hiding the Stranger in Hickory Valley
ISBN: 0980048311 Bezalel Books. 2008 Joan L. Kelly, author of "My Big Feet" and "Lonny the Lizard finds a Treasure," delivers another winning book! The adventure begins when a young farm girl, Katie, finds an unconscious teenager in a meadow. When she and her siblings try to help him discover answers, they find themselves involved in intrigue and possible danger. Who is this mysterious stranger who suddenly shows up on a small Illinois farm? Where did he come from? Where is he going? This first book in the trilogy takes the reader on an adventure filled quest!
Hiding the Stranger on Baker Street
ISBN: 0980048338 Bezalel Books. 2008 Joan L. Kelly, author of "My Big Feet" and "Lonny the Lizard finds a Treasure," delivers the second sensational book in her 'Hiding the Stranger' series. See why classrooms everywhere are enjoying Joan's work! The adventure, which began on a small Illinois farm in the book Hiding the Stranger in Hickory Valley, continues as our hero is followed by vicious kidnappers. While the teen waits at the house of a new friend, Chris Miller, he finds adventure and narrowly escapes recapture in the town of Bedford. As our young stranger continues the quest to find his identity and reach home, his memory begins to return. He has the courage to run through fire and the wisdom to help Chris with a secret. This is the second book of the 'Hiding the Stranger' trilogy that takes the reader on an adventure filled journey!
Hiding the Stranger: The Journey Home
ISBN: 0981885462 Bezalel Books. 2008 The adventure that began on a small Illinois farm comes to a conclusion in the active city of Chicago. Our teenaged hero's quest to find his identity and reach home culminates at the historic Union Station. See how one boy's fate will be changed by another's act of total self-sacrifice. This is the third book in the trilogy (Hiding the Stranger on Baker Street and Hiding the Stranger in Hickory Valley) that takes the reader on an adventure filled journey! See why Mrs. Kelly's work has been called "highly recommended for community libraries." www.BezalelBooks.com


text:
The Ultimate Of Custom Modern Kitchen Appliances
The kitchen nowadays is considered as the important hub of activity in the home. The kitchen has become not only the centerpiece, but also a showplace of the home. So naturally the appliances used in the kitchen have become status symbols. In an effort to keep up with the latest in cooking trends there continues to be a strong trend toward stylish and flexible custom modern kitchen appliances. This is why the biggest change in kitchen takes place when people starting to use high-end appliances.
White Custom Cabinet And Appliances In Modern Kitchen Design
If you are looking to truly complete the look of your kitchen, than integrated appliances are be an important aspect to consider. With their stylish looks, integrated kitchen appliances have quickly become a major trend in modern kitchen design. Integrated appliances can be hidden with cabinetry to blend seamlessly into your new or existing kitchen design. Integrated kitchen appliances are also sought after more and more because they are custom made, so they can be made as your order and needs; this is why they called as special and unique.
For you who want to complete your kitchen with custom modern kitchen appliances, you should consider these integrated kitchen appliances and how they might fit into your kitchen designs:
Stylish Integrated Kitchen Appliances For Modern Kitchen
Custom refrigerator units are one of the most popular choices for integrated appliances. Refrigerator custom side panels and front panels help your custom refrigerator unit blend smoothly and cleanly into the surrounding cabinetry. Refrigerators with custom panels are quickly becoming the new standard in kitchen decor.
Custom microwave trim kits are also becoming increasingly popular in kitchen designs. An integrated microwave adds a touch of class, especially in more traditional kitchen designs where the metal of a standard microwave unit would stand out.
Sleek And Contemporary Custom Kitchen Appliances For Modern Kitchen
While integrated dishwashers have now become the norm, the integrated dishwasher can still benefit from decoration. Like any other appliance, your integrated dishwasher can benefit from a dishwasher trim kit specialized to match your custom kitchen design.
Custom Cabinet And Appliances For Modern Kitchen Idea
Custom ranges add strongly to your kitchen's style. A custom stove, whether it be an island stove or a more traditional unit is a critical part of your custom kitchen design.
Custom made wall ovens are a true sign of class and affluence to add to your kitchen design. A kitchen with custom made wall ovens with trim to match the cabinetry and decor is perhaps the finest and most luxurious addition to any kitchen.
Amazing Custom Made Modern Kitchen Appliances Idea
If you are interested in custom modern kitchen appliances or integrated kitchen appliance design ideas for your home, you can visit the trusted kitchen showrooms in your country. The expert in the line of kitchen appliances will help you to choose the right appliances that are appropriate for your kitchen and your needs.


text:
Our Process
Whether you request an offer online or receive an offer from us by mail, our process is the same. First, our team of experienced energy professionals diligently evaluates every aspect of the property, including the past production history, the volume and decline rates of current production and the future potential of production from any other known hydrocarbon reserve. Fully understanding the property in this manner enables us to make fair and substantial purchase offers that will actually make sense to you - we won't just waste your time with insignificant offers like most other royalty acquisition companies do.
While you are considering our purchase offer, our goal is to educate you so that you can ultimately make the right decision for your family, estate, trust, or business - whatever that decision may be. We understand that you may have questions or concerns during the decision making process, and we are here to help and provide any information you need, at any point. Just contact us toll free at 1 (844) 4-SLATON or at firstname.lastname@example.com. In some cases, you may prefer to sell only part of your mineral/royalty interest, and we will make every effort to accommodate your request if the partial interest is still within our acquisition parameters.
If you choose to accept our offer, closing is simple. If we have already confirmed your title ownership, we will schedule the closing as soon as practical and convenient for you. If not, it typically only takes 2-3 business days to verify title through public record searches online or at the county courthouse. After confirming title, we will prepare a Mineral/Royalty Deed for the transaction. Depending on the purchase amount (and your preference), we may either wire the money to your bank, where you will sign and notarize the deed with your banker, or we can overnight you a cashier's check after we receive the notarized deed by mail. Often times we also have agents in your area that can meet you at your convenience to deliver a certified check and notarize the deed for you.
And that's it! At Slaton, we are constantly working to improve our processes in order to make every transaction convenient, transparent and beneficial for every client.


text:
- The List
- 4 June 2007
The best film & dvd releases
Black Gold Learn about the real cost of all those daily cups of coffee in this intelligent documentary. See review. Filmhouse, Edinburgh, Fri 8 Jun.
Dans Paris Memories of the nouvelle vague ignites this delightfully engaging romantic drama about sibling divide and wounds that never heal. Highly recommended. See review. Filmhouse, Edinburgh, Fri 8-Thu 14 Jun; GFT, Glasgow, Fri 15 Jun.
Ten Canoes Awesome aboriginal action adventure set in tribal times. Think Apocalypto without all the ultra violence and fundamentalist Christian undertones. See interview and Also Released. GFT, Glasgow, Fri 15 Jun.
Tell No One Exemplary Parisian thriller containing one of the finest chase sequences ever. See interview and Also Released. Cameo, Edinburgh and selected cinemas from Fri 15 Jun.
Zizek! Fascinating documentary about philosopher Slavoj Zizek. See review.
The Battle of Algiers Seminal insurgent resistance thriller in new digital print. GFT, Glasgow, Fri 8-Mon 11 Jun.
Six of the Best: They Might Be Giants Six gems from last year's EIFF 1970s retrospective including Peter Fonda's The Hired and Peter Hyams' Busting. Filmhouse, Edinburgh, Fri 8 Jun.
The Forbidden Planet Lovely DVD reissue of the classic 1956 sci-fi adaptation of Shakespeare's The Tempest comes with a ton of new extras. See review. Out Mon 18 Jun (Warner Home Video).


text:
MorningOctober 16
Psalms 63:1-3 (NIV) 1O God, you are my God, earnestly I seek you; my soul thirsts for you, my body longs for you, in a dry and weary land where there is no water. 2I have seen you in the sanctuary and beheld your power and your glory. 3Because your love is better than life, my lips will glorify you.
David had such a all-encompassing desire to be close to God, to be in His presence. In the 61st psalm he said he wanted to live in God's tent forever. In the passage today he compares it to being thirsty and not being able to find water. He knew what that was like, living in Judah. The hill country had long dry seasons, and if the cistern you were counting on was dry, it was a long way to the next one. What is it we seek? What do we long for and how desperately?
He longed for the presence of God, because he had encountered God in worship in the sanctuary. At that time, the Tabernacle was still in use. The temple would be built by his son, Solomon. That tabernacle is probably God's tent that David said he wanted to live in forever. There, in worship, he had an encounter with God that so captivated his soul that it became all he longed for. It was a vision of the power and glory of God. Have you had an encounter with God that has captured your desires? You can find it in His Word. You can find it as David did in worship. If you ask for it, with a motivation of wanting to desire God in a greater way, He will answer. You are praying His will.
What did David understand when he beheld the power and glory of God? He saw God's love is better than life itself. He saw the love of God that passes understanding. As we see His love in a greater way, it births in us a greater love for Him because love begets love. His response to that revelation was to glorify God. The Apostle Paul prayed that the Ephesians would know the love of Christ in all its dimensions so that they might be filled with all the fullness of God (Ephesians 3:16-19).
Prayer: Lord, help me to know your love in all its dimensions.
EveningOctober 16
Colossians 1:15-17 (NIV) 15He is the image of the invisible God, the firstborn over all creation. 16For by him all things were created: things in heaven and on earth, visible and invisible, whether thrones or powers or rulers or authorities; all things were created by him and for him. 17He is before all things, and in him all things hold together.
Paul had no doubts about the deity of Jesus. He understood that Jesus was the visible manifestation of the invisible God. Every manifestation of God throughout Scripture is Jesus Christ. God is a spirit, but when He is manifested, we are seeing Jesus in some form.
The place of firstborn is usually given to a firstborn son. Jesus is eternally existent with God, but He was born into the world of creation at a point in time through Mary. The firstborn is the heir of the Father, with a double portion of the inheritance. So, though everything is God's, the double portion of inheritance belongs to Jesus. Our adoption as sons would give us a single portion of the inheritance. What is incredible is that Jesus is willing to share His inheritance with us, considering us His brothers.
This passage also declares Christ to be the instrument of creation. Everything that was made, everything that exists other than the Father, Son and Holy Spirit was made by Jesus. It was made for Jesus. The rebellion in the Garden only detracted for a moment in eternity, from the ultimate will of God. Everything will glorify the Son. There is no other possible outcome. He holds it all together. At His word it would all cease to exist.
At times, we forget the supremacy of Christ and grow concerned over our temporal situations. It helps us to go back and look at the big picture and realize that everything is in His hands. Everything will bring Him glory. The whole earth is filled with His glory.
Remember: No matter how powerfully present evil appears to you, it is temporary. One word from Jesus will end it.


text:
Jack White's Coca-Cola Commercial3 Comments Published by ThinkaGeek on Monday, April 17, 2006 at Monday, April 17, 2006.
Here is the coolest adv Ever and it was developed from Jack White. I think its Geeky ... I really love frames even That kind of frames ... xixix .... Check it here but ensure that you Have the Dsl line connected........
Thnks to Modernage . P
Thnks to Modernage . P


text:
Search for help on enabling JavaScript
Since 1995 Arts for Oakland Kids (AOK) has been awarding grants to fund hands-on art programs in Oakland public schools. Our mission is to enhance the lives of Oakland students by funding arts education in our most under-served schools. To date, we have served over 18,000 kids in 136 programs at over 50 different schools. Our vision is to create a community where every student has equal access to arts education.


text:
The whole time my narcissist was in my life, I struggled with the idea of trust. I felt like I couldn't trust him, but felt I should be able to because he was the man I loved. Because of all his harrassment about my friends, I started to feel like I couldn't trust other people in my life and, for a while, I really alienated myself from all my friends. I was so confused.
Now I know I can't trust him, but after reading so many articles and personal stories about narcissism, I'm in that paranoid phase of feeling like everyone is a potential narcissist. I'm calling it a phase because I'm really, really hoping it's just a phase.
Recently, a new guy expressed interest, messaged me to say good morning and that set off sirens for me, thinking he's starting the love bombing phase. Too much contact, too soon. Is it? I just remember that's what my narc used to do – it's too familiar, but does that mean it's not normal? Does that mean it's never ok to say good morning to a new interest? I probably wouldn't have given it a second thought in the past, but look where that got me…
And in another case, an old recently reacquainted friend made a joke instead of giving a straight answer and I immediately recoiled. I started reviewing every stage of our reacquainting and fit everything into the narc phases. Am I making it fit, or is he really a danger to me?
I feel like right now I can't tell the difference, which is scary. I know being vulnerable attracts narcissists like moths to a flame, so I'm trying to keep my guard up with everyone just in case. But I also know that narcs are geniously intuitive and would be able to sense my vulnerability regardless, so there's no fooling myself into thinking they wouldn't be able to sniff me out in a crowd. It's up to me to strengthen up and get my boundaries solidified. I guess I just don't know how to do that without isolating myself.
I wish there was a secret question only survivors knew, that we could use to sort out the narcs from the good ones. In the absence of that, I think I'm just going to keep not trusting for now.
After all, I think we all learned from our narcs the importance of trusting our instincts. Maybe all of these worries and paranoid feelings are my gut's way of telling me I'm just not ready to get out into the 'real world' again just yet. Well, I think I can at least trust that.
Just found a great article about learning to trust again after emotional abuse! https://www.psychopathfree.com/showthread.php?6123-Article-Trust-After-Emotional-Abuse&p=86718#post86718


text:
Branded Gazebos for The Royal British Legion
07 December 2015
The Royal British Legion branded pop up gazebos for 2015 'Live On' Poppy Appeal Campaign
The 'Live On' poppy appeal campaign is close to all our hearts, remembering not only the brave veterans of the past, but also honouring those of the present day and future generations. The Royal British Legion poppy helps provide thousands of modern veterans, Service men, women and their families with vital advice and support.
The Royal British Legion fundraising teams were busy around the UK this year on regional initiatives and commissioned XG Group to produce their branded pop up gazebos for use at a range of outdoor locations.
XG Group custom printed 104 x 3mx3m pop up gazebos with printed side-walls and doors.


text:
I think this is one of my favorite coffees ever. I received a 40 K-Cup box a week ago and have gone through more than 18 K-Cups all by myself. So, that would be the only downside. You drink more coffee. Here is the cup I am literally drinking right now! It is amazing. I can't wait to go to work tomorrow so I can share it with my co-workers but not too many. Wink!
To Buy:
To Win:


text:
i think this phone sounds great.
i havent got it yet but i cant wait to get it
isnt it a bit expensive though?
can anyone say if this phone is good for the money?
thank you
this means alot to me x x x
Its lightweight and slim..easy on the pocket. But i have problem transfering video/photos from hp to pc. any1 nos?
Hi i just got the phone today and it doesnt have fido on its network list. Does anyone know how to add it or what i have to do to detect the network. Thnx
hi, please - when dialing, is it possible to change the characters to black and not the coloured big ones that come with the phone? some one help. i love my phone but this is so annoying as am not in kindergarten. thanks
i juz made an order. i juz nd them to call for the confirm. SO.. do u tin i shud buy or shud not? anythin plz email to firstname.lastname@example.com to me rgds the fone. TQTQ =))
i havnt got this phone yet but it sounds great i think i might get it. i hope moor people can tell me what else is on there.
But there seems to be a defect with the phone!!
How to tell if you have this defect:
If you load up the Zoo Zoo game, and the song that plays in the beginning just cuts off and goes directly to the main menu of the game, it is a sign that you may have this defect!!!
Bought my KG810 from ebay for A$360.
Its a very good standard phone - it does everything well (mp3, camera, bluetooth).
What it lacks in camera megapixel functionality or storage it definitely makes up in sexiness.
I love how it USB charges! and the Zoo zoo java game is addictive!
Hi, I am wondering if any of you have the same problem that I do with my LG KG810.
When the default game Zoo Zoo Club loads, the introductory music does not play all the way while the other game Sudoku does. I am wondering if this could be a possible defect of this phone!!
Please, could somebody check if they have the same problem! I'm not sure if it's just my phone that does this.
Thanks!! It would be much appreciated!
received my kg810 yesterday and am pretty happy with it. the cover is a fingerprint magnet so i find myself wiping it often. Interface is okay, sound is okay, camera okay, but definitely very sexy :)
the design is quite trendy and no longer have the sensitive heat sensor touchpad problem in KG800. Check out the review at http://www.mobile88.com/mobilegallery/phonereview.asp?phone=LG_KG810&pg=review&prodid=20082&cat=25
does the phone come with a photo phonebook? as in, can people see who is calling on the external screen?
The KG810 is a good phone with a few problems letting it down. First off, it gets smudged and scratched easily after very little use. Secondly the battery life is terrible. I think it should also have more built in memory... http://www.best-mobile-phones.org/review/28-lg-kg810
The KG810 is a good phone with a few problems letting it down. First off, it gets smudged and scratched easily after very little use. Secondly the battery life is terrible. I think it should also have more built in memory... http://www.best-mobile-phones.org/review/28-lg-kg810


text:
Career opportunities
Journeyman OR Apprentice Lineworker (Caledonia, MN)
MiEnergy Cooperative is seeking applications for either a Journeyman or an Apprentice Lineworker for our Caledonia, MN outpost. Applications will be accepted until the position is filled.
Journeyman application
Apprentice application
Please return application and transcripts from high school and accredited secondary school to:
VP of System Operations
Chad Chaffee
MiEnergy Cooperative
PO Box 626
Rushford, MN 55971


text:
Here at Watch Deals Online we supply our customers an amazing collection of watches such as VibraLITE Mini 12-Alarm Vibrating Watch - Navy Blue which you are looking at right now. Get this incredible timepiece today and enjoy your new timepiece!
Watch Deals Online is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com, Endless.com, MYHABIT.com, SmallParts.com, or AmazonWireless.com. Amazon, the Amazon logo, AmazonSupply, and the AmazonSupply logo are trademarks of Amazon.com, Inc. or its affiliates.


text:
Member Portal
Course Administration
Advancing the EMS profession
Toggle navigation
Join Overview
Membership Categories
Member Benefits
Join NAEMT
Agency Membership Sign-Up
Membership Coordinators
Education Overview
Locate a Course
Become an NAEMT Instructor
Advanced Medical Life Support
All Hazards Disaster Response
EMS Safety
Emergency Pediatric Care
EMS Vehicle Operator Safety
Geriatric Education for EMS
Prehospital Trauma Life Support
Principles of Ethics and Personal Leadership
Psychological Trauma in EMS Patients
Tactical Combat Casualty Care
Tactical Emergency Casualty Care
NAEMT Education Worldwide
Advocacy Overview
Online Legislative Service
Advocacy Coordinators
NAEMT Positions
Letters and Comments
Congressional EMS Caucus
Sample State EMS Legislation
Other Organizations
National EMS Advocacy Awards
Initiatives Overview
EMS Fitness
EMS Mental Health
EMS Preparedness
EMS Research
EMS Safety
Injury and Illness Prevention
National EMS Awards
National EMS Week
Public Awareness
Sepsis Awareness
Stroke Awareness Resources
Supporting our Military
Publications Overview
Events Overview
NAEMT Annual Meeting
World Trauma Symposium
EMS On The Hill Day
EMS 3.0 Workshops
About NAEMT
NAEMT Overview
Board of Directors
NAEMT Committees
Our Staff
History of NAEMT
Press Releases
Corporate Partnership
NAEMT Foundation
About EMS
EMS Overview
Find a Job
Degrees in EMS
Code of Ethics-EMT Oath
Member Portal
Course Administration
NAEMT News
Top News
All News
Will the 21st Century Cures Act level the playing field on hospital readmissions?
Dec 14, 2016
[From Modern Healthcare]
Nestled within the 994 pages of the 21st Century Cures Act that President Barack Obama signed into law on Tuesday is an opportunity for hospitals to change the way they are judged when patients are unnecessarily readmitted.
The law requires Medicare to account for patient backgrounds when it calculates reductions in its payments to hospitals under the
Hospital Readmissions Reduction Program.
Until the passage of the Cures Act, originally meant for biomedical innovation but turned into a smorgasbord of healthcare policies, thorny questions about adjusting for patient demographics had been avoided.
Hospitals have been at fault if, within 30 days after discharge, patients return to the hospital for the same reason they were originally admitted. But some hospitals are located in impoverished areas, and many of their patients cannot afford to buy medication or healthy food, or they lack transportation to attend checkups with primary-care doctors.
Nevertheless, unless a hospital's readmission rate falls below the national average, it will face financial penalties under the program.
Hospital and medical groups hope the 21st Century Cures Act will ensure funds are not unduly taken from hospitals that need it most. Policy experts, however, say that the effectiveness of risk adjustment depends on the details of its implementation, which are scant in the legislation.
They have also raised concerns that because sophisticated, reliable risk-adjustment methodologies are in their infancy, handicapping for patient demographics might foster complacency among some hospitals or even exacerbate health disparities, especially along racial lines.
"Nobody wants to give a blanket pass for hospitals to deliver poor care, and we certainly don't want to further disadvantage any already disadvantaged population," said Melony Sorbero, a senior policy researcher at the RAND Corp.
Created under the 2010 Affordable Care Act, the readmissions program requires Medicare to cut payments to hospitals with excess 30-day readmissions for certain conditions. That list of conditions has expanded from the original three—heart attack, heart failure and pneumonia—to include chronic obstructive pulmonary disease, hip and knee replacements and coronary artery bypass grafts.
The CMS estimated it would save $538 million in fiscal 2017 from payment cuts to 2,588 hospitals under the program. About 3,330 acute-care hospitals and 430 long-term care facilities are eligible. Penalties are capped at 3% of Medicare inpatient prospective payments.
Cures Act
requires the CMS to adjust penalties based on the proportion of a hospital's patients identified as dual-eligible beneficiaries, or those that qualify for both Medicare and Medicaid.
Those patients are often expensive to serve, accounting for nearly a third of total Medicare fee-for-service spending in 2012 despite constituting only 18% of beneficiaries, according to a June report by the Medicare Payment Advisory Commission.
According to Dr. Helen Burstin, chief scientific officer at the National Quality Forum, the risk-adjustment approach may benefit safety-net hospitals the most since it would allow for "apples to apples" comparisons.
Burstin said it might also encourage hospitals to admit the most vulnerable patients, while money saved from reduced penalties could be invested in community initiatives for preventive health.
Even as they praised the gesture contained in the proposed legislation, several experts and hospital leaders questioned the specifics of the risk-adjustment process.
The Cures Act does not contain specifics on how the CMS should adjust for risk. The law states that the HHS secretary "shall assign hospitals to groups" and apply "a methodology in a manner that allows for separate comparison of hospitals within each group." Those groups would be based on hospitals' overall proportion of dual-eligible individuals.
The secretary "may consider" the Medicare Payment Advisory Commission's
June 2013 report
, which found that hospitals with higher proportions of poor patients tended to have higher readmission rates and higher Medicare penalties.
The report suggested setting different target readmission rates for different hospitals that would be grouped according to patient profiles, as determined by dual-eligibility.
For instance, hospitals that see 30% of patients who are dual-eligible will not be compared to those who see 2% dual-eligibles, said Philip Alberti, senior director for health equity research and policy for the Association of American Medical Colleges. Beyond that, not much else is clear.
Dr. Michelle Schreiber, senior vice president and chief quality officer at Henry Ford Health System in Detroit believes long-term research will identify the most equitable approach to risk adjustment.
"The variables that will probably need to be included are not only patient-specific but also community-level variables such as how stressed is the community," Schreiber said. "If you're poor, it increases the risk of readmission, but if you're also poor in a community with poor resources compared to a community with rich resources—that too is different."
These challenges point to why risk adjustment has not been incorporated until four years into readmission program. Although strong evidence indicates that patient demographics and socio-economic status play a role in health outcomes, researchers have yet to figure out how to reliably predict the effects of different variables.
"These data are difficult to capture," said Francois de Brantes, executive director of the not-for-profit Health Care Incentives Improvement Initiative. When de Brantes collaborated on research to see whether sorting patients by ZIP codes in New York City could predict patient outcomes, for instance, he and his colleagues came up empty-handed.
But he adds, now that the bill is law, "it kind of forces the industry to come up with a solution."
Critics of adjusting readmissions penalties based on socio-economic factors say doing so would run the risk of creating a separate, lower standard of care among safety net hospitals serving higher proportions of low-income patients.
The CMS in 2013 explained that it did not adjust risk for socio-economic standards because that would "suggest that hospitals with low SES (socio-economic status) patients are held to different standards for the risk of readmission than hospitals treating higher SES patient populations."
Safety net hospitals are often found in poor areas, where community resources are limited or nonexistent. Some of those areas also tend to be predominately black or Latino, factors that raise concerns that adjusting readmission penalties could further widen racial disparities in health.
However, some safety net hospitals have proven they can successfully treat patients in underserved communities.
Among safety net hospitals, the most recent penalties incurred under the Hospital Readmissions Reduction Program range from zero to 3%, Modern Healthcare has found.


text:
Sketching Around
Wandering through life with a sketchbook in hand...
Marina, Sequoyah Park
Sunday, April 17, 2011
Gardens at Gilcrease Museum
Gardens at Gilcrease Museum, 6 x8 inches oil on canvas covered board
Here is the second painting from the workshop I took this week done in the front gardens at Gilcrease on Monday April 11th. We had a lecture in the morning followed by a demonstration by Curt and then broke up to work on our first painting of the day.
Posted by
Janette Meetze
Email This
Share to Twitter
Share to Facebook
Share to Pinterest
No comments:
Post a Comment
Newer Post
Older Post
Subscribe to:
Post Comments (Atom)


text:
Pick Up That Toothbrush To Lose Weight
Your dentist may have been trying to help you all along!
August 16, 2016 · Leave a comment
5 Easy Ways to Cut 100 Calories Per Meal
Cut 100 and Walk 2000 For Sustainable Weight Loss!
August 1, 2016 · Leave a comment
5 Foods You Should Be Eating Right Now
Stretch your palate to look and feel better with these 5 powerhouse foods!
July 27, 2016 · Leave a comment
Remove "Diet" Foods From Your Kitchen and Vocabulary
Foods labeled "Diet, Low-Fat, and Low-Calorie" may be sabotaging your weight loss goals and Here's why!
January 12, 2016 · 1 Comment
100 Small Steps On Sale $2.57 For The Holidays!
Put the gift of health in their stocking this year for only $2.57 at Amazon.com!
December 15, 2015 · Leave a comment
Keith "Temple" Trotter | WWJ – 100 Small Steps | Tricks of the Trade
Tricks of the Food Trade
February 23, 2015 · Leave a comment
Keith "Temple" Trotter | 100 Small Steps | Goal Setting to Win
In Temple's first television interview, he speaks to Bobbie Pominville of the Western Wisconsin Journal about his process to set small goals and celebrate the victories along the way to obtaining the larger ones.
February 20, 2015 · Leave a comment