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The flu is often dismissed as a viral infection that the body clears in a matter of days, but the truth is that it can be quite dangerous, especially when it causes inflammation in the lungs. The inflammatory response may cause lung damage, which may lead to death. However, scientists believe that they have found a new way of combatting inflammation caused by the flue using a natural human protein.
The scientists recently conducted mouse studies in which they injected mice with lethal influenza doses. Almost all the mice died within days after the influenza dose except one mouse that had been injected with an experimental therapy. The researchers also observed that the mouse that survived did not lose weight, and it maintained its energy even though it had been infected with high levels of the influenza virus.
“Even though these mice had the same viral load as the untreated mice, they didn’t get very sick—with the lethal dose of the flu,” stated Professor Jacob Yount.
What is the experimental therapy given to the mouse that survived?
The therapy administered to the mouse that survived is an experimental treatment that contains MG53, a protein found in the human body, whose role is to facilitate the repair of the cell membrane. Scientists have been fascinated with MG53 for some time. They have even evaluated it as a potential treatment for other conditions such as skin wounds and Alzheimer’s disease.
In the recent mice study, scientists discovered that MG53 prevents excessive inflammation when the mice received a lethal viral load of the flu. However, the protein does not affect the virus. However, it gives the subject a chance to survive while their immune system works to clear the virus.
The scientists have already started running tests that will allow them to understand better how the therapy will affect mice infected with the coronavirus. Perhaps the study’s findings might provide insights on how to boost the survival rate of COVID19 patients. Most of the patients that have died of the coronavirus died due to the resulting excessive inflammation caused by the immune system’s response. | <urn:uuid:c56d94c5-e4a9-4578-aab5-25a8e64c224d> | CC-MAIN-2024-18 | https://guidancewiz.com/scientists-may-have-found-way-to-prevent-deadly-lung-damage-caused-by-the-flue-and-it-involves-using-a-natural-human-protein | 2024-04-20T16:53:02Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.973238 | 416 |
This guide is for students and researchers in Women's and Gender Studies. Hand-picked resources are available using the tabs on the left.
The UT Libraries is thrilled to announce the 2nd annual Black Queer Studies Student Awards!
These awards will recognize, honor, and celebrate excellence in student scholarship and creative endeavors in the field of Black Queer Studies.
To apply: See Instructions, Eligibility and Criteria on this guide: https://guides.lib.utexas.edu/bqsc/awards Submissions are due February 5, 2024.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Generic License. | <urn:uuid:60931402-83b7-4acd-92fd-f0db753f831b> | CC-MAIN-2024-18 | https://guides.lib.utexas.edu/wgs | 2024-04-20T17:27:25Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.888813 | 145 |
Selena Gomez Rema Calm Down Remix Is Currently the Biggest Song In the World
Selena Gomez has never been one to avoid teaming up with new and aspiring talents. In 2022, she collaborated with Nigerian artist musician Rema for the remix of his hit single “Calm Down.” The tune was a momentous achievement, and it immediately became one of Gomez’s most famous melodies to date.
Gomez talked about how working with Rema changed her life in a recent interview. She stated that his music’s “raw energy and authenticity” initially drew her to it. She also valued his willingness to try new things and challenge conventional wisdom.
Gomez said, “Rema is a true artist.” He won’t hesitate to act naturally, and that is something I truly respect. It was an amazing experience working with him, and it really helped me develop as a musician.”
Gomez said that the “Calm Down” remix was something beyond a joint effort for her. It gave her a chance to meet new people and show the world that she loves music.
“This tune is a legitimately big deal to me,” she said. ” It’s about having self-assurance and finding your own voice. I trust that it motivates others to do likewise.”
The song marked a turning point in Selena Gomez’s career. She has been able to connect with a new audience and establish herself as a formidable competitor in the music business as a result.
She stated, “I’m so grateful for this opportunity.” Rema is a genuine ability, and I’m regarded to have worked with him.”
The ” Calm Down” remix is the perfect start for Gomez and Rema. The two artists are certain to continue making waves in the music industry for many years to come, and they have already hinted at potential collaborations. | <urn:uuid:85bd4ee5-581b-4199-99ff-fb2f79225a51> | CC-MAIN-2024-18 | https://gyonlineng.com/selena-gomez-rema/ | 2024-04-20T16:36:32Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.982651 | 412 |
In special cases where the donor region is to thin or too much already used in previous procedures, other donor areas may be. Very often it is the beard. The hair of the beard is very similar to the one of the head, it grows slower, but it can be a bit thicker which is very useful because it gives the impression of greater density. Using a hair out of the neck, the existing beard on his face retains its density and stays practically intact. Hair from the chest is very often used because men who have problem with hair loss, have a lot of hairs on their chest. Those grafts can cover significant areas of the scalp. Also, chest hairs grow a little slower and to a certain length, but sometimes provides a good solution. This region is not to be used as a donor in the case that there is a tendency to keloid creation. Hair from other parts of the body such as the tummy, back, legs or arms is rarely used, but these regions are not excluded as potential donor areas. If body hair is used, one should stay away from sun exposure a few weeks after the surgery until healing is completed. On the special request of the patient ,hair from this area can be used, although preference is always the back of the head as a safe area with the highest density and the ability of regeneration.
Hair transplantation to other areas of the body
If there is a lack of hair anywhere on the body, but most often it is the region of the chest , there is a possibility of a successful transplant of hairs to this region . | <urn:uuid:45e13049-146b-4ce5-a012-03236a836d50> | CC-MAIN-2024-18 | https://haircenter.rs/other-procedures/body-hair-transplantation/ | 2024-04-20T17:01:51Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.96842 | 320 |
oven should be preheated to 180c
its normal cake flour and yes not a very big oval cutter
i just pipped some beaten caramel treat.
wslm i don\'t think apricot jam will work, and yes u can use choc chips but it taste the best with chunks of cadbury chocolate
yes it can
any chocolate but cadbury plain dairy milk taste the best. and m sure it would be fine with almonds. | <urn:uuid:434b39a2-0b94-4b1a-86a8-684a297354a1> | CC-MAIN-2024-18 | https://halaal.recipes/members/comments/5557 | 2024-04-20T15:56:31Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.917136 | 94 |
West Ham attacking midfielder Pablo Fornals is a doubt for tomorrow’s game against Arsenal. The Spaniard is still struggling with a groin strain which kept him out of the defeat to Manchester United.
Ryan Fredericks (groin), though, is nearing full fitness and may well be back in the squad for the match at the London Stadium. The right-back has not featured for the first team since mid-February.
Angelo Ogbonna is still not available. The Italian is progressing well in his recovery from an ankle injury but manager David Moyes says the defender is still not ready to make a comeback
Arthur Masuaku is expected to return to action soon after knee surgery, while Andriy Yarmolenko (knee) is not yet available for selection despite being pictured back in training.
Darren Randolph is the only other fitness concern. The reserve goalkeeper still has a hip injury and his place on the bench will likely be kept by David Martin. | <urn:uuid:10e68235-4b33-4447-840b-cb78e96366a7> | CC-MAIN-2024-18 | https://hammersheadlines.com/blog/latest-west-ham-injury-report-updates-on-fornals-ogbonna-and-four-other-players/ | 2024-04-20T16:59:07Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.97126 | 199 |
With an appreciation of flow and motion Peggy’s life has been always been driven by passion. From surfing and skateboarding to the intimate appreciation what she calls the ‘Cetacean Nation’. Discovering the transformative force of participation artwork through her Origami Whales project was the first step to realising that passion could be harnessed, amplified and ultimately inspire for a deeper purpose. Surfer, Skateboarder, Artist and Activist.
Once the only female member of the famous Zephyr Skateboard team from documentary ‘Dogtown and Z-Boys’: Peggy’s love of the outdoors inspires her to travel worldwide in search of good surf. In 2004, she founded the Origami Whales Project to raise awareness about commercial whaling. She has also developed the Whales and Dolphins Ambassador Program and led campaigns such as ‘Let’s Face It’, which petitions to save New Zealand’s critically endangered Maui’s dolphins and Hector’s dolphins. | <urn:uuid:81ccef76-9917-4532-b016-844e02572bc5> | CC-MAIN-2024-18 | https://happierway.org/pillars/growth/videos-growth/allow-things-to-unfold-and-you-will-find-your-purpose-in-life-peggy-oki-tedxqueenstown/ | 2024-04-20T16:57:34Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.941792 | 213 |
Welcome back for more Cocoa Vanilla Studio inspiration!
Today I am sharing my very first creation with the stunning new UNFORGETTABLE collection!
There are so many gorgeous papers and endless possibilities with this collection, and I wanted to showcase a few of them!
Here's what I created,
"Bloom & Grow"
Oh wow! Isn't this just divine?!!
When I first saw the UNFORGETTABLE collection, I was immediately struck by the cleverness of Zoe Pearn - a floral collection that reflected both Spring & Fall! Florals and blooms to suit both hemispheres - sheer brilliance! I was also impressed by the whimsical & somewhat bohemian feel that UNFORGETTABLE evoked!
With Fall as my favorite season, I just had to create an Autumnal page for my sweet girl! Here's a closer look for you....
Gosh it's so pretty!!!
For that warm & outdoorsy feel, I used the lovely CV-UF008 NATURAL BEAUTY woodgrain pattern paper as my layout base. Next I added the two large concentric hearts to the center of the page. The larger heart is a beautiful vermilion floral pattern paper from the reverse side of CV-UF005 LACEWING. Did I mention it had my heart swooning?! Such a rich and elegant pattern design - LOVE!!! The smaller heart is cut from simple white cardstock. With a 'clean' white base, attention is drawn immediately to my photograph - perfect!
I positioned my darling daughter's picture onto a base of 3 x 4 note cards which I cut from pattern paper, CV-UF004 PRETTY BITS, and then glued the layers to the center of the page. For the embellishments tucked in and around my photo, I started with 3 larger fussy cut butterflies. These were also cut from the CV-UF004 LOVELY BITS paper (& yes, I used two sheets of this paper so that I could keep to my color scheme). Next I added that fabulous FLAIR BUTTON love this, & the two DIE CUT EPHEMERA pieces. And lastly, the CLEAR STICKER leaves tucked under the layers, and that super sweet butterfly to the bottom of the cluster. That smaller butterfly, and the others that you spy on my page, were all fussy cut from pattern paper CV-005 LACEWING - that paper may be my number one pick from this collection! SO incredibly beautiful!
Here's a closer view of the photo cluster details....
As you travel around the layout, you'll notice all the LACEWING fussy cut butterflies either tucked in or on the hearts. I include DIE CUT EPHEMERA blooms, foliage & even an arrow or two for added interest. CLEAR STICKERS also adorn the embellishment clusters and enhance the heart design.
The new FOAM TITLE STICKERS were the perfect go-to option for my layout title. The swirly font is super pretty, and the black foam is really striking on the woodgrain paper. I am also impressed with how easily they were to remove from the packaging, and to apply to my project. A new favorite product to the Cocoa Vanilla Studio range!
I arranged the 'grow' part of my title at the base of my layout, and adorned it with a couple of leafy fronds from the DIE CUT EPHEMERA pack...
Those FOAM TITLE STICKERS are really somethin'!
So many beautiful papers and embellishments!
For a finished look, I scattered a few white ENAMEL DOTS throughout the design.
Simple, Timeless & Beautiful.
The new UNFORGETTABLE collection is breathtakingly gorgeous & will suit whichever season your documenting!
I hope my Fall themed page has inspired you!
Thanks so much for visiting,
til next time, | <urn:uuid:b40066ef-2554-4334-a365-ff6b58a7e179> | CC-MAIN-2024-18 | https://happyartydays.blogspot.com/2019/09/cocoa-vanilla-studio-unforgettable-fall.html | 2024-04-20T16:48:43Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.940689 | 813 |
Ashleigh is an expert fractional sales leader, coach, trainer, and practitioner who has specialized in outbound sales methodologies and full cycle as some of the world’s best startups and corporations like Okta, where she ran sales development. Her popular consultancy and podcast “Across the Pond and Over the Rainbow” has brought critical acclaim and practical tips to software sellers everywhere. Get ready to ask her tough questions about building and scaling sales teams, Sales Operations, Sequence design, and outbound GTM motions that cut through the noise.
Ashleigh’s Hard Skills
Sales & Marketing Leadership
Sales Pipeline Development
Here are the most upvoted questions from the AMA and Ashleigh answered them all. In case you missed it, scroll down to watch the recording.
What are your top 3 tips for sellers looking to crush their quota in 2024?
How did you become good at selling and what's the secret to effectively coaching people?
What's your top tech stack go-to as a solo consultant or for a startup company?
Do you think selling has radically changed or the fundamentals are more important than ever?
Build scalable sales ops - metrics, data?
Why is cold calling so intimidating?
Best advice for an SI to build a co-selling partnership with an OEM's AEs or sales team?
What's your method?
When there aren’t inbound leads, and little money to invest in demand gen, how do you make cold outreach effective?
How do you incorporate PLG strategy in Hardware sales?
What to do if having difficulties processing a lot of information while keeping focus on targets?
What’s your favorite way of nurturing prospects who are not ready to buy?
How do you gain insight on your leads and how do you identify and qualify your top prospects prior to speaking with them?
How can you incorporate PLg in hardware sales?
Please provide feedback for the manager for the session that took place on . | <urn:uuid:2085dc34-d269-4f3c-a8ad-1efcb9d59352> | CC-MAIN-2024-18 | https://hardskill.exchange/ama/ashleigh-early/ | 2024-04-20T16:21:19Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.943858 | 405 |
Tall, athletic and super scopey young horse!
His sire Hardwell is a son of the infamous Clinton! His unique mix of top continental blood lines give this very talented young horse a great start in life!
He is super easy to deal with and well put together, making him a nice prospect for a keen amateur or professional looking to produce a quality horse.
Newroel shares the same big canter, natural balance and tremendous scope as his farther.
Bred from a strong mother line, the mare Kinette Van De Heffinck produced many top jumpers to 1.60m level!
*** Shipping world wide available ***
** Sold with vet check and x-rays, open to further inspection if required **
*Price subject to vat where applicable | <urn:uuid:509998d3-a965-474d-a1d7-bfb42e6e282a> | CC-MAIN-2024-18 | https://harringtonstables.co.uk/horse/newroel/ | 2024-04-20T17:16:18Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.900814 | 163 |
It’s common knowledge that seniors need to maintain an active lifestyle to help them feel better both physically and mentally as they age. One of the easiest ways to do this is by walking. Seniors can go at their own pace, walk with friends or in-home care, and even walk in their homes using exercise videos or YouTube. Keep reading to learn some tips and tricks to encourage seniors to walk more.
Encourage Realistic Goals
When walking is first suggested, it might seem like an easy task. However, if seniors struggle with mobility issues or have been mostly sedentary, walking is harder than it might seem. In-home care can assist seniors in setting realistic goals that are based on their current health and ability levels. This not only helps seniors see the progress they make over time, but it also encourages them to keep going and not get frustrated because they’re trying to achieve something that’s out of their reach from the start.
Make It a Social Event
Going for a walk with a friend, relative, or pet is fun, but this might not be available for some seniors. If this is the case, in-home care can walk with them, or they might look into joining a local walking group. This also encourages relationship building, which can strengthen seniors’ support systems.
Choose Safe and Accessible Routes
It’s important for seniors to choose walking routes that are both safe and accessible. They should choose pathways that are well-lit, have level surfaces, few barriers, and enough places to stop and relax. Indoor tracks, parks, and shopping centers are great choices, especially in bad weather.
Using technology to encourage seniors to walk more can be a great idea. In addition to tracking steps, setting reminders, and monitoring progress, fitness trackers and smartphone apps can also offer real-time feedback and incentives. Senior-specific apps are also available, with features like enlarged fonts and streamlined user interfaces.
Split Walking Into Manageable Segments
Not all seniors can get in 30 minutes of walking at one time. If this is the case, in-home care can encourage them to split the 30 minutes into smaller chunks throughout the day. Even quick walks of ten minutes a few times a day can have a major positive impact on health.
Focus on Footwear
Loved ones should talk with seniors about wearing walking-appropriate footwear and apparel. It’s important to invest in stable, cozy shoes that will cushion their feet and lower their chance of falling. In addition, in-home care can help seniors and loved ones research walking assistance devices like canes or walking poles if needed.
What Benefits Can Seniors Get From Walking Each Day?
There are many advantages to walking each day. In-home care can talk with seniors about these benefits, including how walking can strengthen bones and muscles, reduce joint discomfort, elevate mood, and improve cardiovascular health and general quality of life.
Getting seniors to walk more throughout the day is a good idea that can have a big impact on their physical and emotional health. In-home care and loved ones can encourage seniors to embrace walking as a fun and convenient form of exercise by putting the above suggestions into practice.
- Dentures 101: Home Care and Comfort Tips - April 17, 2024
- How Post Hospital Care Can Help Keep Seniors Motivated During Recovery - April 10, 2024
- Easy Activities for Seniors with Alzheimers - April 4, 2024 | <urn:uuid:62468f33-03ae-47d6-8513-68943afbdf52> | CC-MAIN-2024-18 | https://hcprosonline.com/walking-101-tips-and-tricks-for-seniors-to-stay-active/ | 2024-04-20T17:15:12Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.953851 | 709 |
Last Updated on April 2, 2024 by Francis
Joint pain in the knee can be a debilitating condition that affects everyday activities such as walking and climbing stairs. While there are various medical treatments available, many people turn to home remedies to supplement or replace traditional medicine. In this article, we will explore some of the most effective home remedies for knee joint pain.
Understanding Knee Joint Pain
Knee joint pain is a common ailment that can affect people of all ages. It can be caused by a variety of factors, including injury, arthritis, and obesity. Knee joint pain can be debilitating, making it difficult to perform daily activities such as walking, climbing stairs, or even standing for extended periods. There are many treatments available for knee joint pain, including medications, physical therapy, and surgery. However, home remedies can also be used to alleviate knee joint pain.
Causes of Knee Joint Pain
Knee joint pain can be caused by a variety of factors. Some of the most common causes of knee joint pain include:
- Injury or trauma
- Overuse or repetitive strain
Symptoms of Knee Joint Pain
The symptoms of knee joint pain can vary depending on the cause of the pain. Some of the most common symptoms of knee joint pain include:
- Pain and stiffness in the knee joint
- Swelling and inflammation around the knee joint
- Difficulty walking or standing
- Limited range of motion in the knee joint
- Clicking or popping sounds when moving the knee joint
Home Remedies for Knee Joint Pain
There are many home remedies that can be used to alleviate knee joint pain. These remedies are often simple, inexpensive, and can be done at home. Here are some of the most effective home remedies for knee joint pain:
Exercise is one of the most effective home remedies for knee joint pain. Exercise can help to strengthen the muscles around the knee joint, which can help to alleviate pain and reduce inflammation. Some of the best exercises for knee joint pain include:
Hot and Cold Therapy
Hot and cold therapy can be an effective home remedy for knee joint pain. Applying heat to the knee joint can help to increase blood flow and reduce stiffness, while applying cold can help to reduce inflammation and pain. You can use a hot water bottle or a cold pack to apply heat or cold to the knee joint.
Massage can be an effective home remedy for knee joint pain. Massage can help to increase blood flow to the knee joint, which can help to reduce pain and inflammation. You can use a massage roller or a foam roller to massage the muscles around the knee joint.
Turmeric is a natural anti-inflammatory that can be used to alleviate knee joint pain. You can add turmeric to your food or take turmeric supplements.
Ginger is another natural anti-inflammatory that can be used to alleviate knee joint pain. You can add ginger to your food or take ginger supplements.
Epsom salt is a natural remedy that can be used to alleviate knee joint pain. Epsom salt contains magnesium, which can help to reduce inflammation and relieve pain.
To use Epsom salt, fill a bathtub with warm water and add 2 cups of Epsom salt. Soak in the bath for 15-20 minutes, and then rinse off with warm water.
FAQs – Home Remedies for Joint Pain in Knee
What are some effective home remedies for joint pain in knee?
There are several effective home remedies that can help alleviate joint pain in the knee. These include applying cold or hot compression packs, doing low-impact exercises like swimming or walking, taking supplements like glucosamine or omega-3 fatty acids, practicing yoga or meditation, and consuming anti-inflammatory foods like ginger or turmeric.
How do cold and hot compression packs help with knee joint pain?
Cold compression packs can help reduce swelling and inflammation in the knee joint, which can be a common source of pain. On the other hand, heat therapy can help increase circulation and promote relaxation, which can aid in reducing chronic joint pain. Alternating between cold and hot compression packs can also help alleviate knee joint pain by stimulating blood flow and reducing inflammation.
Can specific exercises help with knee joint pain?
Yes, there are exercises that can help reduce knee pain, particularly low-impact exercises that don’t put too much pressure on the knee joint. Swimming, walking, cycling, and yoga are great exercises for people with knee joint pain. These exercises can help to build strength and flexibility in the muscles surrounding the knee joint, reducing the pressure felt on the knee during movement.
Are there any foods that can help with knee joint pain?
Yes, some foods are known to have anti-inflammatory and pain-relieving properties that can help reduce knee joint pain. These include ginger, turmeric, omega-3 fatty acids found in fish or flaxseed, nuts, and seeds. Incorporating these foods into your diet can help reduce inflammation and relieve knee joint pain.
Is it necessary to consult a doctor for knee joint pain?
While home remedies can be helpful in alleviating knee joint pain, it’s always a good idea to consult with a doctor, especially if the pain is severe or persistent. A doctor can help identify the cause of the pain and recommend proper treatment options, which may include medication, physical therapy, or surgery, depending on the severity of the issue. | <urn:uuid:deb291bb-3130-4d15-820d-c4b46d23d24b> | CC-MAIN-2024-18 | https://healingpicks.com/home-remedies-for-knee-joint-pain-the-ultimate-guide/ | 2024-04-20T17:20:29Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.941006 | 1,109 |
Costs Associated with Underarm Laser Hair Removal
The Underarm Hair is the most irritating thing for a woman when she is in her favorite dress or costume. Some people want to remove underarm hair permanently. Having underarm hairs sometimes becomes uncomfortable for a person while he or she is in public and suddenly realize that they forget to shave underarm hairs. Imagine that what it would be like when you don’t need to shave your underarm hairs for always. There is the only option to remove your underarm hair permanently, the underarm laser hair removal therapy. It gives you the freedom to wearing whatever you like without worrying about uncomfortable and unsightly hair.
If you shave your underarms frequently, it makes the shaved area crystals, razor burn and prone to ingrown hairs. Underarm Laser hair removal is the best idea to remove unwanted hairs permanently. Underarm Laser hair removal therapy is one of the common laser surgery used around the world.
Benefits of Laser Hair Removal
Although the underarm laser hair removal is one of the common and best ideas to remove unwanted hairs permanently, surgeons and hair removal experts also advise choosing the laser hair removal for underarm for long lasting results or removal of hairs.
There are many benefits and good things about the laser underarm hair removal that include:
In the Underarm laser hair removal therapy, your doctor will point the laser at the area where you want to remove the hair permanently. While your doctor points the laser at your skin, it selectively targets coarse hair and dark while leaving the other skin that surrounds the target area undamaged. The laser only shows the results in the target area and does not harm your skin.
You may experience permanent loss your unwanted hair after an average of four to eight sessions of laser underarm hair removal therapy. You can get the better results after using the hair removal therapy more than three times that is also called the sessions.
The laser’s every pulse can treat many hairs at a time while it is taking a fraction of a second. The laser can remove hair according to the area that is approximately the size of a quarter each second. In some cases, the individual wants to remove hair on the upper lip area, and it takes less than 1 minute, and there are some other cases, in which the individual wants to remove hair from his or her back or legs and some other large areas that may take up to an hour.
Preparing for Laser Underarm Hair Removal
An individual who wants to remove some hair from his or her body or to zap the unwanted hair but the laser hair removal is more than this. The Underarm laser hair removal is a medical procedure that needs the training to perform and sometimes carries some potential risks. Before getting the laser hair removal procedure, you should wisely choose an expert and approved underarm laser hair removal expert, and you should also observe their credentials of performing the laser hair removal procedure.
According to experts, if you want to go through a laser hair removal procedure, you should quit waxing, plucking and electrolysis before 4 to 6 months of taking a laser hair removal therapy. As the laser targets, the hair roots and by plucking and waxing it may temporarily remove and that causes some skin risks because the laser could not be able to target the hair roots and affect the skin. Your laser hair removal expert will also advise you to avoid the exposure to sunlight before 4 to 6 months of getting the laser hair removal procedure. The sun exposure can make laser hair removal procedure less efficient and sometimes it may make the procedure result-less. Exposure to the sun can create some complications too after getting the laser hair removal.
Expectations During Underarm Laser Hair Removal Procedure
Just before getting through the laser hair removal, your doctor will trim the hair to a few millimeters that you want to remove permanently. After that, your doctor will adjust the laser equipment according to the thickness, color and the location of the hair and start removing the hair by laser. In some cases, the underarm laser hair removal expert or technician also adjust the equipment according to the individual’s skin color.
While using the laser hair removal equipment, your doctor and you need to wear an eye protection glass, and sometimes it depends on the laser’s light or source. Your doctor may use some cooling devices or cold gel to protect the outer layers of your skin. Mostly, the cooling devices and cold gels are necessary during underarm laser hair removal procedure. These cold gels and special cooling devices help the laser light while it’s penetrating your skin.
After that, your doctor will give a pulse of light at the area where the laser treatment is going on. The pulse of light helps the doctor to be sure about the best adjustment of the laser equipment and to investigate some adverse reactions. It may take several minutes to make sure the doctor while using the pulse of light. When the laser hair removal procedure is completed, your doctor may prescribe you anti-inflammatory lotions and creams, ice packs and cold water that ease any discomfort that you may face after the treatment. Your doctor may schedule your next treatment or laser hair removal session after 5 to 6 weeks of having the last treatment. The laser hair treatments should be taken by you until the hair stops growing.
Risks and Recovery
After 2 or 3 days of getting the laser hair removal, the treated area of the skin will feel and look like it’s sunburned. That’s why your laser hair removal expert prescribes you moisturizers and cool compresses that can help you during this condition. If you remove hairs by laser on your face, you can wear makeup otherwise your skin can blister.
After a month, your treated area starts to fall out the hair. To prevent the temporary changes in the treated area such as the changed color of treated skin or irritation of the skin, use sunscreen lotions or creams for the following month. Having blisters after getting the hair removal procedure is rare, but it is more likely in an individual with darker complexions. Some other potential side effects of laser hair removal may redness, scarring and swollen skin treated area. There are some rare cases in which the individual have some permanent scarring and changed skin color. Click here to know what you Should do Before and After Laser Hair Removal.
Costs of the Underarm Laser Hair Removal Procedure
According to the plastic surgeons, the average cost of every session of laser hair removal is $250 to $300. The laser hair removal cots depend widely on some factors that include:
• The number of required treatments
• The time required for the treatment
• Size of the area that needs to be treated
• Whether a technician or doctor is treating or someone else is treating or performing the procedure
• The country or the part where are you getting the procedure
You should consult more about the costs of laser hair removal to an expert or experienced doctor to be sure. As the Underarm laser hair removal is a bit costly or it may become high of cost because it depends on some factors. You should wisely choose a laser hair removal expert and tell him or her about your expectations as you are going to spend a significant cost on it. | <urn:uuid:e39b5d3f-f02b-4c93-8e02-227df0dfd04d> | CC-MAIN-2024-18 | https://healthaio.com/underarm-laser-hair-removal/ | 2024-04-20T17:38:24Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.950393 | 1,471 |
Are you in need of a reliable and accurate PCR test in Cape Town? Look no further. Horizon Laboratories is your go-to destination for top-notch health and medical diagnostic services, specializing in laboratory testing. With our state-of-the-art facilities and highly trained professionals, we are committed to delivering accurate results for all your medical needs.
Why Choose Horizon Laboratories for Your PCR Test in Cape Town?
At Horizon Laboratories, we understand the importance of accurate diagnostic services, especially when it comes to PCR testing. Our team of experts is dedicated to providing you with the most reliable and precise PCR test results. Here's why you should choose us:
- Quality Assurance: Our laboratory testing procedures follow strict quality assurance protocols. We ensure that all testing is performed according to industry standards and regulatory guidelines.
- Advanced Testing Equipment: We invest in the latest technology and equipment to conduct PCR tests with utmost precision and efficiency. Our cutting-edge laboratory ensures accurate and reliable results.
- Experienced Professionals: Our team consists of highly skilled and experienced professionals who are experts in their respective fields. They possess the knowledge and expertise to conduct thorough PCR testing and deliver accurate results.
- Fast Turnaround Time: We understand the importance of quick results, especially during times of urgency. At Horizon Laboratories, we strive to provide fast turnaround times without compromising on the accuracy of our PCR tests.
- Comprehensive Laboratory Services: Apart from PCR testing, we offer a wide range of laboratory services. From blood tests to genetic testing, we cover various diagnostic needs, making us a one-stop solution for all your medical testing requirements.
The Significance of PCR Testing in Cape Town
PCR testing has become increasingly important in Cape Town, especially in the wake of the COVID-19 pandemic. PCR (Polymerase Chain Reaction) tests are considered the gold standard for diagnosing infectious diseases caused by bacteria or viruses.
Whether you require a PCR test for COVID-19 or other medical conditions, Horizon Laboratories ensures accurate and reliable results. Our PCR tests detect the presence of genetic material specific to the target pathogen in the patient's sample. This allows for early detection, proper treatment, and effective containment of infectious diseases.
By choosing Horizon Laboratories for your PCR test in Cape Town, you are opting for the highest level of accuracy and reliability in your diagnostic journey.
Our Commitment to Accurate and Reliable Laboratory Testing
At Horizon Laboratories, we pride ourselves on our commitment to accuracy and reliability in laboratory testing. Our stringent quality control measures, highly trained professionals, and cutting-edge technology enable us to deliver results that you can trust.
Our laboratory testing services encompass various medical categories, including:
- Health & Medical
- Diagnostic Services
- Laboratory Testing
By covering these categories, we ensure that our services cater to a wide range of medical needs and provide comprehensive solutions for our clients.
How to Schedule Your PCR Test at Horizon Laboratories
Scheduling your PCR test at Horizon Laboratories is quick and convenient. Simply visit our website at horizonlaboratories.co.za and follow these easy steps:
- Navigate to the "PCR Testing" or "Book an Appointment" section on our website.
- Select your preferred date and time for the test.
- Fill in your personal details and provide any necessary medical information.
- Review and confirm your appointment.
Once your appointment is confirmed, our friendly staff will be ready to assist you at our laboratory facility in Cape Town.
When it comes to PCR testing in Cape Town, Horizon Laboratories is the name you can trust. With a strong commitment to accuracy, reliability, and comprehensive laboratory services, we provide the highest level of diagnostic testing. Schedule your PCR test with us today and rest assured that your medical needs are in safe hands.
pcr test cape town | <urn:uuid:496a6a04-721d-4fa7-a355-2147a637c30d> | CC-MAIN-2024-18 | https://healthmasteryretreat.com/sl-113535/pcr-test-cape-town-accurate-laboratory-testing-horizon-laboratories | 2024-04-20T16:06:49Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.925637 | 782 |
Meeting All Your Medical Needs
At Reliable Medic Shop, we understand the importance of having access to high-quality medical supplies online. Whether you are a doctor, practitioner of traditional Chinese medicine, or simply seeking health and medical products, we have got you covered. Our extensive range of medical supplies caters to various needs, ensuring you have the resources you require to provide the best care possible. With a commitment to excellence, we aim to be your trusted partner in the healthcare industry.
For doctors, having access to reliable and efficient medical supplies is vital for providing optimal patient care. We offer a wide range of products specifically designed to meet the needs of medical professionals. From essential diagnostic tools such as stethoscopes and blood pressure monitors to surgical instruments, we have everything you need to equip your medical practice or hospital. Our medical supplies are sourced from reputable manufacturers and comply with industry standards, ensuring you receive only the highest quality products.
Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) practitioners value the importance of natural remedies and holistic healing. At Reliable Medic Shop, we recognize the significance of TCM in promoting overall wellbeing. Our selection of TCM supplies includes herbs, supplements, acupuncture needles, and various TCM treatment equipment. We collaborate with trusted suppliers who share our commitment to authenticity and effectiveness, allowing you to access the finest TCM products online.
Health & Medical
In addition to serving doctors and TCM practitioners, we also cater to the general public seeking health and medical supplies. Your well-being is our priority, and we offer a wide range of products to support your personal healthcare needs. From home first aid kits and personal hygiene products to mobility aids and durable medical equipment, we have a comprehensive selection available. Our goal is to ensure everyone has convenient access to the supplies they require to lead a healthy and fulfilling life.
Shop Now for All Your Medical Needs
With Reliable Medic Shop, you can conveniently shop for high-quality medical supplies online. Our user-friendly website allows you to browse through our extensive catalog and easily find the products you need. Ordering is simple and hassle-free, and we offer convenient and secure payment options. Our team is dedicated to providing exceptional customer service, and we strive to ensure your shopping experience with us is seamless and enjoyable.
Why Choose Reliable Medic Shop?
- Quality Assurance: We prioritize the quality of our products and only partner with trusted manufacturers to ensure you receive top-notch supplies.
- Extensive Selection: Our vast range of medical supplies covers various categories, allowing you to find everything you need in one place.
- Competitive Pricing: We offer competitive prices without compromising on the quality of our products, making healthcare accessible and affordable.
- Convenience: Shopping online with Reliable Medic Shop saves you time and effort, with fast and reliable delivery right to your doorstep.
- Exceptional Customer Service: Our knowledgeable and friendly customer service team is always ready to assist you with any queries or concerns you may have.
When it comes to medical supplies online, Reliable Medic Shop is your reliable choice. We are dedicated to delivering top-quality products to ensure your healthcare needs are met. Whether you are a doctor, TCM practitioner, or individual seeking health and medical supplies, our extensive range, competitive pricing, and exemplary customer service make us the go-to platform for all your requirements. Shop with us today and experience the convenience of online shopping combined with the assurance of superior quality. | <urn:uuid:19e2f332-8e87-4573-9675-3e2e44f3ae3c> | CC-MAIN-2024-18 | https://healthmasteryretreat.com/sl-295436/medical-supplies-online-reliable-medic-shop | 2024-04-20T17:37:18Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.939958 | 705 |
Being able to bring their baby home was a huge step for many parents. It was a positive sign their babies were on the mend from their surgery, and the end of many days, weeks or even months in hospital. But it was also frightening to leave the ‘safety net’ of hospital, doctors, nurses and equipment. Fiona and Mike were aware they had become ‘institutionalised’, as they put it. Louise remembers feeling very emotional as she left hospital with her twins, one of whom had surgery.
Losing the safety net
Many parents described how frightening they found taking full responsibility for their baby, after so many weeks in hospital with often such acute care. Victoria’s son had been born prematurely and needed surgery for necrotising enterocolitis ( NEC)* ‘I don’t think anyone can prepare you for coming home because you are going from having that complete support from doctors, nurses, everybody, to having no-one‘. Jane and Ally explained that because they had other children already it wasn’t as daunting as it might have been, and Jane was keen to push staff to hand over care quickly. But for Michelle the thought of leaving hospital was like taking away ‘the biggest safety blanket you can possibly imagine’. Parents described how hospital staff helped them prepare gradually for this moment by small steps, sometimes called a ‘graded discharge’.
Often the first step towards getting home was taking their baby out for a short walk or visit to the park. After weeks in a hospital ward, or neonatal intensive care (NICU)*, this was a huge step for parents. Fiona and Mike took their daughter to the park, Sally-Anne and Simon took their son out round the city. ‘To some people that’s not a lot but for us that was a big thing cos it was the first time us three had been able to be together as a family.’ Sally-Anne
Parents are often encouraged to come and sleep over, ‘room in’, with the baby for a couple of nights in hospital to give them extra confidence. As Zoe said, ‘It’s horrible, like it’s nothing can prepare you for that..it was a daunting experience’. But it was all part of setting up routines for being at home, such as bath and bed times. Joanne described how part of the process for her and her baby was gradually reducing the tube feeding and replacing it with more breastfeeding, ‘They call it normalisation in those last few weeks’. Pamela said, ‘So just getting to be like a normal baby, so instead of sleeping on their front all the time.they sleep on their back, drinking independently’. Claire found it useful to talk online to other families about their experience of going home with a baby with a tracheostomy*. As well as sleeping over at the hospital, she and her partner were also able to bring the baby home for the odd night to test how well it went. Joanne found that after weeks in hospital, it all felt quite quick. ‘I think we only maybe got a weeks’ notice that we were leaving, when we were actually leaving, you know, it sort of all happened very suddenly at the end as well.’
Training, and managing the technology
While their baby needed to be well enough to go home, it was often the parents who were being prepared and trained in the last few days. Doctors needed to be confident they would be able to cope with their baby at home. ‘It was mainly us, wasn’t it, what we had to do’. Mary said this wasn’t so much about testing whether parents had the skills, but rather making sure they themselves felt confident enough to say, ‘yes, I can do it now’. Many hospitals had a set protocol that involved training parents in the various techniques they might need at home, and giving them the confidence to look after their baby on their own.
Depending on the ongoing needs of their baby, parents had different training in addition to first aid and resuscitation. Claire was trained in looking after her son’s tracheostomy and NG tube*, Mary was trained to look after her son’s stoma*, Fiona and Mike had to get used to managing their daughter’s oxygen tank.
Breathing was an issue that several parents talked about as something they hadn’t anticipated or been warned about. Amy said, ‘Also her breathing and, actually, I had prepared myself so much for the exomphalos* that I hadn’t, hadn’t thought about other issues. So the breathing, you know, it was, you know, there was a chance there’d be other problems but I didn’t realise how much the breathing would be an issue.’ Some babies had to come home on oxygen and have their oxygen levels closely monitored, which was very stressful for parents. Fiona and Mike came home without a monitor to measure their daughter’s oxygen levels and it took a while for the local healthcare trust to agree to provide one. As her oxygen levels fluctuated a great deal, they couldn’t have her home successfully without it, ‘you’d be calling the ambulance all the time.’
Some babies needed a care package and equipment to be in place before they could go home, although the care required varied. Julie’s son needed carers to come in every evening which took months to negotiate, and Fiona and Mike had to arrange for an oxygen saturation monitor at home for when their daughter left hospital (see above). Some parents found persuading their local NHS that they were skilled enough to use this and to fund the equipment was not easy. Claire needed the community team to be notified about her son’s tracheostomy so they could visit regularly.
For many parents, going home was ‘really tough’ and daunting. But worth it. People described feeling proud, relieved and excited to get this far. Amy said it felt a bit flat walking out of the hospital and ‘you almost wanted this ceremony’ to mark it as a watershed moment. Louise found it overwhelming and found herself crying.
Rebekah was thrilled to have her daughter home after three months, but struck by how weird it was bringing home a three month old baby, not a newborn.
‘But then I found the strangest is that, is that she was a three month old baby, she came home and she was three months old, it felt like I had a new born because she hadn’t been home. So she’d be doing things that a three month old baby does like smiling or cooing and I was like what are you doing like this is really bizarre because I felt, it felt like she had just been born.’ Rebekah
Necrotising enterocolitis (NEC)
NEC is a serious bowel condition affecting very young babies. Tissues in the intestine become inflamed. Babies can become critically ill and surgery may be required to remove sections of the bowel that are affected.
Neonatal Intensive Care (NICU)
A unit for critically ill newborn babies and infants who need the highest level of nursing and medical care. Babies in NICU often require support for their breathing. Those undergoing major surgery will often be looked after in a NICU.
An opening created at the front of the neck to allow a tube to be inserted into the windpipe (trachea) to help with breathing.
Nasogastric (NG) tube
A tube placed through the nose into the stomach. This may be used to drain the stomach contents after surgery or to provide milk when babies are not able to feed fully by mouth.
Surgeons may divide the bowel in an operation and bring the two ends out onto the tummy wall. This is usually a temporary situation to help the intestines or bowel rest and heal.
Faeces (poo) passes into a bag attached to the outside of the body.
An abdominal wall defect, that occurs when the baby’s tummy wall does not develop fully in the womb. A hole is present next to the umbilical cord through which the baby’s intestines protrude into fluid around the baby while in the womb, and outside the baby’s tummy after birth.
An abdominal wall defect that occurs when the baby’s tummy wall does not develop fully in the womb. Some of the baby’s intestines and sometimes other organs such as the liver, develop outside the tummy and are covered by the umbilical cord. | <urn:uuid:fb006688-2897-4f45-a3d2-838819752e18> | CC-MAIN-2024-18 | https://healthtalk.org/experiences/parents-experiences-of-neonatal-surgery/preparing-to-go-home-after-neonatal-surgery/ | 2024-04-20T16:39:01Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.98693 | 1,811 |
Kuwait City – 14 June, 2020
Zain Group [Kuwait Stock Exchange (stock ticker: ZAIN)] the leading mobile telecom innovator serving 49.5 million customers in eight markets across the Middle East and Africa today announces it is joining the highly innovative Hedera Governing Council.
Zain is the first company from the Middle East region to participate on the Council, joining a list of prestigious global innovators including Boeing, Deutsche Telekom, DLA Piper, FIS (WorldPay), Google, IBM, LG Electronics, Magalu, Nomura, Swirlds, Swisscom Blockchain, Tata Communications, University College London, and Wipro.
Hedera Hashgraph provides a next-generation form of distributed consensus that is faster, fairer and more secure than traditional blockchains. It offers a new way for people or organizations who do not know or trust each other to securely collaborate and transact online without the need for a trusted intermediary. Through its participation on the Hedera Council, Zain Group will gain extensive early insights into the trends and applications in the distributed ledger technology (DLT) space and will be able to assess opportunities to develop services within its own field of operation.
Hedera’s vision is to create a safer, fairer, more secure internet - one in which online communities can collectively create and evolve shared worlds in cyberspace, and on which developers can build trusted applications that enable people to play games and work together. End-users will also be empowered to buy and sell goods and services safely and securely, without entrusting a central organization with their data and privacy.
As a leading regional digital lifestyle operator, Zain consistently looks to ways technology can provide new solutions to its individual and business customers while also improving its own operating efficiency. Furthermore, the Hedera Hashgraph patented technology platform addresses the universally important issue of the environment as its power usage is super-efficient, utilizing a fraction of the electricity that blockchain platforms use. This is in line with Zain Group’s membership of and commitment to the Carbon Disclosure Project, which provides a reporting framework and guidance to address climate change.
Zain Vice-Chairman and Group CEO, Bader Al Kharafi commented, “We feel a sense of purpose in joining the Hedera Governing Council, which has numerous blue chip, innovation-driven organizations all interested in driving the development of blockchains and the wider DLT space, which we have already noted has phenomenal potential. Council membership provides Zain first-hand exposure to cutting-edge and secure technologies that drive innovation, e-commerce and B2B across the region.”
Al-Kharafi continued, “From our own perspective, the growing list of new services and applications we have and continue to develop in areas such as the Group API platform; mobile money and fintech; e-health; drones; the Internet of Things; and 5G all lend themselves to further enhancement through blockchain and other distributed ledger technologies. Our participation in the Council also speaks to another pillar of Zain’s corporate strategy, which is to collaborate with leading industry players to achieve mutually beneficial outcomes and thereby improve the products and services we can deliver to our customers.”
Hedera aims to realize its vision to create a safer, fairer, more secure internet through a focus on addressing four fundamental challenges to the adoption of public DLT - technology, security, stability, and governance. For the vision to deliver impactful results, the network needs to be governed by representatives from a broad range of market sectors and geographies, each with world-class expertise in their respective industries.
Mance Harmon, CEO of Hedera commented, “We are delighted to have Zain Group join the Council, given the company’s sound track record of innovation, and professionalism in the development and delivery of cutting-edge mobile services and applications. We believe the Council will be enriched greatly by this first organization to join us from the Middle East region, given Zain Group’s eight country footprint. We hope Zain will take full advantage of the opportunity to immerse itself in hashgraph and distributed ledger technologies and gain first-hand knowledge of new technologies and use cases developed on the Hedera network.”
The Hedera Governing Council’s members contribute technical expertise to manage the technical roadmap, business expertise to advise on business operations, and legal expertise to help navigate the evolving regulatory environment.
About Zain Group
Zain is a leading telecommunications operator across the Middle East and Africa providing mobile voice and data services to over 49.5 million active customers and an annual turnover of circa US$5.5 billion as of 31 December, 2019. With a commercial presence in 8 countries, Zain operates in: Kuwait, Bahrain, Iraq, Jordan, Saudi Arabia, Sudan and South Sudan. In Lebanon, the Group manages ‘touch’ on behalf of the government. In Morocco, Zain has a 15.5% stake in ‘INWI’, through a joint venture. Zain is listed on the Kuwait Stock Exchange (stock ticker: ZAIN). We recommend the Investor Community download the “Zain Group Investor Relations” Mobile App. For more information please email [email protected] or visit: www.zain.com; www.facebook.com/zain; www.twitter.com/zain; www.youtube.com/zain; www.instagram.com/zaingroup; www.linkedin.com/company/zain.
Hedera Hashgraph is an enterprise-grade public distributed ledger for building decentralized applications. Developers can build secure, fair, blazing-fast decentralized applications on top of the Hedera platform. Dr. Leemon Baird, Hedera Hashgraph Co-Founder and Chief Scientist, and Mance Harmon, Co-founder and CEO of Hedera, patented the groundbreaking hashgraph technology after working together at the United States Air Force Academy and as founders of Trio Security, BlueWave Security, and Swirlds, Inc. For more information, visit https://www.hedera.com, or follow us on Twitter at @hashgraph, Telegram at t.me/hederahashgraph, or Discord at www.hedera.com/discord. The Hedera whitepaper can be found at www.hedera.com/papers.
For Media Enquiries
Zain Group [email protected]
Hedera HashgraphZenobia Godschalk[email protected]
Hedera HashgraphEmily Kielthy[email protected]+353 87 097 2754 | <urn:uuid:786621e3-0fb1-4614-92c2-4dcdba0cb164> | CC-MAIN-2024-18 | https://hedera.com/blog/a-mena-region-first-zain-group-joins-hedera-governing-council | 2024-04-20T17:40:52Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.911368 | 1,380 |
Beautiful muse, Miss Sapphire Reubens, the inspiration for her lover's latest art exhibition, is missing – items of her clothing found in the river. Worryingly, Miss Matilda Hayward and her fellow writer for the Women’s Journal, Miss Alice Doran, enjoyed a preview of the inspired work featuring Miss Reubens immersed in water. Was it a death portrait?
When another two rival artists are found murdered and posed in the manner of their painting, Matilda and her new beau, Detective Thomas Ashdown, fear the artist's inspiration may have come from ill means. There is mystery, passion and love afoot!
More info →Matilda Hayward is determined to have a career, after all, it is 1888! While reporting for the Women’s Journal newspaper, Matilda is sent to cover the visiting ‘Freak Show’ and to interview Mrs Anna Tufton, a giantess. During the interview, the giantess slips a note to Matilda begging for help to her escape the show she is forced to do by her husband. But when the giantess’s husband is found murdered; the giantess is a likely suspect.
Matilda enlists the help of her lawyer brother, Amos, to prove the giantess is no killer and to free her from a life of exploitation. But close family friend, Detective Thomas Ashdown – who has feelings for Matilda having known her since childhood – would prefer Matilda was nowhere near his murder case. There is mystery, danger, and love afoot!
More info →Miss Phoebe Astin of The Economic Undertaker has always spoken with spirits as they leave this life on their way to the next, so a visit from a senior nurse asking to unburden herself was business as usual. But when the nurse's confession reveals she was frightened to death by a doll from her past, Phoebe decides it is time to tell the man who has her heart, Detective Harland Stone. Aided by her brothers, Julius and Ambrose - or hindered as the case might be as they bury bodies and interfere in her potential relationship - Phoebe is challenged to find peace and justice for the dearly departed. For the Astin family, being dead is no excuse for letting crime go unpunished.
More info → | <urn:uuid:4d8a7d1f-f30e-4cb2-966f-3bf313ce34f6> | CC-MAIN-2024-18 | https://helengoltz.com/genre/victorian-romance/ | 2024-04-20T17:09:17Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.971516 | 474 |
Democracy proved its resilience under the threats of populism and the restrictions of the pandemic, President of the Hellenic Republic Katerina Sakellaropoulou said at during her opening address at the Athens Democracy Forum 2021 (ADF) on Wednesday, but also needs to be renewed.
At the ADF, which is under her aegis and this year devoted to “Resilience and Renewal”, the president said, “Our democracy proved resilient despite the crises, but in order to face current and future challenges, it must also be renewed.” She added that democracy looks to the past to evaluate the strength of its institutions, but it must also turn to the future to make its institutions stronger.
Although populism, its greatest threat, “continues to cast doubt on democracy’s central tenets – the state of law, freedom of the press, minority rights, and the independence of justice,” she said, among others, “populist powers cannot mount their attack anymore so freely as in the past: Now we know and we can react.”
Democracy’s renewal, on the other hand – at national and supranational level – is necessary in order to face challenges and crises such as climate change, Afghanistan, and civil liberties. At European level, she said, the Conference on the Future of Europe is a promising opportunity for citizens and particulary young people. “We must always be alert, ready to grasp the opportunities to improve our institutions and to boost our democratic governance,” she underlined. | <urn:uuid:09047191-a32e-4112-abc5-71de1f5e6b9e> | CC-MAIN-2024-18 | https://hellenicnews.com/greek-president-at-athens-forum-democracy-proved-resilient-but-also-requires-renewal/ | 2024-04-20T17:47:02Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.96381 | 328 |
goodbye rough skin
This unique salt scrub formulation leaves you exfoliated and moisturized without leaving an oily mess in your shower. Most salt scrubs have an inch of oil rise to the top. Not hellomellow's salt scrub. The result: clean, nourished skin without a film of gunk in your shower. | <urn:uuid:2ea8801b-70b1-44f8-ab30-8de30ebec435> | CC-MAIN-2024-18 | https://hellomellow.com/collections/bath-salt | 2024-04-20T17:30:07Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.903788 | 68 |
In light of Crufts 2020, we have put together information covering all the breed groups according to The Kennel Club.
Originally used for hunting either by scent or by sight. The scent hounds include the Beagle, Basset Griffon Vendéen, Bloodhound and sight hound breeds, such as the Whippet and Greyhound. Many of them enjoy a significant amount of exercise and can be described as dignified, aloof but trustworthy companions.
What is a Scent Hound?
Scent hounds primary use their sense of smell to hunt, rather than hunting by sight.
With a scent hound, you can play great hide and seek games with them. Fill a dog safe toy with their favourite Eden treat, hide it indoors or out in the garden and let them hunt and track it down.
With having a more powerful sense of smell, this does of course mean that they are more likely to sniff out some tasty kitchen treats. So be sure that food is out of reach!
Examples of scent hound breeds:
- English Springer Spaniel
- Black and tan Coonhound
- German Shorthaired Pointer
- Basset Hound
What is a Sighthound?
A sighthound will hunt primarily by sight rather than scent. Because of this they are usually very agile and quick as they need to keep up with the prey once spotted.
A sighthound’s frame would typically allude to having a lean body with a deep chest in order to support a larger heart and lungs.
Examples of Sighthound breeds:
- Irish Wolfhound
- Scottish Deerhound
- Pharaoh Hound
- Afghan Hound
- Italian Greyhound
For centuries these dogs were selectively bred as guard dogs and search and rescue dogs. Arguably, the working group consists of some of the most heroic canines in the world, aiding humans in many walks of life. Breeds include the Boxer, Great Dane and St. Bernard. This group consists of the real specialists in their field who excel in their line of work.
- Dogue de Bordeaux
- Siberian Husky
- Bernese Mountain Dog
This group consists of miscellaneous breeds of dog mainly of a non-sporting origin, including the Bulldog, Dalmatian, Akita and Poodle.
The name ‘Utility’ essentially means fitness for a purpose and this group consists of an extremely mixed and beautifully varied, most breeds having been selectively bred to perform a specific function not included in the sporting and working categories. Some of the breeds listed in the group are the oldest documented breeds of dog in the world.
You will notice that the utility group has an extremely beautifully varied of breeds in terms of size. This group is very diverse and can be hard to identify
A few examples of Utility dog breeds:
- French Bulldog
- Tibetan Spaniel
- Boston Terrier
- Chow Chow
- Lhasa Apso
Terriers were originally bred and used for hunting vermin. 'Terrier' comes from the Latin word ‘Terra’, meaning earth. This hardy collection of dogs were selectively bred to be extremely brave and tough, and to pursue fox, badger, rat, otter and more; either above and below the ground.
You might joke and say the name Terrier comes from the word Terror with them having tough/strong personalities!
A few examples of Terrier breeds:
- Jack Russell
- Border Terrier
- Airedale Terrier
- West Highland White Terrier
- Welsh Terrier
- Fox Terrier
- Staffordshire Bull Terrier
Originally trained to find live game and/or retrieve game that had been shot and wounded. This group is divided into four categories - Retrievers, Spaniels, Hunt/Point/Retrieve, Pointers and Setters - although many of the breeds are capable of doing the same work as the other sub-groups. They make good companions as their temperament makes them ideal all-round family dogs.
A few examples of Gundog breeds:
- German Shorthaired Pointer
- Irish Setter
- Hungarian Vizsla
Historically, before game can be shot it needs to be flushed out. To do this, the dog needs locate the game and chase them either to make them run, or fly. Breeds commonly seen on the beat are the Spaniels. These are the more lively breeds, able to get to the more dense areas, they do well to retrieve, making them great for a dual purpose. This isn’t to say that any of the other Gundog breeds don’t do well in the hunting side. With the right training and patience, you can get your Gundog to do all three of these. Some breeds excel in different areas.
This takes a lot of will power for the dog to pick up a scent, freeze ‘on point’ to allow the handler to catch up, before pursuing the trail to flush the game out.
More suited breeds for pointing, are the Pointers and Setters, to name just a few.
This is an important job for gundogs, often when game is shot it can be difficult to see where the game has fallen, it’s the gundog’s job to find the game and bring it back to the owner. Breeds that are the strongest in this category are: Labrador, Golden Retriever and Flat Coated Retriever.
You can also get breeds that have the ability to do all three of these with ease. These are known as your HPR (hunt, point, retrievers) breeds such as Weimaraner and German Shorthaired Pointer sit within this category.
Eden, have a fabulous formula to give your Gundog the full nutritional package they need.
The Pastoral Group consists of herding dogs that are associated with livestock such as, working cattle, sheep, reindeer and more. The herding dogs often have a weatherproof double coat to protect them from the elements when working in severe conditions. Breeds such as the Collie family, Old English Sheepdogs and Samoyeds who have been herding reindeer for centuries are but a few included in this group.
A few examples of Pastoral:
- Border Collie
- Rough Collie
- Australian Cattle Dog
- German Shepherd
- Belgium Shepherd
- Welsh Corgi
- Shetland Sheepdog
- Lancashire Heeler
Generally pastoral breeds are very intelligent and need more extensive amounts of exercise as they were bred for employment, so they have great stamina and endurance.
As well as being great herders and also guard dogs, many of the pastoral breeds have excelled in the world of flyball. This is due to their agility and obedience. But we can’t talk about flyball without talking about sheepdog trials, so much time and patience is put into the dog, their intelligent shines through in the sheepdog trails.
What is flyball?
Flyball is a head to head relay race, each dog must race against each other tackling an obstacle course, a spring board to which a ball is released, then race back down the obstacle course.
The Toy breeds are smallest (as the name suggests) of the groups. Toy breeds can make great companion or lap dogs. Many of the Toy breeds were bred for this capacity, although some have been placed into this category simply due to their size. Don’t let their size fool you though, some of these breeds have huge personalities and in some cases think they are bigger than they are. They do not need a large amount of exercise and some can be finicky eaters.
A few examples of Toy breeds:
- Bichon Frise
- King Charles Spaniel
- Yorkshire Terrier | <urn:uuid:f9998109-da1e-453e-a3a8-c36e01ae514e> | CC-MAIN-2024-18 | https://help.edenpetfoods.com/article/what-breed-group-does-your-dog-qualify-for | 2024-04-20T16:58:58Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.958257 | 1,625 |
The Employee File Approvals Set Up feature allows you to set up your organisation's employee file approval process and specify who can approve an employee file change on your HR platform. You can also use this feature to edit the process if it changes and remove an entry you no longer need.
Please be aware we developed this feature in 2018 and has received minimal updates in the preceding years. So you may run into unexpected issues with the product.
HR Plan: | Free | Standard | Premium | Platinum |
User Access: | Employee | Manager | Admin |
This is the default access level per user and whether they have view, edit and delete access, excluding any changes made via our Custom Security feature.
Owner | Owner of the business, and they have the same access as admin. |
Admin | Administrator access to the whole platform and no restrictions. |
Requesters Manager | The primary manager of the employee requesting the employee requisition. |
Head of Employee's Team | You can assign a team leader from within the Teams Settings feature. If you do not assign a leader, we will automatically approve the request. |
Head of a Specific Team | You can assign a team leader from within the Teams Settings feature. If you do not assign a leader, we will automatically approve the request. |
Specific Person | Specific person you would like to select from the employee list to approve the request. |
Explore related content
- Managing your organisation's new employee requests | HR Web PlatformThis feature allows you to review any new employee requests, and approve or decline the submissions.
- Set up your organisation's new employee request process | HR Web PlatformThis feature allows you to set up your organisation's new employee request approval process and specify who can approve a new employee request on your HR platform. | <urn:uuid:89699de8-b4e3-4d46-af9e-9321e6edffaf> | CC-MAIN-2024-18 | https://help.employmenthero.com/hc/en-au/articles/5834174288527-Set-up-your-organisations-employee-file-approvals-process-via-the-HR-platform | 2024-04-20T16:33:40Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.888494 | 363 |
Personal Assistant Ride Wristbands are available for all rides, free of charge. Please only select this if you will be accompanying a guest with access requirements on to the rides at Winter Wonderland. Please note, you will need the relevant documentation to support this request, and this will be requested at point of purchase.
This wristband will only be valid with an accompanying ticket holder who must also be the guest you are supporting. Access to these rides is at all times at the discretion of the operator who may use their discretion to determine the suitability of the ride.
Your wristband can be collected from one of our two Info Points onsite.
Although we will always try to be as fully inclusive as we possibly can at Hyde Park Winter Wonderland, visitor safety is a priority and certain rides in the event are physically demanding and vigorous. Hyde Park Winter Wonderland therefore reserves the right to refuse admission to any ride or attraction should we feel that there is an unacceptable risk to your safety, or the safety of others should they participate. If you would like further information on the accessibility of our pre bookable rides, please see our Ride Access Guide.
Please note that all access to these rides are at the discretion of the ride operator and they reserve the right to refuse access at any time.
Below is our Ride Accessibility decision chart: | <urn:uuid:bd757c0c-7557-4a2a-92ff-8f10193a4447> | CC-MAIN-2024-18 | https://help.hydeparkwinterwonderland.com/hc/en-us/articles/5821823055645-I-am-an-access-customer-Can-I-go-on-all-the-rides-available-to-pre-purchase | 2024-04-20T16:31:17Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.945818 | 268 |
Interface of agent activity report
(1) Filter information
Time: the amount of time to be counted
Data export: export agent activity report data, excel format file
Notes: color annotations of the respective types of tickets (new tickets, pending tickets, ticket records, closed tickets)
(2) Agent activity report results
Statistics: column statistics, users can see the rate of different types of tickets as well as compare this ratio of different agents. Users can view the quantity details by hovering over the desired color area, the information is displayed as shown in the illustration. | <urn:uuid:7c3b2993-e7a0-4d87-b717-0e6f63dce66d> | CC-MAIN-2024-18 | https://help.stringeex.com/stringeex-tong-dai-cham-soc-and-quan-ly-khach-hang/v/english/ii.-system-features/6.-reports/6.1-statistical-reports/6.1.3-agent/agent-activity-report | 2024-04-20T15:45:47Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.903652 | 116 |
This content is part of Tableau Blueprint—a maturity framework allowing you to zoom in and improve how your organization uses data to drive impact. To begin your journey, take our assessment(Link opens in a new window).
Developing organizational assets—such as a style guide, template workbooks with pre-selected fonts, colors, negative space, etc.—will help your users adopt visualization best practices. It’s important for creators and viewers to both understand what “great” looks like and have a common reference on how to best develop, deliver, and consume content. Your community leaders should work on socializing great content across the organization and share any assets on your Tableau Enablement Intranet.
By providing users with content that looks and feels familiar, you can dramatically speed up adoption. Additionally, you can build consumer confidence by producing content that is recognizable as part of a brand. The core themes to keep in mind when designing your standard are text, color and consistency.
- Text — Use of text is not limited to ; it is also about the use of text and lettering to enhance your analytics and storytelling to improve cognitive recognition of analytics.
- Color — Use palettes, and capitalize on pre-existing associations to increase speed to insight. In addition, keep in mind best practices regarding color-blindness and limit the amount of discrete colors on a dashboard. If your brand has bright colors, use a neutral color palette and use your brand’s colors to call out specific items on a dashboard instead of using them for main colors.
- Consistency — Consistency doesn’t mean having to have a set of identical visualizations or dashboards. Think about how to convey the same look and feel while allow room for design and creativity.
Before creating your corporate-branded standard, remember that you should never compromise efficient analytics for design or stylistic elements. While some design elements can actually increase analytic value, you should never make something that looks good at the expense of performance or functionality.
Visual Style Guide
Do your users know what a great dashboard looks like? By publishing a Visual Style Guide, you will give your users a start on design, as well as guidance on how to differentiate between ad-hoc and certified content, which fonts and brand colors to use, and formatting options. This style guide can be a document or a Tableau workbook.
Dashboard Layout Template
Dashboard layout templates help creators to assemble polished dashboards by adding their individual sheets into predefined layout containers. You can download from Tableau Public and customize it with your own logo and colors.
Dashboard Review Checklist
You would not distribute documents to stakeholders without the proper review, revision, and release processes, and dashboards are no different. Dashboards need to be reviewed and validated before they are promoted and certified.
The first person to validate content should be its author. Authors should solicit feedback from the target audience as well. This can be done in an informal feedback group or by sharing a link to the workbook and encouraging comments. No dashboard is right the first time. Time and collaboration are ideal ways to hone in on the best representation of your data. Other people’s opinions will bring fresh perspectives. Consider the following:
- What type of formal or informal means do we need to gather feedback?
- How can we encourage a constructive conversation?
- Has there been time spent on gathering feedback, improvement, and iteration?
Create a dashboard checklist to help users apply visual best practices and a consistent design with a style guide. Every content creator should apply the checklist of your organizational standards to their work before sharing it with others.
Data Stewards should also play a role to ensure correctness and review an embedded data source as a potential candidate for publishing and certifying. Beyond data and calculation correctness, content validation should also include a review of the branding, layout, formatting, performance, filters, dashboard actions, and edge case behaviors by the Site Administrator or Project Leader site roles.
The metadata checklist below shows best practices for curating a Published Data Source as outlined in Tableau Governance. By establishing data standards using the checklist, you’ll enable the business with governed self-service data access that is user-friendly and easy to understand. Prior to creating an extract or Published Data Source in Tableau, review and apply the following checklist to the metadata model:
- Validate the data model
- Filter and size to the analysis at hand
- Use standard, user-friendly naming conventions
- Add field synonyms and custom suggestions for Ask Data
- Create hierarchies (drill paths)
- Set data types
- Apply formatting (dates, numbers)
- Set fiscal year start date, if applicable
- Add new calculations
- Remove duplicate or test calculations
- Enter field descriptions as comments
- Aggregate to highest level
- Hide unused fields
The last mile of analyzing data is taking insight and communicating it to others. Regardless of the data skill level, people should be able to show a dashboard and clearly articulate a data-driven message in a meeting or a presentation. Designing charts for presentation requires special considerations because a complex chart that works for you on your laptop screen won’t work in a presentation.
When sharing some insight, consider the key purpose of the chart. What is the main message? In the example below, the charts shows malaria cases in Zambia following work by global non-profit organization, PATH. The key message is the 93% reduction in cases; notice how that is stamped on the slide very clearly.
Stated Conclusion with Visualization
Think about how long the chart will be on the screen for. While you might intimately understand the chart, your audience will be seeing it for the first time. If you want to show a complex chart, you must spend the time explaining it. The malaria example above can be understood in moments because of the visual and stated conclusion. A good rule of thumb is that a chart should be understandable by your audience in less than half the time it is on the screen.
Your audience needs to be able to read the relevant parts of your chart. The font defaults to very small fonts because they are designed for consumption on a laptop/monitor. These font sizes don’t work on big screens. Two version of the same chart are shown below. The chart on the right has fonts large enough to be read by everyone in the room.
Legend Incorporated into Visualization
You should use color very wisely to highlight your message. Imagine you are tracking customers by day of the week, and you want to highlight that weekends have far fewer customers than weekdays. The chart on the left (below) most effectively convey that message. It uses a simple color scheme to convey an insight much more clearly than the one on the right.
Color used for emphasis vs. too much color
Before you present your insights in charts, consider the following:
- Have you added state conclusions to tell the story in the data?
- Can the fonts be read from the back of the room you will be presenting in?
- Is color used for highlighting your message rather than decoration?
- Is the chart simple enough to be understood during the time it will be on the screen?
The main takeaway is an appreciation that a dashboard or complex analytical chart, designed for desktop screens are almost never the appropriate choice when sharing insights in meetings or presentations. | <urn:uuid:bd32656a-e6e5-4e5c-a761-aa8780b0949d> | CC-MAIN-2024-18 | https://help.tableau.com/current/blueprint/en-us/bp_organizational_assets.htm | 2024-04-20T17:07:05Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.906396 | 1,521 |
SEO, or Search Engine Optimization, is a bit like having a secret recipe for making your website shine online. Imagine you have a shop on a busy street, but it's hidden behind other shops. SEO is like putting up a big, colorful sign that guides people straight to your shop.
When people search for something on the internet, like "best pool cleaner in town," search engines like Google want to show them the most helpful results. SEO is like whispering in Google's ear, telling it, "Hey, my website is the best place for poll cleaner!"
So, in a way, SEO is like giving your website a superpower – the power to be seen by more people and be more helpful to them, just like a friendly guide in a big online world.
When you sign up for a Premium Account, our AI takes care of all the behind-the-scenes details for your web pages, following the best practices for SEO. In simple terms, you don't have to make any changes because Voolt AI handles your SEO automatically.
If you visit the Search Optimization section in your Website Settings, you can take a peek at the SEO our AI has created and even add more information if you'd like. However, we generally advise against making changes because our AI already knows everything about your website and handles everything automatically, also any changes can affect your website's performance on Google.
Isn't SEO fantastic? But if you want to attract even more visitors and customers to your website, Voolt Marketing can help! Discover how advertising can supercharge your online presence by clicking here. | <urn:uuid:25f6bdb0-28e3-47b3-a22c-f8676cf20b2b> | CC-MAIN-2024-18 | https://help.voolt.com/hc/en-us/articles/20028600667277-How-Does-SEO-Search-Optimization-Works | 2024-04-20T16:17:13Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.945543 | 326 |
“I am both excited and passionate about helping health professionals and consultants as they navigate the complexities of the NDIS.”
Behind every business mission is a personal connection, and the same is true for Sue Falkner of Xpressive Consultancy. At 18 months old, her son was diagnosed with a rare genetic condition – Spinal Muscular Atrophy (SMA Type 2) – which left him unable to walk. But while this journey has been challenging, it is Sue’s love for her son and passion for helping others navigate the NDIS that drew her to start her own niche business.
With over 15 years working in the corporate higher education sector, Sue relied on her expertise in project management, relationship management, web content management, media liaison, and journalism to form Xpressive Consultancy.
Now, Sue specialises in implementing automated business systems for health professionals and consultants. Through research, marketing strategies, webinar support, and building up brand awareness in the media, she works hard to make sure her clients can successfully navigate the complexities of the NDIS whilst also reaching their vision.
Since joining the HerBusiness Network a few months ago, Sue has enjoyed connecting with other members in the community, receiving support, and sharing her own knowledge. She’s excited to continue growing Xpressive Consultancy into a space of exceptional niche services. | <urn:uuid:5555e3aa-5359-488b-80e3-21c0918c22a6> | CC-MAIN-2024-18 | https://herbusiness.com/blog/sue-falkner-xpressive-consultancy/ | 2024-04-20T16:28:30Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.951746 | 279 |
I didn’t realise they were all different sizes which is really handy, I love them. I even had someone at the fruit shop ask me where I found them. They’re really high quality, they take a lot of weight, it’s such an easy swap from using plastic.
Heading out the door and just need something small to take with you for those ‘just-in case’ moments. Water-resistant, smell proof and super cute, this mini wet bag is the bag that keeps on giving! Not only is it great for cloth nappies but it is also a valuable tool in any parents baby items. Whether it’s holding your make-up, a sandwich, baby bottle or wet wipes this little beauty just keeps on giving! | <urn:uuid:efcbaf92-eba9-442c-9ee9-2fa5bccf733c> | CC-MAIN-2024-18 | https://hereandafter.eco/collections/baby-and-kids/products/mini-wet-bag | 2024-04-20T17:44:03Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.969287 | 161 |
For FW15 Supreme have again hit up Comme des Garçons on a collaborative collection, and yeah it’s a banger.
The line-up clashes streetwear with punk and workwear vibes, Supreme’s strong graphics paired with the Japanese line’s signature red and blue plaid and cast across hoodies, shirts, long sleeve tees, wool trousers and jackets.
The apparel comes teamed with a special collaboration between Timberland and the two iconic brands, creating a 6″ boot updated with polka-dots, a graphic print on the leather ankle cushion, and Supreme branding.
While the collection drops this week, the shoes won’t be out ’til late December. Load up with what you can now and get your name down for the rest, trust us.
The collection launches at Dover Street Market and online on Thursday, September 24th. | <urn:uuid:0abf9937-f016-4d38-9b93-f33399289093> | CC-MAIN-2024-18 | https://hero-magazine.com/article/48087/supreme-teams-up-with-comme-des-garcons-on-a-new-capsule-collection | 2024-04-20T18:03:34Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.871177 | 185 |
Guest blog: Realising Net Zero through Green Jobs & Skills
Few people can deny that the climate crisis is very real & we must act now and on a huge scale if we are able to meet Net Zero targets. The term net zero means achieving a balance between the carbon emitted into the atmosphere, and the carbon removed from it. Almost every single country in the world has set out plans for their targets to hit net zero; for example in June 2019 the UK became the first major economy to pass a legislation for net zero, aiming to achieve this by 2050 with many other countries quickly following suit. Billions in funding everywhere in the world is being pushed into the renewable energy industry (growing year on year) as ambitious net zero targets attempt to be met.
There is much debate around how sustainable current practises really are within the industry due to so much of the technology being new & developed every single day. One thing that is certain however, is that not aiming for net zero is not an option. The costs of disastrous effects of climate change if left unchecked will be much higher than the costs of achieving net zero.
What role SK plays in the industry
Samuel Knight International is one of the largest global recruitment solution providers for the Energy and Climate Tech sectors in the world. Our purpose is to create a greener tomorrow today by working with our global community to achieve zero carbon emissions by 2050 through these solutions.
As a cross-functional business model, we support all sub sectors within the Renewable Energy industry including Wind, Solar, Battery Storage, Hydro, Hydrogen, T&D with contractual work and permanent positions.
We act as an extension of other businesses to support their respective goals & objectives by outfitting full teams for large scale renewable projects, right down to filling in singular roles urgently needed to progress.
Samuel Knight has a world-class team of recruiters with a wealth of industry knowledge & experience alike. We pride ourselves on our diverse workforce, encouraging each individual to bring their unique skillset to the team. This shows in the work we do, with each industry demanding different skills & evolving every single day.
What gaps are there in the industry?
Arguably, there are gaps in every subsector of the renewable industry as funding for huge scale projects is constantly being pushed by world governments, with not enough manpower on the market to fill the positions. Whilst it can be difficult to pinpoint exactly where the gaps are largest, some of the most prominent are technical skills, engineering & energy storage. Due to rapid growth & new technologies, expertise in solar panel installation, wind turbine maintenance, and grid integration is often a concern.
Energy storage is also one of the most pressing concerns as to put it simply, it doesn’t matter how much clean energy we can generate, if we have nowhere to store it then it is useless. Many issues also arise with the current lithium-ion batteries used by renewable companies such as short circuits, difficulty recycling and the cost to mine the resources. However, battery storage solutions are evolving every day, developments from companies such as Tesla & more recently the Monash University in Australia claims to have developed a Lithium-Sulfur battery which could store up to 5x the energy & cost half as much as the lithium-ion counterpart.
What aspects do SK find challenging
There is a current challenge of perception of the Renewables industry, in particular women pursuing careers in the industry. This is due to several factors, one being it is a predominately male dominated industry and, two; a lack of awareness that the sector can offer much more than just manual labour-intensive work. Arguably, one relates to the other and that is what we are working on changing. The other factor is the ratio of hard transferable skills being utilised when considering candidates for positions, it should be utilised to close the skills gap in this candidate shy market.
At Samuel Knight, we have recently launched The Women of Today – Energy, which is an organisation solely based on empowering women to pursue careers in the renewable energy industry whilst also supporting organisations to meet their DE&I objectives. Our Co-Founders Katelyn Young – Group Marketing & Communications Manager, Alison Lowrie – Strategic Business Director and Kenzie Morris – Director of Energy USA, all have the same pursuit, to establish equal representation in the Renewables Ecosystem and closing the skills gap.
Visit our LinkedIn page to find out more about we do: The Women of Today – Energy
What do we want and what do we not want in tomorrow’s energy jobs sector?
Many people believe that the renewable energy industry is incredibly difficult to get into & only the very best & most skilled individuals land themselves positions in the industry. This is very untrue as there is a huge demand for transferrable skills – many tradesmen, labourers, engineers, tech professionals & many more jobs have relevant skillsets which can be transferred to renewable energy.
Pros & cons can however come from this fact. As the world transitions to renewable energy away from bad practises found in non-sustainable[DM1] energy vectors, a lot of these bad practices in turn could transfer to the renewable industry. This also correlates to the huge demand for workers in the sector, they are often being pulled from other transferable industries, rather than being a ‘clean sheet’ and being trained from the ground up in new techniques deemed more suitable for the renewable industry.
There is also lots of debate surrounding many of the sectors in the renewable industry regarding how sustainable it really is. For example, battery storage was previously mentioned as it is no secret lithium-ion batteries are incredibly expensive to mine in both money & resources, in turn damaging the environment. In the transition to net zero, there is inevitably ‘fallout’ from fossil fuels being used. Additionally, wind turbines fall victim to similar scrutiny. The epoxy blades used are not recyclable & are huge in scale. This means that methods of transport can be limited & in turn burns lots of fossil fuel & when viewed in terms of some of the largest wind farms on the planet, there is a lot of blades & other large components being delivered. However, new technology is emerging every day such as Vestas, a world leading seller, installer, and servicer of wind turbines is developing a 100% recyclable wind turbine blade through the CETEC project.
Advice for candidates looking for jobs in the renewable sector
We recently asked Adrian, one of our senior recruitment consultants, exactly this question! Adrian’s top 3 tips were:
Understand the global scene and your own market / country / region (growth, potential, drawbacks, opportunities)
Each country & world government has a different approach to the renewable industry & net zero targets, meaning there is a much greater emphasis depending on where you are located. The market is constantly evolving therefore it is crucial to stay up to date with developments around the world! It is not uncommon for companies to acquire visas for the correct individual to work! This means if you do your research & get ahead of the game, you could land huge roles anywhere in the world!
Working in the industry is a great way to help build a more sustainable future & give you a sense of pride in your every day profession. Understand and visualize which part can you take on that? Where do you see yourself with that goal?
Everybody’s skillset is unique to them, everybody takes pride in different things & everybody has their own unique way of thinking. Renewable company’s are crying out for talented individuals to enter the industry, whether you are switching industry’s & have acquired transferable skills, or you are fresh to the working world – there is opportunity everywhere. Sectors range right across the board, from labourers on the tools right to IT professionals & project planning; senior & entry level positions alike! There is no better industry on Earth to give you a sense of pride in your work, knowing that you are contributing to a more sustainable tomorrow! There is no ‘Planet B’ & there is no better time to get involved than right now.
If you are switching industries, understand which skills you already have and analyse which ones you need and how you could get them.
We have already touched on this subject but it is a huge misconception that working in the renewable industry is only for the lucky few. If it were up to us, everybody would be working in the industry! It became a huge ‘wow factor’ if somebody told you they worked in renewable energy; whilst it is still a huge achievement, it is not as unattainable as commonly believed! So many current trades & professions have transferrable & desirable skills. Engineers, technicians, electricians & so many more have skillsets already desired in the industry. There is also demand for IT professionals, so if you are somebody who doesn’t see themselves as very manual labour driven there is still massive opportunity for you to transition to the industry.
Project management, Technical expertise, HSE (Health, Safety & Environment) Knowledge, Regulatory Compliance, Data Analysis, Problem Solving, Leadership & Adaptability are all among the list of highly desired skillsets which are all transferable for a successful transition into renewables; tailoring your CV & Cover letter to highlight these skills can be extremely beneficial when standing out in the industry – particularly when you are looking to land your first role!
Our consultants are all active on LinkedIn & are always happy to have a chat with you if you are considering getting into the industry or you have more questions!
How to access SK services:
Samuel Knight has a whole host of world-renowned clients we work with & maintain strong relationships continuously. We work to fill vacancies every single day to keep the industry moving.
Samuel Knights services can be accessed multiple ways, firstly check out our newly revamped website at www.samuel-knight.com which makes it simpler than ever to access our services; the simplest way for candidates is to use our ‘CV drop’ tool, this will add you to our talent pool & one of our consultants will be in touch with you to discuss your aspirations so that we can work to place you in suitable roles. Once you drop us your updated CV, you can sit back & we will do the rest!
There are also many more services available on our website! If you know exactly what kind of position you are looking for, we have a daily updated job listing page under the ‘Current Opportunities’ subheading, which you can filter through using our many tags to tailor the listings to your needs.
You can also follow us on LinkedIn! We regularly post industry updates & it is the best way to hear about job opportunities we are actively hiring for. Additionally, connect with as many of our recruitment consultants as you can – the team post new jobs constantly & being connected on LinkedIn means you will be among the first applicants. They are also always available to chat & give you more information about a job, helping you decide whether or not a position is for you!
“Disclaimer: This blog post is a guest contribution by Samuel Knight. All opinions expressed herein are solely those of the author and do not necessarily reflect the views or opinions of HI-ACT. HI-ACT is not affiliated with the views, opinions, or content presented in this post.”
Professor Sara Walker joins Mark Fawcett on the ‘Careers Unwrapped’ podcast
In this episode of Careers Unwrapped, host Mark Fawcett is joined by Sara Walker, Director for the Newcastle University Centre of Research Excellence in Energy. Join them as they:
- Delve into Sara’s journey from Physics teacher to Energy Professor
- Discuss dealing with pressure from external organisations
- Explore what it means to be a woman in STEM
- Highlight the multidisciplinary aspects of the energy sector
- Examine the current and future demand for green jobs
And much more! | <urn:uuid:7660e391-e751-4e02-b3c5-3aea60b45303> | CC-MAIN-2024-18 | https://hi-act.ac.uk/category/external/ | 2024-04-20T17:19:34Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.95758 | 2,454 |
Introduction: Why USM Baseball Captures Hearts
USM Baseball holds a unique area inside the hearts of its fans, embodying not just a game, but a legacy steeped in records, achievements, and a completely unique subculture that brings human beings collectively. From its early days, has been about greater than just wins; it’s about passion, dedication, and a network that stands behind its group via thick and thin.
A Closer Look on the Team: Players, Coaches, and Key Figures
USM Baseball’s success story is written by way of its humans – the players who leave all of it on the sector, the coaches who strategize each play, and the important thing figures whose contributions have formed the group’s future. Through profiles and tales, we delve into the journeys of these who have made what it’s far nowadays.
Season Highlights and Memorable Matches
Season after season, can provide moments which can be etched inside the reminiscences of fans for all time. From breathtaking victories to coronary heart-stopping finishes, we revisit the video games that have described the spirit and resilience of this group.
USM Baseball Culture and Community Impact
The effect of extends some distance beyond the diamond. It’s a force for effective exchange in the community, fostering a feel of harmony and delight. We explore how the group and its fanatics have come together to make a difference, growing a legacy that is going past the game.
The Future of USM Baseball: Prospects and Projections
As we appearance ahead, the future of USM Baseball shines brilliant with promise. New expertise, strategic improvement plans, and the relentless pursuit of excellence set the level for interesting seasons to return. We highlight the potentialities and projections that fans can eagerly assume.
How to Support and Follow USM Baseball
For the ones looking to get in the direction of the movement, we offer a comprehensive manual on how to support and observe USM Baseball. From attending games to enticing with the crew on line, we provide all the facts you need to become an essential a part of the own family.
USM Baseball is extra than a group; it’s a tradition that keeps to inspire and unite. As we appearance returned on its storied beyond and beforehand to its vibrant destiny, one aspect stays clean: the spirit of is undying, driven by way of the ardour of its players, coaches, and fans. Together, they write the next chapters in this awesome adventure.
How can I buy merchandise?
What are the satisfactory ways to observe recreation updates?
Can I become a member of the USM Baseball fan community?
Are there possibilities to volunteer with USM Baseball tasks?
How can I make a contribution to the development of centers? | <urn:uuid:c68c7f25-fb41-400a-bbbd-73d50d43372b> | CC-MAIN-2024-18 | https://hintandthink.com/usm-baseballs-shocking-victory-how-they-did-it/ | 2024-04-20T15:56:44Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.948909 | 574 |
Bay Area legend and one/half of “I Got 5 On It” duo Luniz, Yukmouth came through the DXHQ to talk about everything from the recently released part one of his JJ Based on a Ville Story and Dragonfly collaboration with Dime Vapes to his own label Smoke-A-Lot.
During the conversation, he spoke on his relationship with Rap-A-Lot records and its founder and CEO J Prince. During his time on the label, he dropped several renown classics including Thugged Out: The Albulation and Godzilla. Yukmouth even gave an interesting story on how much the storied Houston music executive cared about his career.
“He so solid, I got arrested on a Friday for $150,000 and I didn’t get booked in until Saturday,” he said. “That man had me out by Sunday. What? Boom, out. I spent one day because I was in the middle of the Godzilla Tour. We on tour, go to jail and I get remanded. I go to one of my court dates and they remanded me, them racists muthafuckas where I was at. They just remanded me for being late knowing I had to fly in and all that shit. Since I bailed out so much, the judge was like $150,000. I’m like what? J Prince posted that shit the next day. You done heard the stories of Tupac getting locked up and Interscope not bailing his ass out. You seen Bobby Shmurda getting locked up. A million dollar bail is just $100,000 up front. 10 percent with a house. You ain’t paying no meal ticket. So the record label couldn’t put up $100,000 for their top artist? A record label couldn’t put up $100,000 for ‘Pac? Suge had to put up $100,000 with a house. He didn’t have to put up a million dollars. Same thing. If you care about your artist and your record label and this is the person bringing in your money? What money are you going to make with him being locked up? All the money that you gave for this advance and all the other albums you’ve put the money into stops now? Naw, fuck that. Bail him out and have him back on the road on Monday. That’s mob shit.”
“It was the realest record deal I ever had,” he said. “Record labels get scared of you. I was beefing with everybody. Beefing with Master P, G-Unit, Game and everybody. J didn’t back up. He said these niggas better keep it wrapped or else. He told P that straight out the gate. I was on the plane with Mystikal and all them other niggas. All they could do was mean mug me. They knew better. J ain’t to be fucked with period. P knew better. No disrespect, but P knew better. I’m just saying. That man had some real power. Shout out to J Prince man. The mutha fucking boss don of The South.”
In regards to his own label, Smoke-A-Lot, he says his time on Rap-A-Lot gave him a grand lesson in running his own independent outlet.
“Well basically, the best thing that J Prince taught me was how to grind,” Yukmouth said. “The independent grind out there, I saw the infrastructure. How they press CDs and just do their thing when it came to making these albums and getting them out. I seen how they did it. They turned the album in, mixed and mastered it, take it to the press, which is going to take about a week, you get the product back, get your shipping list, stores like moms and pops, ship them out and get consignment. I learned all of that just by hanging out because I was one of the first artists besides Scarface to get a label deal there.” | <urn:uuid:49bb4861-0c3f-4d73-a431-b25435537e18> | CC-MAIN-2024-18 | https://hiphopdx.com/news/id.42190/title.yukmouth-explains-j-prince-protecting-him-during-various-beefs-teaching-him-how-to-run-label | 2024-04-20T17:40:50Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.98709 | 857 |
The Department of History offers a wide variety of opportunities for students to conduct and present their own research. This not only allows undergraduates to pursue their historical interests but also provides critical training in research methods and writing, which are valuable for a variety of future careers.
HY 430 is taken by every major in history (unless taking the honors thesis option). It is a seminar organized around a particular theme, in which the professor will help guide students through all the phases of a research essay, from formulating an interesting historical question to conducting broad secondary and primary source research, to writing a strong and nuanced paper.
HY 499 is for students pursuing history with honors. They must take HY 399 (Honors Colloquium) in the spring of junior year and HY 498 (thesis research) in the fall of senior year. They then can take HY 499 in the spring of the senior year to graduate with honors. Students who take these courses are not required to take HY 430.
Presenting Undergraduate Research
There are also opportunities to conduct, present, and print research beyond the classroom, including the Public History Initiative, the Undergraduate Research and Creative Activity Conference, and the Emerging Scholars Program.
The Crimson Historical Review
The Crimson Historical Review is The University of Alabama’s first undergraduate history journal, and one of the few of its type in the country. The Editorial Board, Design Team, and Review Board are all comprised of UA undergraduate students. You can contact them here.
The CHR‘s purpose is to give authors the opportunity to publish original, peer-reviewed content and to share that content on a national platform.
The Undergraduate Research & Creative Activity Conference is an annual event that provides undergraduates the opportunity to present their research or creative activity. URCA participants work closely with faculty advisors to edit and strengthen oral and poster presentations on their research and compete for cash prizes.
The Emerging Scholars Program is an opportunity for students at The University of Alabama to get involved in research with a faculty mentor in their chosen field. Students take UA 155, which helps prepare them for research, and UA 156, in which they conduct a research project under the direction of a faculty mentor. Emerging Scholars present their research at the URCA conference. | <urn:uuid:8d492960-4a33-4eaa-bbf0-5f49aee3477d> | CC-MAIN-2024-18 | https://history.ua.edu/undergraduate-program/undergraduate-research/ | 2024-04-20T16:19:27Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.956797 | 456 |
Joe Odagiri and Angela Yuen |
Sylvia Chang and Christopher Doyle exchange compliments courtesy of on.cc |
Christopher Doyle holds Sylvia Chang tightly as Tian Zhuangzhuang and Joe Odagiri look on courtesy of singtao.com |
Joe Odagiri promotes THE WHITE GIRL |
Tian Zhuangzhuang and Sylvia Chang promote their Hong Kong Asian Film Festival closing film LOVE EDUCATION courtesy of mingpao.com |
The "Hong Kong Asian Film Festival 2017" two nights ago held its closing ceremony. This year the two closing films were the Sylvia Chang (Cheung Ngai Ga) directed, Chinese director Tian Zhuangzhuang starred LOVE EDUCATION (SEUNG OI SEUNG CHUN) and the Christopher Doyle (To Ho Fung) and Jenny Suen directed, Joe Odagiri, Angela Yuen Lai Lam, Yiu Hok Chi, Tony Wu Tsz Tung, Leung Kin Ping and Cheng Kwok Pong starred THE WHITE GIRL (BAK SIK NUI HAI). They all attended the closing ceremony.
Cheung Ngai Ga was asked about LOVE's seven Golden Horse Award nominations as the film was called one of the best Chinese films this year. She thanked everyone for their support. "Lately I am also dazed from promoting this film. I just went to Japan for a film festival opening ceremony, after returning I am at a closing ceremony." Tian Zhuangzhuang said, "This film was made for film festivals, it kept opening and closing them. We hope the most for the audience to go to the movie!" Why did Tian Zhuangzhuang give up directing for acting this time? He said, "I don't know, I thank the director very much for giving me this opportunity. I felt the benefits of making this film were pretty good, I especially liked the team's cooking. It was delicious." The audience cracked up.
Cheung Ngai Ga said that drama was very hard to make because many viewers liked to flock to a crowd more than watch a movie, but they would continue to persist and hoped to share the good movie with the audience and communicate with them. Even when the weather was cold they could feel the warmth.
When To Ho Fung was on stage he also invited Cheung Ngai Ga. He said, "Without Cheung Ngai Ga I wouldn't have had my first movie and I wouldn't be here today. I am also a Tian Zhuangzhuang fan. He represented the spirit of Chinese film." Joe Odagiri said, "I have always hoped to work with world class filmmakers, in addition I stayed in Hong Kong for almost a month for the production. I thought it would be fun so I agreed to participate." | <urn:uuid:4fdbee88-3afc-4b1c-92db-8c91e68fb78d> | CC-MAIN-2024-18 | https://hktopten.blogspot.com/2017/11/20171122-sylvia-chang-admits-making.html | 2024-04-20T17:09:28Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.975017 | 578 |
What is patient-focused care?
Patient-focused care is a principle which puts the patient at the heart of their care, allowing them to make decisions and feel in control. It can create a positive, collaborative environment where patients feel valued and comfortable. In any healthcare provider, patient-focused care can make patients feel like they really well looked after, and that what they want is a high priority. This is also an important factor when it comes to CQC inspections, as it demonstrates your commitment to continuously improving your healthcare providers.
Listening to your patients
To offer outstanding care, it is important that you listen to your patients and encourage them to be actively involved in their care. You can do this in several ways, including asking patients what they would like to change and what could be improved for them. This can be difficult in certain settings, so make sure you have other ways of involving patients in their care. Other ways of implementing patient-focused care include involving the patient and their family in the planning process.
It’s also vital that you really do take their feedback on board and make positive changes in your care home. Make sure that you tell patients about any changes, and you could also keep a record of this on the wall for everyone to see, in a ‘you said, we did’ format. This can encourage more patients to get involved as they know their opinions matter. You can also schedule in one to one time with patients and staff so they can engage in a positive discussion about their care.
At the HLTH Group, we believe that every healthcare provider can provide exceptional care, but sometimes you might need a little help. Our CQC experts are here to help you with all aspects of your healthcare provider so when the time for a CQC inspection comes around, you’re already providing outstanding care and meeting the highest standards. | <urn:uuid:5f39076c-aabe-40a8-a989-fdfab4051bf4> | CC-MAIN-2024-18 | https://hlth-training.com/implementing-patient-focused-care-at-your-healthcare-provider | 2024-04-20T15:55:41Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.972987 | 384 |
The Montreal Canadiens wrapped up their mini-road trip on Sunday afternoon with a 4-3 regulation loss to the Minnesota Wild. The day before, the Habs defeated the reigning Stanley Cup champion St. Louis Blues 5-2. Despite the 1-1 record on the road trip, the Canadiens have struggled against both the Blues and Wild in recent years. Both teams have historically been built on size and strength, a trait that has done well against Montreal.
Looking at Saturday’s game in St. Louis, the Canadiens were able to take advantage of Jake Allen’s struggles in net. However, as the game went on and the Blues started to press in the third period, Montreal struggled to gain puck possession and get the puck out of their zone. This trend continued into Sunday’s game versus the Wild.
While the Wild have struggled out of the gate this season (2-6-0 record), they are a team built on size upfront. On Sunday afternoon, Montreal struggled to keep Jordan Greenway and Eric Staal out of Keith Kinkaid’s crease. The Canadiens forwards also struggled to gain puck possession in the offensive zone, particularly in the middle of the second and third periods of the game. This is a growing theme.
While Montreal has an excess of speed and depth on their roster, their lack of size up front is a growing concern. It causes them to lose puck battles and prevents them from getting to prime scoring areas around the opposition’s crease.
Canadiens Need a Tom Wilson
The Canadiens struggle in piercing the opposition’s interior for both primary and secondary scoring chances. Their lack of size keeps them to the exterior far too often. Unfortunately, under the tenure of general manager Marc Bergevin, when the need for size upfront has been addressed, it has been in the form of fourth-line players. The Habs don’t need a Steve Ott or a Dwight King, they need a top-six player with size and skill who can create havoc in the opposition’s zone. They need a Tom Wilson.
On the Washington Capitals, there is a reason why Alex Ovechkin, Nicklas Backstrom and their other key players have extra room and space to use their skills. Ovechkin has talked a number of times about the importance of Wilson to their team, even comparing him to Eric Lindros at one point.
How to Add Missing Element to the Canadiens?
Looking at the Canadiens’ prospect pool, there isn’t really anyone who fits the bill as a Wilson upfront. Ryan Poehling is a sure bet to be an impact center with an interesting combination of size and skill, but his game doesn’t have an edge as Wilson does.
Micheal McCarron has had more chances and mulligans to be an impact player with the Canadiens than any player in recent memory. Yet, he hasn’t been able to fulfill the hope the organization had when they drafted him as a contingency for missing out on Anthony Mantha.
Joel Teasdale is a prospect who plays the interior game and brings both an edge and scoring touch that could make an impact in Montreal. The bad news is that Teasdale is currently out long term with a knee injury.
Going Outside the Organization
Going outside the organization is probably the most viable route for the Canadiens to add a scoring power forward. Some names that come to mind are Josh Anderson (Columbus Blue Jackets), Chris Kreider (New York Rangers) and Jamie Benn (Dallas Stars).
James Yates (The Hockey Writers), recently mentioned Benn’s name as a possible trade target for the Canadiens. If Benn is available, the cost to acquire him would be high, but this is exactly the type of player the Canadiens need. In fact, I would go further and say that if Montreal wants to compete in the tough Atlantic Division, acquiring this type of power forward is a necessity. | <urn:uuid:f1c173a8-8c09-4d40-943f-3483623adfc6> | CC-MAIN-2024-18 | https://hockeyaddicted.com/2019/10/21/canadiens-need-size-and-strength-at-forward/ | 2024-04-20T17:08:41Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.962817 | 811 |
We had a fabulous stay at Studio One. It was an easy self-check in and great location opposite the beach and stunning scenic walk to local shops. Impeccable accommodation, very comfortable bed and well-appointed. Plenty of room for relaxing inside and out in the peaceful sun lit garden. Just loved everything about it, we will be back again, thank you.
This is an amazing house that is right on the beach! We really enjoyed our stay and there were plenty of rooms and living spaces to enjoy. There’s a fully fenced yard for dogs and also plenty of outdoor hoses and an outdoor shower, to rinse off after beach swims. The location is perfect – a short ten minute walk away from a large shopping centre with three supermarkets. Theres also a lovely creek trail at your doorstep. The best part of this house is the stunning view from the upstairs balcony and living areas. You can hear the waves rolling in! The kitchen was extremely well equipped and the extra fridge/freezer in the laundry downstairs was handy for extra storage of drinks and food. I would highly recommend this house!
Thank you Zachary for your wonderful feedback! We appreciate your understanding during the transition to Newhaven! It was an absolute pleasure hosting you and your family.
The Team at Holiday Shacks.Glen Shian is ideally placed – a short walk to the beach & a short drive to Mt Eliza Village. The layout worked really well for us, with 5 seperate sleeping areas (double beds), 4 indoor common areas & ample outside areas (including pool-side). The choice of common-areas allowed us to combine for meals / games or break into smaller groups & ‘chill out’. The premises were modern, clean & well maintained and Holiday Shacks staff were there to greet us & made themselves available for assistance.
Dear Carsten, we are delighted you had a wonderful stay at Glen Shian. Thank you for your great review of this wonderful property and our services.
The Team at Holiday Shacks.Fabulous property that exceeded expectations. Beautifully appointed for larger groups or multiple families. Would highly recommend. Thank you for a lovely stay, was a fabulous house for our kids to play and enjoy family time.
Thank you Sarah for choosing to stay at 2 Marma whilst you visited Melbourne! It was a pleasure hosting you and we hope to see you again in the near future.
The Team at Holiday Shacks.My wife and I, along with our lab, had a fantastic long weekend stay at the property. It was really nice and clean, well appointed and pool is one of the best in the area. The location is really quiet, with great proximity to get supplies (by car). The layout works really well and everything is maintained and worked well.
Thank you Geoff for your wonderful review. We are thrilled to hear that you and your wife enjoyed your stay at Long View along with your dog! It was an absolute pleasure hosting you, we look forward to your return.
The Team at Holiday Shacks.Beautiful and uninterrupted view from the living room and terrace.
Dear Tom, lovely to have you and your guests stay with us at Anchor Beachfront Retreat. The uninterrupted beach view and locale is first class. Thank you for your wonderful review. We look forward to welcoming your return soon.
The Team at Holiday Shacks.Beachside Lane is a stunning property and we had a fantastic stay. The modern architecture and interior design elements are beautiful. The house is brand new and well appointed. The view of the ocean and sunset from the upstairs balcony is spectacular. The Holiday Shacks Team is a delight to work with. Thank you and we hope to be back again.
Dear Andrea, it was such a pleasure hosting you. Thank you for booking with us. We agree Beachside Lane is a stunning home! We thank you so much for your 5-star review and we look forward to welcoming your return.
The Team at Holiday Shacks. | <urn:uuid:4bde0416-f359-4ee4-99b0-cb3c3a7f5a17> | CC-MAIN-2024-18 | https://holidayshacks.com.au/guest-reviews/ | 2024-04-20T16:28:48Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.97105 | 821 |
“How do you help someone who is suicidal to have the will to live?”
“You start by changing the stigma of depression!”
“You make it safe to discuss this subject with others and not keep it locked up inside.”
It tells a story of Taren Foley, who survives her second suicide attempt within a week, and is sent to a psychiatric facility for three days of observation and analysis. Quickly realizing she has no intention of taking her life in the future, she alienates herself from the patients and staff, biding her time until she can be released. When circumstances force her to remain locked up all weekend, a compassionate Taren makes an effort to help her fellow patients with their issues, unaware she still neglects her own. By the time she is released on Monday, Taren has yet to feel better about her life, but there is hope that one day, she might.
The story is told with a surprising amount of humour, which keeps it entertaining while giving the audience a break from the drama.
The film has garnered a great deal of interest from a wide range of people – not only those who identify with the main character’s search for understanding within herself but others who have lost people close to them and want to understand why.
The appeal of the story is that it exposes psychological issues still mostly hidden throughout society yet everyone in the world either knows someone who’s experienced these things or felt this way themselves.
The true story Eyes Upon Waking is based on, is actually the one of its writer, Jennifer Scott. She tells it’s a passion project of hers, about the disease of suicide and how it is misunderstood by society. “This film uncovers the darkness in the minds of those who suffer from their emotions, yet shows how light can be found with the right kind of help. Those who are lost to us cannot be returned – I want to bring awareness of what they went through to those they’ve left behind. It is for any person with a friend or family member who has taken their own life and is left asking why”
Apart from writing the story, she is also the main star in the film, which is, considering what she went through,a great challenge for the actress. While shooting the first 8 minutes of the film, she had to relive the exact events happening years earlier when she almost succeeded in ending her own life.
Suicide, mental health and depression are still heavily stigmatised and many are afraid to talk about it openly, which is why films like this can help to open the door to a more understanding society.
While many suffer, thousands lose their battle with depression and decide to take their lives. If by opening up, assuring them that society is prepared to listen, to talk and to report without prejudice, their lives can be improved and deaths prevented – we should take it seriously.
Films like Eyes Upon Waking should continue to be made.
At the moment the film is in production and we’ll definitely be on the lookout for when it’s complete. | <urn:uuid:59ef72b8-465d-439c-ac7b-46e810353908> | CC-MAIN-2024-18 | https://hollywoodstagemagazine.com/2017/12/07/eyes-upon-waking-is-helping-to-change-the-stigma-of-depression-and-suicide/ | 2024-04-20T16:21:38Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.977399 | 642 |
The horror film ‘Hosts’ is released across North America and Canada on 2 October, and British actress Samantha Loxley is one of its stand-out stars.
This low-budget indie film with humble beginnings has surpassed all expectations and being taken on by Dark Sky Films for distribution.
The film benefited from being shot pre-Covid, mostly in 2019, although the final outdoor scenes were wrapped in January 2020, on the coldest night of the year! With its relentless energy and plot twists, ‘Hosts’ is a fresh take on the home-invasion trope and has gained huge attention from those in the horror industry.
Most recently, the film was nominated for Best Film at the Sitges Film Festival, a huge achievement of which the cast and crew are very proud.
The film, directed by Richard Oakes and Adam Leader, features a normal, happy-seeming family in a small village, who are eating dinner on Christmas Eve when a strange couple joins them, saying they are neighbours. But soon things start to go very, very wrong…
Samantha Loxley plays the role of Lucy, a character we meet early on and whose journey carries the audience through the film. In the early scenes, she is a lovable, bubbly character with puppy-like energy (it is Christmas, after all).
As the story progresses, a sinister entity chooses Lucy as a Host and from then on she becomes the driving force behind the horror and violence that ensue. Her mannerisms become robotic, chilling, dark; she is here for one task and one task only, and it becomes increasingly clear that all traits of humanity have left her. The shift in character is significant, going from cheerful, childlike energy to sadistic, deep-rooted darkness. Samantha’s ability to portray the opposites of her character is truly mesmerising.
‘Hosts’ is an extremely dark insight into how lying to and deceiving your loved ones can destroy the bonds you have with them forever. There’s no turning back…
But behind the scenes, the cast and crew got on famously and have made long-lasting friendships – not an easy job when the entire film was shot at night and many of the cast could hardly tell up from down after a few days!
Every day on set was a new chance not only to film awesome footage but also to have a great time with everybody off-camera (card games have never been such fun). The direction was also second to none – the directors knew what they wanted and delivered it to the actors in a caring and constructive environment throughout the shoot, even when the time was ticking or temperatures were freezing.
Samantha even made good friends with the cat who lived on location, Barry! Barry was perhaps the only soul around who wasn’t scared of her blood-splattered face and clothes.
A few months before ‘Hosts’, Samantha appeared in her first-ever feature film, ‘Election Night’ (due for release later this year), playing the lead role of Natasha. ‘Election Night’ focuses on a group of strangers trapped in a house on a riotous night of ever-building tension, waiting for the results of a controversial election.
Originally from Essex, Samantha trained at ALRA (the Academy of Live & Recorded Arts). She’s had various theatre roles, including Ruby in ‘Can’t Stand Up For Falling Down’ at Wimbledon Theatre, and played a Synth in the Channel 4/AMC series ‘Humans’. Samantha said that playing a non-human character in that series definitely informed her work when it came to ‘Hosts’.
Featured photo credit: Richard Oakes | <urn:uuid:4a18cfe7-6c66-4cf8-8f6a-f3501ce9a203> | CC-MAIN-2024-18 | https://hollywoodstagemagazine.com/2020/10/06/actress-samantha-loxley-terrifies-audiences-in-new-horror-film-hosts/ | 2024-04-20T15:50:36Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.976524 | 780 |
Have you ever stepped into a freezing cold shower because your electric water heater unexpectedly shut off? It’s a frustrating and inconvenient problem, and it’s important to address the issue promptly to avoid further problems or costly repairs.
In this post, we’ll explore the possible causes of an electric water heater that keeps turning off and provide steps for troubleshooting and prevention. Don’t let a faulty water heater ruin your day – read on to learn more!
There are several possible causes of an electric water heater that keeps turning off.
- Tripped circuit breaker
One common cause is a tripped circuit breaker or blown fuse. This means that there may be too much current flowing through the circuit, causing the breaker to switch off in order to prevent an electrical overload.
- Malfunctioning thermostat
Another possible cause is a malfunctioning thermostat. The thermostat is responsible for regulating the temperature of the water in the tank. If it’s not functioning properly, the water heater may turn off unexpectedly.
- Loose wiring
Loose wiring is another potential cause of the problem. If the wiring is loose or damaged, it can cause the water heater to malfunction. To check for loose wiring, you’ll need to remove the access panel and visually inspect the wiring.
Sediment build-up in the tank can also cause the water heater to turn off. Over time, minerals and other impurities can build up in the bottom of the tank, causing the heating element to become less efficient.
- Heating element
Finally, the heating element itself may have failed. The heating element is responsible for heating the water in the tank, and if it’s not working properly, the water heater may turn off.
How to Fix
If you’re dealing with an electric water heater that keeps turning off, here’s how you can troubleshoot the issue:
Step 1: Check the circuit breaker or fuse
As mentioned earlier, a tripped circuit breaker or blown fuse can cause the water heater to turn off. To fix this issue, you’ll need to locate the circuit breaker panel and reset the breaker. If the problem persists, you may need to replace the fuse.
Step 2: Inspect the thermostat and heating element
If the circuit breaker and fuse are functioning properly, the next step is to check the thermostat and heating element. To check the thermostat, you can use a multimeter to test it for continuity. If it’s not working as it should, you may need to replace it. To check the heating element, you’ll need to use a multimeter to test it for continuity. If it’s not working, you’ll need to replace it.
Step 3: Check for loose wiring and sediment build-up
If the circuit breaker, fuse, thermostat, and heating element are all functioning properly, the next step is to check for loose wiring and sediment build-up. To check for loose wiring, you’ll need to remove the access panel and visually inspect the wiring. If you find any loose or damaged wires, you’ll need to repair or replace them. To remove sediment build-up, you’ll need to flush the tank.
How to Prevent
To prevent the problem of an electric water heater turning off unexpectedly from occurring again, here are a few steps you can take:
- Regular maintenance
One of the best ways to prevent issues with your water heater is to perform regular maintenance. This includes flushing the tank to remove sediment build-up and checking the thermostat settings to make sure they’re accurate.
- Upgrade to a newer model
If your water heater is getting old, it may be time to consider upgrading to a newer model. Newer models often have improved features that can help prevent problems from occurring.
- Seek professional help
If you’re having frequent issues with your water heater or you’re not sure how to properly maintain it, it’s always a good idea to seek the help of a plumbing expert. They can diagnose any problems you’re having and recommend the best course of action.
Troubleshooting an electric water heater that keeps turning off can be a bit of a process, but with a little patience and attention to detail, you should be able to find the root cause of the problem and fix it. If you’re not comfortable handling the repairs yourself, it’s always a good idea to consult a plumbing expert for help. | <urn:uuid:5f0ad9b3-68ae-4b1c-b8f9-e86381f01933> | CC-MAIN-2024-18 | https://homeluf.com/electric-water-heater-keep-turning-off/ | 2024-04-20T16:18:39Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.900467 | 949 |
These Traditional Bases are made for traditional style hookahs like Khalil Mamoon, and other Egyptian Hookahs. They will fit perfectly with SAOCCA Hookahs. They have a flared bottom which is even better for stability.
They are 11.5 inches tall with a 2 inch opening.
Payment & Security
Your payment information is processed securely. We do not store credit card details nor have access to your credit card information. | <urn:uuid:24ddd578-8021-4115-9e11-52fe10224ef5> | CC-MAIN-2024-18 | https://hookahjohn.com/products/modern-bases | 2024-04-20T16:50:17Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.965929 | 90 |
WILL KEEPING terrorists in jail longer help the UK’s counter-terrorism efforts? This is the objective underpinning the UK’s new Counter-Terrorism and Sentencing Bill 2019–21, which if passed represents a significant shake up of the legislative system for those convicted or suspected of terrorism offences.
The Bill was introduced on 20 May, following the attacks at Fishmongers Hall in November 2019 and in Streatham on 2 February this year. The measures (detailed below) might sound appealing to voters, and arguably serve the demand for retributive justice. Yet a harder punitive approach is unlikely to reduce the threat of terrorism without accompanying efforts to rehabilitate terrorists.
Programmes to tackle disengagement (a behavioural change process, such as leaving a group, which requires relinquishing the objective of achieving change through violence) and deradicalisation (a social and psychological process, which implies a fundamental change in understanding or belief) are poorly understood and lack credible evaluation. Prisons and local authorities are also woefully underfunded.
It is therefore unlikely that another Bill will help address the threat of terrorism.
On 29 November 2019, Usman Khan launched an attack at Fishmongers Hall. Saskia Jones, 23, and Jack Merritt, 25, were killed in the attack. Khan had been released from jail on licence in 2018, half-way through a 16-year sentence for terrorism offences. Less than three months later, on 2 February 2020, three people were injured by Sudesh Amman who had recently been released from prison, after serving half of his three year sentence for terror offences.
That each attack was committed by a known terrorist offender who had been automatically released from custody at the halfway point of their sentence raised questions about the efficacy of the sentencing, release and payroll conditions handed to terrorist prisoners.
The attacks prompted the passing of emergency legislation, the Terrorist Offenders (Restriction of Early Release) Act 2020. This strengthened reforms made under the coalition government in 2012, ending the automatic early release of terrorist offenders on an Extended Determinate Sentence, forcing them to spend a minimum two-thirds of their term behind bars.
This marked the start of the UK government’s legislative response to the attacks. The new Counter-Terrorism and Sentencing Bill is the next step: intended to “better protect the public from terrorism by strengthening the law which governs the sentencing, release and monitoring of terrorism offenders.”
Presenting the Bill in Parliament on 20 May, Home Secretary, Priti Patel said:
“The shocking attacks at Fishmongers’ Hall and Streatham revealed serious flaws in the way terrorist offenders are dealt with… We promised to act and today we are delivering on that promise.”
Yet what that promise actually entails and whether it might be delivered is worth exploring in more detail.
If passed, the Government says that the Bill will “ensure that serious and dangerous terrorism offenders will spend longer in custody, properly reflecting the seriousness of the offences they have committed.”
Clauses extending prison sentences include the introduction of the “serious terrorism sentence”, which delivers a 14-year minimum sentence and up to 25-year period of extended licence for the most dangerous offenders; plus the ending of automatic release for those serving Extended Determinate Sentences.
(These latter sentences were introduced to provide extra protection to the public in cases where the court found that the offender was dangerous and an extended licence period was required to protect the public from risk of harm. The judge determines the length of prison sentence.)
The maximum sentence available for being a member of, inviting or expressing support for a proscribed organisation, and attendance at a place used for terrorist training, will be increased from 10 to 14 years. As such, the Bill delivers on the political promise to keep terrorists off the street for longer.
Sentencing, though, is only one part of the battle to tackle terrorism (unless one can keep terrorists locked up indefinitely). The other part is what goes on within prisons and with prisoners. There are currently about 220 terrorist prisoners in custody in the UK, with 77% holding Islamist views and 17% far-right views.
The reoffending rate for these prisoners is actually far lower (estimated to be around three percent in England and Wales, rather than 50%) than for other offenders. This does not mean, however, that people will voluntarily change their beliefs and behaviour.
The Government claims the Bill ensures that terrorists will have longer to participate in disengagement and rehabilitation interventions in prison. On the surface, there is nothing particularly wrong with that statement. Efforts to disengage, deradicalise and rehabilitate terrorists are notoriously complex.
The real issue is that behind this rhetoric lies little to no reporting about the effectiveness of the UK’s disengagement and deradicalisation programmes. The UK is not alone in its lack of overall reporting. In fact, it is closer to the norm rather than the exception.
The issue is that this means the government has limited – though admittedly growing – knowledge about how to manage the risk posed by extremists.
The first offender behaviour programmes to be delivered to convicted extremists were piloted in 2010 and 2011.
The Motivational and Engagement Intervention (MEI) and the Healthy Identity Intervention (HII) programmes aimed to encourage and facilitate desistance and disengagement from extremist offending, regardless of a person’s particular ideological background during one on one tailored sessions.
In December 2018, a prison strand of the Desistance and Disengagement Programme (DDP) was established for individuals convicted of terrorism related offences, or identified as exhibiting extremist behaviour.
To date, there has been no independent evaluation to test whether these programmes prevent reoffending or successfully tackle extremist behaviour (a short-term outcome evaluation of the HII programme is reportedly underway). In 2018 the Ministry of Justice published the findings of an evaluation into the pilot project which found it was “viewed positively” by participants and facilitators who attended and ran the course.
This evaluation was based on research conducted during the pilot in 2010 and 2011. There is no way of knowing whether the project is still viewed positively in 2020. This was also a process evaluation designed to assess the effectiveness of the implementation and the outputs of the project, not the actual impact on terrorism. The failure to properly evaluate impact is a serious shortcoming.
Former prison governors report that prisoners know how to “game the system” while Usman Khan is known to have taken part in a HII course. Convicted terrorists are also reportedly refusing to participate in these programmes, while others are facing waiting lists to join the scheme. A possible consequence of the 40% cut to the Ministry of Justice budget is that some prisoners who are willing to go on a programme find they cannot get on it before their release date.
That said, it is impossible to reduce the risk to zero and instances of prisoners reoffending do not mean the intervention is useless or ineffective in the majority of cases. In fact, some experts suggest that it is actually a much better intervention than it gets credit for.
Meanwhile, while considering the needs inside prisons, in January this year there was a terror attack on prison staff at a maximum-security wing in HMP Whitemoor, Cambridgeshire. Four officers and a nurse were injured in the attack by two inmates wielding bladed weapons and wearing fake suicide vests.
Longer prison sentences are unlikely to help in these cases.
The second area of change focuses on the monitoring and disruptions toolkit available to counter-terrorism policing and the Security Service.
The Bill strengthens the Terrorism Prevention and Investigation Measures (TPIMs) on those suspected of involvement in terrorism. A TPIM is an exceptional administrative measure, enabling restrictions to be placed on individuals outside the criminal process on the basis of risk to national security.
Clause 37 of the Bill lowers the standard of proof for imposing a TPIM notice. It will now be sufficient for the Secretary of State to have “reasonable grounds for suspecting” that an individual was or had been involved in terrorism rather than, as previously, “satisfied, on the balance of probabilities.” Further clauses direct that offenders will be sent to approved premises for longer after release, subject to stricter monitoring and electronically tagged to monitor their location.
Yet the intelligence services are already relatively effective at monitoring potential or released terrorists. And the Independent Reviewer of Terrorism Legislation has raised concerns that lowering the standard of proof could increase the possibility that an individual placed on a TPIM may be innocent.
The standard of proof was previously raised by the Counter-Terrorism and Security Act 2015 on the recommendation of the Independent Reviewer of Terrorism Legislation (then Lord Anderson QC) who had concluded that the standard of proof could and should be higher.
If TPIMs are wrongly enforced this could actually fuel violent extremism. There is also evidence that being viewed as an “enduring risk” is a source of frustration, which creates a sense of injustice and actually diminishes the legitimacy of the authority and control to which prisoners are subject.
In cases where terrorists are released from prison (as with the Fishmongers Hall and Streatham attackers) their involvement in terrorist activity is not in doubt in any case. The Streatham attacker was already under active police surveillance at the time he committed the attack, being considered a serious risk. Meanwhile, it is not possible to monitor everyone nor to prevent every attack.
Terrorism is known to be an individualised and non-linear process. Regardless of the mechanism, it is hard to be definitive about whether an individual no longer presents a risk of committing an offence, though the Government is improving in this area.
Longer sentences may keep terrorists off the street for longer and make for good government sound bites. Yet without substantial investment in the prison and probation service and in the UK’s broader prevention efforts, a legislative approach is not only meaningless but simply defers the problem to a later date, while potentially alienating those deemed most ‘at risk’ of radicalisation to terrorism.
Emily Winterbotham is director of the Terrorism & Conflict Research Group at RUSI | @EmsWinterbotham
A Reform Party candidate fantasised about deporting “millions” of British citizens to “rid itself of the foreign plague we have been diseased with”. UPDATE: Reform…
Right-wing comic Kearse saves the worst material for his anonymous Telegram account HOPE not hate has identified an anonymised Telegram account belonging to the GB… | <urn:uuid:cded889d-1e9a-4bd3-8904-d6c49007d34b> | CC-MAIN-2024-18 | https://hopenothate.org.uk/2020/09/27/legislate-terrorism/ | 2024-04-20T16:10:56Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.959872 | 2,177 |
As we begin our series on the theme for the year, “Open the Door”, we realized it was important to also consider that in order to open doors, you also need to know how to close them. The first step in effective delegation is to identify where closing a door for one person or organization is opening one for another. As we sat around a table brainstorming our 2024 theme at our annual company retreat, we realized we were all in somewhat of a state of transition and so were many of our clients. We often work with people, organizations,
Remember Mary Ila’s take on “How to Be Authentic with Your Appreciation at Work”? We reference Chapman & White all the time in training and coaching with our clients. To celebrate Valentine’s Day with full hearts in the workplace, we’re bringing you an early look at the new updated version of The 5 Languages of Appreciation in the Workplace. We subscribe to the newsletter from Appreciation at WorkTM and got one of the first announcements of the new, post-COVID research on professional appreciation. Right away, I asked the team if we could do a blog about it. New research!? Yes!
Ding, dong, the witch is…hovering over your shoulder micromanaging your work!? This Halloween, instead of Trick or Treat, let’s Train. We’re highlighting two applications of training as an employee engagement solution, plus 6 links to related resources on The Point Blog. Last week, Lorrie and I spoke about our Illuminate program at the University of Alabama’s HR Management Conference. Before the session, an attendee came up to chat with us about the HR horrors she’d been dealing with at her new company. Her scariest issue: employees’ fear of big, bad HR. She said she felt like the HR monster, scaring
I recently read an article by the Huntsville Business Journal about adaptive leadership, and I immediately sent it to everyone on the HPC team. I thought, “This is what we’re always talking about!! The HBJ gets it!!” We truly believe that leadership behaviors rooted in CODE have significantly higher impact, and we’re seeing this play out in a big way with one of our clients. Four years ago, a client asked us to explore gender equality in their organization. This included analysis of leadership demographics, a comprehensive survey to all employees, and focus group discussions. During the study, some challenges
My husband has a great analogy for ineffective communication that goes like this: It’s like when they say, “Bring me a rock”. You go outside, grab the first rock you see, and take it to them. They say “No, we need a different rock.” You go back outside, grab a different rock, take it back, and they say “No, not that rock. It needs to be gray.” And so on and so forth until you eventually figure out that they wanted a big, round, gray rock from the bottom of the Mississippi River. How were you supposed to know that? | <urn:uuid:b47018d5-f62f-4699-8f92-7f9b513b1f38> | CC-MAIN-2024-18 | https://horizonpointconsulting.com/blog3/item/category/talent-management-development/talent-management/ | 2024-04-20T17:28:59Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.957772 | 653 |
I’ve got carrots and apples aplenty, I’ve got liquorice and pellets galore, but I want more…. I want more horse treats.
The human tells me that there has been a trend of late for ranking all sorts of things. But apparently no one bothered to rate horse treats? Clearly equine intervention is needed to correct this egregious error.
And it would seem that I am the horse for the job. I have spent several years, well actually a lifetime testing a wide array of treats. you could say that it has been my life’s work.
So here it is the ultimate horse treat heirarchy:
1. Watermelon lollies (definitely not that mushy devil fruit)
2. Licorice all sorts
3. Liqorice – Soft Darrel Lea only, don’t try to trick me with your el cheapo home brand liquorice
4. Barley sugars
7. Grand smith green apples only – They go lower down the list if they aren’t cut up
8. Moloasse Burgers – there are exactly what it says on the tin. But beware, your human may try to hide medications in this delightful concoction – DO NOT FALL FOR IT!!!
20. Carrots – some might say that these are ‘basic’ and they would be right, But I’m not about to turn up my muzzle at them.
999. Mints – Don’t care for these at all
You may have noticed that sugar cubes were not on the list, and while you may be thinking that this is an oversight I can assure you that it is not. Sugar cubes are what the human calls a training reward, so to me they are not a treat and therefore could not possibly have been considered for inclusion on this hierarchy. | <urn:uuid:49a75d61-7777-4a1c-adfb-fc73c3f43bc2> | CC-MAIN-2024-18 | https://horserookie.com/horse-treats-the-ultimate-hierarchy/ | 2024-04-20T15:38:49Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.947429 | 384 |
A Comprehensive Guide: How to Find a Therapist Near You. Therapist For Teenage Anxiety Near Me…
Looking for therapy is a bold step toward much better mental health and wellness. Whether you’re struggling with anxiety, depression, or any other mental issue, discovering the best therapist can make a substantial distinction in your healing journey. In this article, we will check out the procedure of discovering a therapist near you, talk about different types of therapists offered, and offer recommendations for various psychological disorders.
Types of Therapists: Therapist For Teenage Anxiety Near Me
Psychologists: These professionals hold a doctoral degree in psychology and concentrate on identifying and treating psychological health disorders. They frequently use evidence-based therapies such as cognitive-behavioral treatment (CBT) and psychodynamic therapy.
Psychiatrists: Psychiatrists are medical physicians who concentrate on psychological health. They can diagnose mental disorders, prescribe medications, and supply treatment. Their treatment method frequently includes a mix of therapy and medication management.
Licensed Clinical Social Workers (LCSWs): LCSWs are trained in psychotherapy and social work. They assist individuals deal with different issues, such as relationship problems, substance abuse, and life shifts. LCSWs frequently employ methods like cognitive-behavioral treatment, family treatment, and solution-focused treatment.
Certified Expert Therapists (LPCs): LPCs provide therapy to families, individuals, and couples. They attend to a vast array of mental health concerns, including tension, injury, and sorrow. LPCs may concentrate on particular therapeutic methods like mindfulness-based treatment or art treatment.
Marital Relationship and Household Therapists (MFTs): MFTs concentrate on relationships and family characteristics. They help couples and families enhance communication, willpower conflicts, and browse significant life transitions. MFTs frequently utilize strategies such as household systems therapy and mentally focused therapy.
Typical Factors for Seeking Therapy:
Anxiety Conditions: Stress and anxiety conditions include excessive concern, fear, and panic. Recommended therapist: Psychologist, Psychiatrist.
Major Depressive Disorder: Defined by relentless sensations of unhappiness, hopelessness, and loss of interest. Advised therapist: Psychologist, Psychiatrist.
Post-Traumatic Stress Disorder (PTSD): Arises from experiencing or seeing a traumatic event. Recommended therapist: Psychologist, LCSW.
Substance Use Disorders: Includes excessive use of substances and dependence. Recommended therapist: LCSW, LPC.
Relationship Concerns: Difficulties in romantic or family relationships. Suggested therapist: MFT, LPC.
Therapist: Welcome! Please have a seat. I’m Dr. Smith, your therapist. How are you feeling today?
Client: Thank you, Dr. Smith. I’m a bit nervous but also alleviated to finally be here. It’s my very first treatment session, and I’m not totally sure what to anticipate.
Therapist: It’s entirely typical to feel anxious, especially during your first session. I’m glad you took this action towards seeking support. Treatment is a safe and private area where we can explore your issues and work towards your wellness. Is there anything particular you wish to go over or any specific factor you chose to seek therapy?
Patient: Well, I have actually been feeling overwhelmed lately. I have actually been having a hard time with anxiety and finding it difficult to handle my stress.
Therapist: I understand. Anxiety and tension can be challenging to manage, but with treatment, we can work together to develop effective strategies for handling them. Can you inform me a bit more about what triggers your stress and anxiety and when you initially started observing these symptoms?
Patient: Sure. I think my anxiety is activated by job-related stress, social circumstances, and even basic daily jobs. It seems to have actually begun a few years ago when I experienced a significant life modification, and it has actually been gradually intensifying since then.
Therapist: Thank you for sharing that. During our sessions, we’ll explore numerous therapeutic techniques, such as cognitive-behavioral therapy, to assist you acquire control over your stress and anxiety and lower its impact on your life.
Patient: Yes, due dates and high-pressure circumstances at work tend to activate my stress and anxiety the most. I often find myself overwhelmed, continuously worrying about conference expectations and fearing failure.
Therapist: I see. Our goal is to assist you find a sense of balance and restore control over your anxiety.
Client: That seems like exactly what I need. I’m ready to put in the work and make positive changes. I appreciate your guidance and support throughout this procedure.
Therapist: I’m here to support you every step of the way. Remember, therapy is a collaborative journey, and your active participation is essential.
When it comes to the space’s appearance, therapists often make every effort to produce a calm and welcoming environment. The room might feature comfy seating, soft lighting, and maybe some calming components like plants or artwork to develop a relaxing atmosphere. The therapist’s workplace is designed to offer a sense of privacy and safety for the patient to freely discuss their feelings and concerns.
10-Step Guide to Discovering a Therapist in Your Area:
Identify Your Needs: Examine your psychological health concerns, chosen therapy type, and any particular requirements you may have.
Ask for Suggestions: Seek suggestions from trusted good friends, family, or healthcare professionals who have experience with treatment.
Consult Insurance: Contact your insurance service provider to comprehend the coverage for therapy and acquire a list of in-network therapists.
Online Directories: Use online directories like Psychology Today, GoodTherapy, or TherapyTribe to look for therapists in your area.
Research Study Therapist Qualifications: Confirm the credentials, certifications, and licenses of possible therapists. Try to find specialized training in your area of issue.
Check out Testimonials and evaluations: Check out online reviews and reviews to acquire insights into others’ experiences with the therapists you are thinking about.
Contact Therapists: Call or email therapists to inquire about their availability, charges, and treatment approach. Ask questions to figure out if they are a good fit for you.
Initial Consultation: Arrange an initial consultation session with a few therapists to evaluate their compatibility and discuss your needs.
Consider Logistics: Take into consideration factors such as location, schedule, session duration, and costs when picking a therapist.
Trust Your Impulses: Ultimately, trust your suspicion and choose a therapist with whom you feel comfortable, comprehended, and supported.
mount of anxiety but likewise within the very first couple of minutes or at least by the end of the session feeling a lot much better like I simply feel more comfortable now that we got going and really glad that they came so I encourage you not to let anxiety stop you although it also makes sense that we ‘d be a little anxious you understand maybe it’s vulnerable in a manner we’re not utilized to to share ideas with a complete stranger or we think that therapy suggests that we have some issue or issue however actually treatment doesn’t suggest that you’re damaged or insane or have some big concern anyone can benefit from treatment now the therapists task is to likewise help you determine what your objective will be the therapist is likely to ask you in the first session what brought you into counseling to talk with
them what would you like to concentrate on or what would the goal will be of the work and they may even ask like how will you know when you are have satisfied your goal or a done with treatment what would you like that result to appear like so those are questions that you you understand will be most likely asked and if you want you can attempt to prepare a little beforehand by doing some journaling or just reflecting however if you aren’t sure how to respond to those questions then the therapist can assist you in any case during the very first session you’ll most likely be assessing just what development location you wish to resolve whether that’s increased self compassion or ability to manage your stress and anxiety or connect better with other individuals and also keep in mind that that very first session is an interview both methods to see if it’s an excellent fit so feel free to ask your therapist questions that might assist you feel if they are the therapist | <urn:uuid:a5737b81-926b-4b32-ab2a-29fad9c6d9d4> | CC-MAIN-2024-18 | https://housechoir.co.uk/therapist-for-teenage-anxiety-near-me/ | 2024-04-20T17:50:41Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.944903 | 1,736 |
The Lincoln: Single-story, Craftsman House Plan
A great example of Craftsman home designs, the Lincoln house plan is thoughtfully designed, with plenty of built-in storage. This home also has exceptional flow—family members will find it easy to negotiate space in this elegant 2,368 square foot home. As we begin our imaginative tour of the home, we begin at the stunning façade. Staggered gables greet us and add curb appeal. A deep covered front porch makes for a protected entrance. On the left is a 3-bay garage; on the right, a gable with two multi-paned windows. We walk through the central front door, and into the foyer with its 9-foot ceilings.
To our right are the Lincoln’s family spaces, including the kitchen, living room, and dining area; to the left, the private bedrooms, with the master suite in the rear. (As a side note, the fact that The Lincoln is a set of single-story house plans will make it a snap for age-in-place living.) Walking forward from the entrance, we find ourselves in the gracious living room. This airy communal space includes the living room, dining area, and kitchen, with no walls to block the view.
The elegant, functional kitchen is to the right. A central island anchors the open “family triangle.” Down lighting under the kitchen cabinets facilitates food preparation. A hood is included over the stove. There’s plenty of counter space and cabinets for storage. The appliances are ideally situated for functionality—the family’s chefs won’t be tripping over each other, since each appliance is in its own zone.
The dining space, to the rear of the kitchen, is delineated by a slightly lower ceiling height. A beautiful wall of windows illuminates the dining area; they look onto the side yard. This is the perfect amount of space for your dining table.
The living room is open, but feels cozy thanks to a fireplace, set flush in one wall. On both sides of the fireplace are built-in display shelves and media storage, including a place for your flat screen television. Sliding doors lead off this room to a covered back porch, with a deep enough overhang to make this space enjoyable year-round. Built-in outdoor lighting increases the outdoor living appeal.
Wandering to the other side of the home, back through the living room and foyer, we turn to the right and walk to the end of the hallway, to the vaulted master suite. As we enter the master bedroom, you appreciate the separate entrance to the back porch. The gorgeous, vaulted master bedroom boasts four windows onto the back yard. Wrapping around to the left, we walk into the spacious master bath, with twin sinks, a separate toilet room, a walk in shower and a separate bathtub, and plenty of drawers and cabinets for storage. There is a clerestory window over the bathtub, and another window in between the twin sinks, making for plenty of natural light. Clothes horses will love the walk-in closet located off the master bath.
The other two bedrooms on this side of the home have nine-foot ceilings, generous windows, and sizeable closets. They share a bathroom with a shower/tub and yet another big window. The hallway connecting all three bedrooms has two linen closets.
Only two rooms remain in our tour of the Lincoln: the office and the utility room. Both are located on the opposite side of the home, on the same side as the garage. The informal garage entrance leads to a utility room with dozens of built-in storage spaces, including an entire wall with hooks, drawers, and cubbies. This feature will keep your family organized while keeping mud and dirt out of your home. The washer and dryer are also located in the utility room, which has a sink as well. Across a short hall from the utility room is the office. It has a built-in desk on one wall, and two cheery windows onto the back yard on the opposite wall. Nine-foot ceilings help this room feel spacious.
The Lincoln single story house plan oozes curb appeal, but the beauty and charm don’t stop at the front door. This home offers comfortable, refined living to families of all sizes. | <urn:uuid:06b31f53-e250-4fc0-87d1-efba85e0a4c0> | CC-MAIN-2024-18 | https://houseplans.co/articles/lincoln-single-story-craftsman-house-plans/ | 2024-04-20T16:36:41Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.940726 | 900 |
From the Vice Principal’s Desk – 26 April, 2018
We are about to embark on a wonderful 5 day long weekend which is ‘book-ended’ by 2 public holidays. The first being Freedom Day on 27 April and the second being Worker’s Day on 1 May.
While we are all looking forward to some downtime with our families that a long weekend affords us, it is important to remember the reason for the holiday.
On Friday we will celebrate the 24th Freedom Day in South Africa’s history. I was privileged to be part of the very ‘first’ Freedom Day when I worked at a polling station in our first democratic election. I clearly remember the camaraderie that was felt among the people, from all walks of life, that had come to cast their vote. The hope for a better future for all was tangible; a day (or feeling) that I will never forget.
I still have that feeling of hope when I spend time with many of the students in our school, young people who are learning to work collaboratively, be open-minded and above all to be principled, making the right choice when faced with a challenge. Attributes that are very much needed in the ‘new’ South Africa.
Wishing you a safe and enjoyable long weekend. | <urn:uuid:d8248cf6-2e80-43e1-9088-0b1616acf15d> | CC-MAIN-2024-18 | https://houtbayinternational.co.za/vice-principals-desk-26-april-2018/ | 2024-04-20T17:21:44Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.972412 | 272 |
I did a post about a week back on a nap timer for Android, and 'tom s' on Friendica suggested I have a look at MacroDroid. Even though I had found a solution for the nap timer, I was pretty impressed with MacroDroid and have been delving a lot further into it.
Tasker is the absolute kitchen sink of automation utilities. Very powerful, but also a bit complex. MacroDroid is really offering most of the same but ina way more friendly and intuitive interface. Everything is clearly separated by colour into zones for triggers, actions, and constraints. You can get going with the fairly simple stuff, very quickly. But you can still build some pretty good macros from there.
But there's more... they have masses of 3rd party plugins that you can select to further expand functionality, which extends to even directly using Tasker plugins. Then they also have a quick way of listing community templates for macros that you can just export into your app and customise them for your own use.
Some typical macros I'm already using:
1. When screen turns on during the day, and the outside light is over 6k lux, then push screen brightness quickly to 80%.
2. On any failed login attempt, take a photo with the selfie camera, and save it to phone's gallery.
3. When leaving the house, activate the hotspot mode on the phone. When returning, deactivate hotspot mode and reactivate the WiFi.
4. Nap timer activates DND mode for a user inputted number of minutes, and then sounds a notification to wake up, and deactivates DND mode.
The app is free to use for up to 5 macros, or has a once-off cost of around $5 to unlock premium with no ads and unlimited macros.
The video at the link below gives a quick and high level overview of how it works.
Tasker Too Complicated? Give MacroDroid a Try [How-To]#
automationHow to Use MacroDroid to Simplify Android AutomationFull Tutorial: #^http://bit.ly/macrodroidSubscribe to Gadget Hacks: #^http://goo.gl/XagVIIn this video, I'll ... | <urn:uuid:cbda7af2-324d-4d7d-9c6d-e6d81ce91c0b> | CC-MAIN-2024-18 | https://hub.vilarejo.pro.br/channel/gadgeteer/?cat=MacroDroid | 2024-04-20T16:50:33Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.927027 | 465 |
Teacher At Prestigious New York State School Sent Naked Videos To Child
A Hudson Valley teacher from a 100-year-old school confessed to sending sexual videos to a child.
A now-former Lower Hudson Valley teacher confessed to sending sexual material to a student.
Westchester County, New York Teacher Confessed To Sending Sexual Material To Child
A former New Rochelle teacher is pleading guilty to trying to send sexually explicit messages and videos to a 15-year-old boy, NewsSource confirmed to Hudson Valley Post.
Mariela Barajas, 23, of Mount Vernon, New York was charged in January 2022 with disseminating indecent material to minors in the first degree, a felony.
The Westchester County District Attorney’s Office made the arrest following an investigation, with assistance from the Mount Vernon Police Department and New Rochelle Police Department.
New Rochelle, New York High School Teacher Arrested
Barajas was arrested while teaching at the Catholic all-boys Salesian High School in New Rochelle, New York.
"While employed at the New Rochelle school, in December 2021 and January 2022, Barajas engaged in a series of sexually explicit conversations with the male victim on Instagram and Snapchat. During the conversations, the defendant sent the victim naked videos of herself engaged in sexual acts," the Westchester County District Attorney's Office stated in a press release.
It's expected Barajas will be sentenced to five years probation when she is sentenced in April. She will also have to register as a sex offender.
Salesian High School is a private high school for boys in New Rochelle, New York.
A Hudson Valley teacher from a prestigious school is accused of sending sexual videos to a child.
The school was established in 1920.
"We are an all-boys Catholic school located in New Rochelle, New York that is rooted in the principles and teaching of St. John Bosco. Our 100-year tradition is based on reason, religion, kindness and the presence of educators among students," the school states on its website. | <urn:uuid:8f0bc2f5-1e02-4934-904b-05c66a11f645> | CC-MAIN-2024-18 | https://hudsonvalleypost.com/teacher-at-prestigious-new-york-state-school-sent-naked-videos-to-child-new-rochelle-mount-vernon/ | 2024-04-20T16:55:02Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.960097 | 423 |
Since the earliest of times, the circle has signified love, energy and power. To Pythagoras, it was the most perfect of creative forms; for Zen Buddhists, it remains the shape of enlightenment.
In reply to this intense interlude in our contemporary history and our shared struggle Huffy harnesses the universal strength of the unbroken circle to unite us all. Earthy and eye-catching, the We Are Together Collection is a multi-coloured series of everyday bracelets, for men and women, that channels harmony, solidarity and hope.
Strands of nautical rope or braided leather are bound by sterling silver magnetic clasps to bolster our common connection. With a circle, there is no beginning; no end. Just eternal motion and resilience.
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The winds howled all night outside our little cabin on Mt Baldy. Not afraid of any wind ( or not willing to reschedule our summit, anyways) we woke up about seven and were ready to tackle the mountain, all 10,300 feet of her.
It would mean hiking up over 4,000 feet of altitude gain with top wind gusts of near one hundred miles per hour. This would be the hardest hike I have ever done in my life ( although, some how, amazingly, I still had a ton of energy at the end.) my boyfriend came down with the flu and began to feel sick in the morning as we began the hike but he didn’t want to ruin our hike and tell me, so he powered through! He also had really bad leg cramps and shin splints and we still managed to summit, going the long way even, as we missed the ski hut cut off!
We were so amped to start the hike up Mt Baldy that I completely forgot to keep an eye out for the cut off for the ski hit trail, it’s about a mile from the locked gate where you start the hike. The ski hut trail is the steeper, harder way to the summit and the views are incredible. Our original plan was to go up the ski hut to the summit across the Devils Backbone and down to the Top of the Notch Restaurant for a delicious hamburger lunch.
By the time I realized we had passed the cut off we were maybe a mile past it, and just decided to keep hiking up the road to The Notch and go that way. This would add about three miles extra to the total hike.
The wind was blowing pretty hard already going up the road and I was really not looking forward to how blustery it was going to be on the summit.
Some how, I still don’t know how we did this, we made it to The Notch in just an hour. We were hiking at a great pace, passing hikers left and right. We decided to go into the The Notch for a minute, get a beverage, get out of the wind and use the bathroom. As I put it to Adrian,
” As a man, I really don’t think you want to pee in the eliminates today with 65-80 miles per hour wind gusts.”
So yes, we went inside. The bar at The Notch is really awesome. Not only do they have a terrific beer selection but the bartenders are super nice and very helpful. The bartender we spoke to warned us there was a rock slide past The Devils Backbone and we would have a rough time summiting today.
It was awesome advice to get from some one who knew the mountain. We finished up our hot chocolate and iced tea and hit the trail again, deciding that it was just to cold and miserable today to try and summit anyways. We would just make it to the back bone and turn around.
Right after The Notch is ( to me) the hardest part of the whole hike. It’s a ridiculous tough up hill section where you gain almost a thousand feet of altitude gain and this hill seems like it will never end. I actually had to stop about half way up and have some bacon jerky. I needed protein in a desperate way at that moment.
After that I came alive again. Adrian was a couple hundred feet above me and I felt like I would never catch up with him.
I finally did near the top of the big ass hill ( okay, maybe he waited for me) and we tried to enjoy the view of the high desert to the north but the wind was blowing something fierce.
That cold wind was chilling me to the bone and I took one or two pictures than got moving quick. The back bone was pretty close and was thinking we were turning around shortly. I tried to power through.
By the time we passed the back bone the trail had evened out so much and gotten so much easier we decided to try and make it to the rock slide and turn around there. The wind was terrible when it was bad, but when we were hiking on the south side of the ridge it wasn’t bad at all.
So we powered through. When we reached the “terrible rock slide” we had been warned about we saw it was almost nothing! We decided to try and summit although honestly, the wind was so terrible at times I would have been perfectly happy to turn back at any time.
It was around this time that I began to pull way ahead of Adrian in the hike. I had no idea until later in the evening that he was having terrible leg cramps and also that he was in the first stages of having the flu! I was about half a mile ahead of him on the trail and one time I turned around and saw him lying down in the snow! I thought he fell! I waited a little bit in a spot not to terribly windy for him to catch up, I tried yelling back to him but there was no way he could hear me over the terrible wind noise.
When Adrian caught up to me he told me he kept having to lay down in the snow as his legs were cramping up so bad!
As I was waiting for Adrian I was talking to other hikers coming down from the summit. The vast majority of them had gone up the ski hut trail and they mostly all said the same thing; there was so much snow on that route, the trail had been terrible and had taken them way longer than the route we were taking. But most of them didn’t have snow gear! So many people were hiking this without poles and with out cramp ons or cat trax! My boyfriend, when he finally caught up with me, was bummed he didn’t bring his brand new Black Diamond ice ax. ( I had told him to leave it at home, that there would not be a lot of snow, and he wouldn’t need it)
As I tried to continue slowly up hill I was so struggling with the crazy winds! At some points I felt like I could barely put one foot in front of another! I had put on my cat trax and they helped me dig my feet into the icy snow and between that and the poles that was the only thing keeping me standing on the mountain!
I wanted to turn around. I felt like I was not going to make it, that I would be blown into the valley below, but I kept seeing girls coming down who were smaller than me and they had made it! That’s the only thing that kept me going.
Well that and the view.
The pictures don’t even do justice to how phenomenal the view was! We could see at least twenty ships on the ocean. We could see the San Onofre power plant on the way to San Diego. We could see Catalina Island and the skyscrapers of Los Angeles in the distance.
Staring at that view for hours is what kept me going.
That last mile felt like hours.
I have never been so cold in all my life.
People coming down said it was cold enough to get frost bite as the Santa Ana winds were blowing off the snowy summit.
Finally, finally I reached the summit and made friends with some nice people at the top.
They offered me a beer and even had my favorite, Heiniken. It’s one of the few times in my life I’ve said no to a Heiny! My fingers were just to cold to hold the bottle! After they drank some beer, I watched one of the guys pour out the rest and it froze as he was pouring it out!
Finally Adrian and I were at the summit together, it was one hell of a hike, hell being the descriptive word here.
All I could think about was how soon could I have a burger with blue cheese at The Notch!!! | <urn:uuid:8144339b-02aa-4177-8010-18eda25abe1a> | CC-MAIN-2024-18 | https://hungrymountaineer.com/mt-baldy-fever-day-2/ | 2024-04-20T16:22:30Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.990684 | 1,638 |
Property has been completely remodeled. Everything from ceilings to floors, from electricity to central air conditioning and central heating. Every appliance is brand new new including a hot tub and all new kitchen cabinets. Nothing has been missed.
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Fake Iwc Watch Signs
Putting the rotor and frame work back on is a piece of cake compared to adjusting the beat error. I’m Iwc Clone Watches in the home stretch now. The watch features 20mm Portuguese Perpetual Calendar lugs and mine came on a grey Hermes-style and I thought it was not only perfectly paired with the watch but excellent in its own right as a strap. This signals a change in gear for the Ferrari collaboration. Rather than some outrageous, mechanically-mental showcase, these are far more accessible. They’re still limited 1, 000 for the titanium, 500 each for King gold and 3D replica Carbon but they’re far more wearable. If ever I were to own an Hublot, it would not be one of these babies. Yet the Uræd Portofino also stole the limelight from Von Doren’s older pieces, a particular travesty when it comes to the eye-catching little quartz numbers in the Runde collection.
In 1938, Oris introduced a watch designed for pilots characterized by an oversized crown so that the time could be easily adjusted even while wearing gloves. Additionally, the watch also featured a date indicated luxury by a central pointer hand. Over time, this model became Ingenieur Automatic a symbol of the Oris watchmaking heritage. After the El Primero Range Rover Special Edition in 2016 and the Chronomaster El Primero Range Rover Velar in 2017, the latest outcome of the partnership between Zenith and Land Rover is a special edition from the Defy Classic collection created to pair the new-generation Range Rover Evoque. Wings of Hope Wings of Hope was founded in the 1960s as an aeronautical humanitarian effort to bring medical support to remote or impoverished communities around the globe. Additional Highlights from Jaeger-LeCoultre at Watches and Wonders 2022 While we’re regulars, we HAD to head back in to check out Head Chef Insup Kim’s brand new Spring degustation.
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The Frisson is uncompromisingly in vein with conceptual artist and designer Rolf Sachs’, typical oeuvre.
The silver opaline dial is protected by a box-form scratch-resistant sapphire crystal with anti-reflective treatment inside and framed by a stainless steel case with a Portuguese Hand-Wound diameter of 39. 70 mm and a Red gold total thickness of 14. 37 mm. Water resistance is 50 metres / 167 feet. Together with the El Primero Sport, at Baselworld 2015 Zenith presented the Elite 6150 model, a timepiece from the classic lines equipped with a new Manufacture movement, the Elite 6150 calibre. This date wheel sort of eases on in to the next date rather than pop into the next date at midnight. Some of the best Wordle start words include adieu, tears and lares. The DB2109 Calibre is a work or art with its 330 parts and 30” tourbillon in silicon and titanium visible on the back side of the watch. Fast beating at 36, 000 vibrations per hour, this hand-wound movement is equipped with a silicon escape wheel and has 4 full days of power reserve ensured by a self-regulating twin barrel. The aperture at 12 o’clock of the dial side displays the remaining power. The seconds on the clock are replaced by Beats, and you replica have the length of the song to complete the race. As a modern brand, Bvlgari thought it was time to add a larger size as we will discover below. It exudes ruggedness, which is very reassuring. Well, interesting Speedmasters were all over the place in Geneva last week. Phillips had a Portuguese Perpetual Calendar Digital Date-Month number of prototype Speedmasters, including an original Alaska Project II, while Antiquorum impressed with a run of special grade Speedies that closed out its auction with a 1990s Speedmaster that once spent 365 days in outer space aboard the Mir Soviet space station and eventually exploded past its high estimate to reach a total of CHF 312, 500. The CHF 162, 500 total for a skeleton Speedmaster Apollo XI was no slouch, either. Better yet, all proceeds from the sale of items will be donated directly to the Courier Mail’s Children Fund, which helps to improve the lives of kids in need.
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Considering that this version is the least common, it may have been issued to fighter pilots. Bomber pilots were issued the Beobachtungsuhr, a 55mm monster worn over the jacket on a long strap. As I alluded to earlier, working at HYPEBEAST, you definitely get the opportunity to explore different categories – and in my time with the company I’ve tried to learn as much as possible. I started on sneakers and clothing the sheer amount of content in just those two areas is staggering mk replicas watches and Ingenieur Jumbo gradually, as work went along, I began getting all the newsletters and press kits about watchmakers and my curiosity grew from there. To be honest, when you’re submerged in any content 24 hours a day, you’re naturally going to want to learn more about it. The journey of a collectorThe searchSome explanationMy searchMy personal opinionA very lucky breakBack to reality You have to relax and continue to experiment. Once again, light does the dial favors and the blue of the hands—syringe for the hour, lance for the minute—makes glancing at the watch a joyful game of “Will the hands shine? ” Whether by design or not, the bluing of the hands and the circular finish of the hour track provide a sort of gambler’s iwc replicas reward: a wonderful outcome, but not every time you look at the watch. Furthermore, when good names are now hard to find, returning to the tried and tested in some variation becomes commonplace. This was evident in their dial designs. The combination of the “art-deco” case and modern approach taken with the dial layout make the 39A Bauhaus extremely unique in regards to other Bauhaus watches on the market.
Rather than a black sheep to Rolex, he’s the official partner of a growing stable of brands. He’s currently working with Zenith, TAG Heuer and Bulgari, but there are more Steel to come. Nothing I can say of course, but some seriously cool – and unusual – collaborations are in the pipeline. It also comes with sunray brushing on the barrel with 45° anglage and sunray brushing of the ratchet. Portuguese Grande Complication It carries a pre-sale estimate of 200, 000-400, 000. Teddy Baldassarre YouTube Channel The PRW-3400 series will debut with two models in Japan: the black PRW-3400-1JF 44, 000 yen, tax-included and brown PRW-3400Y-5JF 46, 200 yen, tax-included. Release information for other countries has not been confirmed yet. Royal Purple lacquered dial, sunburst Iwc Clone Watches brushing to surface, with sunken subsidiary seconds counter at 6 o’clock, CNC milled and diamond polished ‘Edwin’ Arabic numerals, coated in Rhodium and hand applied Jubilee Edition
Then again, between the accessible price point and the overall presentation, I could see this being a great “first real watch” for a budding enthusiast, for whom the novelty of a visible automatic movement would be exciting either way. Sheraton Sydney’s Most Luxurious Bottomless Long Champagne Brunch Launches The Sheraton Grand Sydney Hyde Park is launching one of the most luxurious long lunches this month. While it is made of precious metal and stones, it seems like it can come to life any minute. Many will find the display too complicated, hard to read, or simply not classic enough for them. You can be ready for any survival situation with the addition of VSSL’s Essential Collection to your bug-out bag. King Octopus is my favourite part of the watches! This is not a dress watch, Portuguese Perpetual Calendar so for people like me, that likes casual non classic divers, it looks very unique. What seems to be a mere detail has quite an impact on the watches’ overall looks as this color contrast makes these functions more pronounced. The slate grey dial presented challenges in making the photographs, as the reflections of the soft box employed to soften the strobe light was caught in the glass.
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The latest Dumoreau DM02 dress watches follow the DM01 integrated sports watch from last year, and things are even more refined this time. What’s this? A Bulova strap on a Hamilton watch! Better than Elgin, I suppose. ha ha! Ooh La La and Ooh Coffee This petite espresso bar offers it all; coffee and fashion. Founded by Danilo Villanueva, Makina was born from his need for a creative outlet other than his day job in advertising and he wanted something less demanding of his time that he could channel his passion into. Not wanting to be held back by what ‘should’ be included in a specific type of watch, their philosophy is that design in a holistic sense is more important than categorisation, through which they naturally drifted into their own waters: sporty dress watches. That kind of oxymoronic label is a bit hard to pin down at first. That is, until you see some of Makina’s designs. As you can see in the picture above, this is a main barrel that has a mainspring with a T-end. The Longines 280 comes in 2 different versions. With a T-end and with the normal bridle.
They often vary between 0. ConclusionLike its compatriots with Minerva-based movements, the Unveiled Secret is an attractive watch because of the wonderfully executed movement. But it is more interesting than past models because the movement is inverted, allowing the watch to be worn back-to-front, which puts on show the excellent, excellent finish. The appeal does come with has a few caveats, namely the middling execution of the dial and case. Sure, any of the green lanterns could probably conjure up their own watch, but let’s assume Hal Jordan would want to take a little bit of Earth with him in the form of a more terrestrial timekeeper. Either way, the eerie green light of the Schofield Black Lamp might not come from the cosmic force of willpower, but it looks pretty damn close. As a result, you will need to clip it onto the back of a shirt/pants making it difficult to reach and Big Ingenieur Chronograph scroll intensity levels. Ollech Wajs aren’t a traditional microbrand, they were a powerhouse of tool watch horology in the 1960s, but were forced to close prior to being revived as a microbrand. The hands and markers carry a black border and a truly impressive amount of Seiko’s Lumibrite luminous paint. Let’s Portuguese Perpetual Calendar Digital Date-Month take a look at the third member of the Batavi family. Address: 209-211 Lonsdale Street, Melbourne VIC 3000 Phone: 61 3 8393 9367 Trading hours: Wed-Thu 4 pm-1 am, Fri-Sat 4 pm-3 am Check it out
The six-time major winner was linked to the tournament as early as February 2022, after biographer Alan Shipnuck published comments where Mickelson was highly critical of the PGA Tour. On the other hand, the glossy ceramic presents a fine contrast to the case and a closer tie to the brightwork on the dial, dressing it up just a bit more, particularly in the rich stainless/blue combination.
The most classic edition of the TAG Heuer Monaco, with its blue panda dial. Combining contemporary design elements typical best of its Meister collection with other details directly inspired to the pilot watches of the 1950s and in particular to the Bundeswehr service watch, the new Meister Pilot from Junghans is strongly characterised by the bi-directional replica iwc rotating bezel featuring 12 concave notches to ensure optimal grip. And because of the thin-ness of the case, measuring only 12mm, is rather elegant at the same time. Sanders’ interview watch, a Tudor 75203 Prince Oysterdate. The P‘6752 WorldTraveler offers the opportunity to select the time at yourhometown from the 24 standard time zones which are also engraved on the rear of the watch. A handwith a red triangle indicates the second time zone on an inner scale divided into 24 hours. The current Portuguese Hand-Wound Ingenieur Chronograph Racer time is shown on the outer 12-hour ring of thewatch face. The date is displayed in a window located at three o’clock. The Arabic numerals and the skeletal hands are filled with white luminous material. But for me, site having a regulateur time display seemed consistent with the chronometric escapement. If you want to join the party, here are the best vegan sneakers for men to get your hands on, or feet in, shall we say.
Chronometer Certified: Yes, new “Ultra-Chronometer” certification through TimeLab in Geneva The case is made from Omega’s own Sedna gold, essentially a proprietary rose gold alloy with a deeper, redder colour. Paired with the dial Ingenieur Jumbo it’s as traditionally rich as velvet drapes at a members’ club. Again, the Tresor Small Seconds is a dress watch at heart, but the brighter, more unusual dial would make it just quirky enough to pull off outside of formal occasions. Competitive Landscape The NOMOS Tetra neomatik red – 175 Years of Watchmaking Glashutte is priced at S$5, 350, and it is limited to a production of 175 pieces for each of the four variants. Harvest time at the Foradori winery in Italy The winery is Foradori based in Trentino, and I’ll get to it shortly. Presented by Zenith on occasion of the LVMH Watch Week, the new Elite Moonphase is a watch of contemporary elegance where the classic lines are combined to modern accents. Audemars Piguet Royal Oak Jumbo Extra-Thin 15202STThe steel case and Bleu Nuit, Nuage 50 dial was, when it was released in 2000, the spiritual successor to the first 5402ST, the original luxury steel sports watch. It’s a classic and the Royal Oak that any devout collector wants to add to their collection. It was unobtainable before this year and god only knows what it’ll be like on the preowned market now. Its replacement is still just as authentically Audemars Piguet, but the mk replicas watches retirement of the 15202ST is a melancholic thing. If you are looking for a vintage inspired flight chronograph, then you should buy an IWC Miramar Top Gun. It has a remarkable manufacture movement, a lovely mk replicas watches ceramic case, and aprice tag of nearly $13, 000. As Ferris Beuller said of Ferrari, “If you have the means, I highly recommend picking one up. ” On the other hand, if you have more of a Bum’s budget and would like a great looking replica iwc watch with its own unique take on vintage military, then you should consider the Szanto 1200 series. Widely considered to be the greatest athlete of all time having won six NBA championships, five MVPs and 14 All-Star games, Jordan also consistently delivered sartorial slam dunks which is not easy given the size of his frame with him standing at 6ft 5in tall. Thankfully, all of this has been highlighted in the ten-part docuseries The Last Dance, which follows Jordan through the 1997-98 season whilst he was playing in his final season with the Chicago Bulls. The CaseThe Squale Atmos GMT measures in at 42mm in diameter, 49mm lug to lug and 13mm thick. You will not have a problem reading this dial. Applied indices are well lumed, as are the fat, highly visible hands reminiscent of a Grand Seiko diver, and they glow a cool fake blue. Oddly enough, the bezel pip glows green, but the whole effect is highly legible. The date window is thankfully small at 4 o’clock, lining up with the screw-down crown. The crown at 4 works well on bigger watches, lessening the chance of digging into your wrist as some 3 o’clock crowns tend to.
The resulting Khaki Navy Scuba Auto ref. Look at those big silly ears on that clasp. The brushed and polished h-link bracelet tapers from quick-release 20mm endlinks to a skinny little Da Vinci Automatic 16mm clasp, and I really liked how it makes the watch look. the heavy taper slims the watch a bit, which top is needed on the chunkier case. Never mind your grumbles about the lack of micro adjustments or worries about the butterfly clasp coming undone: this style is perfect for this watch and not once did I have an accidental release accidentalrelease. Home Watch Brands Jenny Omega Rolex Sinn Diving Deep Portuguese Minute Repeater Into Water Resistance — How Is It Actually Accomplished? In-Depth Jenny Omega Rolex Sinn A watch that will appeal all lovers Ingenieur of vintage-looking watches, the Longines Heritage Classic Chronograph 1946 comes in a round 40 mm stainless steel case that frames a domed silvered opaline dial with two counters, a 30-minute counter a 9 o’clock and a small seconds counter a 3 o’clock. PB02301A1B1A1 for a price of $11, 200 USD or on an alligator strap ref. Last month, it was announced that the 2023 edition of Watches Wonders will take place from March 27th to April 2nd. And the news reminded me of a little experiment I performed at Watches Wonders 2022: I only took one watch with me for a week in Geneva. That watch was the Oris Rectangular. And it is important for Portuguese Minute Repeater Piaget because it is both a technical and aesthetic achievement. Like the old model, the markings on the inner ring mimic distance scales and correspond with measurements of time, but they are only slightly less random than those on the original.
And with a 25 per cent discount for Man of Many readers using the manofmany25 code, you can enjoy a bigger saving than you’ll ever find at your local bean-slinging cafe. Kross Studio watch winder — Wayne Enterprises Edition Want to be like Batman? Maybe start with trying to be or be just like Bruce Wayne. Jorg: Tissot PRX Automatic Chronograph I’m going to jump right in and declare that I’m a big fan of the Tissot PRX! Yellow gold When Balazs showed me a picture of the quartz version that came out Da Vinci Chronograph first, I was immediately sold, especially after he explained that the quality and finish of the watch were far above its 350 price point. How to Start a Vintage Watch Collection the Right WayBy Melvin Hollenberg / Collecting Watches, Editors Pick / 1 Comment Dial: Brown with applied rose-gold-plated indexes, hand-polished rose-gold-plated hands A result is a place that hosts all the greatest tenets of a top barbershop, then and now. That’s 20 layers of lume. Since the catalog does not mention a white M 79-4, I’m left to assume that it’s correctly identified Aluminum but I think that’s a safe assumption. It doesn’t have a faceted crystal but that could have been replaced. Tissot: 50% selected watches The new Fifty Fathoms Automatic in red gold and ceramic dial ref. 5015-3603C-63B is matched to a blue calf leather strap and has a price of Euro 33, 990.
Squeeze the accelerator pedal and the e-Tron does feel quick but it’s no match for the bonkers sub-10sec quarter-mile EVs that seem to be the norm today. Grand Seiko SBGW291 and SBGW293 Grand Seiko has released many larger watches in this particular shape over the past years. Like the Marlin, the Khaki Field is based on Hamilton watches from the 1960s. The watch comes with a black ceramic bezel inlay with cream-colored numerals. Original advertisement for the Globemaster. Courtesy is a great example, as it’s really well documented, and easy to research. It can get a little confusing and the industry probably prefers it that way, hoping customers won’t be able to tell the difference between a gold-tone steel watch and the real deal. 1 compatible and hit stores sometime during the next year. The more proportionate bracelet means the watch isn’t as top-heavy, although it’s still a handful to wield.
Whytes has pulled it Grande Complication off. Cased in a 44mm red gold case wears more like it was 41mm, it retails for CHF 43, 900 before taxes, and is a Limited Edition of 28 pieces only. As I pointed out earlier, brands like Rolex, Omega, and Seiko were all churning out chronometer-certified movements for women’s watches right Rose gold alongside the men’s calibres. In 1954 a couple of other dial options were added and the Signamatic was broken into the Signamatic A and the Signamatic B. Other than the dial options and bracelets, I’m not entirely sure what other differences there might be. It does look like the case on the Signamatic B has slightly shorted lugs. I am a big fan of textured dials, which have been popular in various forms for decades, but seem to be seeing a resurgence reputable in 2020. In this case, the dial has a finely pebbled, almost eggshell texture that is not glossy but not quite matte. The dial branding is minimal, with “Geckota” above and “GMT” below, both in a minimalist, sans serif typeface. I cannot say Ingenieur Chronograph Racer enough about how pleased I am with this new font, which departs from the previous cursive style. It lends a bit more of a rough and tumble, outdoorsy feel to the watch. Marc Philipp Gemballa Marsien Bovet Récital 26 Brainstorm Chapter Two On the 9 o’clock side of the case you Pilot Chronograph Top Gun have the helium release valveHRV, as this watch is rated 2000m water resistant.
The Black Resin Gold Limited Edition In addition to these new colours, the brand also launches a limited edition, with the Fortis Marinemaster M-44 Black Resin Gold. The Longines Spirit with green dial can be matched to a steel bracelet or to a beige leather strap. Prices start from Euro 2, 160 / US$ 2, 150 for the 40 mm version with leather strap ref. Euro 2, 160 / US$ 2, 150. But who knows quite how such a watch might be used? Jack Heuer – of the Heuer family – reports in his autobiography that, soon after World War Two, his father told him that he thought a watch with a moon phase indicator would be useful to him predominantly when out mushroom hunting, since he believed that morels seemed to spring up in greater numbers when the moon was waxing. In addition, with the stance of aiding the American fashion industry impacted by the pandemic, Kering will support A Pilot Double Chronograph Common Thread, the CFDA/Vogue Fashion Fund initiative, as well as ‘Your Friends in New York Want to Help, ’ an organization launched by Kerby Jean-Raymond with a mission to create rapid local impact within the community. The AR-coated sapphire crystal certainly helps while diving, too. Rexhepi wasn’t an overnight sensation. It’s also quite fairly priced, Iwc Clone Watches retailing at EUR 1, 995. The 100 Best Craft Beers in Australia Have Been Named
As Robert-Jan explained in his review , the Ultra-Chron packs a ton of vintage character with its retro case shape, sapphire bezel insert, grained black dial with the Ultra-Chron logo, and brilliant multi-link bracelet. So, wearing a 36mm watch — which, let’s be honest, is not that small — is no problem for me. Kenissi movements are supposed to be better. A movement that is meant to be precise, practical and reliable. Armin Strom’sgoal is a watch that the owner knows will tell the time consistently, day in and day out.
This calibre is a direct descendant of the first automatic alarm watch movement created by Jaeger-LeCoultre in the 1950s. Constantly improved, it still represents pure excellence in accuracy, robustness and reliability. This is a rare example of a movement that has been in production for more than 60 years after its creation, continuously updated and modernized. Beating at 28, 800 vibrations per hour, it guarantees a power reserve of 44 hours. They also offer the old school bottomless, which features 3 hours of bottomless wine, beer spirit mixers with a selection of tasty jaffles, and the big dog bottomless, which features 2 hours of bottomless wine, beer selected cocktails with a selection of tasty jaffles. Olivier Mory — The master watchmaker behind the CMM.
001 connected quartz caliber. 3001-D , but they don’t fit there as reputable well as they do on the Citizen Alarm Date. The Jaeger-LeCoultre Polaris Perpetual Calendar, in steel. Other debuts include a pair of new Atmos models, two impressive grand complications and two glittering additions to the Rendez-Vous collection. These are End Of Days specs yet with breathability and stretch and a plethora of pockets and heavy-duty belt tapes to fix carabiners and so on. Where the legibility issues arise surround the slide rule bezel which is used to complete a wide variety of aviation necessary calculations. And then you were satisfied? Finally, while I was working on my watch, Czapek announced a new Antarctique Passage de Drake with different dials and an improved movement. Although the Hamilton Fontainebleau’s stainless steel case seems imposingly large on paper at 47mm-wide and 14mm-thick, in reality, the watch wears impressively well due to its scant 40mm lug-to-lug distance. | <urn:uuid:1faf1e87-d484-4ab5-9998-4891d700058d> | CC-MAIN-2024-18 | https://i.businessbreitling.com/replika-names-iwc-clone-watches-datejust/ | 2024-04-20T16:44:33Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.93928 | 6,448 |
Car frames are essential for a vehicle’s stability and performance. Therefore, it’s crucial to ensure that it’s in good condition. A bent frame can lead to reduced performance, increased fuel consumption, and even dangerous situations on the road. In this article, we provide a comprehensive guide on how to tell if your car frame is bent and what you can do about it.
Signs of a bent frame include a loud thump or bang when driving over bumps or potholes, unusual vibrations or shaking when driving at high speeds, difficulty turning the steering wheel or braking, sagging or uneven suspension, and a noticeable difference in how your car feels when you sit in it.
If you suspect that your car frame may be bent, take your car to a professional mechanic for an inspection. They will determine whether the frame is bent and provide a detailed report on the extent of the damage. If the mechanic determines that your frame is bent, they may recommend repairs or replacement. In the meantime, avoid driving your car as much as possible, especially at high speeds, to prevent further damage and keep yourself safe on the road.
In conclusion, it’s essential to regularly inspect your car frame for any signs of bending. By doing so, you can catch any problems early on and avoid dangerous situations on the road. If you suspect that your frame is bent, be sure to take your car to a professional mechanic for an inspection and follow their recommendations to ensure the safety of yourself and others. | <urn:uuid:fefcfbc0-76ec-40a8-95dd-b6f5dfd7d33b> | CC-MAIN-2024-18 | https://iac2012.org/how-to-tell-if-your-car-frame-is-bent/ | 2024-04-20T16:24:45Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.942042 | 307 |
So Jack Straw has banned prisoners at Whitemoor Prison from learning about how to write a comedy script or do stand up. They were taking part in an eight day course as part of an education programme. What harm can possibly be done by learning about comedy script writing and improvisation? I'd have thought learning how to diffuse potentially harmful situations by the use of humour was a good thing. Instead, Jack Straw has jerked his knee and responded to synthetic tabloid outrage. Not only that he's ordered an inquiry! you couldn't make it up.
Prison is a balance between punishment and rehabilitation. I don't believe in going soft on people in prison - but nor do I believe that activities which make them want to learn and develop should be discouraged. | <urn:uuid:61a7a71d-1fa0-4112-b9d4-32b7ab88355f> | CC-MAIN-2024-18 | https://iaindale.blogspot.com/2008/11/prisoners-education-jack-straw-jerks.html | 2024-04-20T16:10:29Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.98684 | 152 |
I know what you’re all thinking. Here comes another version of all the reasons the overhyped insuretech names aren’t going to make it. Not so fast (said the tortoise)! Today, I will make the case for how the seemingly misguided strategy of the hare may be the better path to ultimate success.
The Two Paths to Startup Success
Most people in the insurance world are used to the tortoise path where startups focus their efforts on gaining acceptance in the marketplace and getting to underwriting profitability relatively quickly, while following the traditional carrier business model of a well capitalized balance sheet with aspirations of an A or A+ Best rating.
Contrast that to the hare who is motivated solely by achieving hyper growth. Polite references are made to achieving underwriting profitability, but it is clearly a secondary concern. Operational mistakes are expected while breaking things, but accepted as long as the growth trajectory is on track. Balance sheets are typically non-traditional (MGA, reciprocal) and growth capacity is reliant on the kindness of others (particularly reinsurers).
How The Tortoise Wins
The tortoise wins by identifying an attractive area of the market where they can profitably underwrite, usually due to a lack of capacity in the market. They often have a reason to think they can produce better than peer combined ratios due to better talent or new pricing methodologies.
The obvious examples of this are the Bermuda startups post 9/11 and KRW. Another good example is PURE who realized consolidation in the high net worth market created an opportunity for a savvy new entrant.
The tortoise is typically funded with a large initial capital raise from private equity and doesn’t need to raise capital again until it goes public. Thus, there is less reason to create “buzz” in the media. The eventual IPO is likely directed towards traditional insurance investors and the valuation is dictated by traditional metrics like ROE, book value growth, and CR.
How The Hare Wins
As I said, the hare is focused on hyper growth. Why? Because they have a greater risk tolerance. This is really the biggest difference between insuretech and insurance startups. It’s not necessarily the technology…it’s the risk appetite.
The most obvious place you can see this is in the different burn rates of the tortoise and the hare. The tortoise is disciplined at customer acquisition, typically relying on existing distribution channels like agents. The hare spends whatever is necessary to acquire customers (whether they will prove profitable or not) even if this spending seems irrational.
However, there is one thing the tortoise doesn’t consider. While the tortoise is taking cover in its shell, the hare is out generating excitement about it’s greater potential if it threads the needle and ultimately succeeds.
Investors get excited about the greater upside of the hare (even if the odds of success are low). This lets the hare continue to raise more and more capital. Most important, the capital is super cheap. In fact, it is cheap enough that all the $ spent on “irrational” customer acquisition, may actually be rational…if the super cheap capital never goes away.
Building a Business vs. Funding a Business
Now we’ve reached the point where the difference in strategies has becomes clear. The tortoise is focused on minimizing underwriting losses and ignores the cost of capital for the most part. The hare is focused on minimizing the cost of capital so that it can ignore the cost of acquiring customers for the most part.
I’m sure most readers are now thinking, that’s great but we know capital isn’t free forever. At some point, the hare (or coyote) runs off the cliff.
You’re right in theory, but, as we’ve seen, it can remain free for a long, long time. Uber, Tesla, and others have been able to raise free capital for a decade with no end in sight and without needing to show profitability.
On the other hand, there are stunning examples of crashes like WeWork and many other smaller companies that fail before they become household names.
Frequency vs. Severity
To put it in more familiar terms, the hare is running a low frequency, high severity strategy. Most hares will fail, but those who succeed will succeed massively as they can use the free capital to undercut traditional competitors and keep driving growth.
Tortoises have better odds of becoming a “real” company, but they are also less likely to achieve breakout success. They are more likely to be above average, but not top decile. They will almost certainly be smaller than the best hares and they will have less optionality in their business model (e.g. M&A will be constrained by the higher funding cost).
They also ironically have less room for error than the hare because mistakes are punished by investors whereas the hare’s mistakes are largely ignored as long as they still represent a lottery ticket. In other words, fundamentals matter for the tortoise, but not the hare. The hare is all about psychology and sentiment.
There will always be some hares that win (just like some companies that bet on no cats win…see those who have written CA quake for the last 25 years).
Because human beings are irrational, they respond to the winners in one of two ways: assume that because one hare won it must be a winning strategy or otherwise they complain how unfair it is that a hare won because they didn’t do it “the right way”.
Both groups miss the simple truth that the hare pursued a more aggressive strategy with greater risk of ruin but a chance at a great reward.
Is the Hare Rational or a Thrillseeker?
I guess it may be both, but there are times when it is rational to be a hare. Note most of the famous hares (Uber, Tesla, etc.) are in businesses with high entry costs and large capital needs where there is a race to capture market share.
If you are starting an E&S carrier whose growth plan is based on being relevant to wholesale brokers, none of the above applies. There is no reason to be a hare.
However, if you are in a space like auto with large incumbents who spend $1B/yr on advertising, it is extremely expensive to enter that space. Pursuing a grind it out approach likely leads to failure. The cost to fund customer acquisition is way too high.
The only real way to succeed is to have free capital that allows you to spend like mad. This requires hype generation about how you will change the world while also drawing derision from industry experts who think your business model is vapid.
So, yes, one can argue Root is acting rationally to focus on a low cost of capital over underwriting profits. There will always be the question, like with Uber and others, of whether they can ever transition to profitability, but you can build a successful brand at a minimum with this approach and that’s very valuable.
Is the hare playing “greater fool theory“? Of course they are! But longtime investment professionals can tell you that many fortunes have been made selling things to the greater fool whether you think it’s “fair” or not.
Is It Better to be the Hare or the Tortoise?
It’s not a question of better. The hare is harder to pull off. If you can pull it off, the low cost of capital is extremely valuable. It allows you to make a lot of other mistakes and creates opportunities that the tortoise will never have. It also allows you to be extremely long term focused which can be beneficial (though is often an excuse for being a bad operator who can only sell the ever elusive future).
On the other hand, the tortoise never has to worry about the music stopping. The hare is always on edge that the willingness to believe could be suspended before the next required fund raise, otherwise known as the WeWork nightmare.
The point of this missive is to show that both are viable. While it may be fashionable to pick on the “insuretech unicorns” (yes, I’m guilty too), it doesn’t mean they’re destined to fail. They are similar to investors who are good traders but don’t always know what business the stock ticker is in.
Those of us who are purists like to see the companies with the best fundamentals and strategies win. However, one only has to look at the broader stock market to see that isn’t always relevant. Just because the hare isn’t your cup of tea doesn’t mean they can’t succeed. | <urn:uuid:830489d0-a23e-4031-bdce-06a2e3439772> | CC-MAIN-2024-18 | https://iansbnr.com/the-insuretech-tortoise-vs-the-insuretech-hare/ | 2024-04-20T15:41:29Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.955776 | 1,836 |
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For most, when the name "Consumer Reports" comes to mind, you might think of the last time you were in the market for a dishwasher and wanted to know how the brand you were eyeing stacked up against the competition. Would it clean the dishes efficiently? How loud would it be? No one wants the dishwasher that sounds like an indoor construction site. Or, maybe you've sought the longstanding nonprofit's advice during a Google search on bike helmets. Which one will keep that head of yours best protected out on the road? But consumers looking for advice and insight on products might soon start turning to the agency for something more than product performance and physical safety: digital safety.
Consumer Reports is in the process now of hiring a team for its newly announced Digital Lab, comprising engineers, technologists and investigative journalists testing products for privacy and security.
"The definition of safety is evolving, it’s not only about the risk of injury it’s also about the risk of injury it’s also about the potential risks, the potential threats posed to your personal data," said David Butler of Consumer Reports. "And with connected products across every category of product we rate, Consumer Reports is making an unprecedented commitment to prioritize privacy and security and testing rating evaluating products for privacy and safety."
While the Digital Lab is quite literally a lab in the physical sense, its creation will also serve as a hub for the proliferation of ideas and data to inform Consumer Reports' policy work and investigative journalism in an aim to hold both private companies and the U.S. government to higher standards on privacy and security, Butler said. The agency already had engineers and journalists rating products on privacy and security elements, in 2017 announcing it had launched an open source "digital standard," encouraging companies to address digital privacy and security risks, as well as giving companies optics on the elements of the standard Consumer Reports would use to measure and rate products. Now, the lab aims to expand that work.
"The ultimate goal is to apply these privacy and security standards to products around every product category that Consumer Reports currently tests and rates, and even categories that haven’t yet been invented," Butler said. "While we’ve already applied digital product to smart TVs and routers, looking ahead, we plan to put password managers through their paces and examine a wide variety of other products, including a whole host of apps and even automobiles."
In August, Consumer Reports announced it had hired Ben Moskowitz, a technologist, to direct the Digital Lab. He comes to Consumer Reports from Mozilla, where he worked as director of development strategy.
"We're trying to figure out how we can take the great capabilities we’ve got here and see how they can force multiply each other," Moskowitz said. "How can we do deeper investigations, revaluate the practices of tech companies, find new ways of users taking control over their data? Right now, most of what we’re doing is testing and reporting: We look at products and say, 'Buy this one, it’s a better value.' In the future, through the digital standard, we want data privacy and security quality of the product to be part of the rating. If you look at IoT, every product we rate is going to be a connected device. It's no longer 'This is the best toaster.' It the toaster connects to the internet, is it going to become compromised? Is it going to become part of the botnet?"
Justin Brookman is director of privacy and technology policy at Consumer Reports. He said the agency's policy work is important because keeping consumers safe can't be a burden placed squarely on consumers themselves. Of course it's important to do your homework, but it's the role of policymakers, companies and governments to do the work that ultimately codifies that safety. Brookman said the Digital Lab will play a significant role in informing that work.
"It’s not just relying on self-help,"he said. "Empowering [consumers] is important, but none of us have the bandwidth to tweak 40 settings for every company we deal with, or to understand the attributes of every device."
Mostkowitz shares Brookman's sentiment that the onus cannot be solely on the consumer to make the right choices.
"We want consumers to have information so they can choose products best for them," he said. "That might not always be possible, either because the marketplace isn’t transparent, or maybe it is but there aren’t really meaningful choices." It's then that the agency's policy work kicks in, to "engage with supply. ... Sometimes it's consensual, sometimes we put the pressure on. When that’s not possible, we work with rulemakers."
Brookman adds that even consumers doing their due diligence and reading a product review may not know how to apply that to their actions.
"You can see a rating and may not understand. 'What does that mean: Ford got a 67, what does that mean exactly?' Well they can sell [your data] to a data broker, share it with third parties. Even if there is a score, you might not understand it or don’t want the responsibility. Or maybe you think it’s wrong people should pay with their data, or privacy."
And that's where policy, and the lab's findings to inform that policy, plays an important role, he said.
"So when we do test products we see X, Y and Z is happening, and that can inform what we tell people, but it also can inform what we tell the Federal Trade Commission or what we tell Congress or what we tell California," he said. He pointed to Consumer Reports' work on Facebook's use of facial recognition, resulting in the agency filing a complaint this year to the FTC alleging the practice constitutes "deception" and violates Section 5 of the FTC Act.
It's that kind of collaboration between Consumer Reports' investigative and policy work he sees the lab bolstering.
"The testing side is really the most important thing to make sure we have the skills and relationship for all the things we look at. I think they can feed off of each other," he said. "I’ll be working on testing some, and then I’ll hopefully have more resources to back up what I’m arguing for from policy makers."
Moskowitz envisions similar outcomes. While he notes it's early days — he's been on the job less than a month and the lab is just standing up — he said in the near term, the agency is aiming to help enforce new privacy laws, namely, the California Consumer Privacy Act.
"We want to make sure that that goes into effect in January in fact," he said. "That will set stage for federal privacy law that we think is very likely to come out. We want to influence that, make sure it’s robust it works and is enforced in the right ways."
Both Moscowitz and Brookman say the time is ripe for this kind of work, noting growing consumer mistrust over what's happening to their data.
"There's a general sense of anxiety and lack of agency," Brookman said of the consumer climate. "People feel like their information is being collected, and it feels adversarial, like it’s not being done for them but more to them -- without regard for their interest. People want to see more accountability and changes and have the defaults work for them."
Moscowitz said while consumer awareness is certainly rising, it's the rate of change that makes this work especially important.
"I was just looking at the Consumer Reports archives, just in a room in the building where every magazine every published, every rating ever published is, looking back 12 years ago. We were rating digital cameras; the iPhone is out. Or, five years ago, seeing the first story going, 'Hey, interesting, here’s what happens when you sign up and use Facebook.' If you just think about the pace of change, you’re talking about five-, 10-year ramp ups for things hundreds of thousands of people are using. There's not time to talk about expectations or norms. I think consumer awareness is catching up and people are paying more attention. But even if they weren’t, the rules and trajectory of the digital economy are being set now."
And it's those rules Consumer Reports aims to impact.
If you want to comment on this post, you need to login. | <urn:uuid:a484368b-3c52-4d8a-9f32-af49b4d3ee8f> | CC-MAIN-2024-18 | https://iapp.org/news/a/consumer-reports-launches-digital-lab-to-rate-on-privacy-inform-policy/ | 2024-04-20T17:47:51Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.969677 | 1,751 |
Toni Atkins, Speaker of the Assembly, has appointed Gretchen Newsom, IBEW 569’s Political Director, to the California Employment Training Panel.
The ETP is a labor and business-supported state agency that funds vocational training, and has contributed more than $1 Billion toward training workers in over 80,000 businesses since 1982.
Regarding her appointment, Gretchen Newsom said,
“I will seek to uphold ETP’s mission of connecting quality training to good paying, long-term jobs, while also advocating for the interests of workers, businesses, and taxpayers.
In my current work with IBEW 569 and Building Trades, I have witnessed firsthand the positive impact of apprenticeship programs. These programs allow participants to ‘earn while they learn’ and strengthen businesses by providing a highly-skilled, well trained workforce. I will also seek to continue my work in supporting the growth of the green economy and investments in quality training aligned with good-paying, green jobs.”
(Photo by Jeremy Thompson) | <urn:uuid:80926d14-e6be-46a6-aee5-f4fe2ac00d2e> | CC-MAIN-2024-18 | https://ibew569.org/news/news-ibew-569-appointed-california-employment-training-panel/ | 2024-04-20T17:03:07Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.958507 | 217 |
Get To Know Us
Here To Serve
We Are Redemptive Home Buyers
Hello, my name is Marcus Trahan, and I have deep roots in Youngsville. Both my wife and I were born and raised in this area, and we take great pride in raising our three sons here in Acadiana. Honesty and transparency are core values that we hold dear, and we believe in offering fair deals when it comes to purchasing your home.
We buy houses in any condition and under any circumstance. Maybe the home has termites or has fallen into disrepair, perhaps it has become uninhabitable, or you’ve acquired it as an inheritance, and you’re just trying to figure out what to do with it. Whatever the reason and whatever the condition of the home, we want to buy it.
At Redemptive Home Buyers, we are truly passionate about our work, as our main goal is to provide exceptional service to the Acadiana community. Contact us today to receive a fair offer on your home! | <urn:uuid:82a8c1d3-6ecc-40d4-8142-0221a89765bb> | CC-MAIN-2024-18 | https://ibuyhomeslafayette.com/about/ | 2024-04-20T15:36:37Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.978792 | 213 |
Improved OOD Generalization via Adversarial Training and Pretraing
Mingyang Yi · Lu Hou · Jiacheng Sun · Lifeng Shang · Xin Jiang · Qun Liu · Zhiming Ma
Keywords: [ Deep Learning Theory ]
Recently, learning a model that generalizes well on out-of-distribution (OOD) data has attracted great attention in the machine learning community. In this paper, after defining OOD generalization by Wasserstein distance, we theoretically justify that a model robust to input perturbation also generalizes well on OOD data. Inspired by previous findings that adversarial training helps improve robustness, we show that models trained by adversarial training have converged excess risk on OOD data. Besides, in the paradigm of pre-training then fine-tuning, we theoretically justify that the input perturbation robust model in the pre-training stage provides an initialization that generalizes well on downstream OOD data. Finally, various experiments conducted on image classification and natural language understanding tasks verify our theoretical findings. | <urn:uuid:90141ec7-6511-4198-8d99-9d36e2045e2f> | CC-MAIN-2024-18 | https://icml.cc/virtual/2021/poster/10511 | 2024-04-20T17:23:47Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.89186 | 215 |
10 Health Tips Ins that Can Stone The Coming Year
As individuals age, cavities are extra prone to occur. Chewing wears down enamel and receding gums make teeth more susceptible to cavities. As well, each day plaque that builds up and is not eliminated by an expert yearly could cause very critical tooth issues. Older individuals often produce less salvia, which helps wash away bacteria within the mouth. With less salvia, bacteria formation is extra doubtless and can trigger tooth decay. Brittle teeth in older adults is very more frequent due to medications folks have been on over an extended period of time. These medications might end in bone loss, tooth sensitivity and enamel discount.
Often, greatest results can be achieved when planning to start out the implant course of soon after removal of the unique tooth. Work together with your doctor to pick out the very best timing to your process. One of the vital common reasons for dental implant failure is the improper completion of the healing course of.
Brighten enamel that have misplaced their sparkle.
In case you are involved about your look due to your enamel, you might want a cosmetic dentist that can assist you with that. A cosmetic dentist is liable for enhancing a person’s facial features by specializing in the dental attributes of that particular person. You’ll profit from the assistance of a cosmetic dentist if you need to boost your confidence with a stupendous smile. A cosmetic dentist affords several types of treatments. Listed here are some of them.
*Your voice could be sufferer of hoarseness.
It might offend some individuals to suppose their look could influence their job search, but the reality is many companies are on the lookout for someone who is polished and put together through the hiring process. While it is fallacious to guage somebody on how pretty they’re or how shapely their physique may be, it’s human nature and sensible enterprise sense to be happier with an individual who takes care of their appearance and looks nicely put together.
Lexington has a number of nicely-outfitted clinics. Simply because it smells like mint doesn’t imply toothpaste ought to be eaten. Many websites list an array of sensible and logistical knowledge in addition to postings from previous sufferers about their experiences. In dentistry, tooth extraction is outlined as the surgical removal of the tooth from its socket. As compared to other processes, laser whitening is more practical and less damaging. | <urn:uuid:b88201da-359e-4be0-99f8-b4be70199714> | CC-MAIN-2024-18 | https://icyveins.us/10-health-tips-ins-that-can-stone-the-coming-year | 2024-04-20T17:44:25Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.957635 | 502 |
Tramadol is a strong pain medication used to treat moderate to severe pain that is not being relieved by other types of pain medicines. It is a synthetic opioid and works in the brain and spine (central nervous system) to reduce the amount of pain felt by the individual.
Looking for a hassle-free way to buy Tramadol online? Look no further! With our secure payment system, you can purchase Tramadol without any risk. Say goodbye to the stress of worrying about payment security and focus on getting the relief you need. Our user-friendly platform ensures a seamless and safe transaction process, giving you peace of mind every step of the way.
Order Now: ▶▶▶ https://medsrite.com/product-category/buy-tramadol-online/ | <urn:uuid:81f17aa7-f2a5-4be4-aa53-0e3192e60e4d> | CC-MAIN-2024-18 | https://idees.orange.sn/feedbacks/182762-buy-tramadol-online-without-any-risk-of-payment | 2024-04-20T16:31:15Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.902796 | 167 |
Programming Hub Learn Coding Programming Hub Learn to code apk.
40MBProgramming Hub Learn to code apk
Programming Hub for Android Programming Hub Learn to code apk.
The “Best of the Best” for 2017 on Google Play.
Acknowledgable and supported by the Google Launchpad accelerator
All of your programming needs are covered with a massive library of over 5000 programs (code examples), more than 20 courses, and the quickest compiler available.
Is Programming Hub safe to use?
Yes, It’s completely safe to install our app as we value customer privacy and security the most.
Is Programming Hub completely free?
Despite being free, several of the courses on the app need a paid upgrade. But the free courses on their own—which cover anything from artificial intelligence to data analysis—are worth looking into.
Is Programming Hub certificate valid?
Yes, the certificates are legit and cannot be duplicated as each certificate has its unique ID and is signed by the owners of organization.
How does hub app work?
What is the Hub App? It is a tool for managing your get-together invitations for informal gatherings and hangouts with friends, family, coworkers, and all of your loved ones. You may send, manage, vote, and receive invitations with ease thanks to it. Users will have to respond to an invitation by RSVP-ing. | <urn:uuid:4c343237-3140-4b62-893f-c89377cf0e5e> | CC-MAIN-2024-18 | https://igetsintopc.com/programming-hub-learn-to-code/ | 2024-04-20T17:12:27Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.943844 | 287 |
This game will let you enjoy and to spend your time Sam Ur Eye MOD.
Sam Ur Eye MOD A fun and engaging way to pass the time is to play Sam, Ur Eye! (MOD, all unlocked). It can be played against each other or in a proud, lonely manner. The two ninjas you will be controlling will be perched on a slick log. They will all hurl knives at their rival. Your expertise is the biggest thing standing in your way. After all, it’s not always feasible to determine the throw’s exact distance and direction. Although management is easy, it takes some getting used to in order to play a more effective game.
Each of them will throw knives at the enemy, and you must learn to control your character Sam Ur Eye MOD.
most recent games, shows, and headlines. You may download full versions of any apps and games, including MOD games, for free and without registering on this page for your Android device. Since they have all been tested for viruses and functionality, they are all completely safe. Please remember to rate us and leave a comment so that we can better understand your preferences.
You May Also play games on Android & iOS
- Art of War Legions
- FOG MOBA Battle Royale Game
- Merge Monster Truck MOD
- Extreme Jeep Snow Stunts
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If there is a mistake between the description and the downloaded file, please report it to us via the contact section at the bottom of the page.
what is Broken link?
If there is a problem with the broken link, cannot download file, please report to our webmasters. Thank you! | <urn:uuid:86ba60d1-5661-46aa-9da2-642bbe821d0b> | CC-MAIN-2024-18 | https://igetsintopc.com/sam-ur-eye-mod/ | 2024-04-20T16:18:05Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.933294 | 406 |
SPRINGFIELD – To better determine how the COVID-19 pandemic has harmed LGBTQIA+ communities in Illinois, State Senator Mike Simmons (D-Chicago) passed legislation out of an Illinois Senate committee Thursday that would require state agencies and hospitals to gather more specific data on age, sex, disability status, sexual orientation and gender identity when dealing with COVID-19 patients.
Simmons, the first openly gay member of the Illinois Senate, said visibility is the first step to ensuring justice in how services are delivered to these historically marginalized communities.
“For members of the LGBTQIA+ communities, who already disproportionately face challenges in getting medical care or sadly lack the support of family, COVID-19 has the potential to be even more devastating,” Simmons said. “We can’t protect these communities if we refuse to see them.”
The AIDS Foundation of Chicago and Equality Illinois have called for the legislation, citing a lack of routine data collection that has prevented an accurate outlook of the coronavirus’ effect on the LGBTQIA+ community in Illinois. Studies have shown members of those communities are more likely to have chronic conditions and other risk factors that can increase vulnerability to COVID-19. As one example of how the pandemic can exacerbate existing challenges, older LGBTQIA+ people already face higher rates of social isolation.
“The effects of COVID-19 will have consequences for years to come,” Simmons said. “As we mobilize our health care system to respond, it is our duty to leave no community behind.”
Senate Bill 2133 passed the Senate Human Rights Committee Thursday and awaits consideration before the full Senate. | <urn:uuid:e89ddb90-bf94-4c9a-a12d-8310f749a8e7> | CC-MAIN-2024-18 | https://illinoissenatedemocrats.com/caucus-news/74-senator-mike-simmons-news/2114-simmons-moves-to-gather-data-on-how-covid-19-has-harmed-lgbtq-communities | 2024-04-20T17:16:22Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.929885 | 344 |
A Darling Home, neat as a pin, is calling your name. Enter into a spacious living room with high ceilings & formal dining area. The Modern Kitchen with breakfast bar opens up into a cozy family room with gas fireplace. Each sq ft was carefully designed in this wonderful layout of 1733 sqft. The high ceilings follow you through the entire home with unique architectural details. The Main Suite includes a large walk-in closet. Enjoy wonderful evenings in the private low maintenance Backyard with turf & irrigation for front & back gardens. Plenty of room on the side to use for what you'd like. Includes a large shed for your hobbies or outdoor room. New HVAC enhanced for the enjoyment of the home. Garage has lots of storage too! Hurry fast. This CuldeSac home just adds to the delight of a home like this. Wheatland is just a short commute to Roseville, it's worth the drive.
Courtesy: Tami Anderson, Century 21 Cornerstone Realty
Agent Cell Phone: 530-906-8279
Agent License: 01818775 | <urn:uuid:fd1ed2ef-8e1d-4e1a-b749-10106d5b6ad0> | CC-MAIN-2024-18 | https://ilovegoldcountryre.com/homes-for-sale/119-Johnson-Court-Wheatland-CA-95692-311407779 | 2024-04-20T15:47:11Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.909805 | 220 |
Part 1: The Plan!
The plan was always to replace the car: an ugly, 3 litre diesel beast; with a bicycle. I remember, very fondly, my teen years and the bicycle I had. The independence the bicycle gave me then was enormous and I would think nothing of cycling to places 20 or even 30 miles distant. I lived on the South Downs then and there were some serious hills there but there was not a single hill that could get me off my bicycle and force me to walk it!
After moving to Cheshire I immediately started volunteering at Community Recycle Cycles. What a wonderful idea! All those unwanted bicycles spruced up, serviced and sold on, usually for much less than £100. Every week I went in I asked if there was a bike for me, all the time eyeing up the gorgeous Chris Boardman frame that was waiting to be used. Eventually I was offered the frame and I got the opportunity to build my own bike.
We could not find a set of front forks for the bicycle so I bought a pair from eBay and before I knew what happened I was the proud owner of an awesome bicycle, that I put together, from a bare frame, myself! Of course, under the watchful eye of Glyn, the chief engineer and all-round bicycle wizard. Have you noticed that there is nothing quite as satisfying as building something yourself? I believe this is the key to Ikea’s success.
I had built a high performance bike. It is made of superlight alloy and carbon fibre and weighs about 9kg, very light-weight, even the spokes of the wheels are flattened for better aerodynamics. Two cogs at the pedals and 9 cogs on the wheel making a total of 18 possible gears. Admittedly as soon as I got it home I spoilt its performance by adding a pannier rack, mudguards and a new saddle. These extra features, despite their detrimental impact on the bicycle’s performance, are essential. This bicycle is a working machine, not just for Sunday joy rides, hence the panniers. I will be travelling in all weathers and are you aware of how much of any puddle you cycle through ends up over your bum and back? Let me tell you – all of it; hence the mudguards. Finally a new saddle was necessary. I was offered a super-lightweight, narrow racing saddle for this performance bicycle but having some experience I refused this point blank. “Give me an enormous saddle, one suitable for the size of my ass; make sure it has copious padding and I want it with springs too.” Honestly, good people – do not mess with the saddle – most of your weight rests there and every bump in the road will rattle through that tender spot. All this equipment added an extra 3kg to the weight of the bike and, of course, spoiling its aerodynamics and the extra weight is something I will have to push around. It is still a grand bicycle, one to be proud of and would certainly perform excellently.
The performance issues are nothing to do with the bicycle, its components, the additional parts, the construction are all top notch. Sadly the problem is the “engine” – me! Think for a moment of any great cyclist, Bradley Wiggins or Chris Hoy maybe; it doesn’t matter as their build is startlingly similar. Slim men with powerful legs. One look at my physique and your expression will change to one of immediate concern: “Listen, Simon, about this cycling thing, perhaps you should reconsider the idea? I am concerned you will do yourself an injury and frankly that saddle is nowhere near big enough!” Think of my physique as exactly wrong: chunkily put together with skinny legs. Those skinny legs are not just pushing around the 12kgs of bicycle but the additional 100kgs of me!
This “engine” has also seen some wear and tear too, it is not the tightly put together teenage “racing snake” model that you may have seen just over 30 years ago; oh no! This is the model that has been fuelled by cigarettes, alcohol and takeaways for most of those intervening years. This is the model that has been in the IT industry and then a maths teacher because it was “indoor work with no heavy lifting”. This is the model whose exercise was solely achieved between the armchair and car seat and the office chair and car seat. Still, it was a well put together engine those thirty plus years ago, what can possibly go wrong …. | <urn:uuid:f6052ff2-58cf-48b4-a470-46a64fb5eba4> | CC-MAIN-2024-18 | https://imaginalcollective.eco/blogs/me-my-bike-and-saving-the-world/ | 2024-04-20T16:34:59Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.978765 | 945 |
From letters sent to FFI from Jose Cesar Salinas from the Otay Mesa Detention Center. Unfortunately, Jose's current whereabouts are unknown.
I would like to begin by how I ended up in this place. Last year after Mother's Day, I made plans to see my old mom through the border fence at Imperial Beach at a park I know migrants use to see their families. Unluckily, Border Patrol decided to question my status and that's how I ended up here.
In this place me and many others are treated in a way no human being should be treated. The food is horrible. We know it is food but many times we have no idea what they are serving us. They have been serving me the exact same thing for 13 months because I have a special (renal) diet. Unsalted soy bean meat, white rice, lettuce, boiled carrots and bread every day for lunch and dinner. For breakfast it is oatmeal, butter and bread, the same things over and over.
Some of the officers treat us like military recruits. The rooms or cells are freezing, and the faucet is where the toilet is. Some of the officers take great advantage of their position to torture us in many little ways, like leaving us locked in our cells until they are done opening everyone else's, taking forever, and sometimes ignoring our requests. They use us to take care of a lot of duties like laundry, kitchen, cleaning, among other things for $1.00 a day.
I fell in a transportation van and suffered an injury to my back. The officers who drove me to dialysis didn't assist me in getting in or out of the van, and as a result I fell getting off the van. I reported it to the supervisor but nothing was done. To this company, their employees never do anything wrong, and when we file a grievance report it never gets anywhere.
Dear friend, this is only a little of what has happened to me. I've been in detention for 13 months fighting to stay in this wonderful country. I have been dealing with psychological torture from some officers here. It's like they wish we will desist in fighting our case and leave, but they don't care or understand that going back to our countries would mean would mean getting killed by criminals for some of us. I know if I was returned to my country I will die in a matter of days, maybe two weeks, [without] dialysis. It seems that nothing I say or do is good enough for the judges. All they know is deportation, and that's it. Hopefully my petition for a U-Visa gets approved. I am going to ask for a bond hearing in the next month.
Please share my story and if you want more details do not hesitate to contact me. | <urn:uuid:2d78f5f4-d69b-48c0-959e-dc0f06d8013f> | CC-MAIN-2024-18 | https://imm-print.com/a-son-attempts-to-visit-his-mother-at-the-border-and-is-arrested-and-detained/ | 2024-04-20T16:04:24Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.980487 | 571 |
Vaccination Vacation – how the Maldives hopes to boost their economy through a vaccination vacation
The Maldives has suffered significantly due to the border closures during the COVID-19 pandemic. However, through a loyalty programme and their vaccination-vacation concept, the country hopes to rejuvenate its tourism industry.
The Maldives – a paradise on earth that needs no introduction. This small, picturesque country made up of several islands mainly developed for tourists, holidaymakers and famously, honeymooners, has seen a considerable dip in revenue since border closures due to the COVID-19 pandemic. Thus, the Maldives will soon offer tourists vaccinations on arrival as part of the country’s three-pointed initiative to revitalise its struggling tourism industry.
An introduction to the Maldivian economy
In 2009, 42.7% of the local Maldivian population were living on less than $5.50USD a day. In a bid to restabilise the country’s economy, investments and funding by both government and private funders were introduced at a multi-level and multi-industry developments have been made to the little Islands’ in recent years, including improvements to the education and healthcare sectors.
This in turn salvaged the unemployment crisis and restabilised the local economy. Within seven years, the poverty rate decreased to 3.4% and the exquisite country now boasts a close to 100% literacy rate and a life year expectancy of more than 78 years old, according to the Borgan Project.
It is through these huge economic developments; the Maldives has attained the status of an ‘upper-middle-income’ country. With tourism accounting for 21% of the Maldives GDP in 2019 (pre-COVID), it is fair to say that the country depends on the tourism industry greatly.
However, what happens to a country like the Maldives with a pandemic and the untimely occurrence of COVID-19, global travel restrictions and the tourism industry globally shutting down is devastating to its economy.
The Maldives began experiencing the economic consequences of the COVID-19 pandemic early on already in March 2020. After the tourism industry abruptly halted, the border was initially closed until mid-July 2020. Due to the decline in tourism in 2020, gross domestic product dropped to 28%, and the poverty rate increased to 7.2%.
The “3 V” strategy: visit, vaccinate, vacation – How the Maldives is implementing the vaccination vacation to promote tourism
Despite the reopening of travel to the country, only some 18,000 travelers visited the country, unlike the monthly 140 000 visitors pre-COVID. According to Al-Jazeera, a leading global news agency, the Maldivian government pulled out “all the stops” to prompt travelers back into the country for tourism.
These included a quick vaccination roll out for locals, excess stocking up on hospital supplies, safeguarding tourists through the promotion of accessible healthcare and the introduction of a “point” system so that tourists gain value-for-money during their travels.
Described as a “more convenient” way of traveling to the country, the 3V strategy emphasises “visit, vaccinate, and vacation” to attract visitors, Abdulla Mausoom, Tourism Minister of the Maldives, told CNBC.
How does the strategy work?
The country has already fully vaccinated 58% of its own population and with further vaccines coming through via the COVAX system with the World Health Organisation and other donated viles from neighbouring countries like India, the Maldives hopes to be able to secure enough vaccines to fully immunise its population and then vaccinate on arrival, without quarantine any visitors.
The strategy itself is as straightforward as it sounds. To further their bid for more tourist visits, the Maldivian Department of Tourism has also announced the ‘Border Miles’ programme, established to entice tourists to visit more than once. Working on a point system, the programme will award visitors points per entry and in turn, visitors can find themselves enjoying posh holidays at a lower cost. | <urn:uuid:f3599b88-52b7-4596-b764-3ef7de5bb172> | CC-MAIN-2024-18 | https://imm.ac.za/vaccination-vacation-how-the-maldives-hopes-to-boost-their-economy-through-a-vaccination-vacation/ | 2024-04-20T16:59:44Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.949091 | 854 |
Founder and director of the digivolution foundation, Gérald VERNEZ was DDPS cyberdefence delegate. A graduate of a MAS SPCM in security policy from ETH Zurich, he is a former auditor of the IHEDN and followed the courses of the NATO Defense college. He is a recognized expert in cyber defense in Switzerland.
Committed on a daily basis to serving young people, Nicolas Barthe is passionate about the transmission of knowledge, ethical and responsible values. Teacher, educator, military leader, football team captain, writer, graduate of the Université Côte d’Azur, the University of Montpellier, Sciences Po Paris and the IMSG, he is present to take up sporting challenges and
Marie Peretti-Ndiaye holds a doctorate in sociology and is a research associate at the CADISS EHESS Center for Sociological Analysis and Intervention. His work focuses on the manifestations and causes of racism, the links between nationalism and racism, the links between ethnic and racial discrimination and gender, the political sociology of Corsica and disparities and
Olivier Naray helps companies and individuals to communicate and defend their interests to their external stakeholders (authorities, media…) and target audiences. He has specialized in corporate public affairs and strategic external relations. Olivier Naray founded the Blockchain & Politics group. Swiss and multilingual (French, German, Swiss German, English), he previously managed projects promoting SMEs in
Serge VIDAL is a specialist in substantial, international projects, where a complex solution must be built from scratch, taking into account various drivers: costs, performances, risks, operational constraints, local specificity… Such multifaceted projects require a good understanding of many issues : commercial and technical, but also financial, legal, regulatory, logistical, cultural, and even diplomatic affairs. With
Rolin Wavre, professor of compared political systems, has worked for 18 years at the International Committee of the Red Cross (ICRC), and possesses a large experience in international humanitarian operations. He’s also committee member of the Swiss PLR.
Gilles-Emmanuel Jacquet holds Master degrees in Political Science from the University of Geneva and in European Studies from the European Institute of the University of Geneva. Mr. Jacquet specializes in History, International Relations and Geopolitics. His research includes: armed conflicts, terrorism, religious and political radicalism, ethnolinguistic and cultural issues as well as the treatment of religious and ethnic minorities. | <urn:uuid:6ef7533d-33d3-4168-9e3d-c7b23425c7d9> | CC-MAIN-2024-18 | https://imsgeneva.ch/category/geopolitique-et-intelligence-economique/ | 2024-04-20T16:51:00Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.93654 | 509 |
The Count of Monte Cristo is an Indian web series from Mirchi Bangla. The Bengali language web series will release on 28 November 2021. It is available to watch online on the Mirchi Bangla website and app. The web series cast has Gaurav Chakrabarty etc.
The plot is about the mysterious events in a locality. The shocking events unfold around two individuals.
The Count of Monte Cristo Cast (Mirchi Bangla)
- Anirban Bhattacharya
- Gaurav Chakrabarty | <urn:uuid:5d96eb6e-d057-44f9-95dc-26fa9262d202> | CC-MAIN-2024-18 | https://indiantalents.in/the-count-of-monte-cristo-web-series-mirchi-bangla-cast-crew-release-date-real-names/ | 2024-04-20T16:04:10Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.894445 | 110 |
It’s time for you.
Mental health support that fits your life.
University of Saskatchewan is pleased to provide MindBeacon's confidential mental health support for faculty, staff and family.
We’ve structured payments for Guided CBT Programs + Insights into multiple, smaller payments to allow you to maximize your insurance coverage:
• Assessment Diagnostic call: $225
• Assessment Report: $125
• Guided CBT Program: 3 payments of $150. The first invoice is sent after you are onboarded and treatment has started. The remaining two invoices are sent every two weeks.
Total Price: $800
Accessing MindBeacon support is easy
- Access to MindBeacon’s Virtual Mental Health Clinic offering a full complement of mental health supports
- Evidence-based, high-quality care that can be accessed from anywhere
- Free mental health wellness content including our e-newsletter, articles and online events.
- Unlimited access to your account including therapist messages, content and more.
MindBeacon Virtual Therapy Clinic
Guided CBT Programs
Your therapist guides you through a CBT program of readings and exercises, to help you improve your resilience.
Price: Covered by University of Saskatchewan.
Book a video or phone session with a therapist you choose – appointments typically available next day!
Price: First 3 sessions covered by University of Saskatchewan.
Subsequent sessions may be reimbursable under your paramedical health benefits through Sunlife. Additional sessions: from $130/hr.
Peer to Peer Support
Peer-to-Peer Support, powered by TogetherAll, is an online community that provides a safe and anonymous place to share.
Price: Covered by University of Saskatchewan.
Trusted. Proven. Approved.
What people are saying about MindBeacon
Our therapists are rated 4.9/5
I wouldn’t be where I am today without this program. Traditional therapy approaches weren’t constant enough for me to work towards change. MindBeacon made me feel safe knowing I have my therapist and the tools right at my fingertips.
I found the flexibility most appealing as I didn’t have to sacrifice taking time off from work for therapy. Messaging and going through the exercises with someone to guide me made it successful.
My therapist has been so supportive, and I appreciate her time and thoughts. I’m looking forward to learning more and feeling better about things.
Even if I suffered a setback my therapist helped identify different things I could do when I felt distressed. I also really appreciated how they gave me ideas for when I felt triggered by something.
I've really gained more confidence in my abilities to tackle different solutions. And my therapist has given me motivation and positive reinforcement along the way. It’s all having a positive impact on me.
Thank you for providing this lifeline to me – it’s helped in ways I didn't expect. That includes feeling like I’m functioning well in my everyday life despite my physical limitations.
I've learned so much and felt my therapist supported me the whole way. I’m very thankful to have been paired with her.
Due to confidentiality we don't share MindBeacon client identities
Develop skills to help you thrive
Cognitive behavioral therapy (CBT) is one of the most effective forms of therapy. With MindBeacon you experience CBT at your own pace and on your own schedule, with your dedicated therapist guiding you throughout. Our program content includes readings and exercises that have all been developed by clinical experts to help you develop the skills you need to thrive. You can access the program when and where it suits you, and send messages to your therapist when something is on your mind. Your therapist will get back to you within 1 business day.
How Guided CBT Programs work
What questions do you have?
MindBeacon Guided Programs are available to all Canadians, age 16 years or older. Guided Programs can help you tackle a wide range of issues, including depression, anxiety, panic, PTSD, stress and many other concerns that impact your well-being. But MindBeacon IS NOT a crisis service. If you’re ever in crisis, please phone ‘911’ immediately or visit your nearest hospital emergency room. Your safety is absolutely the most important thing to us.
It starts with your assessment, to better understand the issues and challenges you’re facing. From there, we create a unique treatment plan and assign a dedicated registered therapist to oversee your progress. Each time you visit, you’ll have readings, activities and check-ins that will help you develop new skills and let us better understand how you’re progressing. Remember: Your therapist will always be there for you throughout the process via messaging.
You are paired with one therapist for the duration of your Guided Program, and they are dedicated to your progress from beginning to end.
Your therapist will tailor a course of therapy based on your unique needs, selecting readings and activities that will help you develop new skills. As you work through the activities, your therapist will review your progress, provide encouragement and advice, as well as new perspectives to consider. You interact with your therapist via secure messaging through the MindBeacon digital therapy platform, and they will always respond within two business days.
Every Guided Program is personalized and unique. Your therapist will provide a tailored and progressive set of readings and activities for you over the course of your therapy – things like learning worry management and relaxation techniques, exposure activities or thought records. The main goal for all these activities is to reflect on what you’re thinking, doing and feeling, and then help you learn strategies to help change these cycles for the better.
Yes – you get your own therapist, who will be dedicated to you throughout your care, and who will tailor your program from start to finish. MindBeacon therapists are registered mental health professionals who are experienced in providing CBT treatment online.
We’ve got a therapist who’s right for you
MindBeacon offers an extensive roster of licensed therapists. With a broad range of backgrounds and specializations, you can easily find a therapist suited to address your unique needs. And, you can book either a video or phone session, next day (vs month-long waiting lists elsewhere).
How Live Sessions Work
What questions do you have?
Live Sessions are virtual sessions that allow you to speak with a therapist at a dedicated time through video or phone. You can select a therapist who’s right for you, schedule a time that works for your schedule, and get started using their favourite device. Live Sessions provides personalized care to help with a wide range of mental health concerns and allows you to talk one-to-one with a therapist of your choice on a secure platform. It’s great for those who prefer to talk to someone and have a conversation face-to-face or over the phone.
All sessions are booked as 60 minutes, which includes 50 minutes of treatment and 10 minutes for clinical documentation.
During the first session, the therapist will try to get to the heart of why you’ve chosen to seek help and will ask about the challenges you’re facing. If the therapist believes that the services we offer are a good fit, they’ll discuss a potential treatment plan. (A second session may also be necessary to properly determine next steps.) We refer to this as an assessment. The assessment is customized based on the your needs and the therapist’s assessment structure, which follows evidence-based practices. It may consist of an interview, self-report measures, discussion of your concerns/goals, and next steps. It’s an opportunity for you to share more about your challenges, issues, background and history and understand expectations for therapy and your treatment plan.
Everyone is different. There's no one-size-fits-all answer to that. The therapist will work directly you to let you know what to expect. An individual may need 6-15 sessions in a typical treatment plan, but the number of sessions vary based on the individual’s needs.
You start by creating a MindBeacon account (or logging in if they already have one). From there, you will see the Live Therapy option directly in their account homepage. After clicking on that option, you can indicate the concern they are looking to address and will then be provided with therapist profiles and availability to choose from and book a session.
Therapists enter in availability 7 days per week between 8 a.m. and 9 p.m. in their respective time zones, with variances depending on therapist schedules per province.
Peer-to-Peer Support, powered by Togetherall.
Togetherall is an online community that is clinically moderated by mental health professionals. It provides a safe and anonymous place to express your thoughts, concerns, and triumphs.
How Peer-to-Peer works
What questions do you have?
Togetherall is a digital mental health support service which is available online, 24/7, and is completely anonymous so you can express yourself freely and openly. Professionally trained Wall Guides monitor the community to ensure the safety and anonymity of all members. In addition to Togetherall's online community, you will have access to a wealth of useful resources and can work through tailored self-help courses covering topics such as anxiety, sleep, weight management, depression and many more.
Togetherall offers a range of activities that allow you to work through what's troubling you. Access an anonymous community of support available from members 24/7. Share your thoughts and join a Talkabout alongside fellow members to share and discuss what's on your mind and gain support and advice. You can post a Talkabout to the whole community or form your own groups or one-to-one chats. If you prefer to express yourself and your feelings creatively, you can post a Brick by drawing or uploading your own images.
You can also find more information in Resources to help you understand more about how you are feeling, set goals, and track your progress. Take self-assessments to help you understand more about yourself or join our Courses with others to learn how to manage everything from depression and anxiety to improving your problem solving and avoiding procrastination.
Anything that is causing people emotional or psychological distress: This can include anxiety, stress, feeling low and depressed, feeling out of control, trauma; all of which may be triggered by life events such as the loss of a loved one, relationship breakdowns, employment related issues, financial worries, sexuality, isolation, alcohol or drug related problems.
Are you in crisis?
If you are at immediate risk, call 911 or visit your local emergency.
To access crisis services, please see below:
Canada and USA
- National Suicide Prevention Lifeline at 1-800-273-TALK (8255)
- Canada Suicide Prevention Service toll free 1 833 456 4566
- Text START@45645
- Quebec (Suicide Action Montreal (SAM)) 1 866 277 3553
- Kids Help Phone 24/7 1 800 668 6868
- First nations and Inuit Hope for Wellness 24/7 Help line 1 855 242 3310
- Trans LifeLine 1 877 330 6366 | <urn:uuid:1cd90585-0e25-49d2-af64-03f93c914fca> | CC-MAIN-2024-18 | https://info.mindbeacon.com/access-mb/usask | 2024-04-20T17:13:28Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.945096 | 2,342 |
Cyber Liability Insurance Solutions
Measure, benchmark and reduce cyber risk using proven best practices. Our cyber insurance solution enables both covered clients and the insurers that cover them to easily understand and reduce cyber risk.
Insurance Providers and Broker
Measure and Reduce Cyber Risk for Clients
ComplianceShield enables insurance providers and brokers to easily measure and reduce cyber risk across their entire portfolio. Using our Cyber Risk Score ™ clients can measure their cyber program maturity and quickly identify gaps. Insurance provider dashboards provide real-time visibility into the true cyber security maturity of your clients.
Learn more about our Cyber Insurance Loss Mitigation for Insurers and Brokers.
Covered Clients Seeking Cyber Liability Insurance
IT Security Made Easy with ComplianceShield
ComplianceShield enables any business to quickly define, deliver and demonstrate a robust information security program. Using a simple, wizard-driven software system, clients can get the policies, training and documentation they need to demonstrate cyber risk program. ComplianceShield replaces months of manual effort using spreadsheets and expensive consultants with a simple software solution.
Learn more about our Cyber Insurance Solution for Clients seeking insurance. | <urn:uuid:b39cc78b-b013-406e-81be-5d2828fc688a> | CC-MAIN-2024-18 | https://informationshield.com/cyber-insurance-risk-management/ | 2024-04-20T16:22:03Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.877147 | 232 |
The Beauty Revolution…
Check out my homegirl and fellow blogger, Patrice Yursik, on TheRoot.com today as she waxes poetic about her previous life as a Miami New Times entertainment editor and the changing relationship between Corporate America and black women. So happy to see larger media outlets continue to recognize and embrace thought leaders in the blogosphere. Much love and respect to Patrice for paving the way!
“I have no hard feelings toward corporate America, I just couldn’t ever be a part of it. I think we’re in a time where individuals have power. The existing structures are crumbling and it calls for ingenuity. So I’m seeing lots of black women start their own side hustle. I’m seeing lots of women who have been laid off or are actively job hunting, find ways to bring home the bacon by freelancing and moonlighting and stepping out in faith to control their own destinies. It’s been a slow, steady change but it’s remarkable and very inspiring.” | <urn:uuid:27d3d057-9c69-4ac6-832d-978f5b29c7b2> | CC-MAIN-2024-18 | https://inhershoesblog.com/the-beauty-revolution | 2024-04-20T15:42:15Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.926546 | 218 |
Take a look at some of our latest Projects
The appearance of your lawn reflects how you feel about your home. Innovation Home Improvement artificial turf installation services in Las Vegas can help bring out the best in your lawn. We treat every lawn as if it were our own.
You want a lawn that stays thick, green, and healthy all year long… and we do, too. At Innovation Home Improvement, we care about the results we deliver, and we care about our customers’ satisfaction. Many of your neighbors have come to rely on our professional approach and personal service. Our artificial turf installation team in the Las Vegas area can also install your very own putting green! | <urn:uuid:a7ae7b2b-a2c9-4847-9879-c47fa86821fa> | CC-MAIN-2024-18 | https://innovationhomeimprovement.com/services/turf-installation/ | 2024-04-20T15:54:30Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.959684 | 135 |
Christine Wormuth will testify May 13 before the Senate Armed Services Committee on her nomination to become the next Army secretary.
If confirmed, Wormuth will be the first woman to serve as the service’s top civilian and will be front and center of the Army’s ambitious modernization efforts.
She is currently the director of the RAND International Security and Defense Policy Center and previously held positions as the under secretary of defense for policy during the Obama administration and senior director for defense policy on the National Security Council. She joined the Obama administration in 2009 as the principal deputy assistant secretary of defense for homeland defense and civil support.
If confirmed, Wormuth will replace John Whitley, who is currently serving as the acting Army secretary. | <urn:uuid:7b51faba-7ef0-4b2d-a472-9e2350d84683> | CC-MAIN-2024-18 | https://insidedefense.com/insider/wormuths-nomination-hearing-set-may-13 | 2024-04-20T16:12:06Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.961517 | 148 |
In the new trailer for Marvel Studios’ The Marvels (2023), viewers got a glimpse at the film’s new villain. And fans of the Marvel Universe may be surprised at who it is.
Nia DaCosta directs the Marvels and finds Brie Larson’s Captain Marvel, AKA Carol Danvers, powers getting mysteriously entangled with Teyonah Parris’ Captain Monica Rambeau and Iman Vellani’s Kamala Khan, AKA Ms. Marvel. The trio must work with Nick Fury and each other to solve this mystery and battle a new Kree menace.
That menace is played by Zawe Ashton, an actress who is most well-known for her performances in Velvet Buzzsaw (2019) and Fresh Meat (2011-2016). Ashton’s casting signifies a massive and welcome change to the original character.
‘The Marvels’ Gender-Swapped Villain
Zawe Ashton will play Dar-Benn, a Kree revolutionary who wields the same weapon as Ronan the Accuser. She’s accompanied by Ty-Rone, played by Daniel Ings. Both are trying to fill the empty throne left by Captain Marvel, defeating the Supreme Intelligence.
This signifies many changes to the original character, including his weapon, motivations, and gender. That’s right, Dar-Benn was originally a man in the comics.
Originally, Dar-Benn was a general who overthrew the Kree emperor Clumsy Foulup with his co-conspirator Ael-Dan, who Ty-Rone has replaced. They did this by creating a robotic Silver Surfer that murdered the previous emperor and framing the Skrull for the assassination.
While there will undoubtedly be people complaining about these changes, it should be noted that both characters are incredibly minor villains who died during their second appearance in Marvel Comics. There are bigger plans for Dar-Benn and Zawe Ashton in the Marvel Cinematic Universe.
What do you think of these massive changes? Let Inside the Magic know in the comments down below! | <urn:uuid:24347675-a966-4c43-8662-f7d2b3400437> | CC-MAIN-2024-18 | https://insidethemagic.net/2023/04/disney-confirms-major-change-marvels-villain-captain-marvel-cinematic-universe-kamala-khan-jh1/ | 2024-04-20T16:52:29Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.95146 | 438 |
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Its next few days of your own NCAA Competition and therefore mode Nice 16 action on the West Part is on all of us since the the new SEC knots to the Large Ten around away from Angels. The newest seventh-seeded Texas A good&Meters Aggies race the 3rd-seeded Michigan Wolverines for the right to progress to your Elite Eight Thursday evening. Colorado A&M cutting-edge because they surprised 2nd-seeded North carolina Week-end afternoon.
The newest gaming program has Jeetwin BD gambling establishment where you are able to play more desired-once online game. There is games blogs of team including Progression Gambling, Betgames, TVBet, PlayTech, SABA, Pragmatic Enjoy, EBet, HRLive, and you will Ezugi. Jeetwin Bangladesh now offers its people a huge number of other activities. Do not disregard one to Jeetwin is actually an authorized gaming platform. Consequently you will want to go through account confirmation. This procedure is required for everybody professionals because the, inside law, you should know all the participants. | <urn:uuid:8e92168a-ace1-4355-8e87-6357bf639594> | CC-MAIN-2024-18 | https://insightvisainternational.com/jeetwin-on-line-casino-and-you-will-triple-magic-casino-gambling-in-the-bangladesh-jeet-earn-2024/ | 2024-04-20T17:02:21Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.936698 | 1,003 |
The word inventory is one that is floated about very commonly in business sectors—it actually represents the goods and material that a company stocks in order to make them available to customers.
An Inventory Management is a must as it helps to streamline, track and manage the inventory so that goods and stock can be replenished and always remain available to consumers. Inventory is tracked not only by quantity but also by batch numbers—this is in the case of perishables that have expiry dates. In a nutshell, inventory management utilizes people and equipment optimally and coordinates activities within the organization and communicates with customers.
Inventory management systems are pretty useful when it comes to tracking, optimizing inventory levels and also accounting for the cost of inventory. Given the nature of today’s quicker production cycles and increase in products, such systems are even more essential.
They are useful even for small businesses and vendors, who are responsible for keeping products always stocked so that customers don’t go away disappointed.
The concept of inventory management systems is not a new one but it was only in the late 1990’s that retailers started using inventory tracking software to track sales and also to cater to seasonal demand. Managers get the real picture of what’s exactly happening out there and help them make decisions.
By using inventory management software, businesses can optimize their inventory management and this not helps reduce and control costs but also helps in accurate accounting. Together, all of this increases the efficiency, generates growth and increases profits. Thus any organization that manages a supply chain should benefit from such a system.
In the larger analysis, it’s easy to understand why an inventory control system is significant. Inventory control implies an understanding of what you have, where your stock is going and how much you need. Put simply, it means maintaining the right balance of stock —not more nor less. When you have control over inventory, you know what’s selling and what’s not, what satisfies customers and what they want. Inventory control software helps you manage inventory levels and get a grip on inventory operations.
Needless to say, inventory management is linked with your supplier for you have to plan, forecast and manage inventories only by working with them. This is where supply chain management software could be really very handy not only for retailers but also for wholesalers and distributors. A good supply chain management system can handle complex supply chain challenges while offering cost-effective, low-risk solutions that optimize and automate operations across the company.
A comprehensive supply chain management software most often includes inventory management, manufacturing, and purchasing capabilities that help inventory levels to be maintained. When this happens inventory can be moved to where it is needed – when it is wanted without incurring high costs.
No wonder then that inventory management and supply chain management systems are in such great demand!
One of the unique services that Seo Insights offers is inventory management.
We can help your supply chain process by helping you manage your inventory. Whether you’re a manufacturer, wholesaler or distributor we can help get your product to market using our Ecommerce tools.
The benefit of our inventory management tool is that you can create different pricing for different vendors or retailers of your supply chain process.
It’s important to work with a website company that understands logistics, finance, and how it all ties into the website that’s showcasing your product.
We know what platforms work best for app integration and how to sync and best utilize the tools needed to manage your supply chain as smooth as possible.
Work with us and let us help you maximize your efficiency. | <urn:uuid:23936452-deb5-47e2-a768-f38efb1904f2> | CC-MAIN-2024-18 | https://insigniaseo.com/inventory-management-system/ | 2024-04-20T17:26:03Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.950326 | 736 |
Euro Zone Inflation Expectations Tick Up in ECB Consumer Survey
In a recent survey conducted by the European Central Bank (ECB), consumer expectations for inflation in the eurozone over the coming years have shown a slight increase. This development is likely to fuel concerns that the decline in price growth may not stabilize within the ECB’s target range.
ECB’s Ongoing Rate Hikes Amid Economic Uncertainty
The ECB has been consistently raising interest rates at its past nine meetings, bringing them to a more than two-decade high. However, the current economic landscape has prompted policymakers to reconsider their approach, given the rapid deterioration in the growth outlook and the increasing fear of a recession.
Inflation Expectations on the Rise
The ECB’s Consumer Expectations Survey revealed that inflation expectations for three years ahead rose from 2.3% in June to 2.4% in July, surpassing the ECB’s 2% target. This uptick is noteworthy as it contrasts with the trend of declining inflation expectations seen since spring.
ECB’s Outlook and Market Sentiment
The ECB’s own projections foresee a sharp drop in price growth for the current year, followed by a slower disinflation process in 2024. Some policymakers even caution that the “last mile” of disinflation may be protracted, potentially leading to a resurgence in price growth that exceeds the target.
However, market-based expectations suggest longer-term inflation rates of around 2.6%. This divergence underscores investors’ skepticism about the ECB’s willingness to take sufficient measures to mitigate inflationary pressures.
Economic Sentiment and Projections
Despite the uptick in inflation expectations, consumers continue to anticipate economic contraction. Growth expectations for the next 12 months were revised downward from -0.6% to -0.7%, as reported by the ECB.
Unemployment expectations remained unchanged, though respondents anticipated slightly slower nominal income growth. The ECB noted that the decline in expected nominal income growth was primarily driven by respondents in the lowest income quintile.
As of now, financial markets perceive only a 25% chance of a rate hike on September 14th. Nonetheless, they anticipate a 25 basis point increase to 4% by year-end, preceding potential rate cuts expected to commence in mid-2024.
Stay informed as the ECB navigates a complex economic landscape, with inflation expectations and growth projections shaping their monetary policy decisions. | <urn:uuid:c0e7a0dd-262f-4b72-8f5c-dc4c8c1d08c3> | CC-MAIN-2024-18 | https://instantnewsupdate.com/ecb-survey-reveals-rising-inflation-expectations/ | 2024-04-20T16:43:09Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.937557 | 497 |
/Institute of Coding Summer School
Come and learn coding online from the Exeter Coding Summer School
The University of Exeter is running a coding summer school, supported by the Institute of Coding, in June and July 2020.
This year the summer school is offered online and will be operating within an online classroom so that we can create the same friendly collaborative atmosphere as for our face to face summer school of previous years.
The summer school will be run over 3 separate weeks and focusses on:
- Coding bootcamp (22nd – 26th June)
- Social data analytics (29th June – 3rd July)
- Machine learning and AI (6th – 10th July)
The summer school includes guest lectures from industry and sector specialists from within the wider University.
The summer school provides an introduction to coding and is open to all UK university students who do not have experience in coding or computer science. You do not need any experience to attend the summer school, except that for week 3 it would be helpful if you have some basic coding knowledge, or have attended week 1.
If you are interested to attend, sign up now to register your interest. The deadline for applications is 10th May 2020.
The cost of attending is only the registration fee and is payable only once you are offered a place on the school. | <urn:uuid:cf853218-0322-4d58-b520-0e2853452d1b> | CC-MAIN-2024-18 | https://instituteofcoding.org/events/institute-of-coding-summer-school-2/ | 2024-04-20T16:18:02Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.965136 | 278 |
What does Integrate offer you?
Integrate offers individual opportunities for growth and competitive benefits for full-time employees including:
- Ongoing learning and development programs
- Medical, dental, vision and life insurance
- Wellness programs
- Retirement plans (with match)
Join our team
Interested in growing your career at Integrate? We’re always looking for innovative problem solvers who can help us deliver the best building solutions for our clients. | <urn:uuid:3e347d5a-6977-486f-8ccc-e7b32aa36d38> | CC-MAIN-2024-18 | https://integratecp.com/careers/ | 2024-04-20T15:46:26Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.946091 | 94 |
The Future of Pharma’ series, Part 3 - How leading IT projects in the pharma industry requires a unique set of skills and considerations. Here are our top 3 IT project management considerations for success:
1. Understand regulatory compliance: The pharmaceutical industry is highly regulated, and IT projects must follow strict compliance requirements. Familiarisation with various regulations such as Good Clinical Practice (GCP), Good Manufacturing Practice (GMP), and data privacy laws (e.g. HIPAA) is a must. Ensure that project teams, vendors and suppliers, understand these regulations and that sufficient time and effort are built into plans to cover the specifics.
2. Engage stakeholders and cross-functional teams: Projects in pharma often involve various stakeholders, including business users, developers, plant operators and IT application professionals. Engage with all relevant stakeholders from the beginning to understand and document requirements, expectations, and constraints. Promote continuous collaboration to ensure alignment and effective mitigation of risks. Open and transparent communication will help to build trust and increases the chances of overall project success.
3. Prioritise data security and privacy: The pharmaceutical industry deals with sensitive employee and patient data, as well as valuable intellectual property. Protecting data and privacy is extremely important, so implement robust security measures, encryption, and data backup protocols. Ensuring compliance with data privacy regulations, such as GDPR, is also essential. Complete regular security assessments and audits to identify potential
vulnerabilities as proactivity is key to safeguarding data.
Additionally, it's crucial to establish effective change management processes, complete thorough risk assessments, and to leverage IT delivery methodologies like Waterfall or Agile. The ever-evolving technology and regulatory landscape in the pharmaceutical industry requires delivery managers and teams to stay updated on trends and best practices.
The Future of Pharma: Part 3
What are the top 3 considerations for IT project success?
Published by: Integrity
14 Feb, 2024
3 minute read | <urn:uuid:9228dc2c-0111-4b2b-9035-e607b99e8699> | CC-MAIN-2024-18 | https://integrity.net/news/future-of-pharma-3 | 2024-04-20T15:42:54Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.91943 | 398 |
March Madness tips off this week. The fan in you is excited, but the business owner in you is cringing: While the tournament is all fun and games (literally), you know the bracket buzz and non-stop play time will seriously cut into your employees’ productivity.
This brings us to blocking. No, not shot blocking. Program blocking. When it comes to improving employee productivity, what should you block on work computers?
We don’t think you should block March Madness. (Bet you didn’t see that coming.)
Although it is true that the games can result in lost work time, we’ve suggested in the past that you embrace March Madness, and we’re sticking to it. Allowing employees to watch the games can increase employee morale (and that’s a big win for everyone on your team!) You can read more about our reasoning here.
As far as lost productivity goes, we’re here with the assist. (See what we did there? Okay, we promise we’re done with the basketball puns.) Our friends over at Time Doctor put together an infographic about wasted work time, so let’s take a look:
So, with March Madness in, what’s out?
That’s up to you.
Commonly blocked sites include:
*Some businesses require social media sites for their operations so completely blocking the sites isn’t always an option. If you’d like to deter improper use, we suggest including the prohibition of unauthorized blogging and non-work related social networking in your employee handbook.
A few things to keep in mind:
-Be sure employees are aware of your internet usage expectations (your employee handbook is the best place to do so)
-Let employees know immediately of any policy changes regarding their Internet access
-Update your employee handbook with any changes as well
-If you choose to use website-blocking software, include in your employee handbook that you reserve the right to utilize the software to identify and block access to sites violating company policy
If you need help putting together such policies in your employee handbook, we can help. | <urn:uuid:37a086ef-8b75-4f4d-a1a2-aaa4a005f9de> | CC-MAIN-2024-18 | https://integrityhr.com/hrblog/march-madness-social-media-block-work-computers/ | 2024-04-20T17:48:23Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.947132 | 450 |
Click on the photo to watch a short video on the Brain Science of Sex Addiction. Lorraine is an APSATS-trained therapist and is training with Carol the Coach to get her Early Recovery Coupes Empathy Model (ERCEM) certification in 2023.
Ready to embark on a journey of healing and personal growth? We're here to support you every step of the way. Fill out the form below to schedule a consultation and begin your transformation. Let's navigate life's challenges together and create a brighter future. | <urn:uuid:6b761108-d46e-4478-80cf-5b26a95d4bcd> | CC-MAIN-2024-18 | https://intimatemattersllc.com/resources/brain-science-of-sex-addiction | 2024-04-20T16:15:39Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.903983 | 105 |
Recently, we introduced the PurVue Analyzer™ feature for the SV6E-X Mid Frequency Digital Test Module. This feature is a completely embedded real-time oscilloscope that works closely with the protocol analyzer and exerciser cores to enable incredibly sophisticated measurement features. One of the main reasons we created this real-time oscilloscope was to help our customers debug the complex I3C protocols. We recognized that engineers needed an oscilloscope, but we also recognized that conventional benchtop oscilloscopes were not going to do the job. Read on to learn why!
Probes Are Antennas
One of the most frustrating aspects of using conventional benchtop real-time oscilloscopes is the need to attach active probes to signals being measured. Whether engineers know it or not, every time they attach a wire (such as an active probe) to their system, they are creating an antenna! And this antenna not only confuses the measurements, but it can also affect the protocol analyzer transitions that they are trying to debug in the first place. Referring to the figure below, two oscilloscope screens are shown, and they both show the typical “probed” waveforms that engineers must grapple with. Namely, some of the ringing in these digital waveforms is due to the system under test itself, but some is completely extraneous! For example, the highlighted areas are radio frequency spurs being “picked up” by the antennas created by the probe. These are most likely due to neighboring WIFI or cellular signals on the engineers’ own smartphone.
Most engineers get confused by these signal artefacts, and it takes experience and further debugging to isolate them. More importantly, these signal artefacts often make it difficult to make proper electrical measurements for the purposes of characterization.
On the other hand, by embedding the real-time oscilloscope into the SV6E-X, we completely eliminated the need for an extra set of probes. The result is much more pristine waveforms as shown in the following figure.
The top waveform is the SDA line measured using the PurVue Analyzer, and the bottom waveform is the same signal that is simultaneously probed using a conventional real-time oscilloscope. As can be seen, the external scope measurement exhibits way more noise.
General Purpose Probes Are Not Always Accurate
Because of their general-purpose nature, sometimes active probes do not always perform in an ideal way for all applications. For example, a high-frequency active probe is often optimized for low-impedance systems, and it might struggle when measuring an I3C signal. Referring to the figure below, we see the same signal measured simultaneously using the PurVue Analyzer and a conventional benchtop real-time oscilloscope. As can be seen, the PurVue Analyzer has a flatter response and generally produces a more accurate representation of the signal under test.
Exact Time Correlation With Protocol Data
Finally, the PurVue Analyzer is a real-time oscilloscope that works in conjunction with the internal protocol analyzer of the SV6E-X. This means that it provides exact time-correlated measurements between the analog domain and the digital domain. This is by far the easiest way to debug an I3C system.
In our quest for providing the best user experience for our customers, we recognized that we had to create a real-time oscilloscope. More importantly, we recognized that we had to make this oscilloscope work seamlessly with the rest of the SV6E-X Mid-Frequency Digital Test Module. The result was the highly innovative PurVue Analyzer! | <urn:uuid:df709ada-7d2f-400e-aa19-e16aaed09acd> | CC-MAIN-2024-18 | https://introspect.ca/blog/why-we-embedded-a-real-time-oscilloscope-inside-our-sv4e-i3c/ | 2024-04-20T18:27:08Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.943453 | 750 |
Celebrating Corvette's overall back-to-back class wins at the 2002/2003 24 hours of LeMans, Chevrolet produced a special edition Corvette Z06 for 2004 known as the "24 hours of LeMans Commemorative Edition". This special edition Corvette was painted in the same hue of LeMans Blue as the C5R race car and featured matching silver stripes with red accents. The emblems front and rear were modified to show the two GTS class wins at LeMans. The wheels were polished aluminum to add some visual excitement and wrapped in Goodyear Eagle F1 supercar tires. Not just a stripe package, this special Z06 featured a carbon fiber hood that weighed just 20 pounds, some 10 pounds less than the standard fiberglass reinforced unit. This was the first use of carbon fiber for a major body panel on a mass produced automobile, another Corvette first. Inside is a black leather interior with all the power accessories you would expect. Power windows, locks, mirrors and seats with two person memory are all here. Now add to that a driver information center that can display fuel mileage and digital guage readouts along with tire pressures, and a snazzy fighter jet based heads up display to keep you informed without ever taking your eyes off the road. This is one driver oriented vehicle, but not to say the passenger is forgotten. There is dual zone automatic climate controls and a premium Delco BOSE stereo to keep your passenger comfortable and relaxed, even while you roast the tires off or pull 1g in cornering!! Under the hood of this blue streak is where the magic happens, and that comes in the form of GM's legendary LS6 V-8. Producing 405 horsepower and 400 ft. lbs. of tire smoking torque from only 346 cubic inches, this powerhouse far exceeds the vaunted 1-to-1 horsepower to cubic inch ratio without any form of forced induction or variable valve timing. This all aluminum pushrod V-8 loves to pull all the way to redline, and never runs out of breath. All this power is routed through a 6 speed manual transmission because real race cars have manuals, and nothing feels as good as a beautifully weighted clutch pedal and a rifle bolt smooth shifter in the palm of your hand. Brakes are monster discs at all four wheels and suspension is independent with transverse leaf springs front and rear. The exhaust noise is lustful, and makes the Delco Bose sound system completely unnecessary! This beautiful one owner 6,000 original mile example is as close to new as you're going to come. Having been garage kept and lovingly cared for by it's collector owner, this beauty needs absolutely nothing!! This is the 1967 427ci coupe of the modern era, the ultimate edition of the ultimate C5 Corvette. Act now and put this beast in your garage, call Brian at 352-307-1968 or email [email protected] today!!
FEES & TAX INFORMATION - We are a licensed dealer in the State of Florida and adhere to all state and federal laws and regulations concerning the sale of a used vehicle. All applicable taxes and fees will be charged accordingly as required by the State of Florida. A fee of $495.00 will be charged to process the vehicle. | <urn:uuid:03885c5b-2b08-43a8-988d-cc27ee0f3173> | CC-MAIN-2024-18 | https://inventory.burnyzz.com/legacy/view/11019 | 2024-04-20T17:20:49Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.942584 | 664 |
In September 2019, the third edition of the Legal Design Summit (#LDS2019) took place in Helsinki, Finland. With its six hundred participants from all around the world, #LDS2019 was the largest legal design event so far — and the first event of its kind that the InvestCEE professional designer team attended. It provided us with plenty of insights and inspiration about this exciting new field. In this post, we share the three key takeaway notes from #LDS2019 from our designer Forián-Szabó Ferenc.
#1 Let’s bring design theory into legal practice
While legal innovation trends generally recognize the pain points in current legal processes, design thinking methodology enables lawyers to solve those challenges in practice. Design is by definition human-oriented and designers are skilled at creating user-friendly tools and processes — this knowledge only needs to be adapted to legal context. While design and technology are in many cases already available, it often requires courage to apply them in practice.
Legal design offers a great opportunity to explore ways to create better legal processes.
#2 Let’s increase user experience in legal context
Design thinking should be more than a well sounding term: we should make efforts to truly connect design methodology and legal services. It seems that the main principles along which designers think are mostly missing from the current legal processes. Take for instance the contracting workflows in organizations. From a designer’s perspective, there are good arguments in favor of simplifying contract life cycles, enabling flexible drafting via technology tools or considering the data hierarchy to prevent value leakage.
Legal design aims to increase the user experience in legal context, which is a much needed addition to current legal services.
3# Let’s open up towards diversified professional services
It is not possible to innovate professional services exclusively through internal inputs — openness to new approaches is essential. Diversity of thought in legal services, however, is not that easy to achieve. In legal design context, it requires flexibility and enthusiasm from both legal professionals and designers, while we also need to take account of technology tools available for legal professionals.
Innovative services building on legal design should be a combination of law, design and technology.
Interestingly, the participant ratio at the #LDS2019 was approximately 75% lawyers and 25% designers. For our team at InvestCEE, this meant that increasingly user-centric legal services need more designers on board. Essentially, innovative legal services need to make sure that design thinking is put to practice in client context. How is this possible? Through successful client projects that find the right balance between law, service design and technology. We at InvestCEE are eager to explore this intersection of diverse professions. | <urn:uuid:dbb85745-9592-476d-9f4e-73d657ecb737> | CC-MAIN-2024-18 | https://investcee.hu/legal-design-summit-investcee-notes/ | 2024-04-20T17:02:57Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.943754 | 552 |
Who are they?
The Ita Wegman Institute in Moscow was founded in November 1993 as the first training center for curative pedagogy and social therapy in Russia. In January 2001, a collaboration with the Moscow City Pedagogical University was established. This means that the students receive a diploma, recognized by the Russian state.
In 2020, during the pandemic, the insitute started offering online classes. As a consequence the education is now available for a larger audience and students who live far away can participate in a special online course. | <urn:uuid:bd167492-b25e-48b5-b993-2e9b924acab5> | CC-MAIN-2024-18 | https://iona.nl/en/project/ita-wegman-education-center/ | 2024-04-20T17:35:03Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.972424 | 111 |
Analyst, Client Support – 6039
Client Services, Full-time, Dallas
This role has been filled
Roles and Responsibilities
This position will be responsible for managing a diverse set of client support responsibilities, collaborating across numerous teams and systems, and providing internal and external stakeholders with a best-in-class customer experience.
The Corporates Client Services has a need to augment its customer-facing client support team.
This function includes developing and utilizing product, technical, and market capabilities to provide best-in-class customer experiences to ION's customers.
The client support team drives customer success, builds content and knowledge repositories, and increases operational efficiency.
Focus areas include positive customer satisfaction through high quality deliverables, investments in automation and tools, and empowering the Client Support team to enhance and scale services to our customers.
Required Experience, Skills and Qualifications
· customer complaint resolution
· help desk support
· responding to technical questions
· root cause analysis
· service improvement
· troubleshooting technical issues
We’re a diverse group of innovators who provide trading and workflow automation software, high-value analytics, and strategic consulting to corporations, central banks, financial institutions, and governments. More than 40% of the world’s largest companies use our solutions. Founded in 1999, we’ve achieved tremendous growth by bringing together some of the best and most successful financial technology companies in the world.
Over 2,000 of the world’s leading corporations, including 50% of the Fortune 500 and 30% of the world’s central banks, trust ION solutions to manage their cash, in-house banking, commodity supply chain, trading and risk.
Over 800 of the world’s leading banks and broker-dealers use our electronic trading platforms to operate the world’s financial market infrastructure.
With 10,000 employees and offices in more than 40 cities around the globe, ION is a rapidly expanding and dynamic group.
At ION, we offer careers that provide many opportunities: To invent. To design. To collaborate. To build. To transform businesses and empower people around the world to do more, faster and better than before. Imagine what you can do and experience. This is where you can do your best work.
Learn more at https://iongroup.com/
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Sign up to receive job alerts | <urn:uuid:6c72e115-ee37-4bae-987b-44515aa7e27a> | CC-MAIN-2024-18 | https://iongroup.com/jobs/analyst-client-support-6039-ac59adcd-c55c-44a2-8255-c022498bc382/ | 2024-04-20T17:52:26Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.914321 | 493 |
The surface structure of Few-Layer Graphene (FLG) epitaxially grown on the C-face of SiC has been investigated by TM-AFM in ambient air and upon interaction with dilute aqueous solutions of bio-organic molecules (l-methionine and dimethyl sulfoxide, DMSO). Before interaction with molecular solutions, we observe nicely ordered, three-fold oriented rippled domains, with a 4.7 ± 0.2 nm periodicity (small periodicity, SP) and a peak-to-valley distance in the range 0.1-0.2 nm. Upon mild interaction with the molecular solution, the ripple periodicity "relaxes" to 6.2 ± 0.2 nm (large periodicity, LP), while the peak-to-valley height increases to 0.2-0.3 nm. When additional energy is transferred to the system through sonication in solution, graphene planes are peeled off, as shown by quantitative analysis of Raman spectroscopy and X-ray photoelectron spectroscopy which indicate a neat reduction of thickness. Upon exfoliation rippled domains are no longer observed. In comparative experiments on cleaved HOPG, we could not observe ripples on pristine samples in ambient air, while LP ripples develop upon interaction with the molecular solutions. Recent literature on similar systems is not univocal regarding the interpretation of rippling. The ensemble of our comparative observations on FLG and HOPG can be hardly rationalized solely on the basis of the surface assembly of molecules, either organic molecules coming from the solution or adventitious species. We propose to consider rippling as the manifestation of the free-energy minimization of quasi-2D layers, eventually affected by factors such as interplanar stacking, and interactions with molecules and/or with the AFM tip.
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Non ci sono file associati a questo prodotto. | <urn:uuid:5757c904-7495-4050-a21d-7c3fca44b452> | CC-MAIN-2024-18 | https://iris.unige.it/handle/11567/920213 | 2024-04-20T16:40:57Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.895862 | 409 |
I have sold a property at 35 Ranchers CRESCENT in Okotoks. See details here
Welcome to 35 Rancher's Crescent. Perfectly located in the prestigious Air Ranch. Tired of the same old 2 storey floorplan? This lofted Bungalow may be for you.. Exceptionally maintained, freshly painted, newer flooring and freshly developed this home features over 3360 square feet of developed space. With a large open floor plan and large vaulted ceilings it feels bright and large. With a beautifully upgrade kitchen including stainless appliances, gas cooktop, built in oven and wonderfully large island with quartz countertops, the layout works really well for so many types of people. The upper area consists of a small sitting area as well as the primary bedroom including the primary bathroom and walk in closet. The main floor also features a bedroom and full bathroom as well as a den/office area that could be used so many different ways. The lower level has another large bedroom with large bright windows as well as a large recreation area and a bar (roughed in for a sink) area with a full size fridge, as well as another full bathroom and extremely large storage room which could also be further developed. The garage has a few nice features not often seen in other homes such as large radiant heater, a floor drain (no more messy garage floor) and 2 single 9' wide doors, offering plenty of space for a full size truck with a work area along the side. There is a good sized deck off of the main dining room accessing the fully landscaped backyard featuring a wonderful sitting area and plenty of space for gardening. Come and see what 35 Ranchers Cres has to offer. You will be surprised. | <urn:uuid:36154fe6-ef41-4a70-a4d0-9fff3303b4b1> | CC-MAIN-2024-18 | https://ironrealty.ca/blog.html/i-have-sold-a-property-at-35-ranchers-crescent-in-okotoks-7887917 | 2024-04-20T16:23:46Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.9722 | 351 |
In the world of manufacturing, effective management of operations, resources, and processes is critical for small manufacturers to thrive and compete. Enterprise Resource Planning (ERP) software offers a comprehensive solution that integrates various business functions into a unified system.
Specifically designed for small manufacturers, ERP software provides the tools and capabilities necessary to streamline operations, improve efficiency, and drive growth. In this article, we will explore the key features and benefits of ERP software for small manufacturers and discuss how it revolutionizes their operations.
Understanding ERP Software for Small Manufacturers
What is ERP Software?
ERP software is an integrated business management solution that enables organizations to automate and streamline their core business processes. It provides a centralized platform to manage various functions, including inventory management, production planning, purchasing, sales, finance, and human resources. ERP software allows businesses to achieve real-time visibility into their operations, make data-driven decisions, and optimize overall efficiency.
Key Features of ERP Software for Small Manufacturers
- Inventory Management: ERP software provides robust inventory management capabilities, allowing small manufacturers to track and control their inventory levels accurately. It enables businesses to manage stock levels, track raw materials and finished goods, automate reorder points, and optimize supply chain processes.
- Production Planning and Scheduling: ERP software helps small manufacturers optimize their production processes by providing tools for production planning and scheduling. It allows businesses to create manufacturing orders, allocate resources, track work orders, and monitor production progress in real-time, ensuring timely delivery of products.
- Supply Chain Management: ERP software enables small manufacturers to manage their supply chain effectively. It provides functionalities for supplier management, procurement, and order management, allowing businesses to streamline purchasing processes, reduce lead times, and ensure timely availability of materials.
- Financial Management: ERP software includes financial management modules that help small manufacturers manage their finances efficiently. It offers features for general ledger, accounts payable and receivable, cash flow management, and financial reporting. By integrating financial data with other business functions, small manufacturers can gain accurate insights into their financial health.
- Quality Control: Quality control is crucial for small manufacturers to maintain customer satisfaction and product consistency. ERP software offers quality control modules to track and manage quality-related processes, such as inspections, non-conformance handling, and corrective actions. This ensures adherence to quality standards and continuous improvement.
Benefits of ERP Software for Small Manufacturers
Implementing ERP software can bring several benefits to small manufacturers:
1. Streamlined Operations and Improved Efficiency
ERP software integrates various business functions into a unified system, eliminating data silos and manual processes. It provides a single source of truth, enabling small manufacturers to streamline their operations and improve overall efficiency. By automating routine tasks, reducing data entry errors, and optimizing processes, ERP software enables teams to focus on value-added activities, leading to increased productivity and reduced operational costs.
2. Real-time Visibility and Data-driven Decision Making
ERP software offers real-time visibility into all aspects of a small manufacturer’s operations. It provides comprehensive dashboards, reports, and analytics that enable businesses to monitor key performance indicators, track production progress, and analyze financial metrics. This real-time information empowers decision-makers to make data-driven decisions, identify bottlenecks, optimize resource allocation, and respond quickly to changing market conditions.
3. Improved Inventory Management and Demand Planning
For small manufacturers, efficient inventory management is crucial to meet customer demands while minimizing carrying costs. ERP software provides robust inventory management capabilities, allowing businesses to optimize inventory levels, track material usage, and automate reorder points. With accurate demand forecasting and planning, small manufacturers can reduce stockouts, minimize excess inventory, and improve cash flow.
4. Enhanced Collaboration and Communication
ERP software facilitates seamless collaboration and communication among different departments within a small manufacturing organization. It provides a centralized platform where employees can access and share real-time data, documents, and information. This improves cross-functional communication, enables better coordination between teams, and reduces miscommunication or duplication of efforts. By fostering collaboration, ERP software enhances overall productivity and accelerates decision-making processes.
5. Scalability and Adaptability
ERP software is designed to accommodate the growing needs of small manufacturers. As the business expands, the software can scale to handle increased data volumes, user counts, and complexities. Whether it’s adding new product lines, expanding into new markets, or acquiring new customers, ERP software provides the flexibility to adapt and grow with the business. This scalability ensures that small manufacturers can continue to operate efficiently and effectively as they evolve.
6. Compliance and Traceability
Small manufacturers must adhere to regulatory compliance and maintain traceability throughout their operations. ERP software helps in achieving compliance by capturing and storing critical data related to materials, processes, and products. It provides traceability features that enable businesses to track and record the movement of goods, maintain batch or lot control, and meet regulatory requirements. This ensures transparency, quality control, and accountability, strengthening the reputation of small manufacturers in the market.
7. Customer Satisfaction and Relationship Management
ERP software enables small manufacturers to enhance customer satisfaction by delivering products on time, maintaining consistent quality, and providing excellent customer service. By integrating customer data from various touchpoints, including sales, customer support, and order management, ERP software helps businesses gain a comprehensive view of their customers. This allows for personalized communication, efficient order processing, and effective customer relationship management. By understanding customer needs and preferences, small manufacturers can build strong relationships, increase customer loyalty, and drive repeat business.
8. Cost Savings and Return on Investment
While implementing ERP software requires an initial investment, it can result in significant cost savings for small manufacturers in the long run. By streamlining operations, reducing manual efforts, optimizing inventory levels, and improving resource allocation, ERP software helps minimize operational costs. It eliminates redundancies, reduces errors, and maximizes productivity, resulting in improved profitability and return on investment over time.
For small manufacturers, ERP software is a game-changer that streamlines operations, improves efficiency, and drives growth. By integrating various business functions into a unified system, ERP software provides real-time visibility, data-driven decision-making, and enhanced collaboration. It enables small manufacturers to optimize inventory management, improve demand planning, and achieve regulatory compliance. With its scalability, adaptability, and focus on customer satisfaction, ERP software empowers small manufacturers to compete effectively in a rapidly changing marketplace. Investing in ERP software is a strategic decision that can revolutionize the way small manufacturers operate, paving the way for sustainable success and long-term growth. | <urn:uuid:1be3b842-09c6-4fc2-8127-4084b6852cae> | CC-MAIN-2024-18 | https://iskandarnote.com/erp-software-for-small-manufacturers/ | 2024-04-20T15:58:19Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.91005 | 1,382 |
Today International Socialists and local Living Wage activists joined striking First Union members in an hour’s action outside the Warehouse store in Porirua. We were asking shoppers to show their support for the in dispute workers by signing protest postcards to The Warehouse Group boss Mark Powell. In that short time over 200 signed.
Back in 2013 The Warehouse Group told us that they were going to pay the Living Wage, which is currently $19.25 an hour. The reality is rather different. Instead, the claimed living wage is what The Warehouse call a “career retailer wage” of at least $18.50 an hour. The catch is that to qualify you have to have been employed for 5 years or have clocked up 5,000 hours; a tall order given staff turnover and the number of part-time jobs in retail. Only 15% of The Warehouse workers get the boasted “career retailer wage”.
Nicky Clemens, an on-strike First Union delegate, told the International Socialist Organisation what the current dispute is about. She said that most check-out operators and other shop floor workers were paid anything from only $15.32 to $18.30 an hour. Another sore point is that The Warehouse have increased workloads so that the same amount of work is done by fewer staff.
The union’s collective agreement expired on 31 July. In bargaining a new agreement the union is claiming a 3.5% pay increase over one year. The Warehouse has offered a paltry 30c an hour for one year and 40c for a second year. This meanness further gives the lie to the Warehouse’s underserved reputation to be a living wage employer.
Let’s hope that further action, backed up by public solidarity, will put pressure on the company to take some steps towards a genuine living wage. | <urn:uuid:f2487ea5-9207-4679-b24d-ed8bdf6ebfd8> | CC-MAIN-2024-18 | https://iso.org.nz/2015/09/12/get-the-warehouse-to-pay-a-living-wage/ | 2024-04-20T17:35:37Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.967908 | 381 |
- Generates Arbitrary instances for Thrift structs, enums and exceptions
- Provides Arbitrary instances for GHC's Int64, Data.Map.Map and Data.Set.Set
- Makes Thrift enums instances of Bounded and improves the Enum instance declaration
Making a type an instance of Test.QuickCheck.Arbitrary specifies how to generate random instances of the struct. This is useful for testing.
For example, consider the following simple Thrift declaration:
With the patch, the following program (import statements elided) is a fuzzer for the log service.
In implementing the Arbitrary instances, it was useful to make Thrift enums instances of Bounded and to improve the Enum instance. Specifically, whereas before,
would throw an exception, now it behaves as expected without an exception.
I consider the patch incomplete. It's more of a starting point for a discussion at this point than a serious candidate for inclusion. If it is of interest, I'd appreciate some direction on testing it as well as style, and I'd welcome any other comments or thoughts. | <urn:uuid:49952e84-afca-42a6-8d0e-19c4b5f25879> | CC-MAIN-2024-18 | https://issues.apache.org/jira/browse/THRIFT-728 | 2024-04-20T17:56:18Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.90856 | 228 |
The Peer-Authored Management Source for Lab Professionals since 1969 MLO-online.com April 2024 Vol 56, No. 4 2024 LAB of the YEAR Salem Health Laboratories — Salem Health Hospitals & Clinics p.14 CE: Realizing the potential of digital pathology Page 8 LAB INNOVATOR Jessica DesLauriers, MBA, MLS (ASCP)CM Laboratory Director, Avera McKennan Hospital & University Health Center
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2 | APRIL 2024 MLO-ONLINE.COM IN THIS ISSUE... FACEBOOK facebook.com//MLOMedicalLaboratoryObserver LINKEDIN linkedin.com /groups/2301731/ TWITTER twitter.com /MedicalLabMLO April 2024 | Vol. 56, No. 4 32 30 26 14 8
From the editor
The observatory CONTINUING EDUCATION
Realizing the potential of digital pathology
chain: Unraveling the diagnostic and prognostic threads in neurological disorders
OF THE YEAR
By Dr. Thomas Kampfrath and Dr. Sascha Lange LAB
Salem Health Laboratories at
Hospitals and Clinics — Continuous and sustained commitment to excellence
OF THE YEAR — RUNNERS UP
Christina Wichmann LAB
Southwest Transplant Alliance Laboratory
Transforming infection detection with the CBC-Diff
By Melissa Naiman, PhD, EMT-B and Ahmed Bentahar, MD, PhD
The role of training in error prevention
clinical laboratory professionals
How addressing bullying in medical labs will improve overall retention
By Stephen Bishop, MBA, MS, CLS, MLS(ASCP)CM, CPHQ
Molecular testing supports early, effective use of ESR1 -targeting therapies
Bittick PRODUCT FOCUS 38 Lab safety DEPARTMENTS
Index of advertisers LAB INNOVATOR
Jessica DesLauriers, MBA, MLS (ASCP) CM By Christina Wichmann ON THE COVER: Courtesy of Salem Health Laboratories
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Happy Medical Laboratory Professionals Week!
By Christina Wichmann Editor in Chief
This year, Medical Laboratory Professionals Week is celebrated April 14–20. This week highlights the vital role played by laboratory professionals and pathologists in diagnostic medicine. Lab Week is now in its 49 th year, and MLO would like to extend its appreciation for everything you do each day for the care and treatment of millions of patients.
To coincide with this celebration, MLO publishes its annual Lab of the Year award. This is my second year with MLO, and I am again extremely impressed by all the laboratory nominations I read. It is one of my favorite features in the magazine.Thank you so much to all the labs that submitted thoughtful nominations, and thank you tothe judgesfor yourtimereviewing and scoring the labs in the five categories: customer service, education and training, productivity, teamwork, and strategic outlook.
This year’s Lab of the Year award goes to Salem Health Laboratories at Salem Health Hospitals and Clinics in Salem, Oregon. The two runners-up are Southwest Transplant Alliance Laboratory Services in Dallas, Texas and Wisconsin Diagnostics Laboratories in Milwaukee, Wisconsin. We feature all three labs in this issue beginning on page 14. Some things you may find noteworthy about each winner include the following:
At Salem Health Laboratories, Lean management is used to support the overall laboratory quality management program, and all 226 employees lead and complete a process improvement project during the year. One laboratory project utilizing Lean tools improved on-time collections for inpatient morning rounds from 66% of the time to 98% of the time. On-time collections ensure that results are available to physicians first thing in the morning so that they can make treatment and discharge decisions. The laboratory’s work developing a tool to plan the next day’s morning rounds contributed to an overall reduction of 4.8% in average length of stay across the hospital over 12 months.
Innovations at Southwest Transplant Alliance Laboratory Services reduced organ donor infectious disease serology testing from an average of 7.67 hours to an average of 37 minutes. Previously, hands-on testing with a lot of manual pipetting was performed by staff, which is a high-pressure, time-consuming job. The biggest impact was the purchase of the Diasorin Liaison XL, an automated infectious disease analyzer. The ability to expedite a donor case and provide a recipient with a much-needed organ can make the difference between life and death, which this lab has done.
Wisconsin Diagnostic Laboratories (WDL) bolsters educational opportunities for its current employees, but it also does quite a bit of outreach to the community on laboratory professions. WDL visits local high schools to help teach students about the laboratory profession, and it partners with one high school to provide internship opportunities — these students got to work in specimen processing. WDL is also a sponsor of HOSA and provides a scholarship to an aspiring clinical laboratory student. WDL also supports students looking for clinical site opportunities to complete their MLS/MLT degrees, providing clinical spots to three area colleges/universities.
It is not an easy task choosing winners of this award, and something notable can truly be shared about each laboratory that applied. Thank you to all the laboratories that applied this year, and happy Medical Laboratory Professionals Week to all our readers!
I welcome your comments and questions — please send them to me at [email protected].
Vo l.56, No. 4
PUBLISHER Chris Driscoll [email protected]
EDITOR IN CHIEF Christina Wichmann [email protected]
MANAGING EDITOR Erin Brady [email protected]
PRODUCTION MANAGER Edward Bartlett
ART DIRECTOR Kermit Mulkins
AUDIENCE DEVELOPMENT/LIST RENTALS
Laura Moulton | [email protected]
ADVERTISING SERVICES MANAGER
Karen Runion | [email protected]
DIRECTOR OF SALES
EAST COAST/MIDWEST SALES, CLASSIFIEDS
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MLO EDITORIAL ADVISORY BOARD
John Brunstein, PhD, Biochemistry (Molecular Virology) President & CSO PathoID, Inc., British Columbia, Canada
Lisa-Jean Clifford, COO & Chief Strategy Officer Gestalt, Spokane, WA
Barbara Strain, MA, SM(ASCP), CVAHP Principal, Barbara Strain Consulting LLC, Formerly Director, Value Management, University of Virginia Health System, Charlottesville, VA
Jeffrey D. Klausner, MD, MPH Professor of Preventive Medicine in the Division of Disease Prevention, Policy and Global Health, Department of Preventive Medicine at University of Southern California Keck School of Medicine.
Donna Beasley, DLM(ASCP), Director, Huron Healthcare, Chicago, IL
Anthony Kurec, MS, H(ASCP)DLM, Clinical Associate Professor, Emeritus , SUNY Upstate Medical University, Syracuse, NY
Suzanne Butch, MLS(ASCP)CM, SBBCM, DLMCM Freelance Consultant, Avon, OH
Paul R. Eden, Jr., MT(ASCP), PhD, Lt. Col., USAF (ret.), (formerly) Chief, Laboratory Services, 88th Diagnostics/Therapeutics Squadron, Wright-Patterson AFB, OH
Daniel J. Scungio, MT (ASCP), SLS, CQA (ASQ), Consultant at Dan the Lab Safety Man and Safety Officer at Sentara Healthcare, Norfolk, VA
CEO Chris Ferrell
PRESIDENT June Griffin
COO Patrick Rains
CRO Paul Andrews
CHIEF DIGITAL OFFICER Jacquie Niemiec
CHIEF ADMINISTRATIVE AND LEGAL
OFFICER Tracy Kane EVP CITY SERVICES & HEALTHCARE Kylie Hirko 30 Burton Hills Blvd., Suite 185 Nashville, TN 37215 800-547-7377 | www.mlo-online.com Medical Laboratory Observer USPS Permit 60930, ISSN 0580-7247 print, ISSN 2771-6759 online is published 10 times annually (Jan, Feb, Mar, Apr, May, Jul, Aug, Aug CLR, Sep, Nov) by Endeavor Business Media, LLC. 201 N Main St 5th Floor, Fort Atkinson, WI 53538. Periodicals postage paid at Fort Atkinson, WI, and additional mailing offices. POSTMASTER: Send address changes to Medical Laboratory Observer, PO Box 3257, Northbrook, IL 60065-3257. SUBSCRIPTIONS: Publisher reserves the right to reject non-qualified subscriptions. Subscription prices: U.S. $160.00 per year; Canada/Mexico $193.75 per year; All other countries $276.25 per year. All subscriptions are payable in U.S. funds. Send subscription inquiries to Medical Laboratory Observer, PO Box 3257, Northbrook, IL 60065-3257. Customer service can be reached toll-free at 877-382-9187 or at MLO@ omeda.com for magazine subscription assistance or questions. Printed in the USA. Copyright 2024 Endeavor Business Media, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopies, recordings, or any information storage or retrieval system without permission from the publisher. Endeavor Business Media, LLC does not assume and hereby disclaims any liability to any person or company for any loss or damage caused by errors or omissions in the material herein, regardless of whether such errors result from negligence, accident, or any other cause whatsoever. The views and opinions in the articles herein are not to be taken as official expressions of the publishers, unless so stated. The publishers do not warrant either expressly or by implication, the factual accuracy of the articles herein, nor do they so warrant any views or opinions by the authors of said articles. 4 | APRIL 2024 MLO-ONLINE.COM FROM THE EDITOR
Announcement of the re-approval of COLA under the Clinical Laboratory Improvement Amendments of 1988
The Centers for Medicare & Medicaid Services published a notice on March 6, 2024.
The notice announces the application of COLA for re-approval as an accreditation organization for clinical laboratories under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) program for the following specialty and subspecialty areas under CLIA: Microbiology, including Bacteriology, Mycobacteriology, Mycology, Parasitology, and Virology; Diagnostic Immunology, including Syphilis Serology, and General Immunology; Chemistry, including Routine Chemistry, Toxicology, and Endocrinology; Hematology, including routine hematology and coagulation; Immunohematology, including ABO Group, D (Rho) typing, Unexpected Antibody Detection, Compatibility Testing, and Antibody Identification; Pathology, including Histopathology, Oral Pathology, and Cytology.
One in eight people are now living with obesity
A new study released by the to by the World Health Organization shows the number of people worldwide living with obesity. The study also shows that even though the rates of undernutrition have dropped, it is still a public health challenge in many places, particularly in South-East Asia and subSaharan Africa. Countries with the highest combined rates of underweight and obesity in 2022 were island nations in the Pacific and the Caribbean and those in the Middle East and North Africa.
It was determined that COLA meets or exceeds the applicable CLIA requirements. The re-approval and grant COLA deeming authority for a period of 6 years was announced. This notice is effective from March 6, 2024, to March 6, 2030.
FDA clears over-the-counter continuous glucose monitor
The U.S. Food and Drug Administration cleared for marketing an over-the-counter (OTC) continuous glucose monitor (CGM).
The Dexcom Stelo Glucose Biosensor System is an integrated CGM (iCGM) intended for anyone 18 years and older who does not use insulin, such as individuals with diabetes treating their condition with oral medications, or those without diabetes who want to better understand how diet and exercise may impact blood sugar levels. Importantly, this system is not for individuals with problematic hypoglycemia (low blood sugar) as the system is not designed to alert the user to this potentially dangerous condition.
The Stelo Glucose Biosensor System uses a wearable sensor, paired with an application installed on a user’s smartphone or other smart device, to continuously measure, record, analyze and display glucose values in people 18 years and older that are not on insulin and who do not have problematic hypoglycemia. Users can wear each sensor up to 15 days before replacing with a new sensor. The device presents blood glucose measurements and trends every 15 minutes in the accompanying app. Users should not make medical decisions based on the device’s output without talking to their healthcare provider.
Data from a clinical study provided to the FDA showed that the device performed similarly to other iCGMs. Adverse events reported in the study included local infection, skin irritation and pain or discomfort.
Scientists develop a simple blood test to quickly diagnose sarcoidosis
A research project supported by the National Institutes of Health has developed a tool to rapidly and inexpensively diagnose sarcoidosis.
The tool, which uses a simple blood test, could allow for selective use of more invasive diagnostic tests often used to identify the disease. The findings published in the American Journal of Respiratory and Critical Care Medicine.
To identify antigens and determine which might be linked to sarcoidosis, scientists collected lung fluid samples and blood cells from patients with pulmonary sarcoidosis, then
6 | APRIL 2024 MLO-ONLINE.COM
2X obese adults since 1990.
>1 billion people in the world are now living with obesity.
smartboy10/DigitalVision Vectors/Getty Images
43% of adults were overweight in 2022.
4X obese children and adolescents (5 to 19 years of age) since 1990.
Half of deaths in children under 5 years of age are by undernutrition and obesity can cause noncommunicable diseases such as cardiovascular diseases, diabetes and some cancers.
extracted the genetic material. Using a combination of molecular techniques, the researchers homed in on two newly described disease-specific antigen biomarkers that only bind to the antibodies of sarcoidosis positive patients.
They next designed a highly specific blood test, which only requires a small amount of blood, to determine if they could accurately detect sarcoidosis. To verify the test, researchers compared blood samples from 386 people, which included patients with sarcoidosis, patients with tuberculosis, patients with lung cancer, and healthy individuals. The researchers confirmed that their test was able to differentiate patients who had sarcoidosis from those with other respiratory diseases.
275 million new genetic variants identified in NIH precision medicine data
Researchers have discovered more than 275 million previously unreported genetic variants, identified from data shared by nearly 250,000 participants of the National Institutes of Health’s All of Us Research Program.
Half of the genomic data are from participants of non-European genetic ancestry. The unexplored cache of variants provides researchers new pathways to better understand the genetic influences on health and disease, especially in communities who have been left out of research in the past. The findings are detailed in Nature, along with three other articles in Nature journals.
Nearly 4 million of the newly identified variants are in areas that may be tied to disease risk.
To date, more than 90% of participants in large genomics studies have been of European genetic ancestry. NIH Institute and Center directors noted in an accompanying commentary article in Nature Medicine that this has led to a narrow understanding of the biology of diseases and impeded the development of new treatments and prevention strategies for all populations.
In a companion study published in Communications Biology, a research team led by Baylor College of Medicine, Houston, reviewed the frequency of genes and variants recommended by the American College of Medical Genetics and Genomics across different genetic ancestry groups in t he All of Us dataset. These genes and variants mirror those in the
program’s Hereditary Disease Risk research results offered to participants. The authors found significant variability in the frequency of variants associated with disease risk between different genetic ancestry groups and compared with other large genomic datasets.
In a separate study, investigators tapped the All of Us dataset to calibrate and implement 10 polygenic risk scores for common diseases across diverse genetic ancestry groups. These
scores calculate an individual’s risk of disease by taking into account genetic and family history factors. Without accounting for diversity, polygenic risk scores could cause false results that misrepresent a person’s risk for disease and create inequitable genetic tools. Using the diversity of the All of Us data, these polygenic risk scores are applicable to a broader population.
More than 750,000 people have enrolled in All of Us to date.
THE OBSERVATORY :: NEWS • TRENDS • ANALYSIS
Realizing the potential of digital pathology
By Carolyn Pressman, PhD
Advancements in whole slide imaging (WSI), also known as digital pathology, now support the ability of clinical laboratories to image large numbers of slides rapidly and at high resolution.1 Entire stained tissue sections from glass slides can be viewed by a pathologist on a computer monitor, where digital images can be magnified and visualized in a way that feels like standard microscopy. Similar to the transition in radiology from film to digital images, pathology labs feel the pressure to develop more efficient digital workflows and reduce the time to diagnosis. 2 Embracing digitization of slides has the potential to revolutionize the delivery of pathology services as labs face increasing volumes and complexity in the histopathology workload. 3
Digital pathology today
Digital pathology is a dynamic, imagebased environment that enables the acquisition, management, and interpretation of pathology information generated from a digitized glass slide.4 Common applications include primary diagnosis, review of immunohistochemistry (IHC) and/or special stains, intraoperative consultation, second opinion consultation, and presentation at a tumor board.2 To further clarify, primary diagnosis is the establishment of a final diagnosis solely by review of the hematoxylin and eosin (H&E) stain based on the histopathologic findings of the pathologist. In addition, slide digitization enables the use
See test online at https://ce.mlo-online.com/ courses/realizing-the-potentialof-digital-pathology/
Passing scores of 70 percent or higher are eligible for 1 contact hour of P.A.C.E. credit.
Upon completion of this article, the reader will be able to:
1. Describe how digital pathology works in the laboratory to support patient care.
2. Describe typical applications of digital pathology
3. Demonstrate an overall understanding of current technologies used in digital pathology
4. Describe key considerations for implementing digital pathology
of artificial intelligence (AI) derived algorithms for clinical decision support, which is perhaps the most exciting and rapidly advancing technology to be deployed in pathology. Examples include H&E image analysis for cancer detection and classification, and quantitative image analysis for IHC biomarkers like HER2 and PD-L1. WSI and AI image analysis will likely become integral to the practice of pathology and are already helping pathologists to improve workflow and turnaround times, support accurate and timely diagnosis, and may ultimately contribute to improved patient care.5,6,7
Digital pathology ecosystem
The digital pathology ecosystem is composed of three main parts — information systems, whole slide imaging systems (which include scanners, image management software, and monitors), and system tools such as native applications, third party applications, and image analysis.
Many labs may be familiar with the whole slide scanner and the digital image viewer. To truly harness the power of digital pathology, a full ecosystem needs to be implemented where the whole slide system is integrated with one or more of following systems: hospital information systems (HIS), picture archiving and communication systems (PACS), laboratory information systems (LIS), electronic medical record (EMR), and/or radiology information systems (RIS).
Digital pathology begins with a whole slide image (WSI) scanner that captures an entire glass slide in high-resolution images comparable to images seen under brightfield microscopes. Scanners can accommodate a broad range of stain or specimen types, including H&E, IHC, in situ hybridization (ISH), special stains, cytology, and frozen sections. Historically, whole slide imaging systems store image data in proprietary
8 | APRIL 2024 MLO-ONLINE.COM CONTINUING EDUCATION :: DIGITAL PATHOLOGY
Figure 1: Scanned H&E image for primary diagnosis, or comparison with IHC and/or special stains.
Scan code to go directly to the CE test.
file formats. While these systems allow interactive viewing, the proprietary nature of data formats and interfaces create vendor lock-in and impede data access.8 Other specialties, such as radiology, use Digital Imaging and Communications in Medicine (DICOM®) as the standard for the representation, storage, and communication of medical images and related information. While a DICOM file format for pathology has been defined, adoption by vendors is varied, limiting interoperability with other software solutions.8
Image quality, reliability, ease of use, and speed are all important considerations when choosing a whole slide imaging system. A tray-based system can reduce slide-handling errors, such as breakage, jams, and failure to pick up. Other considerations include capacity, with the flexibility to accommodate future growth of digital image interpretation, and built-in calibration to enhance accuracy.
Central to the digital pathology workflow is a dedicated software for pathologists, histologists, and administrators to view, organize, retrieve, and integrate digital images for a comprehensive review of disease status. Software systems that are intuitive, easy to use, and provide annotation tools can optimize user experience and workflow.
With the acceleration of personalized healthcare and increased test complexity, flexible software solutions that integrate third party vendor tools offer pathologists more choice and flexibility to adapt the digital workflow to their specific environment. For example, imagine how difficult it would be to operate a smartphone if an integrated app store did not include apps developed by third parties. This flexibility allows for faster innovation and improves access to the latest technologies with minimal disruption to the digital workflow.
Advantages of digital pathology
Compared with using glass slides and a microscope, digital pathology offers multiple advantages.
One operational benefit of WSI is the elimination of courier costs for transportation of physical glass slides to multiple locations.9 Instead of transporting slides to pathologists for diagnosis, slides are scanned at or near the point of collection. Scanning at or near the point of collection can reduce the risk of slides being lost, mislabeled, or damaged during physical transport, which impacts patient safety.3 Digitization also preserves the integrity and quality of the original slide by eliminating the risk of fading, stain degradation, or other changes to physical slides during storage or transport.3 Since whole slide images are delivered electronically, remote review is immediate and collaboration can take place across geographic regions, reducing time to results.9 Furthermore, a digital workflow may provide faster access to molecular and other ancillary testing.3
Digital pathology also enables a flexible and remote work environment that can increase recruitment and retention of pathologists, potentially prolonging careers of senior pathologists and providing a remote sign out option for locum tenens staff.3
Whole slide imaging can improve pathology service quality by streamlining access to archived images. For
example, direct comparison of digital H&E and IHC images from a former tumor biopsy with a current resected tumor from the same patient, may reduce additional costly immunohistochemical testing.3 To review a previous biopsy in the current glass slide workflow, slides must be pulled from the archive, potentially couriered/transported to the pathologists, then returned and refiled in the archive, all of which is time consuming to the pathologist and the ancillary staff. Digital pathology software permits synchronous analysis of multiple slides on a single screen, permitting faster and easier review.3 Access to on screen measurements tools make cancer staging more convenient and potentially more accurate and reproducible, with a clear audit trail of who has viewed the images and made annotations.3 For immunohistochemical analysis of biomarkers like HER2 and PD-L1 with targeted therapies, interobserver variability in manual scoring may impact patient treatment.10,11 The addition of biomarker quantitative image analysis (QIA) to the digital workflow offers a reproducible and objective method to decrease interobserver variability, improve therapy selection, and potentially lead to better patient outcomes.11,12
Regulatory and reimbursement considerations
The COVID-19 pandemic facilitated adoption of digital pathology for remote use in two ways. First, the Food and Drug Administration (FDA) issued guidance in April 2020, for the duration of the COVID-19 public health emergency, that allowed the marketing of new digital pathology devices that are intended for use in remote settings and that are not currently 510(k) cleared for any use.14 This guidance document expired in November 2023.15 Secondly, the Centers for Medicare & Medicaid Services (CMS) provide an updated memorandum in May 2023 pertaining to the continued use of remote digital image viewing: “To ensure the accuracy, reliability and timeliness of laboratory results, CMS will continue to exercise enforcement discretion to permit pathologists and other laboratory personnel to review laboratory digital data, digital results, and digital images (“digital materials”) remotely, without obtaining a separate CLIA certificate for the remote testing site, provided that the designated primary site or home base has such a certificate (using the address of
MLO-ONLINE.COM APRIL 2024 | 9 CONTINUING EDUCATION :: DIGITAL PATHOLOGY
Figure 2: Example of adjunctive quantitative image analysis tool for calculating HER2 gene amplification in breast cancer.
the primary site) and the work being performed at the remote testing site falls within the specialties/subspecialties under the primary site’s certificate.”16
Multiple WSI systems have submitted 510(k) premarket notifications and gained marketing authorization.Per the FDA, “The whole slide imaging system is an automated digital slide creation, viewing, and management system intended as an aid to the pathologist to review and interpret digital images of surgical pathology slides prepared from formalin-fixed, paraffin-embedded (FFPE) tissue. The system generates digital images that would otherwise be appropriate for manual visualization by conventional brightfield microscopy. The whole slide imaging system is not intended for use with slides prepared from frozen tissue, cytology, and non-FFPE hematopathology specimens. The whole slide imaging system consists of an image management system, a scanner and associated software, and a display monitor. The whole slide imaging system does not include any automated Image Analysis Applications that would constitute computer aided detection or diagnosis. Pathologists view and interpret scanned digital images, employing appropriate processes to ensure the validity of the interpretation.”17
Currently, there is only one on-market artificial intelligence tool that has marketing authorization as a software algorithm device to assist users in digital pathology. According to the FDA, “A software algorithm device to assist users in digital pathology is an in vitro diagnostic device intended to evaluate acquired scanned pathology whole slide images. The device uses software algorithms to provide information to the user about presence, location, and characteristics of areas of the image with clinical implications. Information from this device is intended to assist the user in determining a pathology diagnosis.”18
Reimbursement of digital pathology is evolving. Currently, the standalone process of whole slide imaging is not reimbursed. However, there are a small number of existing Current Procedural Terminology (CPT) Category I codes for IHC/ISH using computer-assisted technology that implicitly include reimbursement for digitization of whole slide images as part of the quantitative image analysis process.19 These Category l tissue codes have not been revalued in a decade, leading to suboptimal reimbursement for biomarker image analysis. In addition, there currently are no Category l tissue codes for other AI image analysis applications such as H&E.
The College of American Pathologists and the American Medical Association have been making strides in creating 43 digital pathology CPT Category III add-on codes to help close this gap. The use of these codes will inform the Centers for
Medicare & Medicaid Services when it is making reimbursement decisions for new services. Assuming that laboratories are diligent in consistently using them, which will establish an ongoing record that supports their value, the new codes could be seen as a step toward potential greater reimbursement in the future.
When digitized glass slides are used for consultations and second opinions, the appropriate Cat III add-on codes should be used.
Implementing digital pathology
As adoption of digital pathology gains momentum, the collective experience of early adopters provides a rich resource for institutions that are just beginning the planning process.20,21 Technical readiness, operational readiness, and cost are identified as the most significant challenges.21 A critical step in adopting digital pathology is to assemble a multidisciplinary implementation team to evaluate pathologists’ readiness for a transition to digital pathology, propose a budget, and evaluate resources needed for implementation, such as appropriate data storage and internet bandwidth.22
The initial assessment will lead to a better understanding of resources and infrastructure requirements than can then lead to a plan for execution, including definition of workflow, validation and delineation of SOPs, and training. To support labs in the implementation process, validation guidelines have been established to ensure whole slide digital images are acceptable for clinical diagnosis.23,24 Additionally, the National Society for Histotechnology has created an online Digital Pathology Certificate of Completion program to increase knowledge and improve competency in whole slide imaging.25
Given the complex, multifaceted nature of change management, it comes as no surprise that experts advocate a stepwise implementation, with the identification of one or two clinical needs as a starting point, adding additional applications over time.20
There are different perspectives to consider when implementing digital pathology. The first category encompasses tangible issues: acquisition costs of the digital pathology solution and personnel costs of planning and implementation, including validation, and new reimbursement strategies are just a few examples.22 The second category includes costs related to infrastructure updates and upgrades, notably in IT and training, personnel realignment with the new workflow, and the technical expertise and core competencies to support it.22 Last but not least is the human factor; change is difficult. As pathologists, lab personnel, IT, and other stakeholders learn new ways to work and collaborate, they develop the groundwork for a more efficient digital workflow.
1. Zarella MD, Bowman D, Aeffner F, et al. A Practical Guide to Whole Slide Imaging: A White Paper from the Digital Pathology Association. Arch Pathol Lab Med. 2019;143(2):222-234. doi:10.5858/ arpa.2018-0343-RA.
2. Parwani AV. Digital pathology as a platform for primary diagnosis and augmentation via deep learning. Artificial Intelligence and Deep Learning in Pathology. Elsevier; 2021:93-118.
3. Williams BJ, Bottoms D, Treanor D. Future-proofing pathology: the case for clinical adoption of digital pathology. J Clin Pathol 2017;70(12):1010-1018. doi:10.1136/jclinpath-2017-204644.
10 | APRIL 2024 MLO-ONLINE.COM CONTINUING EDUCATION :: DIGITAL PATHOLOGY
Figure 3: Tray-based WSI scanner.
Scan code to go directly to the CE test.
4. About digital pathology. DPA. Accessed February 21, 2024. https:// digitalpathologyassociation.org/about-digital-pathology.
5. Vodovnik A. Diagnostic time in digital pathology: A comparative study on 400 cases. J Pathol Inform. 2016;29;7:4. doi:10.4103/2153-3539.175377.
6. Clarke E, Doherty D, Randell R, et al. Faster than light (microscopy): superiority of digital pathology over microscopy for assessment of immunohistochemistry. J Clin Pathol. 2023;76(5):333-338. doi:10.1136/ jclinpath-2021-207961.
7. Eloy C, Marques A, Pinto J, et al. Artificial intelligence-assisted cancer diagnosis improves the efficiency of pathologists in prostatic biopsies. Virchows Arch. 2023;482(3):595-604. doi:10.1007/s00428-023-03518-5.
8. Herrmann MD, Clunie DA, Fedorov A, et al. Implementing the DICOM Standard for Digital Pathology. J Pathol Inform. 2018 Nov 2;9:37. doi: 10.4103/jpi.jpi_42_18.
9. Guo H, Birsa J, Farahani N, et al. Digital pathology and anatomic pathology laboratory information system integration to support digital pathology sign-out. J Pathol Inform. 2016;4;7:23. doi:10.4103/2153-3539.181767.
10. Casterá Redal C, Bernet Vegué L. “HER2 immunohistochemistry inter-observer reproducibility in 205 cases of invasive breast carcinoma additionally tested by ISH” Answer to the statistical issue to avoid misinterpretation. Ann Diagn Pathol. 2020;48:151566. doi:10.1016/j.anndiagpath.2020.151566.
11. Brunnström H, Johansson A, Westbom-Fremer S, et al. PD-L1 immunohistochemistry in clinical diagnostics of lung cancer: inter-pathologist variability is higher than assay variability. Mod Pathol. 2017;30(10):1411-1421. doi:10.1038/modpathol.2017.59.
12. Gough M, Liu C, Srinivasan B, et al. Improved concordance of challenging human epidermal growth factor receptor 2 dual in-situ hybridisation cases with the use of a digital image analysis algorithm in breast cancer. Histopathology. 2023;83(4):647-656. doi:10.1111/ his.15000.
13. Haragan A, Parashar P, Bury D, Cross G, Gosney JR. Machine-learningbased image analysis algorithms improve interpathologist concordance when scoring PD-L1 expression in non-small-cell lung cancer. J Clin Pathol. 2024;18;77(2):140-144. doi:10.1136/jcp-2023-208978.
14. Regulations.Gov, Enforcement Policy for Remote Digital Pathology Devices During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency Guidance for Industry, Clinical Laboratories, Healthcare Facilities, Pathologists, and Food and Drug Administration Staff. Accessed February 21, 2024. https://www.regulations.gov/document/ FDA-2020-D-1138-0078.
15. Withdrawn or expired guidance. U.S. Food and Drug Administration. Published December 18, 2023. Accessed February 21, 2024.
16. CMS.gov. Accessed February 21, 2024. https://www.cms.gov/files/ document/qso-23-15-clia.pdf.
17. US Food and Drug Administration. Product classification. Accessed February 21, 2024. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfpcd/classification.cfm?id=5344.
18. US Food and Drug Administration. Product classification. Accessed February 21, 2024. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfpcd/classification.cfm?id=5349.
19. American Medical Association. AMA CPT® licensing overview. American Medical Association. Published May 31, 2023. Accessed February 21, 2024. https://www.ama-assn.org/practice-management/ cpt/ama-cpt-licensing-overview.
20. Evans AJ, Salama ME, Henricks WH, Pantanowitz L. Implementation of Whole Slide Imaging for Clinical Purposes: Issues to Consider from the Perspective of Early Adopters. Arch Pathol Lab Med 2017;141(7):944-959. doi:10.5858/arpa.2016-0074-OA.
21. Hartman DJ, Pantanowitz L, McHugh JS, et al. Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities. J Digit Imaging. 2017;30(5):555-560. doi:10.1007/s10278-017-9946-9.
22. Lujan G, Quigley JC, Hartman D, et al. Dissecting the Business Case for Adoption and Implementation of Digital Pathology: A White Paper from the Digital Pathology Association. J Pathol Inform. 2021;7;12:17. doi:10.4103/jpi.jpi_67_20.
23. Evans AJ, Brown RW, Bui MM, et al. Validating Whole Slide Imaging Systems for Diagnostic Purposes in Pathology. Arch Pathol Lab Med 2022;1;146(4):440-450. doi:10.5858/arpa.2020-0723-CP.
24. Bui MM, Riben MW, Allison KH, et al. Quantitative Image Analysis of Human Epidermal Growth Factor Receptor 2 Immunohistochemistry for Breast Cancer: Guideline from the College of American Pathologists. Arch Pathol Lab Med. 2019;143(10):1180-1195. doi:10.5858/ arpa.2018-0378-CP.
25. Digital pathology certificate of completion program. Nsh.org. Accessed February 21, 2024. https://elearn.nsh.org/products/ digital-pathology-certificate-of-completion-program.
Carolyn Pressman, PhD, Scientific Partner, Medical and Scientific Affairs, Roche Diagnostics, received her doctoral degree in Genes and Development from the University of Texas Health Science Center, at Houston. Her current work as part of the medical and scientific affairs team focuses on digital pathology and AI image analysis.
MLO-ONLINE.COM APRIL 2024 | 11 CONTINUING EDUCATION :: DIGITAL PATHOLOGY
Figure 4: Review of immunohistochemistry using digital pathology software.
Neurofilament light chain
Unraveling the diagnostic and prognostic threads
in neurological disorders
By Dr. Thomas Kampfrath and Dr. Sascha Lange
The pathological foundation of numerous acute and chronic neurological disorders, leading to enduring disability, lies in neuroaxonal damage and loss. The capability to easily identify and track such damage would offer significant advantages in evaluating disease activity, monitoring responses to treatment, and predicting prognosis. Neurofilaments are attracting growing interest as potential biomarkers for neuroaxonal injury. These abundant structural scaffolding proteins are exclusively present in neurons and show elevated levels in response to axonal damage in various conditions, including neurodegenerative, inflammatory, vascular, and traumatic diseases. Notably, this increase is observable not only in cerebrospinal fluid (CSF) but also in blood. The specificity of neurofilaments for neuronal cell damage and eventual cell death provides a distinct advantage over other potential biomarkers.
The clinical diagnosis of Alzheimer’s disease relies on the cognitive decline or post-mortem diagnosis. Nonetheless, studies have shown that brain damage starts decades before the onset of clinical symptoms. NfL levels are significantly elevated in patients with mild cognitive impairment (MCI) and dementia stages when compared to the healthy population. Besides that, NfL can be used to predict cognitive decline and susceptibility in combination with other biomarkers. However, NfL is not able to predict the conversion from MCI within the disease spectrum.9
Amyotrophic lateral sclerosis (ALS)
ALS is characterized by the degeneration of both upper and lower motor neurons. Elevated NfL levels in the CSF or blood may therefore be indicative of motor neuron damage and can be used for assessing disease progression and prognosis.10 The FDA has accepted the use of NfL as a prognostic biomarker in ALS associated with a mutation in the superoxide dismutase 1 (SOD1) gene as a biomarker.11
Huntington’s disease is characterized by an increased repeat of the CAG triplets in the Huntingtin gene (HTT) on chromosome 4 causing different neuronal symptoms. CAG triplets refer to a specific sequence of DNA nucleotides consisting of the bases cytosine (C), adenine (A), and guanine (G) repeated three times. The CAG triplet repeat expansion is a characteristic genetic feature of Huntington’s disease and is used in genetic testing to diagnose the condition or determine an individual’s risk of developing the disease. It has been shown that there is a correlation between prognosis and NfL levels as well as disease onset.12
Multiple sclerosis (MS) is an immune-mediated disorder characterized by neurodegeneration. In MS, NfL has been shown to predict susceptibility risk 13, as well as a marker for monitoring, treatment, and correlated prognosis of the disease.14
Neurofilaments are proteins classified as type IV of intermediate filaments (including the three neurofilament proteins) and are exclusively expressed in the cytoplasm of neurons. Together with microfilament and microtubules, neurofilaments form the neuronal cytoskeleton. As of today, there are five known neurofilament subunits that can be differentiated by their molecular mass. Besides neurofilament light (NfL), medium (NfM), and heavy (NfH) with molecular masses of approximately 68, 150 and 200 kiloDalton (kDa), peripherin and internexin with a molecular mass of 57 and 66 kDa exist.1 While NfL, NfM, and NfH are ubiquitously expressed in mature neurons, internexin is mainly found in central nervous system while peripherin is in the peripheral nervous system. Due to their stability and role in the neuronal structure, they gained interest in usage as markers for axonal damage. As the intermediate filaments always contain NfL, it was determined to be the optimal molecule for use as a biomarker. 2
Neurofilament light chain biomarkers: Which holds the diagnostic edge – blood or CSF?
Upon damage, neurofilaments leak into the interstitial space and eventually into CSF and blood (serum, plasma) where it can be quantified. While blood NfL concentration is at a lower level than CSF NfL concentration, there is a tight and strongly positive association between CSF NfL and blood NfL levels.3 CSF collections require lumbar punctures that are associated with more side effects such as headaches, backaches, nausea, or vomiting. In recent years, however, the development of improved assay technologies now allows for reliable NfL quantification in blood samples.4
How specific is neurofilament light chain as a clinical biomarker?
Any neuroaxonal damage or degeneration can lead to NfL release into the CSF and bloodstream. The clinical specificity of NfL as a biomarker can vary depending on the specific neurological disorder. It is crucial to emphasize that although increased levels of NfL are linked to neurodegeneration, they are not specific to a particular disease. In addition to increases due to clinical relapses in multiples sclerosis (MS), NfL levels can be influenced by age, comorbidities, and other diseases such as Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), Parkinson’s disease, as well as in stroke, traumatic brain injury (TBI), and epilepsy. Of these diseases, NfL is most strongly associated with MS.4 NfL appears to increase with age as well as show more variability. Studies have shown that NfL levels in the blood of healthy people can increase by 2.2% per year.5 These increases in the older population are likely partially explained by the higher prevalence of comorbidities such as diseases or stroke. Cardiovascular risk factors such as high body mass index (BMI), smoking and blood pressure, as well type 2 diabetes can also influence NfL levels, and careful interpretation is necessary in a clinical context.4
12 | APRIL 2024 MLO-ONLINE.COM CLINICAL ISSUES :: NEUROFILAMENT LIGHT CHAIN
Table 1. Disease states and application of NfL.
How does neurofilament light chain manifest across a spectrum of neurological disorders?
A recent publication analyzed blood NfL concentrations in 13 neurodegenerative diseases, Down syndrome, and depression.6 An increase in blood NfL levels was observed in all of them, confirming its role as a marker of neurodegeneration. Easy access to blood biomarkers such as NfL can play a significant role in the management of neurological disorders. It can be used as a rapid screening tool to identify or reject neurodegeneration as an underlying cause of cognitive symptoms for AD and beyond.7
Elevated NfL levels can also indicate non-disease-specific neuronal damage. Thus, interpretation of NfL results should always consider the overall clinical context and should be combined with a prior established disease diagnosis. Ongoing research continues exploring the utility of NfL as a biomarker in various neurological conditions, and its role in predicting risk and monitoring disease is continually evolving. A good overview regarding the use of NfL can be found in the review by Barro et al.7 and Khalil et al.8
Table 1 gives an overview of different diseases and the potential benefits for the use of NfL.
1. Yuan A, Nixon RA. Neurofilament Proteins as Biomarkers to Monitor Neurological Diseases and the Efficacy of Therapies. Front Neurosci 2021;27;15:689938. doi:10.3389/fnins.2021.689938.
2. Mücke N, Kämmerer L, Winheim S, et al. Assembly Kinetics of Vimentin Tetramers to Unit-Length Filaments: A Stopped-Flow Study. Biophys J. 2018;22;114(10):2408-2418. doi:10.1016/j.bpj.2018.04.032.
3. Disanto G, Barro C, Benkert P, et al. Serum Neurofilament light: A biomarker of neuronal damage in multiple sclerosis. Ann Neurol. 2017;81(6):857-870. doi:10.1002/ana.24954.
4. Khalil M, Teunissen CE, Otto M, et al. Neurofilaments as biomarkers in neurological disorders. Nat Rev Neurol. 2018;14(10):577-589. doi:10.1038/s41582-018-0058-z.
5. Thebault S, Booth RA, Freedman MS. Blood Neurofilament Light Chain: The Neurologist’s Troponin? Biomedicines. 2020;21;8(11):523. doi:10.3390/biomedicines8110523.
6. Ashton NJ, Janelidze S, Al Khleifat A, et al. A multicentre validation study of the diagnostic value of plasma neurofilament light. Nat Commun. 2021;7;12(1):3400. doi:10.1038/s41467-021-23620-z.
7. Hampel H, O’Bryant SE, Molinuevo JL, et al. Blood-based biomarkers for Alzheimer disease: mapping the road to the clinic. Nat Rev Neurol 2018;14(11):639-652. doi:10.1038/s41582-018-0079-7.
8. Barro C, Chitnis T, Weiner HL. Blood neurofilament light: a critical review of its application to neurologic disease. Ann Clin Transl Neurol. 2020;7(12):2508-2523. doi:10.1002/acn3.51234.
9. Jung Y, Damoiseaux JS. The potential of blood neurofilament light as a marker of neurodegeneration for Alzheimer’s disease. Brain 2024;4;147(1):12-25. doi:10.1093/brain/awad267.
10. Abu-Rumeileh S, Vacchiano V, Zenesini C, et al. Diagnostic-prognostic value and electrophysiological correlates of CSF biomarkers of neurodegeneration and neuroinflammation in amyotrophic lateral sclerosis. J Neurol. 2020;267(6):1699-1708. doi:10.1007/s00415-020-09761-z.
11. Benatar M, Wuu J, Andersen PM, et al. Design of a Randomized, Placebo-Controlled, Phase 3 Trial of Tofersen Initiated in Clinically Presymptomatic SOD1 Variant Carriers: the ATLAS Study. Neurotherapeutics. 2022;19(4):1248-1258. doi:10.1007/s13311-022-01237-4.
12. Byrne LM, Rodrigues FB, Blennow K, et al. Neurofilament light protein in blood as a potential biomarker of neurodegeneration in Huntington’s disease: a retrospective cohort analysis. Lancet Neurol 2017;16(8):601-609. doi:10.1016/S1474-4422(17)30124-2.
13. Bjornevik K, Munger KL, Cortese M, et al. Serum Neurofilament Light Chain Levels in Patients With Presymptomatic Multiple Sclerosis. JAMA Neurol. 2020;1;77(1):58-64. doi:10.1001/jamaneurol.2019.3238.
14. Abdelhak A, Benkert P, Schaedelin S, et al. Neurofilament Light Chain Elevation and Disability Progression in Multiple Sclerosis. JAMA Neurol. 2023;1;80(12):1317-1325. doi:10.1001/jamaneurol.2023.3997.
15. Frank A, Bendig J, Schnalke N, et al. Serum neurofilament indicates accelerated neurodegeneration and predicts mortality in late-stage Parkinson’s disease. NPJ Parkinsons Dis. 2024;9;10(1):14. doi:10.1038/ s41531-023-00605-x.
Table 1 (continued). Disease states and application of NfL. Parkinson’s disease
The clinical course of Parkinson’s disease is categorized into different stages of the disease. While the first stages vary, the late stage is characterized by rapid clinical deterioration. Although NfL levels were described to be low in the early stages, a recent publication demonstrated that high levels of NfL not only correlate with clinical symptoms (e.g., disability) milestones but were also able to predict death within three years.15
It has been shown that after the first days after stroke, the NfL level continuously increases and remains at a higher level for up to six months. In addition, a recent publication was able to correlate the infarct volume and long-term outcome with NfL levels. Although the study cohort was very small and not adjusted for age and other confounding factors, the results looked very promising for future evaluations.16
Traumatic brain injury (TBI)
TBI is caused by non-penetrating head trauma that leads to a damage of neurons. Consequently, NfL levels increase and can remain elevated for months, depending on the severity of the trauma. Therefore, in TBI NfL can be used to assess the severity of the injury and predict outcomes.17
HIV-associated neurocognitive disorders (HAND)
HIV can affect the central nervous system, leading to neurocognitive disorders. Elevated NfL levels may be associated with neuronal damage in HIV-infected individuals, providing insights into the risk of developing neurological complications.18
Coronavirus disease 2019 (COVID-19)
Although COVID-19 is a respiratory illness, it also has been linked to various neurological complications. The meta-analysis conducted by Huang et al. provides an overview regarding recent findings. In summary, COVID-19 patients showed elevated levels of NfL. While mild symptoms were no associated with significantly higher levels of NfL, moderate and severe cases showed not only elevated NfL levels but also were able to predict prognosis of COVID-19-related neurological injuries.19
16. Ahn JW, Hwang J, Lee M, et al. Serum neurofilament light chain levels are correlated with the infarct volume in patients with acute ischemic stroke. Medicine (Baltimore). 2022;30;101(39):e30849. doi:10.1097/ MD.0000000000030849.
17. Shahim P, Gren M, Liman V, et al. Serum neurofilament light protein predicts clinical outcome in traumatic brain injury. Sci Rep 2016;7;6:36791. doi:10.1038/srep36791.
18. Hagberg L, Edén A, Zetterberg H, Price RW, Gisslén M. Blood biomarkers for HIV infection with focus on neurologic complications-A review. Acta Neurol Scand. 2022;146(1):56-60. doi:10.1111/ane.13629.
19. Huang Z, Haile K, Gedefaw L, et al. Blood Biomarkers as Prognostic Indicators for Neurological Injury in COVID-19 Patients: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2023;30;24(21):15738. doi:10.3390/ijms242115738.
Dr. Thomas Kampfrath is a board-certified clinical chemist and medical officer for Siemens Healthineers Dr. Sascha Lange is a biochemist and serves as director of Clinical Sciences for Siemens Healthineers
MLO-ONLINE.COM APRIL 2024 | 13 CLINICAL ISSUES :: NEUROFILAMENT LIGHT CHAIN
14 | APRIL 2024 MLO-ONLINE.COM LAB MANAGEMENT :: LAB OF THE YEAR
Courtesy of Salem Health Laboratories
Salem Health Laboratories at Salem Health Hospitals and Clinics
Continuous and sustained commitment to excellence
By Christina Wichmann
Medical Laboratory Observer’s 2024 Lab of the Year is the Salem Health Laboratories at Salem Health Hospitals and Clinics. Salem Health Laboratories employs 226 people and handles 1.6 million test requests at its three high-complexity laboratories; the laboratories also support and oversee all point-of-care testing across its health system. The health system includes Salem Hospital, a 502-bed, level II trauma center in Salem, Oregon and West Valley Hospital, a 25-bed critical access hospital in Dallas, Oregon. The health system also includes Salem Health Medical Group, which provides primary care and specialty services throughout the health system’s five-county service area.
MLO received many outstanding nominations for the 2024 Lab of the Year. However, Salem Health Laboratories’ sustained commitment to improving laboratory quality and services made it stand out. Lean management is used to support the overall laboratory quality management program, and all 226 employees lead and complete a process improvement project during the year. The laboratory staff believe that if they have good processes and well-designed systems, they will consistently achieve high-quality outcomes.
Laboratories partners with anatomic pathologists, who are an independent practice. The new LIS upgraded the interoperability between the pathologists and Salem Health Laboratories by integrating rich format pathology reports and images, whereas previously, the lab was only able to capture unformatted textual data. This has improved the useability of the pathology reports by clinicians throughout the health system.
Previously, in Oregon, state law limited a laboratory’s ability to provide results directly to patients. The patient’s provider was primarily responsible for sharing results with patients. With the implementation of the 21 st Century Cures Act, the Oregon law was amended to allow all laboratory results to be available directly to patients. In 2023, the number of patients electronically interacting with their laboratory results reached 80%. Now, patients and their providers can see results together, which improves outcomes and allows patients to be full partners in their care. As Salem Health Laboratories continues its work to increase patient engagement with the laboratory, it is now exploring methods to allow patients to pre-schedule lab visits and complete insurance verification prior to arriving in the laboratory.
Lab of the Year nominations are judged on achievements across five categories: customer service, productivity, teamwork, education and training, and strategic outlook. Salem Health Laboratories’ achievements in each of these categories follows.
In January 2023, the laboratory went live on Epic Beaker. The multi-year project to replace the legacy laboratory information system (LIS) resulted in full integration of laboratory services with Salem Health’s Epic medical record. This integration improved communication of orders to the laboratory, useability of pathology reports by clinicians, and distribution of results to clinicians and patients.
While the full integration of the LIS with Salem Health’s medical record has improved workflows and provided a complete patient record, the new LIS has improved access to laboratory results to everyone in the community. Prior to the conversion, none of the providers in the laboratory’s community were able to submit orders electronically to the LIS — each order had to be hand entered. Test results were made available electronically to only 16% of the clinics the laboratory served. The remainder of results were issued via facsimile, which is still very common in laboratory outreach.
The new LIS also improved useability of anatomic pathology reports. Like many health systems, Salem Health
This past year, Salem Health Laboratories participated in two significant performance improvement initiatives. The first was to improve on-time collections for inpatient morning rounds. The second was to reduce medically unnecessary testing in preoperative patients.
The laboratory’s work to improve on-time collections for morning rounds contributed to the overall goal to improve patient length of stays post-pandemic in the Salem Hospital.
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Courtesy of Salem Health Laboratories
Salem Health Regional Lab staff.
On-time collections ensure that results are available to physicians first thing in the morning so that they can make treatment and discharge decisions. By working with its partners throughout the medical center, the lab discovered that if results posted to a patient chart after the physician had already seen the patient, it could delay care and discharge decisions by up to six hours. At baseline, the laboratory was performing on-time collection of morning rounds only 66% of the time.
Utilizing Lean process improvement to review this process, the phlebotomy teams identified three drivers that were key to successful on-time collections. The first driver was the number of patients hospitalized during morning rounds. The second driver was the number of patients under isolation precautions. And the third driver was the availability of team members to collect specimens.
Through job breakdown analysis, the team identified the amount of time needed to perform collections, how many minutes the amount of time increased when caring for patients with isolation precautions, and how many collections a phlebotomist could do to determine an appropriate workforce to perform these collections. With a clear understanding of the process, the team created a predictive tool based on these drivers. Each afternoon, the phlebotomy teams across the organization assess the number of hospitalized patients and evaluate the staffing for the next shift, including unplanned absences, etc. The tool informs the team if they have enough resources to complete rounds on time and allows them to react the day prior to ensure that collections can be performed on time and results available when physicians are on the unit with their patients. Now, utilizing this tool, the lab has been able to increase on-time collection of morning rounds to 98% of the time. And, on the rare occasion where they have not met their goal, they have reduced the amount of time they were late from an average of 62 minutes to only 16 minutes. This work contributed to an overall reduction of 4.8% in average length of stay across the hospital over 12 months.
In the second project, the laboratory medical director and one of the laboratory managers participated in Salem Health’s Physician Leadership Institute (PLI). As part of the lab leaders’ participation in PLI, they completed a quality improvement project, setting a goal to reduce preoperative Type and Screen testing by 50% by December 31, 2023, in patients undergoing vascular surgery. By reviewing current performance, the team identified that preoperative blood bank testing for open
carotid vascular surgery patients was unnecessary 91% of the time. The team estimated that the cost to each patient of this unnecessary testing was between $274–$368 per episode. Additionally, unnecessary testing diverts laboratory resources that can be utilized to improve patient care. Through review of current literature, the team discovered that presurgical type and screen was frequently obtained, because the surgical procedure was considered an intermediate risk for blood loss. However, current literature also showed that patients require transfusion only 1.7% of the time, and in a single institution study with a cohort of over 1,500 patients, transfusion was used less than 5% of the time for patients undergoing this procedure. This knowledge allowed the team to challenge assumptions that presurgical type and screen testing was essential to the care of these patients.
The team developed a simplified algorithm, that classified patients with a hematocrit below 30% as at risk. Patients that had a presurgical hematocrit above 30% were more likely to tolerate the procedure successfully, without transfusion. During their study period, the team also monitored the use of emergency release or urgent transfusion in patients who did not have a preoperative type and screen. Zero patients required emergency release or urgent transfusion when their preoperative hematocrit was above 30%.
As a result of their work, the team surpassed their initial goal and reduced unnecessary preoperative transfusion testing by 73%, with an estimated annual savings of over $13,000.
In 2023, 100% of laboratory staff led and completed a Lean process improvement project, calling this work, “Lean to the Front Line.”This front-line commitment to improvement and the empowerment of employees to be in control of their work sets Salem Health Laboratories apart. To achieve sustainable improvement, employees must work together as a team. Some of the improvement projects are laboratory centric and affect a small team. Other projects stretch across the health system, involving multiple teams and many people.
An example of this work was partnering with two other clinical departments to improve communication and teamwork. Microsoft Teams chat was implemented to assist with communication. With the pharmacy team, the lab targeted improving the environmental cultures process. Before this work, the lab was successful in completing cultures only 10% of the time. With the improved communication on when cultures were being started and completed, the lab improved completion to 100%, with no failures.
16 | APRIL 2024 MLO-ONLINE.COM LAB MANAGEMENT :: LAB OF THE YEAR
Blood draw at West Valley Hospital.
Photos Courtesy of Salem Health Laboratories
Salem Health Laboratory staff at Salem Hospital.
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With the infusion and wound clinic, the lab was struggling to ensure that blood product was ready and available for transfusion when the patient had a scheduled appointment. The lab identified that everything was ready for patient care only 70% of the time. Using Teams chat to improve communication, the lab was successful in getting blood products ready for patient appointments 100% of the time. And, while there is a quality component to these projects, they also had a financial impact. All staff quality projects combined saved Salem Health Laboratories over $4 million last year.
Education and training
In 2023, 82% of the laboratory’s leadership positions were filled with internal candidates. Not only does this practice promote career growth within the organization but builds stronger teams. Each new leader on the laboratory’s team participates in a formal leadership training pathway. They receive training in the Lean management system and participate in laboratoryspecific training on the strategic plan, future planning, financial management tools, and high-reliability culture. They also receive support on developing their personnel and how to lead in an area where they may not be the subject matter expert. The outcome of this work is that leaders can successfully support their teams. Leaders that have gone through this process have an easier transition into leadership and they feel supported in their development. As they apply what they learn, their teams experience a better transition without experiencing a significant decline in support because of a new leader.
In 2023, Salem Health Laboratories launched an internal development pathway for all its employees. While some of employees are enrolled in local programs, the lab has leveraged online Medical Laboratory Science programs to help its employees have another pathway for career growth. Employees apply to be part of the formal program, which includes support for flexible scheduling to allow them to attend online classes. It also ensures a place to complete their clinical rotations, as the laboratories partner as a clinic site with the online program. Additional support is given with an assigned mentor, so the student has someone to help them and encourage them to complete their program. The hospital provides test proctoring services, so students can participate in exams. Last fall, the lab welcomed its first three employees into this program.
In addition, all of Salem Health Laboratories routinely host students from local medical laboratory education programs. By rotating them among the laboratories, students see how the different-sized laboratories function similarly and differently. This program also includes preceptor support. Laboratory staff meet with students regularly to get their feedback and to support them as they complete their rotations. Salem Health Laboratories has employed 100% of the students upon completion of their degrees.
Improvements in the laboratory are not possible without a strong strategic outlook. As the Salem Health laboratory staff worded it,“We believe it is critical for laboratory staff to know who they are, what they want to become, and to do it well and have fun.” The two primary goals of the strategic plan are to deliver a consistent and highly reliable patient and provider experience that is aligned with and supports the strategic goals for Salem Health Hospitals and Clinics and to develop a team of staff and leaders who have the skillset to support the future of laboratory services.
The laboratory’s strategic plan is built on a foundation of the following characteristics:
• Al igned leadership
• Sta ndard procedures
• Al igned instruments
• Training and competency
• Sha red accreditation
• St aff recruitment and well-being
• St udent program and career pathway
This past year, Salem Health Laboratories realigned all laboratory functions under one leadership structure and all locations now operate together as a single laboratory system, bringing quality and regulatory oversight together. Bringing all laboratory operations together into one structure allowed them to review policies and procedures and align them with shared best practices — spreading these best practices throughout the organization.
This alignment of operations required cooperation. The laboratory leadership team meets weekly to discuss issues and initiatives and to benefit from the combined experience of every member of the team when moving forward. The regular meetings ensure protected time each week to work towards strategic goals. Sometimes they meet for less than 30 minutes and other times longer. This regular forum has become a place for innovation and partnership.
Medical Laboratory Observer is proud to award the 2024 Lab of the Year to Salem Health Laboratories. Its commitment to providing high-quality laboratory services, continuous improvement, and fostering a culture of teamwork is very impressive and inspiring. When we shared the news with the laboratory, its leadership expressed the following sentiments about this hard-working laboratory in Oregon:
Director, Laboratory Services — Jamie Rouse, MBA-HM, MT(ASCP) — “I am deeply humbled and honored for our lab to be recognized as the 2024 MLO Lab of the Year. This achievement is a testament to the unwavering dedication and hard work of our team. Despite how busy we are, we remain resilient and committed to delivering the highest quality services. I am incredibly proud of each member of our team, and I am grateful for the opportunity to lead such an exceptional group of individuals.”
System Director, Clinical Support Operations — Karl Kamper, MBA, MT(ASCP), FACHE — “I am so proud of the commitment to continuous improvement by our laboratory team. They are excellent. This honor recognizes their hard work, their commitment to our patients and their contributions to Salem Health.”
18 | APRIL 2024 MLO-ONLINE.COM LAB MANAGEMENT :: LAB OF THE YEAR
Salem Health Laboratory staff at Salem Hospital.
Courtesy of Salem Health Laboratories
One big family.
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Hematology • Hemostasis • Urinalysis • Flow Cytometry • Informatics
2024 Lab of the Year Runner Up Southwest Transplant Alliance Laboratory Services
By Erin Brady
Southwest Transplant Alliance (STA) Laboratory Services is one of MLO’s 2024 Lab of the Year Runner Ups! STA is one of the largest federally designated organ procurement organizations in the United States.
Located in Dallas, Texas, STA’s service area includes 10 hospital transplant centers, over 270 hospitals, 89 Texas counties, and one Arkansas county. They serve a population of more than 10.5 million people, honoring heroic donors, courageous donor families, and those on the transplant waiting list. Over the last 50 years, STA has recovered more than 35,000 organs and saved more than 100,000 people. The laboratory provides timely testing for donors giving the gift of life, including a variety of clinical testing on viability of organs, any infectious diseases, and compatibility testing.
STA’s mission is to save lives through donation. They operate 24 hours a day, 365 days a year and perform over 66,000 specialized tests annually. The laboratory specializes in infectious disease/ serology for organ and tissue donors, chemistry, hematology, urinalysis, coagulation, special chemistry, molecular, NAT, histocompatibility (HLA and ABO), histology, and microbiology. The organization is regulated by Clinical Laboratory Improvement Amendments (CLIA), College of American Pathologists (CAP), Food and Drug Administration (FDA), American Association of Tissue Banks (AATB), and Eye Bank Association of America (EBAA).
STA saw opportunities for improvement in these categories: Discarded organs: Of the 25 expedited cases for 2022 that were reviewed, 92 organs were unable to be transplanted due to time restraints. This resulted in many missed opportunities and discarded organs.
Turnaround time: Lab average turnaround time in 2022 for infectious disease serologies was 7.67 hours, up from an average of 4–6 hours. If there were any repeats, it could take up to 12 hours.
Staff stress: The STA staff performed a lot of hands-on testing with a good deal of manual pipetting, which complicated processes dictated by timers.
User errors: There were user errors due to manual entry of results and lots of paperwork tracking each step.
High costs: For the volume of testing, staffing and reagent costs were high. Several test kits would only have a small part used, resulting in over 400 tests being discarded after two weeks.
STA’s laboratory aims to minimize the testing turnaround time, providing more opportunities to save lives through organ donation. In 2023, they accomplished that goal by improving turnaround time (TAT) and confidence in the lab’s TAT. They decreased the stress on their staff resulting in improvements in staff satisfaction. This led to reduced costs and errors.
20 | APRIL 2024 MLO-ONLINE.COM LAB MANAGEMENT :: LAB OF THE YEAR
STA LAB Team. Photos Courtesy of STA
Specifically, STA validated the following specialties:
• Human leukocyte antigens (HLA) typing
• D iasorin Liaison brought in and validated 9 assays
• Epredia Cryostat validated for frozen sections
• Chagas blood test
• 3 new EPOC blood gas analyzers validated for use in the donor care unit
• M icrobiology - blood cultures validated to reduced TAT and recipient outcomes
STA said the implementation of the Diasorin Liaison XL made the biggest impact in their laboratory. STA was doing all testing manually and wanted a platform that could perform all their organ serology testing needs.
Southwest Transplant Alliance saved $297,000 in 2023 on reagents and hands-on tech time after switching to an automated platform. An additional $110,000 was saved by internalizing coagulation, hematology, and microbiology.
Three of STA’s strategic goals are to create a culture of joy, act as a catalyst for donation, and be a center of excellence. They achieved CAP accreditation in 2023. They lowered organ donor serology testing from 7.67 hours to about 37 minutes! To accomplish this, they separated organ donor testing from tissue donor testing. Doing this resulted in the opportunity to save more lives.
Employee training and updates to policies reduced sample hold times down to 15 in November versus more than 50, 3% holds versus an average of 16%. To remove identical orders, an LIS rule was written. Another improvement was made to the ABO subtyping workflow, allowing for better outcomes for transplant recipients. To decrease errors, the report structure
was changed to match documentation formatting in the donor record. Three new IQCPs were put into action, resulting in cost savings and increased staff satisfaction. In addition, employee engagement action plans were implemented, increasing engagement scores in nearly every category.
STA has five core values: passionate, selfless, trustworthy, collaborative, and creative. The following departments collaborated to accomplish STA’s 2023 goals: Finance, Leadership, Project Management, Facilities, Quality, Education, Information Technology, Clinical, and the external LIS Admin teams.
To help create a culture of joy, they introduced a new automated platform to replace manual testing. STA said, “The burden on the staff has been significantly reduced, allowing them to focus on other critical areas in the laboratory. This has not only resulted in increased efficiency, but also mitigated the risk of human error. Manual testing requires extensive attention to detail, concentration, and dexterity. The pressure to avoid errors and ensure accurate results can be overwhelming, causing high stress levels that can impede productivity and even compromise the quality of testing. The new platform has successfully eliminated much of the burden faced by the staff. As a result, the staff can allocate their time and expertise to other crucial aspects of the laboratory operations.”
STA saved $142,598.82 on their annual reagent costs and had a 92% turnaround time improvement on their infectious disease assays. The decrease in turnaround time led to staff confidence, which leads to employee satisfaction and retention. In addition, these improvements open doors to countless opportunities for hope and healing.
MLO-ONLINE.COM APRIL 2024 | 21 LAB MANAGEMENT :: LAB OF THE YEAR
Skills Fair 2024.
Southwest Transplant Alliance Dallas, TX.
The campus was designed around a 100-year-old oak tree that anchors the donor memorial garden. The memorial garden is a tribute to every donor, their family, and every transplant recipient.
STA COO Doug Butler, with Lab Director Selena Warden and CEO Brad Adams.
Photos Courtesy of STA
2024 Lab of the Year Runner Up Wisconsin Diagnostic Laboratories
By Erin Brady
Wisconsin Diagnostic Laboratories (WDL) is one of the recipients of MLO’s 2024 Lab of the Year Runner Up Awards! WDL is located in the Milwaukee Regional Medical Center but operates independently while being owned by Milwaukee-based organization, Froedtert Health. They are the main laboratory for this 735-bed teaching hospital and the only Level-1 adult trauma center in Southeastern Wisconsin. They perform over 6.5 million tests each year.
WDL uses the My MOMENT and AIDET customer service guidelines. Each department is accountable for their customer service, but the WDL Client Services department handles over 100,000 customer calls a year and provides 24/7/365 support to Froedtert Health. Client Services launched the “Epic Cheers Customer Relations Management (CRM) system.” This system optimizes workflow by documenting customer calls and concerns in a more formalized, standardized, and centrally captured way. It was designed by WDL staff and will help improve customer experience by identifying issues.
Other notable customer service achievements from different departments at WDL included:
• I n the past year, over 240,000 specimens were collected by the Phlebotomy and Long-Term Care Services Department.
• M aking sure multiple locations have adequate staff.
• Resolving conflict the first time.
Another example of WDL’s customer service is their Anatomic Pathology department introducing oncology panels. Now, patients with advanced disease have the chance to get novel molecularly targeted treatments.
One of WDL’s valued customers, Froedtert’s Cancer Center and Transplant Services, said,“Without our partnership with WDL we would be unable to provide our essential services to the community.”
Productivity and teamwork
The WDL team achieved ISO 15189 Accreditation through the College of American Pathologists in June 2023. WDL says one of the keys to their success in productivity is,“That every department has a Leadership Team with the authority and support to manage their own resources and the flexibility of decentralized decision-making. This structure has led to consistent and numerous operational achievements, which are then presented by each Department Leader at the annual Operational Excellence meeting.”
The Anatomic Pathology department expanded its IHC menu by 35 new strains. They also grew the number of stains within Histology cases by 40%. This led to a turnaround time decrease of 25 hours! Their Blood Bank also reduced turnaround time by bringing in Grifols antisera. The Chemistry and Toxicology Departments also got a technology upgrade. They replaced the Roche Cobas 6000 modular system with the Roche Cobas Pro. This reduced instrument maintenance.
22 | APRIL 2024 MLO-ONLINE.COM LAB MANAGEMENT :: LAB OF THE YEAR
Courtesy of WDL
WDL all staff photo.
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When faced with supply shortages, an Inventory Specialist was hired for Microbiology and Molecular Diagnostics. The Cytogenetics department reduced staff shortages and burnout by modifying workflows. Impressively, the Billing Team recovered over $430,000 in lost revenue.
Other 2023 team accomplishments:
• Internal audit program administered to track risks and prevent failures.
• MediaLab was launched to monitor nonconforming events.
• Ac ross all laboratory services, key performance metrics were reviewed and standardized.
• Th rough the launch of new policies and procedures, noncompliant documents in the lab were significantly reduced, including those in PolicySTAT.
• Flow Cytometry went from 8-color to 12- color antibody panels reducing reagent costs, the amount of sample needed, and processing time.
work in specimen processing. WDL visits local high schools to help teach students about the laboratory profession. One of WDL’s laboratory members, Clinical Laboratory Utilization Specialist, Kathryn Golab, MLS(ASCP)CMSH(ASCP) CM, is also a board member at large at the Healthcare Career Academy with Menomonee Falls High School. WDL said, “This allows laboratory input into the curriculum for high school students who plan to go into a healthcare related field after high school. Upon her integration into the board, several graduating senior students have declared an MLS/MLT major going into college.”
For students completing their MLS/MLT degrees, WDL provided clinical site opportunities for the University of Wisconsin-Milwaukee, Marquette University, and the Milwaukee Area Technical College. In fall of 2023, WDL offered ten clinical spots to students, following thirteen in fall of 2022.
To combat staffing shortages, WDL Executive Director, Mike Baron, created a virtual WDL Laboratory Collaborative. The collaborative connects laboratories, so they can share their strategies for staff recruitment. Baron also initiated another way for individuals to complete certification. Specifically, the Anatomic Pathology Department incorporated an apprenticeship opportunity where Laboratory Technical Assistants (LTA) work to obtain eligibility for histology certifications. In 2023, three staff members achieved certification and more will be eligible to take the exam in 2024.
• Long Term Care and Phlebotomy Services simplified the management of their vehicle fleet with eMV. The new electronic system gives WDL a direct connection to the DMV for automated notifications regarding vehicle registration renewal. WEX fuel cards were allotted to each vehicle’s VIN so team members could use different vehicles.
• The Chemistry Team and the Beaker team worked together to introduce 158 IT improvements, including auto-verification for blood gases and a new generation of AST and ALT that prevents falsely low enzyme activity in patients with Vitamin B deficiency.
• The WDL 6 Reference Testing Team and the MCW Department of Pathology Medical Section Directors conduct a yearly review of all reference testing, resulting in patients saving more than $90,000.
Education and training
WDL endorses the education of their employees and community, raising awareness of jobs in the laboratory. Last academic year, they partnered with Cristo Rey High School to provide internship opportunities for their students. Five students participated in the internship program last year and got to
Department managers at WDL develop “operational excellence plans” for their teams. Some of the goals include improving customer service, employee wellness, teamwork, quality, and supporting technical advancement. They plan to expand on programs already implemented, like their Education Collaborative, their non-conforming event process, and Atalan- an Access-to-Access Lab Network.
Matthew Long, Third Shift Laboratory Operations Manager, Wisconsin Diagnostic Laboratories said, “While labs across the nation are struggling to keep their doors open, WDL Team Members have found a way to normalize excellence…to make the extraordinary feel ordinary.”
Management OF DUSTRY ta ta NNOV Bork aging meriP 24 | APRIL 2024 MLO-ONLINE.COM LAB MANAGEMENT :: LAB OF THE YEAR
WDL Anatomic Pathology Technologist examining specimen.
WDL 3rd Shift Team.
ISO Quality Team- Lauren Otter, Alyssa Thomaschek, Mike Baron, Kate Jacoby, Gilberto Cruz, Titi Tieu.
Photos Courtesy of WDL
Management Source for Lab Professionals since 1969 No 3 OF DUSTRY VATOR owski MD and Medical Director ath, Central Florida of Excellence PLUS Qualit d control merging FREE MAGAZINE SUBSCRIPTION! 9 Issues Plus the annual Clinical Laboratory Reference guide. WEBSITE mlo-online.com MAGAZINE mlo-online.com/subscribe NEWSLETTERS Sign up for monthly updates FACEBOOK MLOMedicalLaboratoryObserver X (FORMERLY TWITTER) @MedicalLabMLO LINKEDIN medical-laboratory-observer Scan Here to Subscribe to our FREE Magazine
Transforming infection detection with the CBC-Diff
By Melissa Naiman, PhD, EMT-B and Ahmed Bentahar, MD, PhD
In a world overpopulated by pathogens, the human immune system has evolved to protect against pathogens that are, themselves, continually evolving. Host immune response to infection refers to the dynamic process that maintains the delicate balance between effective pathogen clearance and minimizing damage to the host tissues that allows the body to recognize and fight infections. However, when the system becomes dysregulated, overreacting to invaders, it can lead to sepsis, septic shock, and ultimately death.
With nearly 50 million yearly global cases of sepsis and 11 million sepsis-related deaths,1 the need for diagnostic tests that quickly identify infection and immune dysregulation is obvious. This clinical need has inspired significant innovations over the past decade, which are now emerging as regulatory-cleared diagnostic products and solutions.
Innate immunity diagnostics:
Targeting the first line of defense
The host immune response is a diverse, complex, and dynamic defense system that plays a crucial role in protecting the body against infectious agents. When an infection occurs, the immune system is activated to identify and eliminate the pathogen. This response involves coordinated efforts between innate and adaptive immune components, as well as various immune cells, molecules, and signaling pathways, working together for an effective defense.
Each of these components, to varying degrees, could serve as diagnostic targets for the presence of infection and/or indicate infection severity. Based on these diagnostic targets, multiple tests have been developed, such as those in Table 1
One of the challenges in implementing these tests is that they require an additional order when there is diagnostic
26 | APRIL 2024 MLO-ONLINE.COM INFECTION DIAGNOSTICS :: COMPLETE BLOOD COUNT WITH DIFFERENTIAL
Photo: Beckman Coulter
uncertainty or suspicion of sepsis. However, many patients present to the emergency department (ED) with vague signs and symptoms that do not align with sepsis screening criteria. In a study of over 2,100 ED patients that ultimately developed sepsis within 12 hours of presentation, 33% did not meet SIRS criteria and 88% did not meet qSOFA criteria.2 Accordingly, for these tests to aid in sepsis management, they would need to be performed routinely during triage and provide useful insights to support clinical decisions. For example, MeMed BV rapidly and accurately discerns bacterial from viral infections in suspected sepsis patients,3 potentially leading to earlier initiation of appropriate care in the ED. One of the challenges in implementing these tests, however, is that they require an additional order when there is diagnostic uncertainty or suspicion of sepsis.
One of the first and most commonly ordered tests in the ED is the complete blood count with differential (CBC-diff).
One of the first and most commonly ordered tests in the ED is the complete blood count with differential (CBC-diff).4–6 Significant advances in hematology analyzers have expanded its capabilities so that the tried-and-true technique can be applied to enhance severe infection screening.
White blood cell activation
The automated differential is a cornerstone of modern medicine. In the context of host immune response, an abnormal white blood cell count is among the first signals of infection and immune dysregulation in many clinical scenarios. Absolute count and percentages of the five normal blood cell types provide a wealth of clinical insights. High band counts (immature neutrophils) and elevated immature granulocyte levels can signal severe infection. The neutrophil to lymphocyte ratio (NLR) is recognized as a marker for infection and inflammatory stress indicative of severe illness. Absolute count and percentages of metamyelocytes, myelocytes, and promyelocytes suggest immune response to bacterial illness.
More recently, some hematology analyzers have introduced enhanced volume measurements, permitting automated assessment of morphological characteristics. For example, monocyte distribution width (MDW) is a regulatory-cleared
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hematological parameter that measures variation in monocyte size.7 MDW values of ≥20 (K2EDTA) or ≥21.5 (K3EDTA) are associated with a higher risk of developing sepsis within the first 12 hours of hospital admission. MDW elevation is pathogen agnostic,8 meaning that it will respond similarly to bacterial, viral, and fungal agents. Interpreting MDW in the context of other leukocyte parameters can enhance diagnostic accuracy. For example, many studies have demonstrated strong diagnostic performance of elevated MDW and abnormal WBC as compared with any single leukocyte parameter.9–11 In one study, patients with elevated MDW, abnormal WBC count, and elevated NLR were 12 times more likely to develop sepsis and 9.3 times more likely to develop septic shock.12
Sepsis, like many serious conditions, often presents with vague symptoms, but without prompt treatment, septic patients can rapidly deteriorate. Thus, identifying and validating novel biomarkers to assist in accurate disease diagnosis is important to help in early sepsis detection and timely treatment. Using MDW, abnormal WBC count, and NLR in combination has shown superior diagnostic performance over any single parameter, including among patients who presented to the ED without overt sepsis symptoms.13,14
Maximize clinical insight, minimize microscopy
Like monocytes, each white blood cell type undergoes specific morphological and functional changes during the host immune response. Neutrophils increase in number and, in some severe infections, can present cytoplasmic toxic granules and vacuoles, eosinophils show increased cytoplasmic vacuolization, and monocytes, in addition to changing in size, show large coalescing cytoplasmic vacuoles that can be visualized under light microscopy.15,16 However, conducting a manual review to identify these features is too time consuming for routine clinical screening or as part of emergent care.15,16 The advent of digital hematology systems have provided the power to review, detect, and identify cells in full context with AI-powered image recognition and clinical decision support technology without reverting to the microscope.17,18
Bacterial (and bacterial co-infections) from viral infections
Automated hematology analyzers will never fully replace manual slide review. Manual review is still required to fully characterize cell abnormalities and establish whether these abnormalities are likely associated with infection or some other cause. However, recent advances in digital hematology will minimize microscope time and enable streamlined slide review. And hematology automation innovations introduced by companies such as Scopio® provide integrated hardware and software solutions to streamline the transition from automatic differential to manual review.
Bacterial infections from non-bacterial infections
SeptiCyte® Four genes using real time RT-qPCRSIRS from sepsis in critically ill adults
The next generation of digital pathology imaging incorporates larger fields of view in high resolution, as well as AI decision support and off-site reviews. For example, the Scopio Lab Full-Field Peripheral Blood Smear ®
MLO-ONLINE.COM APRIL 2024 | 27 INFECTION DIAGNOSTICS :: COMPLETE BLOOD COUNT WITH DIFFERENTIAL
Table 1. Tests that differentite infection and infection severity.
application provides a view of all clinically relevant areas of the blood smear, including the monolayer and feathered edge, at 100X magnification. This configuration supported remote viewing for a tertiary medical center hematology division that reduced turnaround time while maintaining overall workload and clinical quality. Retrospective analysis of 10,704 peripheral blood smear samples were analyzed pre- and post-implementation over a 5-month period. Incorporating effective remote viewing, where pathologists were able to conduct satisfactory peripheral blood smear slide review from home, resulted in an overall 15.8% reduction in turnaround time for the entire lab.
These capabilities could provide a new opportunity to evaluate additional aspects of white blood cells to determine the presence and severity of infection. As AI cell typing matures, the opportunities for assistance in cell classification, disease identification, and response to therapies will grow.19,20
Continued study of the intricacies of the host response to infection is facilitating novel diagnostic strategies to identify disease presence and severity using results from the CBC-diff and other blood biomarkers. These advances are changing diagnostics, providing opportunities to improve routine clinical care and give clinicians valuable tools to quickly identify infections and immune dysregulation, leading to improved patient outcomes. Diagnostic tests that measure host immune response biomarkers have shown promise for earlier sepsis detection as well as in differentiating between bacterial and viral infections. Additionally, advances in hematology analyzers, including enhanced volume measurements and AI-powered image recognition, allow for more accurate and efficient blood analysis. The integration of AI support in digital hematology imaging with CBC-diff results and other patient information holds great potential for further advancements in cell classification and disease identification— all with less than 0.5 mL of blood.
By leveraging these evolving complementary technologies, discovering how they can be combined and protocolized and adopting future innovations as they become available, healthcare professionals can effectively triage, detect, and intervene, to deliver a higher standard of care in the battle against infections, from common colds to septic shock.
1. Sepsis. Who.int. Accessed March 4, 2024. https://www.who.int/ health-topics/sepsis.
2. Crouser ED, Parrillo JE, Martin GS, et al. Monocyte distribution width enhances early sepsis detection in the emergency department beyond SIRS and qSOFA. J Intensive Care. 2020;5;8:33. doi:10.1186/ s40560-020-00446-3
3. Angel A, Eden E, Avioz NZ, Gottlieb T, Navon R. 161 A host response test (MMBV) for differentiating between bacterial and viral infection has potential to improve antibiotic stewardship in patients with suspected sepsis. Ann Emerg Med. 2023;82(4):S72-S73. doi:10.1016/j. annemergmed.2023.08.183.
4. Young GP. CBC or not CBC? That is the question. Ann Emerg Med 1986;15(3):367-371. doi:10.1016/s0196-0644(86)80587-x.
5. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 Emergency Department Summary Tables. U S Census Bureau 2017;2017(37).
6. Barnes PW, McFadden SL, Machin SJ, Simson E, international consensus group for hematology. The international consensus group for hematology review: suggested criteria for action following automated CBC and WBC differential analysis. Lab Hematol. 2005;11(2):83-90. doi:10.1532/LH96.05019.
7. Crouser ED, Parrillo JE, Seymour C, et al. Improved early detection of sepsis in the ED with a novel monocyte distribution width biomarker. Chest. 2017;152(3):518-526. doi:10.1016/j.chest.2017.05.039.
8. Piva E, Zuin J, Pelloso M, et al. Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units. Clin Chem Lab Med. 2021;59(7):1307-1314. doi:10.1515/cclm-2021-0192.
9. Crouser ED, Parrillo JE, Seymour CW, et al. Monocyte distribution width: A novel indicator of Sepsis-2 and Sepsis-3 in high-risk emergency department patients. Crit Care Med. 2019;47(8):1018-1025. doi:10.1097/CCM.0000000000003799.
10. Hausfater P, Robert Boter N, Morales Indiano C, et al. Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department: comparison with CRP and procalcitonin in a multicenter international European prospective study. Crit Care 2021;25(1):227. doi:10.1186/s13054-021-03622-5.
11. Poz D, Crobu D, Sukhacheva E, et al. Monocyte distribution width (MDW): a useful biomarker to improve sepsis management in Emergency Department. Clin Chem Lab Med. 2022;60(3):433-440. doi:10.1515/cclm-2021-0875.
12. Malinovska A, Hinson JS, Badaki-Makun O, et al. Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department. J Am Coll of Emerg Physicians Open 2022;3(2):e12679. doi:10.1002/emp2.12679.
13. Hinson JS, Sarani N, Smith A, et al. A-155 Unlocking the complete blood count: derivation of a single-panel laboratory test that includes monocyte distribution width to create a universal sepsis screening tool. Clin Chem. 2023;69(Supplement_1). doi:10.1093/clinchem/ hvad097.140.
14. Hinson J, Sarani M, Smith A, Badaki-Makun L, Malinovska A, Levin S. Unlocking the CBC: Derivation of a Single-Panel Laboratory Test That Includes Monocyte Distribution Width to Create a Universal Sepsis Screening Tool. In: Wiley; 2023. Accessed December 13, 2023. https:// onlinelibrary.wiley.com/toc/15532712/2023/30/S1.
15. Zonneveld R, Molema G, Plötz FB. Analyzing neutrophil morphology, mechanics, and motility in sepsis: options and challenges for novel bedside technologies. Crit Care Med. 2016;44(1):218-228. doi:10.1097/ CCM.0000000000001266.
16. Pozdnyakova O, Connell NT, Battinelli EM, et al. Clinical significance of CBC and WBC morphology in the diagnosis and clinical course of COVID-19 infection. Am J Clin Pathol. 2021;155(3):364-375. doi:10.1093/ ajcp/aqaa231.
17. Katz B-Z, Benisty D, Sayegh Y, Lamm I, Avivi I. Remote digital microscopy improves hematology laboratory workflow by reducing peripheral blood smear analysis turnaround time. Appl Clin Inform 2022;13(5):1108-1115. doi:10.1055/a-1957-6219.
18. Katz B-Z, Feldman MD, Tessema M, et al. Evaluation of Scopio Labs X100 Full Field PBS: The first high-resolution full field viewing of peripheral blood specimens combined with artificial intelligence-based morphological analysis. Int J Lab Hematol. 2021;43(6):1408-1416. doi:10.1111/ijlh.13681.
19. Walter W, Pohlkamp C, Meggendorfer M, et al. Artificial intelligence in hematological diagnostics: Game changer or gadget? Blood Rev 2023;58:101019. doi:10.1016/j.blre.2022.101019.
20. Walter W, Haferlach C, Nadarajah N, et al. How artificial intelligence might disrupt diagnostics in hematology in the near future. Oncogene 2021;40(25):4271-4280. doi:10.1038/s41388-021-01861-y.
Melissa Naiman, PhD, EMT-B serves as a Medical Director for Sepsis and Host Response at Beckman Coulter Diagnostics . She holds a Master of Science in Forensic Science and a PhD in Public Health from the University of Illinois at Chicago. Prior to coming to Beckman Coulter, Dr. Naiman spent most of her career in an academic research center for science and technology developing medical devices and diagnostics, including identifying novel biomarkers for military health applications.
Ahmed Bentahar, MD, PhD is a clinical pathologist with more than 30 years of experience in the fields of hematology and laboratory medicine. For the past 33 years, he served as a hematology product specialist, hematology product manager, staff applications scientist, senior manager of global scientific marketing, and Medical Director at Beckman Coulter. Dr. Bentahar received his MD and PhD from État de Liège University, Belgium. Dr. Bentahar has earned international recognition as a respected thought leader and uniquely qualified facilitator of hematology industry seminars, workshops, and congresses.
28 | APRIL 2024 MLO-ONLINE.COM INFECTION DIAGNOSTICS :: COMPLETE BLOOD COUNT WITH DIFFERENTIAL
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The role of training in error prevention for clinical laboratory professionals
By Stephen Bishop, MBA, MS, CLS, MLS(ASCP)CM, CPHQ
Every day, clinical laboratory professionals stand at the vanguard of patient safety by ensuring that errors in laboratory testing are either prevented or identified and managed. Errors in the clinical laboratory testing process can have serious consequences. The ramifications in delayed interventions for sepsis patients and stroke patients can be devastating. Inappropriate treatments can cause undue harm and expense, and not just from a financial position — some expenses cannot be measured, such as decreased trust in the health system. Regardless of the scenario, errors in laboratory testing can compromise the reliability of diagnostic information, leading to erroneous conclusions or ineffective therapeutic interventions. Clinical laboratory leaders can enhance error prevention by strengthening their team’s onthe-job training through elevating personnel competency and cultivating a culture of continuous improvement.
Competency assessment versus attainment
Clinical laboratory leaders should be acquainted with the CLIA (Clinical Laboratory Improvement Amendments) guidelines for competency assessment for laboratory personnel. Initially, competency must be assessed upon hiring or assignment to new testing procedures. This typically occurs after initial “on the job” training. Ongoing assessment is required
at six months for new personnel, and then subsequently, competency is assessed annually for all employees. Additionally, competency assessments should occur whenever significant changes in laboratory procedures, methodologies, or instrumentation take place. Furthermore, prompt assessment is necessary if performance problems or errors are identified. These guidelines ensure that laboratory personnel remain competent and proficient in their roles, promoting the quality and reliability of laboratory testing processes.
Regardless of the interval (initial, six months, etc.), the six elements of the CLIA competency assessment must be present. Firstly, direct observation of routine patient test performance ensures personnel can proficiently conduct testing procedures correctly. Secondly, monitoring the recording and reporting of test results verifies adherence to standard operating procedures and regulatory requirements. Thirdly, reviewing test results, proficiency testing performance, and quality control records assesses personnel’s ability to manage results and maintain quality standards. Fourthly, direct observation of instrument maintenance and function checks confirms personnel’s competence in instrument upkeep and troubleshooting. Fifthly, assessment of problem-solving skills evaluates personnel’s ability to identify and resolve issues effectively. Finally, evaluating basic knowledge through written exams or
30 | APRIL 2024 MLO-ONLINE.COM EDUCATION :: COMPETENCY ASSESSMENT
oral assessments ensures personnel possess the foundational understanding required for safe and competent performance. These elements collectively provide a baseline framework for assessing the competency of laboratory personnel.
Attaining competency encompasses the acquisition of skills and knowledge, while assessing competency involves evaluating the extent to which those skills and knowledge have been acquired and can be effectively applied. Clinical laboratory leaders are now faced with a challenge because current CLIA standards for competency assessment do not necessarily address the complexities of clinical decision making. CLIA merely defines how competency should be assessed, as opposed to how competency should be attained. The CLIA six elements do not provide laboratory leaders with a roadmap for attaining competency, which is a crucial aspect of error prevention. Complexities in clinical decision making are ever more present, so every laboratory professional, regardless of their role, should attain competencies that address the intricacies associated with their particular work.
Elevating personnel competency
Methods for attaining competency should be a joint effort from the laboratory medical director, administrative leaders, and technical leaders in the laboratory. It also takes significant input from experienced team members from all roles. Engagement and collaboration from all are essential. Clinical laboratory personnel should be taught and trained to analyze situations critically by recognizing patterns and identifying deviations from expected results that may indicate an error. Additionally, they should learn how to troubleshoot problems systematically, employing logical approaches to isolate and address the root causes of errors.
Phlebotomists and pre-analytic staff should be trained to think critically about various tests and the requirements of those tests. For example, during my phlebotomy training program, my clinical instructor required students to know which tests could be performed on corresponding tube types based on the anticoagulant present in the tube. Various tests would be listed off by the instructor, and the students needed to know if the hepatitis panel could be performed on the same specimen as the CMP (comprehensive metabolic panel). This of course corresponded to the tests and specimen types that were validated on the instrument, so this was laboratory specific to an extent. On the surface, this may appear to be a great deal of work, but ultimately, the phlebotomist becomes empowered to make appropriate decisions regarding use of tubes, which can minimize errors where specimens are received and accessioned into the laboratory for analysis.
One way that the testing personnel can attain competency is through the use of scenario-based training. This is especially true in trauma and emergency blood banking situations. Once baseline blood banking competency has been attained, laboratory leaders can create scenarios to mimic the pressures of real-life situations to better equip the trainees. For instance, the blood bank can call a mock trauma, using the phones and/or alarms, and run through scenarios such as preparing and modifying blood products while timing the trainees. Time standards can be set for the completion of coolers or trauma packs.
While performing the tasks necessary to complete the cooler, the trainees may also be given “unknown” factors, such as repeated phone calls asking for the status of the blood products, or a notification that the ED is unable to send a runner to pick up the blood. These types of scenarios can allow trainees to develop
critical thinking skills under pressure, where the likelihood of errors occurring increases. Following the training scenario, it is important to debrief each scenario with the trainee, offering both positive and constructive feedback on their performance. In every case, and for every role, laboratory leaders can deploy scenario-based training as a means to prevent errors, especially when personnel are under pressure.
Leading the change to job integration
The relationship between training and a culture of continuous improvement is essential to error prevention in the clinical laboratory. Routine training not only equips laboratory personnel with the necessary knowledge and skills to perform their duties accurately and efficiently, but also instills a culture of continuous improvement. In a culture of continuous improvement, laboratory personnel are enabled to seek out opportunities for growth, actively participate in training programs, and apply new insights and best practices to their work. This continuous cycle of learning, feedback, and adaptation enhances personnel competency, promotes critical thinking and problem-solving skills, and fosters a proactive approach to quality assurance. Personnel who are supported with tools and resources to continuously improve are better equipped to identify and mitigate potential sources of error, which enhances the reliability and integrity of the laboratory testing process.
However, shifting the mindset of training from a single event to a fully integrated aspect of one’s job demands focused planning and execution. Leaders play a crucial role in communicating the value of continuous learning, emphasizing its importance in achieving organizational objectives and its role in error reduction. By aligning training initiatives with the laboratory’s strategic goals, leaders provide employees with a clear understanding of how their learning efforts contribute to overall success. Integration of training into daily work processes is essential and is achieved through methods such as incorporating training modules into onboarding processes or scheduling regular learning sessions. Through these efforts, laboratory leaders can cultivate a culture of continuous improvement, driving error reduction in laboratory operations.
The consequences of errors in the total testing process can be severe and the complexities of clinical decision making create more opportunities for errors to occur. As a means to prevent errors, laboratory professionals should be trained to think critically, especially under pressure. This luxury can empower the laboratory team to provide clarity in the midst of complexity. Additionally, laboratory leaders should work to empower their personnel to continuously improve their skills. Training is a cornerstone of continuous improvement and clinical laboratory leaders can cultivate team members that are vigilant, responsive, and committed to error prevention. By enriching personnel competency attainment and fostering a culture of continuous improvement, clinical laboratory leaders can strengthen their laboratory’s error prevention efforts and amplify the integrity of the laboratory testing process.
Stephen Bishop, MBA, MS, CLS, MLS(ASCP)CM, CPHQ is currently the Director of Laboratory Services at Dignity Health California Hospital Medical Center, located in downtown Los Angeles, CA. Stephen is passionate about healthcare leadership, clinical laboratory education, and process improvement.
MLO-ONLINE.COM APRIL 2024 | 31 EDUCATION :: COMPETENCY ASSESSMENT
How addressing bullying in medical labs will improve overall retention
By Alex Mitchell
It is well established that medical laboratories continue to face an unprecedented staffing crisis that is putting a strain on patient care and healthcare systems across the country. While this shortage is being driven by several factors, including an aging workforce, a lack of training programs, and a significant demand for lab services, these factors are also combining to create increasing anecdotal reports of bullying.
“This issue of bullying or creating less than welcoming work environments in healthcare is not unique to labs, but it is a problem we’re hearing more and more about from the professionals we work with and is something we feel has been underreported,” said Jon Harol, President of Lighthouse Lab Services, a Charlotte, North Carolina–based laboratory management, recruiting, and consulting firm.
Last fall, Harol and Lighthouse conducted an informal poll inviting lab professionals to weigh in on whether they’ve ever witnessed or personally experienced bullying in the lab during their careers.
Out of 341 total respondents, 75 percent said bullying in the lab is a real concern. Just 14 percent said they have never experienced bullying, while the remaining 11 percent said they were unsure. See Figure 1.
This response, combined with continued reports of burnout and dissatisfaction, is an obvious thorn in the efforts of labs to increase the long-term recruitment pipeline while improving the retention of their existing employees. However, by acknowledging and addressing these concerns head-on, labs can be part of the solution to building a more sustainable future for the patients they serve.
As part of Lighthouse’s 2023 annual survey of wages and morale among laboratory professionals, the dual issues of limited staffing and stagnating compensation routinely were cited by respondents as the chief reasons for dissatisfaction with their careers. But a majority of the 1,062 respondents (52 percent) also said they are overworked relative to the responsibilities of their role, which in turn creates friction between bench-level employees and managers.
The hierarchical structure of labs and healthcare systems in general contributes to the prevalence of bullying, according to some survey respondents who chose to leave follow-up comments. Subordinates may be afraid to report incidents due to concerns about retaliation, damaging their career prospects, or simply not being taken seriously. The culture of silence surrounding instances of bullying perpetuates the problem, allowing it to fester and persist.
“It’s very difficult to get decent supervisors who will work the bench, which helps with morale,” reported one season tech, who asked to remain anonymous. “A bad manager can take a good staff and destroy it, causing the best employees to flee and the remainder to lose all motivation.”
Others cited a lack of communication from their managers regarding administrative changes that caused their working relationships to deteriorate.
“Our managers don’t relay anything from management or nursing and that fails to create a harmonious spirit,” another lab professional responded.
Another form of bullying cited by some lab professionals is lateral violence, which involves colleagues attacking each other, most often with verbal or emotional abuse. This behavior can manifest in various ways, from condescending remarks and gossip to workplace sabotage and exclusion.
However, while such behaviors are a concern in medical labs and must be addressed, many are quick to point out that these problems exist across the spectrum in healthcare settings and are not unique to the laboratory setting. According to a 2021 Joint Commission report, 44 percent of nursing staff members report having been bullied in a healthcare setting.
Rick Panning, Senior Healthcare Consultant for ARUP Laboratories, said in response to the Lighthouse poll that while he believes bullying exists in labs, those examining the issue must be careful not to generalize or overstate the problem.
“I think a lot of the issue has to do with the example set by leadership,” Panning said. “I really don’t believe we can generalize on this topic.”
Addressing bullying to improve retention and morale
Addressing the issue of bullying in medical labs in order to improve overall morale and retention will require a multifaceted approach that begins with cultivating a working culture of openness and support. Encouraging employees to report incidents without fear of reprisal is crucial in dismantling the walls of silence surrounding bullying. Establishing confidential reporting mechanisms, such as hotlines or anonymous surveys, can also provide an avenue for victims to share their experiences.
Education also plays a vital role in preventing bullying. Healthcare professionals should undergo training to recognize the signs of bullying and learn effective strategies to address and prevent such behavior. Leadership training is equally essential to ensure that those in supervisory positions understand their role in fostering a positive and respectful workplace culture.
Yes 75% No 14% Unsure 11% 32 | APRIL 2024 MLO-ONLINE.COM BEST PRACTICES :: WORKPLACE BULLYING
Figure 1. Have you ever seen or experienced bullying in a medical laboratory?
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But, as mentioned previously, bullying is often a symptom of other pervasive issues such as staffing constraints and stagnating compensation, which in turn can create increased stress that leads to workplace conflicts. With that in mind, here are proactive steps labs can take to improve overall morale and employee retention within their labs.
Create clear growth paths
Establishing a well-defined growth path for employees in your medical lab is vital in retaining top talent and ensuring they feel like a part of your organization’s future, Harol notes. This can be done by:
• Outlining promotion criteria: C learly outline the criteria for promotions to various roles within the lab. For example, achieving specific performance targets or obtaining new certifications may be goals on career ladders you create for your employees.
employees to gain a better understanding of their perception of your lab’s benefits and compensation.
• Non-CLIA-designated roles: Develop supervisor or manager positions that offer advancement opportunities beyond just CLIA-designated roles. This is key to making employees feel they have something to progress toward instead of being stuck on a hamster wheel with little hope of advancement.
Invest in professional development and training
Promoting employee growth and development is essential for their career progression and overall engagement. By investing in skill training, employees can grow alongside your lab and take on new responsibilities. This can be achieved as follows:
• Mentorship programs: Create a mentorship program within the lab where experienced managers and supervisors can train newer employees and facilitate their skill development.
• Industry-wide welcome: Welcome individuals from non-traditional pathways into the industry and offer training in specialized areas to enhance their skill set.
Harol noted that many new techs joined the industry during the pandemic through pathways that didn’t involve graduating from two- or four-year laboratory-centric programs. While their knowledge may be specialized in certain lines of testing, these individuals also should be viewed as a boon to the workforce who can be retrained to remain in the industry long term.
“Treat new employees well to help make sure they want to stay in the industry,” Harol said. “Investing in them early on will show that you care about their growth and their career in general.”
Stay competitive in the job market
Labs should regularly evaluate and adjust compensation, benefits, and growth opportunities to remain competitive with other employers. Consider the following:
• Ma rket analysis: Examine what competitors offer in terms of salary, benefits, and professional development opportunities to stay competitive.
• Internal review: Continuously assess the benefits package for current employees to ensure it remains attractive compared to external offers. You can also survey
“You have to stay competitive, or you will see your top talent jump to competitors,” says Joe Kessler, Director of Recruiting for Lighthouse Lab Services.“The days of pizza parties being an acceptable reward or bonus are long over.”
Prioritize employee engagement
Engaged employees outperform their disengaged counterparts by as much as 28 percent, Harol noted, making employee engagement a priority. Lab managers and leadership should:
• Be present and listen: Regularly engage with employees, attend to their concerns, and actively listen to their feedback to make them feel valued.
• Pr ovide transparent leadership: Keep employees informed about the company’s performance, goals, and plans to instill a sense of investment in the organization’s future.
By addressing bullying in laboratories head-on, the industry and its stakeholders not only improve the well-being of the professionals who dedicate their lives to providing accurate test results but also enhance patient outcomes. Promoting a culture of respect and support while also working to improve overall working conditions and morale can contribute to a more positive and effective lab environment, where benchlevel techs and managers alike can thrive. By shining a light on this issue and talking about its impact openly, we can collectively pave the way for a healthier future in healthcare.
1. Quick Safety 24: Bullying has no place in health care (Updated June 2021). Jointcommission.org. Accessed February 28, 2024. https://www.jointcommission.org/resources/ news-and-multimedia/newsletters/newsletters/quick-safety/ quick-safety-issue-24-bullying-has-no-place-in-health-care/ bullying-has-no-place-in-health-care/.
Alex Mitchell is Marketing Communications Manager at Lighthouse Lab Services . He works to keep the team and their clients abreast of industry news and changes that could impact their operations or revenue. Alex also manages Lighthouse’s educational content, including monthly webinars, blogs, and industry newsletters.
34 | APRIL 2024 MLO-ONLINE.COM BEST PRACTICES :: WORKPLACE BULLYING
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Molecular testing supports early, effective use of ESR1 -targeting therapies
By Tom Bittick
Avery important change in the breast cancer treatment landscape has made it necessary to expand access to routine testing for acquired genetic variants in patients: the availability of new drugs to address mutations associated with treatment resistance.
Patients diagnosed with hormone receptor-positive (HR+) breast cancer are typically treated with first-line endocrine therapies designed to reduce estrogen levels in the body. A common outcome of these treatments is the development of mutations in the ESR1 gene, seen in up to 40% of patients.1 These acquired variants are specific to patients undergoing endocrine therapies, particularly aromatase inhibitors; they are very rarely seen in treatment-naïve patients.
Of the many variants that have been documented in the ESR1 gene, a certain subset can confer treatment resistance. Such mutations actually eliminate the tumor’s need for estrogen, turning on the biological pathway that is usually only active in the presence of estrogen and once again giving the cancer the ingredients it uses to grow. The endocrine therapies blocking the activation of estrogen cease being effective, and the cancer can relapse.
There are a few approved therapies targeting ESR1 mutations (fulvestrant, elacestrant) that can be used to render those tumors susceptible to treatment again. And positive data from ongoing clinical trials indicates that more effective ESR1-targeting treatments may be on the way.
In light of these developments, it has become essential for clinical laboratories to perform routine monitoring for ESR1 variants in patients with HR+ metastatic breast cancer who are being treated with endocrine therapies. Recently, guidelines from the American Society of Clinical Oncology were updated; they now include a recommendation for frequent ESR1 monitoring to detect emerging mutations during the course of treatment for patients who have been diagnosed with estrogen receptor-positive metastatic breast cancer.2 Clinical data clearly demonstrates that intervening early — as soon as a new mutation is detected — gives patients better outcomes.
In some cases, monthly testing may be appropriate to catch mutations as early as possible.
Clinical trials that are underway have shown promising interim results to support the idea of using ESR1-targeting therapies to overcome treatment resistance in cancers that previously responded well to endocrine therapies. One major trial has been evaluating a currently available therapy, while another has been assessing a candidate therapy not yet approved by the FDA.
The multi-center, randomized, phase 3 PADA-1 trial has been going on for about seven years. It is testing the outcomes of incorporating an ESR1-targeting therapy for patients who develop an ESR1 mutation. The trial includes about 1,000 patients diagnosed with HR+ metastatic breast cancer, all of whom began on a conventional endocrine therapy.3 Patients in one arm of the trial are monitored with bi-monthly ESR1 genetic testing, and the detection of a relevant mutation triggers a shift to fulvestrant, a treatment that has shown good results when used for cancers with ESR1 mutations. Other patients can be switched to fulvestrant if their regular imaging scans reveal growth of the tumor, indicating that the cancer was no longer responding to the endocrine therapy. The PADA-1 trial is scheduled for completion in 2025, but already, reported results have been promising. While patients who were switched to fulvestrant due to imaging-based detection of tumor progression received little benefit, the patients who made the switch earlier — when ESR1 mutations were first detected by genetic testing — had a significant change in outcome.4,5 For the latter group, median progression-free survival was more than twice that of a control group that stayed on aromatase inhibitor therapy.
A candidate ESR1-targeting therapy from AstraZeneca also appears to be performing well in clinical trials. The SERENA series of trials is evaluating the new therapy, camizestrant, in patients with breast cancer.6 In a phase 2 trial, results demonstrated that patients with ESR1 mutations experienced almost three times as much progression-free survival when
36 | APRIL 2024 MLO-ONLINE.COM MOLECULAR DIAGNOSTICS :: ESR1 GENE
45895879 © 9nongphoto | Dreamstime.com
using the candidate treatment compared to standard of care.7 A phase 3 trial known as SERENA-6 is now underway, but expectations are that camizestrant will be effective against a broad range of ESR1 mutations for patients whose cancers become resistant to endocrine therapy.
How to test for ESR1 mutations
For clinical laboratories interested in expanding their test menu with ESR1 monitoring, there are a number of options. Due to differences in technology availability and other factors, though, not all approaches will be right for all labs. Before considering any individual method, it is worth reviewing the key attributes of any ESR1 test.
Sensitivity: ESR1 mutations will first emerge at very low levels against a significantly larger wild-type. Any testing platform must be sensitive enough to identify a clinically relevant mutation that may be present at vanishingly small volumes.
Accuracy: While a test must be sensitive enough to detect ESR1 mutations, it must also be accurate enough not to lead to false-positive results. Most molecular detection technologies that have the required sensitivity will also have the necessary specificity, but it is important to confirm this in any platform evaluation.
Easy access: Clinical trials have proven that shifting patients to an ESR1-targeting therapy as soon as possible is the best way to improve health outcomes. Consequently, ESR1 monitoring must be performed frequently — maybe even monthly — for HR+ metastatic breast cancer patients taking endocrine therapies. Given the need for such frequent testing, an easily accessible sample such as a liquid biopsy is preferable.
With increasing demand for ESR1 testing, an in-house test is likely to be faster and more cost-effective than a send-out test. Here’s a quick look at the different technology platforms available for this application.
Droplet digital PCR: This is the technology used in the PADA-1 clinical study, with demonstrated sensitivity for detecting ESR1 mutations. Digital PCR is highly sensitive and can be used with blood samples. However, there is limited availability of digital PCR platforms in clinical laboratories because of their high cost and complex setup. For ESR1 mutations, there is the added drawback of having to run several different reactions to test the full range of clinically relevant variants.
Next-generation sequencing: This widely available technology is also sensitive enough to detect ESR1 mutations amid a background of non-tumor DNA from virtually any sample
What are exosomes?
Exosomes are part of the vast communication network among cells. These small particles are shed by cells — by all cells, every day, by the thousands — and they carry molecular cargo of DNA, RNA, and/or proteins used to convey biological messages to other cells. By intercepting these molecular data packets and analyzing their contents, clinical labs can identify valuable signals and infer key information about the cells from which these exosomes came. Because exosomes are released by all cells, they can be accessed in all biological fluids. Exosome analysis has already been used to distinguish high-grade from low-grade prostate cancer, identify neurological biomarkers typically blocked by the blood-brain barrier, and more.
type. Unfortunately, most NGS platforms are not designed for cost-effective analysis of single genes. Clinical labs with very high demand for ESR1 mutation testing might have sufficient sample volume to run an NGS-based test affordably, but most labs will find it too expensive to deploy a modern sequencer for this purpose.
qPCR: Unlike the prior two techniques, qPCR instrumentation does not typically meet the sensitivity threshold for ESR1 variant detection. But a new method may allow clinical lab teams to use this affordable, widely available technology for ESR1 monitoring. Scientists have successfully paired circulating tumor DNA (ctDNA) with exosomal RNA analysis to produce highly sensitive ESR1 mutation detection on a standard qPCR instrument. The idea is to use a liquid biopsy approach, capturing both the low-abundance ctDNA and the high-abundance exosomes shed by a tumor. Either signal on its own may be undetectable with qPCR, but combining them into a single assay overcomes that issue. In a presentation at last year’s annual meeting of the Association for Molecular Pathology, scientists reported the development of a single workflow identifying allele-specific ESR1 mutations from ctDNA and exosomal RNA, achieving the sensitivity required for clinical monitoring.8
Going forward, clinical lab teams may find that one of the approaches above is a good fit for incorporating ESR1 monitoring. With ESR1-targeting therapies available today, and more on the horizon, routine variant testing will be a useful way to spot the signs of treatment resistance among HR+ breast cancer patients undergoing endocrine therapy.
1. Hermida-Prado F, Jeselsohn R. The ESR1 Mutations: From Bedside to Bench to Bedside. Cancer Res. 2021;1;81(3):537-538. doi:10.1158/0008-5472.CAN-20-4037.
2. Burstein HJ, DeMichele A, Somerfield MR, et al. Testing for ESR1 Mutations to Guide Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer: ASCO Guideline Rapid Recommendation Update. J Clin Oncol. 2023;20;41(18):3423-3425. doi:10.1200/JCO.23.00638.
3. National Library of Medicine. PAlbociclib and Circulating Tumor DNA for ESR1 Mutation Detection (PADA-1). Available at https://clinicaltrials. gov/study/NCT03079011. Accessed February 28, 2024.
4. Bidard FC, Hardy-Bessard AC, Dalenc F, et al. Switch to fulvestrant and palbociclib versus no switch in advanced breast cancer with rising ESR1 mutation during aromatase inhibitor and palbociclib therapy (PADA-1): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol. 2022;23(11):1367-1377. doi:10.1016/S1470-2045(22)00555-1.
5. Helwick C. PADA-1 Trial: With Early Identification of ESR1 Mutation, Switch to Fulvestrant in Metastatic Breast Cancer. October. 2022;10.
6. National Library of Medicine. Phase III Study to Assess AZD9833+ CDK4/6 Inhibitor in HR+/HER2-MBC With Detectable ESR1m Before Progression (SERENA-6) (SERENA-6). Available at https://www. clinicaltrials.gov/study/NCT04964934. Accessed February 28, 2024.
7. Camizestrant significantly delayed disease progression in advanced ER-positive breast cancer, adding at least 3.5 months benefit versus Faslodex. Astrazeneca.com. Published December 8, 2022. Accessed March 4, 2024. https://www.astrazeneca.com/media-centre/ press-releases/2022/camizestrant-significantly-delayed-diseaseprogression-in-advanced-er-positive-breast-cancer.html.
8. Thibert JR. Development of a Novel Exosome-Based, Multiplexed RT-qPCR Technology for Rapid and Accurate Detection of Circulating Tumor Acquired Resistance Variants in ESR1 at ≤ 0.1% Frequency. Poster Presented at the Annual Meeting of the Association for Molecular Pathology.; 2023.
Tom Bittick serves as senior product manager for oncology in the molecular diagnostics division at Asuragen, a Bio-Techne brand. He has 30 years of experience in the life sciences, with prior positions at Sigma-Aldrich, Ambion, and Thermo Fisher. He holds a master’s degree in microbiology and immunology from LSU Medical Center and a bachelor’s degree in biology from Louisiana State University.
MLO-ONLINE.COM APRIL 2024 | 37 MOLECULAR DIAGNOSTICS :: ESR1 GENE
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38 | APRIL 2024 MLO-ONLINE.COM PRODUCT FOCUS :: LAB SAFETY
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Jessica DesLauriers, MBA, MLS (ASCP) CM is a laboratory professional with a successful career of delivering efficiency and standardization and maintaining CAP ISO 15189 and Six Sigma quality management systems. She is the Laboratory Director for Avera McKennan Hospital & University Health Center in Sioux Falls, SD and oversees four laboratories and over 200 employees. Avera McKennan Laboratory consists of the core lab as well as several specialty departments including genetics, HLA, molecular, cellular therapy, and flow cytometry. Jessica is responsible for ensuring services are provided in a safe, efficient, and cost-effective manner that enhances patient, staff, and physician satisfaction in collaboration with interdisciplinary team members. She also serves as the Quality and Compliance Functional Leader for Avera’s Laboratory Service Line as well as volunteers her time as a member of the Quality Expert Panel for CLSI.
Avera McKennan’s Department of Pathology and Laboratory Medicine was MLO’s 2023 Lab of the Year. One thing that set your lab apart was your use of data analytics to improve laboratory operations. Could you share a recent example(s) of how your lab is utilizing data to improve?
Avera McKennan Laboratory is harnessing the power of data analytics to drive continuous improvement and enhance key metrics within the lab, such as reducing blood culture contamination rates and optimizing other laboratory initiatives. By collecting and analyzing data on blood culture contamination incidents, the laboratory can identify patterns, root causes, and trends that
Directing a winning lab
By Christina Wichmann
contribute to contamination events. This data-driven approach enables Avera McKennan Laboratory to implement targeted interventions, such as staff training, process improvements, and workflow modifications, to reduce contamination rates and improve the accuracy of blood culture results. Through real-time monitoring and analysis of data, the laboratory can proactively identify areas for improvement, track progress over time, and drive sustainable quality enhancements in blood culture testing processes.
Furthermore, Avera McKennan Laboratory is leveraging data analytics to optimize various laboratory initiatives and performance metrics, such as turnaround times, test accuracy, and resource utilization. By collecting and analyzing data on testing processes, equipment performance and staff productivity, the laboratory can identify opportunities for efficiency gains, workflow enhancements and cost savings. This data-driven approach empowers Avera McKennan Laboratory to make informed decisions, set performance targets, and monitor key metrics to drive operational excellence and deliver high-quality patient care. Through a culture of continuous improvement and data-driven decision-making, the laboratory can achieve greater efficiency, accuracy, and patient satisfaction.
What are some of your goals
for the Avera McKennan Laboratory this year?
In line with the health care system’s commitment to innovation, Avera McKennan Laboratory also seeks to enhance its testing capabilities by adopting cutting-edge technologies and expanding its test menu to meet the growing demand for specialized tests. By staying abreast of technological advancements and industry best practices, the laboratory aims to offer a comprehensive range of diagnostic services to support clinical decision-making and patient care.
Avera McKennan Laboratory is also navigating the growing needs of the rapid population growth of Sioux Falls, S.D., while also serving as a reference lab for our rural regions. Our goal is to ensure that the laboratory can scale its operations effectively to meet the growing demand, while maintaining high standards of quality and efficiency. Our
goals involve strategic planning for infrastructure, workforce optimization, and technology integration to enhance the laboratory’s capacity and ability to serve a larger patient population effectively. Furthermore, we aim to collaborate with educational institutions, professional organizations, and industry partners to cultivate a pipeline of future MLS professionals and address the long-term sustainability of the laboratory workforce.
What measures does your laboratory take to prevent staff burnout?
Avera prioritizes the well-being of its staff and implements strategies to prevent burnout. One approach is to foster a supportive and collaborative work environment that encourages open communication, teamwork, and mutual respect. The laboratory has developed a Culture Committee that has staff representation from various departments and shifts. The committee is completely run by the staff who work hard to put on events and activities throughout each month. They do an incredible job at fostering a fun, educational, and collaborative environment. The team hosts events that range from continuing education and community volunteer opportunities, to themed potlucks and games. Occasionally, they will plan competitions with traveling trophies that add a lot of fun and camaraderie throughout the lab. Additionally, Avera offers wellness programs, mental health resources, and professional development opportunities to help employees manage stress, maintain work-life balance, and enhance their overall well-being.
What is the most exciting new technology currently being used in your laboratory?
One of the exciting new technologies being utilized in our lab is the Liquid Chromatography Mass Spectrometry (LC-MS) system in our special chemistry department. The LC-MS system offers unparalleled sensitivity and specificity in detecting and quantifying a wide range of compounds in biological samples. This advanced technology allows for precise analysis of complex molecules, such as drugs, metabolites, and proteins, with high accuracy and efficiency.
40 | APRIL 2024 MLO-ONLINE.COM
hospital performs one
tests per year
loses one in 1,400 tubes at a cost of $400-600 per tube, then the annual cost could be as much as $428K – not to mention the burden on patients and hospital1.
Avoid lost samples and save thousands with Indexor. PRE-ANALYTICS, POWERED BY INDEXOR DIGITAL HEALTH SOLUTIONS © 2024 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Indexor trademarks are owned by Isens-Electronica, LDA. The Indexor system is manufactured by Isens Electronica, LDA and is available in select countries. ADD-148277-USA-EN 1/24 1. Wiwanitkit, V. Types and frequency of preanalytical mistakes in the first Thai ISO 9002:1994 certified clinical laboratory, a 6 – month monitoring. BMC Clin Pathol 1, 5 (2001). SEE HOW INDEXOR STREAMLINES AND AUTOMATES SAMPLE TRACKING FOR BETTER RESULTS.
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The Roche cobas® 5800 System is built to offer a fully automated workflow that encompasses primary vial handling for cervical and sexual health samples, transfer and preparation, amplification and detection, result calculation and delivery to the laboratory information system (LIS).
Designed to bring efficiency, flexibility and simplicity to laboratories of all sizes, enabling greater patient access.
Learn more and contact your Roche representative, today. | <urn:uuid:d8852b66-b75d-40a6-9d1a-0888a3583640> | CC-MAIN-2024-18 | https://issuu.com/docs/be9c4c349984ae3e44ad673ca34e8534?fr=sOTM3ZjcxMDYwNjM | 2024-04-20T18:11:20Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.905228 | 32,483 |
We are pleased to announce Ivy Station will be hosting the return of the Culver City Expo on Wednesday, 9/14/22, 3:00 pm – 7:00 pm.If you have a product or service of interest to other Culver City businesses and residents, this is the place to showcase it. Booth location and availability will be based on timing/order of registration.
Reach hundreds of businesses and residents by showcasing your business at this year's event. Advertise your products and services to other companies and residents! Food Samples, Raffles, and Lots of Networking! For more information, please scan the QR code on the flyer or visit www.culvercitychamber.com. | <urn:uuid:e92df4b1-aed8-49d9-af48-c4aca32264b0> | CC-MAIN-2024-18 | https://ivystationculvercity.com/blog/329/culver-city-expo-ivy-station | 2024-04-20T15:35:25Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.938833 | 145 |
New Hampshire is the most economically free state in North America and in the United States, once again edging Florida to top every Canadian province, U.S. state and Mexican state as ranked by the Fraser Institute, Canada’s free-market think tank.
The Fraser Institute’s 2023 Economic Freedom in North America report, released in partnership with the Josiah Bartlett Center for Public Policy, measures government spending, taxation and labor market restrictions using data from 2021, the most recent year of available comparable data.
New Hampshire surpassed Florida as having the highest level of economic freedom in the U.S., having scored 7.96 out of 10 in this year’s report. Rounding out the top five freest states are Florida (2nd), Tennessee (3rd), Texas (4th) and South Dakota (5th). Puerto Rico came in last with 2.85. The least free states were New York (50th), California and Vermont (tied for 48th), Oregon (47th) and Hawaii (46th).
The Granite State also topped the list of all states in North America, scoring 8.14 out of 10, followed by Florida (8.07), South Carolina (8.06), and then Idaho and Indiana, tied for fourth (8.05). Alberta is the highest-ranking Canadian province, tied for 31st place with a score of 7.90.
“New Hampshire is proof for all of North America that economic freedom creates maximum opportunity and prosperity,” Josiah Bartlett Center President Andrew Cline said. “The formula is proven, and anyone can follow it. Even Vermont, if it wants to.”
“The freest economies operate with comparatively less government interference, relying more on personal choice and markets to decide what’s produced, how it’s produced and how much is produced; as government imposes restrictions on these choices, there’s less economic freedom and less opportunity for prosperity,” said Fred McMahon, the Dr. Michael A. Walker Research Chair in Economic Freedom at the Fraser Institute and report co-author.
The report includes an all-government ranking, which adds federal government policy to the index and includes the 50 U.S. states and the territory of Puerto Rico, 32 Mexican states, and 10 Canadian provinces.
Taking into account both federal and state policies, U.S. economic freedom declined from 2003 to 2011, began to recover, and then declined again after 2017. The last two years have seen the lowest levels of measured economic freedom in the U.S. in the last two decades. And while the U.S. remains more economically free than Canada, the gap is relatively small.
“The evidence is clear—lower levels of economic freedom are associated with less prosperity, slower economic growth, less investment, and fewer jobs and opportunities,” said Dean Stansel, economist and research associate professor at Southern Methodist University and co-author of the report.
The Economic Freedom of North America report, also co-authored by José Torra, the head of research at the Mexico City-based Caminos de la Libertad, and Ángel Carrión-Tavárez, director of research and policy at the Instituto de Libertad Económica in Puerto Rico, is an offshoot of the Fraser Institute’s Economic Freedom of the World index, the result of more than a quarter-century of work by more than 60 scholars, including three Nobel laureates.
See the full report at www.fraserinstitute.org/economic-freedom.
New Hampshire’s cores in key components of economic freedom (from 1 to 10 where a higher value indicates a higher level of economic freedom):
- Government spending: 8.25
- Taxes: 7.68
- Labor Market Freedom: 7.60
About the Economic Freedom Index
Economic Freedom of North America measures the degree to which the policies and institutions of countries support economic freedom. This year’s publication ranks 93 provincial/state governments in Canada, the United States and Mexico. The report also updates data in earlier reports in instances where data has been revised.
For more information on the Economic Freedom Network, datasets and previous Economic Freedom of North America reports, visit www.fraserinstitute.org. And you can “Like” the Economic Freedom Network on Facebook at www.facebook.com/EconomicFreedomNetwork.
Download the entire report here: EFNA-2023-US. | <urn:uuid:c53ae0e5-973f-42b3-ae49-6e4a872c014c> | CC-MAIN-2024-18 | https://jbartlett.org/2023/11/n-h-again-tops-all-of-north-america-in-economic-freedom/ | 2024-04-20T15:39:41Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.917085 | 935 |
Jamaica Center for Arts and Learning
Diversity, Equity, Inclusion and Accessibility Plan (DEIA)
The Jamaica Center for Arts & Learning (JCAL), founded in 1972, is a multidisciplinary arts center based in the diverse community of Southeast Queens. It is devoted to offering quality visual, performing, and literary arts, and to provide accessible arts education programs that encourage participation in the arts.
Jamaica Center for Arts and Learning (JCAL) is the one and only multidisciplinary urban arts center located within the diverse community of Southeast Queens. Created in 1972 as part of an effort to revitalize Downtown Jamaica, JCAL has earned a reputation for showcasing the talents of legendary and up and coming local artists and performers, inspiring youth to take an interest in the arts, and creating dynamic multicultural programs that have been engaged by all generations and local residents.
Over the years, JCAL has grown from a community organization into a CIG with a mission to reach out and represent the ever-growing culturally complex population and to engage even the smallest enclave of diversely self-identified members of the community. JCAL is an equal opportunity organization in all ways especially in today's world of identifying oneself beyond one's ethnic identity; we welcome all and do our best to consider programming that will reach each of Queens and NYC's community members and tourists.
JCAL vision - to ensure that its two building campus and programs create a safe space that honors, respects and welcomes all people with the following categorized identity markers along with welcoming new self created Identity markers as a testament to human uniqueness and a place where we can collectively celebrate individuality. Our vision is meant to hold all of JCAL’s spaces, programs and practices as sacred and meant to honor our cultures and creativity. Every day, we seek ways to actively promote and recognize principles of fairness and equity, in relation to, and across, intersections of race, age, color, disability, faith, religion, ancestry, national origin, citizenship, sex, sexual orientation, social class, economic class, ethnicity, gender identity, gender expression, and all other identities represented among our diverse communities. JCAL is committed to be a safe creative incubator, an institution that advances Jamaica as the unique resource of arts and culture for residents and visitors in Queens, New York City, and beyond.
Diversity is a defining feature of JCAL's past, present and future. JCAL, residing in one of the most diverse cities in the world, celebrates and promote diversity in all its forms since its inception. The Jamaica community first came together in creating JCAL as a means of correcting an imbalance in the greater cultural landscape - to include artists who were denied access because of their race, gender, and proximity to Manhattan. Since that time, JCAL has consistently proven that there is value in the alternative. However, communities are not static and the Jamaica neighborhood has changed dramatically since the 1970s. JCAL has always worked to remain true to its principles by engaging with the extremely varied artists of Queens. This DEIA process has shown us that our framework, while successful, is reactionary. At a time when the boundaries of gender are shifting and the fluctuations of immigrant populations are causing rapid (and positive) upheaval to the status quo, we have learned that with the right process in place JCAL can reside at the vanguard of these changes - thereby providing support for the most vulnerable in our communities.
During a time in which identities are being used to divide, JCAL firmly believes that arts and culture are vital components to forging mutual understanding and building a sustainable society. JCAL dedicates its space and programming to the pursuit of collaboration and the celebration of the multiplicitous perspectives that diverse life experiences bring. All people are welcomed, respected and nurtured in their artistic and social development at JCAL.
Our first step was to conduct an internal scan of our current practices and perceptions, which included input from all staff and board members. A consultant firm was brought in through DCLA's support to work with senior staff members to start the interview and drafting process. The senior staff held meetings with junior staff members and included their input in the comments given to the consultant firm. The senior staff members include Asian, LatinX, African American, and Caucasian from a diverse age spectrum, physical abilities and gender identities representing the heads of departments across JCAL's program and operations. The updated draft of this plan will again be reviewed and approved by the Board of Directors.
Definitions (as per the NYC Culture Plan, Create NYC)
Diversity: Diversity is all of the ways in which we differ. Among these dimensions are age, gender, mental/physical abilities and characteristics, race, ethnic heritage, sexual orientation, communications style, organizational role and level, first language, religion, income, work experience, military experience, geographic location, education, work style, and family status. JCAL is also open to understanding and adding self-identifying moniquers that are not a part of the existing American (colonial based) definitions.
The definition of diverse communities includes those marginalized groups that have historically experienced a lack of access to financial resources and/or social and organizational mobility. We note the significant and vital interconnection, overlap, and intersectionality between these communities.
Equity: Improving equity means promoting justice, impartiality, and fairness within the procedures and processes of institutions or systems, as well as in their distribution of resources.
Inclusion: Inclusion refers to the degree to which all people, including people with disabilities, with diverse perspectives and backgrounds are able to participate fully in the decision-making processes of an organization or group and in all elements of an organization, performance, event, or programs. While a truly inclusive group is necessarily diverse, a diverse group may or may not be “inclusive.”
Access: Improving access means reducing economic, social, communication, and physical barriers to inclusive participation. Accessibility describes the degree to which an environment, service, product, or program allows access and eliminates barriers to participation by diverse or underrepresented communities, especially people with disabilities.
DCLA plan DEI: acronym for "Diversity, Equity & Inclusion"
JCAL’s inclusion of Accessibility IDEA: acronym for "Inclusion, Diversity, Equity & Accessibility" or DEIA “Diversity, Equity, Inclusion & Accessibility”
Adding Accessibility (the A) to JCAL’s DEIA plan: To understand programming priorities and how to best serve the diverse population of Southeast Queens communities the newly formed programming department, prior to and during work on the DEI plan, initiated projects Building Equity for Immigrant, Indigenous and Native American artists in Southeast Queens (Building Equity) as well as engaging in discovery of the area’s plethora of “identity markers” / “identity monikers” through the project The World of Queens. Working on these two projects made it clear that JCAL’s DEI plan needs to include Accessibility because it also deals with not only the physical space but also the conceptual, emotional and philosophical/spiritual space.
A summary of the Building Equity includes a deconstruction of producing and presenting events (using seven pillars of producing/presenting and each pillar’s coinciding constituent groups) at Jamaica Center for Arts and Learning, a center that is Western Centric in its architecture and has a history shaped by Jamaica Queens’ historic African diaspora. By continuing to serve JCAL’s deep-rooted community and expanding its programmatic reach it is broadening its definition of presenting and producing the arts paying close attention to many of the underserved community members of Immigrant, Indigenous and Native American’s encompassed within the Asian, LatinX, Arab, African and Native American (ALAANA) communities of the Southeast Queens area. | <urn:uuid:0acb501e-2041-4f29-a43a-d1e909969005> | CC-MAIN-2024-18 | https://jcal.org/deia-plan | 2024-04-20T17:29:04Z | s3://commoncrawl/crawl-data/CC-MAIN-2024-18/segments/1712296817670.11/warc/CC-MAIN-20240420153103-20240420183103-00168.warc.gz | en | 0.95241 | 1,607 |
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