text:
- Archie Cochrane on epidemiologists and NHS merit awards
- A day in hospital
- Elsevier, double-dipping, and the NHS
- Integrated Reading Environment
- The Research Works Act
- Parliament Hill Fields
- Types of cloud - app internet versus drive-in-the-sky internet
- 'Good' organizational reasons for 'bad' clinical records
- Digression
- Is ownership important?
- VistA going Open Source
- Semantics and semantic interoperability of health records
- Copyright and innovation
- Your text is out there somewhere (but probably not in an IR)
- Wordle
- The case for terminologies in healthcare
- What is value in healthcare?
- Cloud watching
- Sobering realities about Health Information Technology
- Does the NHS have an IT infrastructure?
- docs.com ux
- Flowdock looks interesting
From One Mans Medicine:
Beyond all this, I think that I also failed epidemiology in another way because I did not make enough fuss about a problem I saw looming ahead. It dated back to Nye Bevan's bribe to get consultant physicians and surgeons into the National Health Service. He promised the senior physicians and surgeons that they would get merit awards which would increase their salaries well above that of the average consultant in private practice. The top merit award could double the salary. There were, however, at that time no epidemiologists in
Harley Street, so when the scheme was inaugurated, epidemiologists were not included.
The Pneumoconiosis Research Unit had a ward with patients and some of the clinical physiologists were in charge of it. I knew these people would in time get merit awards (the whole system is very secret), while there was no chance of an epidemiologist getting one. I never complained on my own account as I have a private income and I thought the MRC paid me adequately, but I became increasingly worried about recruitment of epidemiologists in the future. There was an increasing interest in epidemiology amongst bright young men and women in the late 1950s and several came to see me. I felt it my duty to point out to them that though epidemiology would give them a fascinating and satisfactory life their top salary level would always be much less than that of their clinical colleagues. This problem became acute in the 1960s and almost killed the promising resurgence of British epidemiology which had started in the 1950s. I certainly raised the problem, but I did not shout loud enough. I do not blame Nye Bevan; his bribe was well worth while to help get the National Health Service started.
We spent 24 hours in Royal United Hospital Bath over the weekend, dealing with a broken arm. Heres what we learnt: * THE NHS IS AN AMAZING IDEA. To be treasured. I explained to my son that if wed have been in the US we might have had to pay thousands dollars for the investigations, overnight stay and surgical care hed received, even if wed been able to claim it back. And that if we werent insured or well- off who knows what sort of care wed have received. A pox on the Tory modernisers who dont understand the law of unintended consequences, and a double pox on those who want to privatise the NHS. And their cheerleaders. * ROYAL UNITED HOSPITAL BATH IS A VERY GOOD HOSPITAL. On a Sunday. At Easter. Checked-in to A&E, dosed up on pain killers, x-rayed, first plaster cast in an hour. Nurse led, doctors at hand. Lots of checklists. _Thank you Nurse Conway_. I challenge anyone, anywhere, under any payment system, to get a better service. * INFORMATION SYSTEMS IN NHS HOSPITAL ARE CURIOUS. The front desk found our home address in another part of the country. But thats all - no access to any existing patient record. Apart from the x-ray record everything was paper based. * It was interesting to see the nurse fish out her IPHONE (thank you Kirsty!) when she needed to do a calculation. * MOST REMARKABLE WAS THE WAY OF MOVING THE PATIENT RECORD CREATED IN BATH TO HEREFORD. This is what happened. Most of the notes that had accumulated over the last 24 hours were photocopied (10 pages) and put in an envelope. The first set of x-rays were burnt onto a CD and put in the envelope. But the second set of images, taken in theatre, werent available so we presume they wont be going to Hereford. A handwritten discharge note was added. The package was given to us to convey to the fracture clinic at Hereford where his care will continue. Does this constitute a Patient Held Record? What about PACS? Couldnt we do with something like a NHS wide IT programme? :-)
Mike Taylor recently questioned the practice of paywalling and profiteering from selling the results of publicly funded research back to taxpayers in a Guardian comment http://www.guardian.co.uk/science/2012/jan/16/academic-publishers-enemies-science Central to the surge of criticism of Elsevier is that they take a free good and charge for it. What has figured less prominently is that Elsevier sometimes charges twice or even three times for the same free good. The practice is known as double dipping. Publishers at least recognise the phrase and are a pains to deny that they do it. Unfortunately the paywall business model makes it almost certain that they do. Lets take the NHS. Elsevier et al double dip the NHS by selling subscriptions to the same journals at all levels. Where they can they sell subscriptions to electronic versions of journals to the NHS as a whole. They also sell electronic and paper subscriptions to departments, individual libraries across the NHS. They also sell subscriptions to universities, to which many NHS staff are associated. As a result it is quite feasible for an academic clinician to have had a subscription to a journal paid three or four times over. What makes Elsevier a stand out though is triple-dipping. In addition to multiple charging the NHS for subscriptions they require the NHS to pay $3-$4,000 dollars PER ARTICLE to enable the NIHR to implement its policy of open access to the findings of NIHR funded research - research that has usually been conducted on volunteer NHS patients, in taxpayer funded facilities, with grants and other funding from NHS budgets. Elsevier argue that the NHS is paying for different things - and they deny that paying for subscriptions and paying to archive is double-dipping. Yet Elseviers costs only occur once and ultimately all the different payment streams are off-setting that one parcel of costs. So double, triple or even higher orders of dipping is the almost inevitable consequence of their approach.If Elsevier are genuinely concerned to avoid double dipping what could they do? Firstly, drop their charges to NIHR. And if they are really concerned, they should hasten the move away from a business model that makes double dipping inevitable - perhaps by supporting the Federal Research Public Access Act.
Elsevier are very sensitive about double dipping. They claim they lower subscription prices to reflect any articles in closed access journals that the NHS has paid to make open access. This is an admission that the costs of subscriptions and the costs of open access are linked.
Elseviers double dipping avoidance list is here - http://bit.ly/ycCyQP - and it is notable that it doesnt include any papers published in the Lancet. This seems extremely unlikely, and indeed PubMed Central contains many Lancet papers. So something doesnt add up.
How much does double dipping cost the NHS? The figure is hard to quantify because Elseviers pricing model lacks transparency and has little interest in monitoring a practice that the NHS seems happy to permit. But at a guess Elsevier probably benefits several millions pounds a year overall from double- dipping the NHS. In an NHS desperately short of cash enough to worry about.
As far as I know there is no such thing as an Integrated Reading Environment (IRE). But there should be. Lets see what it would do: Webpage, app or widget, you would drop a well formed bibliographic reference, DOI or URL into the IRE, which would fetch the full text and load it for reading. Youd be able to see comments from other readers Youd be able to call up the papers in the reference section in a popup window Youd be able to add comments and lengthier responses, which would be relayed directly to the authors Youd be able to check data, obtain datasets, re-analyse Youd be able to read protocols, grant applications and other related documents Youd be able to find similar papers Id happily pay £10-£15 per week for a service like this.
My experience of negotiating with publishers is that they find it difficult to quantify or even identify the value they believe they add to the outputs of publicly funded research. I dont want to be too specific about the publisher. I dont think it matters who they were, although it wasnt Elsevier. About ten years ago we were negotiating the terms and conditions for the renewal of a large contract involving publicly funded research outputs. We were trying to reach fair price essentially, somewhere on a continuum between £0 and £several million per annum. Difficult. At one point we wrote to the publisher asking two questions: * How were they going to take account of the financial contribution from the public sector into the production of the research, which we estimated conservatively at £20M? and * Could they identify and quantify the value that they added as a publisher?
I remember the whole episode quite clearly because of the nature of their reply. The value they added was set out in terms of a few rather obvious and generic services (marketing, innovation) and not costed in any way despite our request. Not helpful. But the more telling part for me was that they seemed genuinely baffled with the concept that the public sector had largely paid for the production of the resource. It seemed as if no one had ever suggested this to them before.
I worry when I read about the Research Works Act because it is regressive, because if passed it may create a threat to open access to Pubmed, and because once again it shows Elsevier to be on the wrong side of the argument. I wonder as well if any publisher has answers to the questions that went unanswered ten years ago?
No inherent objections to the use of health records for medical research. There are ways to anonymise, protect AND link records, as the SAIL project has shown. But a few observations come to mind at this point: * Research on large sets of anonymised NHS records has been taking place in the UK at least since the 1960s (Lester Gill PDF) * The critical question in relation to medical records is who owns them. This development answers the question in a round about way - the government has primary ownership, not clinicians or patients. * What research will be done? Research using large datasets has been talked about for many years, and has been conducted, especially in the US. Datasets are much easier to assemble than prospective sets of consented patients. But the nature of the dataset methodology makes it unclear that it produces genuinely new knowledge. * Pharmaceutical companies have worked with the NHS on anonymised datasets under the heading of practice audit. The general aim of these studies has been to increase prescribing rates of existing drugs. * The key area of development is personalised medicine. But this requires the collection of genomic information - a complex process requiring explicit patient consent being explored in the Stratified Medicine Programme * The political aspects of the decision being made here has some similarities to the previous Governments National Programme for IT.
In February 1996 Wired magazine published an interview with Steve Jobs in which he predicted an Internet of digital agents rather than websites (http://www.wired.com/wired/archive/4.02/jobs.html). The ideas in that interview pre-dated Tim Berners-Lee and colleagues better known semantic web paper by 5 years. (http://www.scientificamerican.com/article.cfm?id=the-semantic-web) An internet of digital agents didnt look likely at the time. But 15 years on it is beginning to take shape as one vision of the computing cloud. Apples iCloud shifts the centre of personal computing from the device (PC, Mac, smartphone, tablet, whatever) to the cloud. As Steve Jobs said "Were demoting the PC to being just another device". There is another vision of the cloud, as a hard drive in the sky (dropbox for example) which lets you store files remotely. Its a great model. But it might not be around for too long. The iCloud model does away with file-syncing altogether. If anything it is data-syncing. And it is transparent - you dont have to do anything to have a photo on one device appear on another. The first implementation of the cloud was file-oriented. The second implementation, which will benefit Apple at Microsofts expense, is data oriented. And a cloud of data may be the beginning of a new app-oriented, intelligent-agent Web. And what the Wired article shows most is the benefit of having a good clear vision and sticking to it. Apple has done that, but Microsoft hasnt. The huge cash mountain at Microsoft has disguised an underlying lack of vision for a long time; even (maybe especially) the purchase of Skype is a sign of playing catch-up
As the inverted commas imply, good and bad are the words analysed in this foundational text for health informatics by Howard Garfinkel. Unfortunately it isnt available online. At the risk of censure from fair dealing zealots here is a central part of the paper:
When any case folder [medical record] was read as an actuarial record its contents fell so far short of accuracy as to leave us puzzled as to why "poor records" as poor as these should nevertheless be so assiduously kept. On the other hand, when folder documents were regarded as unformulated terms of a potential therapeutic contract, ie as documents assembled in the folder in open anticipation of some occasion when the terms of a therapeutic contract might have to be formulated from them, the assiduousness with which folders were kept, even though their contents were extremely uneven in quantity and quality, began to "make sense".
Leopold Bloom: "What is weight really when you say the weight? Thirtytwo feet per second per second. Law of falling bodies: per second per second. They all fall to the ground. The earth. Its the force of gravity of the earth is the weight." Frank Wilczek: "Matter is not what it appears to be. Its most obvious property - variously called resistance to motion, inertia, or mass - can be understood more deeply in completely different terms. The mass of ordinary matter is the embodied energy of more basic building blocks, themselves lacking mass" Bloom, and his creator, would have liked that, especially the phrase "themselves lacking mass"
There was a debate on LinkedIn recently about personal health records, and about what patient control meant. A fairly prevalent view was that the question of who owned the record was irrelevant.Yet it seems to me that ownership is easily the most important aspect of a health record. I realise Im in a minority on this issue. I was therefore interested to read yesterday from Sir Ian Kennedy (http://bit.ly/eWVAIr):
I begin with the culture of professionals.The professional owns knowledge. From this, as I suggested in the Reith Lectures, flows power.And, power here is used in a neutral, descriptive sense. Speaking in general terms, and conscious that, being general, we all know of exceptions, the patient is someone in the professional's power whom the professional seeks to care for.The professional grants the patient the benefit of his/her knowledge, but does so on terms.The fundamental term is that the professional remains in charge of the exchange. Yes, the patient may be granted the autonomy to make a choice, but it is an autonomy granted by the professional, rather than owned by the patient. The striking feature of this analysis is that the relationship between patient and professional is not perceived as one of service.The professional is simply not at the patient's service.Thus, analogies with relationships more obviously characterised by the notion of service are out of place. (And this is equally true of the two other ancient professions, the law and the church.) Introducing the rhetoric of the market, in the form of there being a commercial relationship between the patient and the professional, does not change this dynamic.The fact that the patient is paying the bill has to be managed by the professional. Manners may change a little, but little else. Power is not relocated. Indeed, the very word "service" is too close to "servile" to many a professional's ear.To repeat, the professional in healthcare is not like, does not see her/himself as a on a par with, a restauranteur, an electrician, a hotelier, or a shopkeeper.To all of these "the customer is always right".To the professional in healthcare, the word customer sticks in the throat, given its symbolic quality of being the more important player in the exchange, and is not right.The patient is there to be guided, advised, led, but not in charge.And, none of this analysis is intended to deny for a moment that the vast majority of professionals are immensely caring and supportive people, committed to doing their best for their patients. What I am seeking to understand is some kind of cultural characteristics which constitute the DNA of professionals.This consideration does not suit existing suppliers, who are struggling to get clinicians interested in electronic records. But in the longer term a more patient-owned approach to information will be part of new forms of professionalism.
Quite an important moment, though it should have happened years ago. From the RFC/RFP: Specifically, VA believes that a structured, deliberate, and predictable migration from our custom and proprietary EHR software to an openly architected, modular, and standards-based platform will achieve five crucial objectives: * It will unleash EHR innovation inside and outside VA. * It will release VA's captive dependency on any particular component or service and give our clinicians access to the best available tools and solutions. * It will reduce the costs and risks of reliable implementation (and integration) of new functional modules that improve VistA's capabilities. * It will measurably improve health outcomes for our nation's Veterans. * It will enable other providers in the public and private health care system to benefit from, contribute to, and interoperate with this national asset.
I share Robert Dolin and Liora Alschulers view that evaluation and measurement in health informatics is vital, and that frameworks for evaluation should be informed by examining the underlying concepts to be measured, in this case semantic interoperability. (JAMIA 2011;18:99-103 ) Their analysis raise a few questions however. Firstly, the most basic type of semantic interoperability is that which enables one computer to correctly interpret a character string sent from another computer. "John Smith" for example, interpreted as the name of a relative rather than the patient himself, or 02-19-1959 as a date of birth rather than a date of death. This is a modest but valuable type of semantic interoperability. It has been available for many decades in computer science, for example through semantic modelling in relational database management systems. As Dolin and Alschuler note, health informatics has yet to provide a truly reliable method for the semantic interoperability of structured data. They cite the example of the differential diagnosis of pneumonia. In fact, as William Hogan has shown, HL7 can struggle to reliably model even basic information such as marital status (http://bit.ly/fSRN70 ) and gender (http://bit.ly/iitzPL ). Ambiguity and complexity are hard-wired into the construction of HL7; these are not desirable features for a system intended to exchange meaningful information transparently. Secondly, the meaning of a piece of data might not be self-contained but may depend on other data items. For example, a data point ("prescribed penicillin") could be interpreted as vital, or unnecessary, or harmful, depending on other data about the patient. Measures of semantic interoperability need to take into account the potential interdependency of data items in a record. Dolin and Alschuler discuss context sensitivity, but as far as I am aware there appears to be no recognition in any current HIT standards that the meaning of a piece of information may depend on the meaning of other pieces of information. Thirdly, it is not clear how much of the meaning in a record is locked in unstructured data. This matters because even if all the structured data in a record could be exchanged accurately, a portion of the meaning of a record cannot be exchanged, at least not in machine oriented form. It could be argued that it is becoming possible to parse and auto code free text. But this is technically problematic. Doing so also highlights the largest challenge of all, which is that codification is always a translation, and translation risks losing, changing or adding to the semantics in the original text of a medical record. In conclusion, Dolin and Alschulers paper is very welcome, but it does not sufficiently challenge the assumptions about meaning made by messaging and coding standards for EMRs. These need to be examined, and a more sophisticated model of meaning within the EMR developed, before a framework for evaluation semantic interoperability between EMRs can be established.
A couple of things struck me when reading the submission to the the Hargreaves review from the Copyright Licensing Agency, prepared for them by Price Waterhouse Cooper http://bit.ly/fJeWst For a report which its commissioners could only want support for its position, the message is surprisingly lukewarm. Take Figure 9 for example, which compares global competitiveness with strength of IP protection. Both measures are problematic, but presumably PWC were charged with finding the most supportive evidence, so this must be it.
Needing a copy of this, and not wanting to pay $40 for something Ive already paid for as a tax payer, I found this Institutional Repository record which needless to say didnt link to the full text. Eventually I found a copy on the University of Plymouth extranet. University Institutional Repositories continue to under perform, often seeming like glorified publication lists.
Published in December 2010 by a Whitehouse scientific advisory group which includes Craig Mundie and Eric Schmidt, available at http://www.whitehouse.gov/blog/2010/12/08/pcast-releases-health-it-report . Main recommendation
It is crucial that the Federal Government facilitate the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records while strictly ensuring patient privacy. More specifically, PCAST recommends that the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services develop guidelines to spur adoption of such a language and to facilitate a transition from traditional electronic health records to the use of healthcare data tagged with privacy and security specifications.Summary of report: * Great potential for health IT but held back because 80% of US docs have no EMR system. * Even where EMRs do exist they are rudimentary and lack interoperability. * Areas where IT has had a transformational effect have employed simple standards and developed new products to knit together fragmented systems into a unified infrastructure. [Examples? Google, which knits the web into a unified search engine. Not iTunes though, which is anything but disparate] * Health IT is a long way off this goal. Current EMRs are highly proprietary; inward looking; generate legitimate privacy concerns; and are oriented towards administration. * Meaningful use rules have been helpful but establishing a framework for information exchange is vital to accelerate progress. * Standardized records and SOA arent the solution * Health IT should use the disruptive effects of the Internet to move forward, and not wait for EMRs to evolve. * A universal exchange language and the associated infrastructure are priorities. Both need to be funded centrally. * Tagged data elements, accompanied by meta-data, are key * The indexing and retrieval of metadata-tagged data, across large numbers of geographically diverse locations, is an established, highly developed, technology—the basis of web search engines, for example. * The approach that we describe requires that there be a common infrastructure for locating and assembling individual elements of a patient's records, via secure "data element access services" (DEAS). Importantly, this approach does not require any national database of healthcare records; the records themselves can remain in their original locations. Distinct DEAS could be operated by care delivery networks, by states or voluntary grouping of states, with possibly a national DEAS for use by Medicare providers. All DEAS will be interoperable and intercommunicating, so that a single authorized query can locate a patient's records, across multiple DEAS.
Some other points in the review:
* More than 3 million Kaiser patients are registered to access their health record online. Over 100,000 access the system on a given day, reducing office visits by 26% * Google and Microsoft, the two largest vendors of web-based PHRs, recently agreed on mechanisms to enable the free exchange of information between their respective PHR systems, and others may follow. * US physicians who adopt electronic records by 2014 can qualify for Medicare bonus payments of up to $44,000
One of the foundational axioms in health informatics is the need for codes, more formally clinical terminologies, to represent conditions, diseases and symptoms. For example, this paper, or this statement from IHTSDO:
The IHTSDO seeks to improve the health of humankind by fostering the development and use of suitable clinical terminologies, notably SNOMED CT, in order to support safe accurate and effective exchange of clinical and related health information. The focus is on enabling the implementation of semantically accurate health records that are interoperable.I want to show that coding creates the _illusion _of semantic interoperability, and that far from improving, it degrades the quality of semantic exchange. What do codes look like? Heart Failure for example, can be coded as D006333. It can also be coded as 150 or G58 (Read Code v2, widely used in primary care in the NHS). It can be coded 10019280 in the Medra Ontology. You might ask "Why so many codes for the same thing?", and a plausible answer might be "it doesnt really matter, because the codes all point to the same concept, and this way everyone can use the coding system they are familiar with, and share information when they need to". And this would be true if heart failure was a single entity. But heart failure is a syndrome. It embodies a collection of concepts - several causes, a range of underlying pathology and a variety of symptoms. It is not a single thing, and the coding schemes reflect this. Even a relatively simple scheme such as ICD 10 includes a range of possible codes to cover different types and causes of Heart Failure, including I11.0 for heart failure caused by hypertension, 150.0 for congestive heart failure, and 150.1 for left ventricular failure. Do both 150.0 and 150.1 map onto D006333? Or do they map to sub-codes of D06333? Read Codes contain separate codes for acute and chronic congestive heart failure. How do these map to 150.0? Several coding schemes have separate codes for the grades of hypertension as defined by the New York Heart Association scale for grading the severity of Heart Failure. Read Codes 662f - 662i cover these, but they are not represented in all coding schemes (Medra lacks codes for NYHA grades for example). It is recognised that some of the distinctions encapsulated in codes - for example between systolic and diastolic heart failure - are "somewhat arbitrary" (see this ref) In principle it would be possible to map between each of the codes for heart failure in the major coding schemes. But even if it were done the mapping across schemes would not be 1:1, resulting in a loss of information and the inclusion of code generated uncertainty. As a result, machine based translation would only be reliable if the terms in each coding scheme were kept high level. But that would mean that the high level code for Heart Failure in one scheme would be translated to the high level code for Heart Failure in another scheme. It would be simpler to use the term Heart Failure in this case. There are two more significant issues with codes. First issue - was the original diagnosis correct? Setting a diagnosis in a code removes the ambiguity and uncertainty that often surrounds diagnoses, which then travels unencumbered across systems. Second issue - has the diagnosis been coded correctly? Research shows a good deal of variation within and between clinics in the way diagnoses are made and coding is applied. In part this is because of operator error. But also it arises from the often multiple ways of coding a diagnosis. Choice of codes is always a local decision, based on rules which do not travel with the code. Clinicians are aware of the problems of medical coding, and these problems cover most diagnoses. A receiving doctor will want to review the diagnosis medication and treatment of a newly presented patients. In which case a narrative account will convey enough information for semantic interoperability. Coding adds nothing, and may cause semantic degradation by reducing the amount of information available in the originator document. Even if all coding were done in a single terminology variation and error would be present. All the studies show variation in the coding for the same condition. Coding therefore introduces new uncertainty on top of the uncertainty already in the underlying narrative record. There are other justifications for coding. Use in decision support or clinical audit for example. The introduction or error and the loss of information associated with coding mean that coding does not have the value it is assumed to have. In the early days of computing it was useful to code diagnoses because bandwidth and hard disk space were at a premium. But that is no longer the case. The remaining justification is that coding is useful for re-imbursing and other administrative systems. Coding in these circumstances may be valuable, but this is not in itself justification for the continuing development of detailed coding systems. to carry clinical meaning.
Professor Michael Porter has written passionately about the need to reconsider what constitutes value in healthcare for many years. His latest article in the New England Journal of Medicine summarises his views http://bit.ly/gl4XIm and highlights the health informatics issues associated with not focusing on value. What is surprising is that his perspective should still be seen as radical and challenging in an open market such as the US. In other areas of life the idea that "value should always be defined around the customer" would hardly deserve mention, yet in healthcare it is radical and challenging. The idea works well in the UK. But there is one thing to add. That in the UK system some of the value of health expenditure is manifest at the population level, and there is still (just) some value in the notion of social solidarity which the NHS represents - some of the value I gain from NHS expenditure is knowing that people I dont know may gain access to healthcare.
There is still a chance for Microsoft to get ahead in the cloud. But with each passing day that they dont it gets less likely that they will. Just this week, more innovation, all driven by cloud computing - Chrome Webstore, Salesforce database, Google Cloud Print, new Amazon Web Services. This level of innovation is exceptional and it makes it very hard for Microsoft to get ahead.
Just noting this important paper in JAMIA (J Am Med Inform Assoc 2010;17:617e623. doi:10.1136/jamia.2010.005637) . The paper identifies critical issues for Health Information Technology (HIT) in all healthcare systems * HIT has been slow to embrace the concepts and practices of safety critical computing. There doesnt need to be FDA level of scrutiny, but there has to be recognition that HIT is analogous in some ways to a new drug or device. I would add that the current approach to certifying the fitness for use of HIT in the NHS appears to be User Acceptance Testing, which is wholly inadequate. The current consultation document Information Revolution says nothing about safety critical computing. The final version could of course, but it would require a more centrally directive approach than seems to be envisaged at the moment, a consequence of NPfITs failure. * The logic that since to err is human, computerisation will reduce error is too simplistic. Errors are generally produced by the interactions between multiple systems/people. So its wrong to assume that computerising manual processes necessarily reduces error. Computerisation may introduce error. * Measurements of usage are not in themselves an adequate measure of the success of an implementation. I think a lot of people _WOULD _settle for usage as a measure of success. The point made here is that in a complex system any single measure doesnt tell the whole story. * The messy desk fallacy - it is tempting to think of clinical processes as somewhat chaotic and therefore ripe for rationalisation. Some truth in this of course, but only some - healthcare is complex and non-linear. I would add that some of key techniques of computerisation, such as Business Process Modelling, look pretty inadequate in relation to complex systems. * HIT is too focused on delivering benefits of an administrative nature, and not enough on delivering direct benefits to clinicians and patients. With a few exceptions, this appears to be true. Think for example about the huge efforts that go into standardisation and terminologies, which are largely irrelevant to clinicians and patients, compared to functionality and user experience. The basis for this error is the belief that a central aim of healthcare is the efficient production of good records. That it is not was demonstrated by Garfinkel in the 1950s. But major areas of HIT activity, for example HL7, appear to have overlooked this. * The field of dreams fallacy - if we provide new IT systems they will attract users * Sit-stay. The fallacy that computers are in a smarter than humans. A very deep seated error, almost one of the founding stones of HIT - medicine is a cognitive/information processing profession (make a diagnosis then apply the right treatment), so lets see if computers can do better. The NHS PRODIGY programme was an example of this erroneous way of thinking. * HIT is often designed as if a single clinician were dealing with a case, or at most a team of clinicians sharing a common perspective on a case. Again, this may be too simplistic. * "Paper forms are not simple data repositories that, once computerized, could be eliminated. Rather such 'scraps' of paper are sophisticated cognitive artifacts that support memory, forecasting and planning, communication, coordination, and education" * "Teams of well-intentioned clinicians and software engineers may believe that understanding of clinical processes coupled with clever programming can solve the challenges facing healthcare. But such teams typically will not have the requisite breadth and depth of theories, tools, and ideas to develop robust and usable systems." Individually and collectively, these criticisms of the current approach to developing HIT have some force. The NPfIT can be seen as suffering from most of them. But there is nothing to suggest that the incoming governments market led strategy has recognised these issues yet.
The NHS spent something like £1bn plus per year on IT even before the advent of NPfIT. But for all that expenditure it is questionable whether or not it has an IT infrastructure in the sense described by Susan Leigh Star and Karen Ruhleder (reference here , criteria set out below). Why is this important? Because until there is an infrastructure the NHS wont be in a position to benefit from IT, and expenditure will be fragmented and of uncertain purpose. Infrastructure includes the following, and Ive scored the NHS on each * EMBEDDED (3/10 - computers and computing seem to be an anathema to many NHS staff) * TRANSPARENT ie does not need to be reinvented for each new task (2/10 much of the NHS computing estate consists of point solutions which need to be significantly modified as each new need arises - including BI systems) * REACH OR SCOPE BEYOND LOCAL PRACTICE (2/10 . This is an area where NPfIT has signally failed to make a case or implement change) * LEARNED AS PART OF MEMBERSHIP (1/10 . There are some steps are being taken to embed IT in professional life but little impact yet) * LINKS WITH CONVENTIONS OF PRACTICE (2/10 - a few honourable exceptions in primary care. Maybe PACS is on the way to becoming infrastructure) * EMBODIMENT OF STANDARDS (2/10 the keyword here being _embodiment._ And no, the use of TCP/IP doesnt count) * BUILT ON AN INSTALLED BASE (4/10 - once upon a time there was an installed base, for example regional computing centres. Nowadays there are a few elements of an installed base, such as N3 and NHSmail, NHS Choices, NHS Evidence) * BECOMES VISIBLE UPON BREAKDOWN (Comments about the breakdown of IT systems having no impact on patient care suggest 1/10 for this criteria, but in some situations a failure of an IT system would be significant, so 6/10)
A reasonable conclusion is that, with a few exceptions, despite huge expenditure the NHS lacks a an IT infrastructure.
Derek Meyer has produced a timely critique of the NHS Summary Care Record and Healthspace - The report argues that SCR and Healthspace in their present format are doomed, but also that alternatives such as Google Health and HealthVault are unlikely to succeed either. The success of Web 2.0 points the way towards an NHS 2.0 approach, as outlined below. I think its worth discussing:
Potentially useful... A spin-off of Finnish software development company Nodeta, Flowdock aspires to help developers and others sift out actionable bits of knowledge from ongoing conversations and make them retrievable. Their team messenger services allows separation and tagging of conversational elements. In Flowdock, the epiphany comes when you tag a chat message for the first time, Nodeta and Flowdocks CTO Otta Hilska wrote us. You realize how you just took a piece of conversation and turned it into a nugget of knowledge. Somebody talked about a bug, and you turned it into a bug report. Or pasted a snippet of code, and you categorized and organized it. The real validation for the concept comes when you are looking for some other snippet of code, a link to a partner, an eBook or something else and come to think I wonder if its tagged in Flowdock. Sure enough it will be. Designed for groups, Flowdock attempts to address a new kind of information overload, the one that intensified when social media tools began to be adopted by exponentially more people. The theory is that by tagging bits of the conversation, they are made discreet and retrievable based on folksonomy. "


text:
Can-Four Industrial Supplies Ltd. and Mcgurrin Enterprises Ltd. market and distribute the highest quality industrial and food-grade lubricants available on the market today. Founded in 1991 our family owned and operated business has grown to become an industry leader in specialized lubricant distribution. The corner stone of our success is our Service which often precedes our reputation for effective solutions and sound technical advice. As a full line distributor for Houghton International and JAX Inc. we can handle all of your lubrication needs throughout British Columbia, Alberta, Saskatchewan, Yukon and the Northwest Territories
Our Mission
Our mission at Can-Four Industrial Supplies Ltd. and Mcgurrin Enterprises Ltd. is to always exceed our customer's expectations with respect to the highest quality lubricants available, technical support, on-time delivery and above all honest answers.

subset: commoncrawl


text:
Fullerton: Driver Ran Red Light, Caused Crash Injuring Six
Comments (0)
Shortly before 4:25 p.m. on Saturday, June 2nd, a driver ran a red light in Fullerton, causing a crash that injured six people. While traveling northbound on North Gilbert Street, the driver neglected to stop for a red light at Hughes Drive, colliding with a vehicle that was turning left. Six people suffered trauma and were transported to a hospital. Authorities are investigating the crash.
"When a driver's negligence causes an accident resulting in injury, he or she may be obligated to compensate the victims for expenses associated with their recovery," explained an auto accident attorney in Orange County, "including for medical bills, lost wages, and pain and suffering."
Fullerton accounted for 7 of the 101 fatalities and 890 of the 16,620 injuries suffered by motor vehicle occupants in traffic accidents throughout Orange County in 2009, according to the California Highway Patrol's Statewide Integrated Traffic Records System. That year, traffic signals and signs were primary collision factors in 140 of the fatal and 12,994 of the injury crashes that occurred in the state.
All of us at Allen, Flatt, Ballidis, and Leslie would like to wish a full recovery to the six people who were injured when the motorist ran the red light in Fullerton.
Resources for accident victims and their families, including books and articles on the injury claims process, are available to the public free of charge.
If you would like to request one of these free resources, or to speak with an auto accident attorney in Orange County, feel free to call 866-981-5596.
Post a comment
Post a Comment to "Fullerton: Driver Ran Red Light, Caused Crash Injuring Six"To reply to this message, enter your reply in the box labeled "Message", hit "Post Message."


text:
everyday wonderful IMAGINARY-MUSEUM to enhance your feeling of well-being!
viewed by more than thousand of everyday visitors from 182 countries
- World Gallery welcomes your Posting, Exhibit and Selling of your Paintings, Photos and Artimages -
Wednesday, January 28, 2015
Arthur Elsley
The Day's Catch
oil on canvas
82 x 102 cm
Private collection
Arthur John Elsley (1860-1952) was one of the most popular English artists who depicted scenes of children with their pets in playful settings in the late Victorian and Edwardian periods. A large number of his paintings were inspired by sketches made on frequent cycling trips around the countryside. His works were so popular during his lifetime that much of his art was reproduced as prints and posters, and was often used in calendars, advertisements, books and magazines.
He was born in London, one of six children of a coachman and amateur artist. Around the age of 14, he contracted measles, which caused permanent damage to his eyesight. In 1876 he became a student at the Royal Academy School and submitted his first exhibit to the Academy in 1878. He then began to earn his living from art, prints and posters of children, horses, and dogs.
During the period of the First World War, he worked part-time at a munitions factory, and he only painted four works from 1915 to 1917. His eyesight continued to fail, and by 1931 it became so poor that he confined his activities to woodwork, metalwork and gardening.
Posted by merryhaha at 05:51


text:
Despite encouraging initial signs regarding an initiative to lobby for a comprehensive bill of rights (see Focus Report 2013), the situation has deteriorated due to new government-led initiatives aimed at curtailing the work of voluntary and humanitarian non-governmental organisations, including those CSOs engaged in defending, monitoring and advocating for human rights.[1] Moreover, the outbreak of armed civil conflict in December 2013 has increased the number of human rights violations and threats to the work of HRDs.[2]
[1] EHAHRDP. "Change will not come until we talk about reality: The closing Space for Human Rights Defenders in South Sudan". Kampala. December 2013. pp. 15-16.
[2] EHAHRDP. "NGO written statement to the 25th session of the UN Human Rights Council". 18 February 2014.
*** This information originates from PI's publication – FOCUS 2014.


text:
A/N This story will actually start being posted on the 1st of November as part of the NaNoWriMo challenge. It is the first time I will be participating in the challenge and I hope to be able to finish the story in the span of the month. However, until then, I am very interested to see what you guys think of the idea I'm going to present in the story. As usual I do not own anything and my native language is not English.
Title: Much more than a simple slave
Additional title: 30 Days
Pairing: Zevran/Leliana, Surana/Fenris
Rating: M
Summary:When the King of Fereldan is poisoned it is revealed that the poison was Tevinter at origin. But what happens when the antidote can only be found in the clutches of the Magisters? Surana and Zevran think up a ruse with Leliana where they get sold as slaves in order to find the precious antidote. Time is ticking… they have only 30 days to do so!
Novel Excerpt:
"It was poisoned!" the assassin said… "It's Tevinter posion."
"I'll cast a stasis spell on him… with the road back and forth we have only thirty days to get it."
"I have to pose as a slave!
"No! I cannot do this to you!"
"You are the only one who can do this, Leliana! There are no better masters of deception like the Orlesian! Act like you own me!"
"I'm going with you!"
"Zevran …"
"I want her and the Dalish… make sure I get them!"
"Yes, Master!"
"Never dare contradict me again, slave!"
'I am not a slave! I am a free elf! I am a mage of the Circle! I am a Grey Warden!' the mantra was repeated again and again in her head. 'I have to save Alistair! I have to save Alistair!'
"You say you are an assassin?"
The former Antivan Crow had anticipated the question… however he had not anticipated who would ask that particular question.
"Yes. Would you care to use my talents?"
"Magic," he spat. "You're a mage! You traitorous…"
"I can explain!"
"Explain what? How you used me? Pretended to be my friend? YOU LIED TO ME!" he spat. "What are you? A spy? Did another magister send you?"
"I'm Ferelden! I came to help a friend!"
"A friend… such a likely tale! Tell me why I shouldn't tell Danarius now?"
"I came to help King Alistair damn you!"
"King Alistair! You are..."
Footsteps echoed behind them.
"We have to find Zevran!"
"No time!"
"I fought a Blight alongside him! I will not abandon him here!"
"Make sure Alistair gets this. You have five hours left!"
Her eyes closed and the world died around her.


text:
As I started pulling old pens out of storage and cleaning & filling them, I realized another change that's happened in the intervening years. I'd switched to black ink.
My mother was always a black ink fan. She always said that nothing seemed permanent until it was written in black – she was raised in the fountain pen era, by the way. I always thought it made more sense to write in blue, so that one's signature would stand out on copies. In fact, Namiki/Pilot blue was my favorite. I think that is partly why I ended up switching to Gel pens and then to the Fisher – the color was just so consistent.
But after I switched away from fountain pens, I switched to black ink. I'm not sure why, or when exactly. All I know is that when it came to filling pens, there was no black ink in the house.
I surfed a bit looking for some recommendations, and ended up at the Fountain Pen Network. Opinion there suggested to me that Aurora and Noodler's were the blacks of choice. After a quick order at Fountain Pen Hospital, a bottle of each should be on my doorstep, along with a Namiki Vanishing Point nib section in broad, on Monday.


text:
UW Daily Previews Men's and Women's Golf
Sept. 30, 2009
By Taylor Soper
The Daily
After men's golf head coach Matt Thurmond called the 2008 season 'one of the best,' it would be hard to believe that this year's squad could produce better results.
But the impressive part of last year was that the team had immense success without any seniors. And the top three golfers from last season are now seniors, meaning only one thing: They can only get better.
The Huskies are looking just as dominant in 2009 as they did during their record-breaking season last year. Thurmond couldn't be happier with his players.
'I think we'll be an awesome team, and we're going to have a great year,' Thurmond said, who will enter his ninth year as head coach. 'The team has really bonded, come together.'
They already won a tournament early in the season.
At the Topy Cup in Tanagura, Japan, the Huskies rallied to capture first place by just four strokes and defeated the four-time defending champs Tohoku Fukushi University. Senior Richard Lee was 7-under overall and finished second individually.
Seniors Nick Taylor, Darren Wallace, Chris Killmer and Lee all return for their final year. All four competed regularly in the starting lineup last year, gaining valuable experience. Thurmond praised his seniors for their leadership skills.
'The great thing about the senior class is that they're not only great players, but they're the kind of leaders I want to have,' Thurmond said. 'It's nice to have players who have played so long. They are not too emotional, and they are matured. They know how this thing works, so you can count on them.'
Junior Tze Huang Choo returns for his third year. Choo, who averaged 73.91 strokes per round last year, was also a consistent starter last year.
The proven seniors and juniors will be joined by talented freshmen. Headlining the new class is freshman Chris Williams. The native of Moscow, Idaho, was a four-time Idaho State 4A state champion and has an impressive junior resume. He finished second in the Huskies' most recent qualifying round.
Charlie Hughes, who hails from British Columbia, is a long-hitting freshman who has also had great junior results. Rounding out the group is Larry Iverson. The native of Kalispell, Mo., is a solid all-around player, Thurmond said.
'All three [freshmen] have potential to help us this year,' he said.
Taylor will lead this year's squad and is the No. 1 golfer. Taylor played all throughout the summer. Earlier this year, Husky golf fans may have noticed a familiar name on the U.S. Open leader board. Taylor surprised many by shooting 2-under during the first two rounds. He was in seventh place overall and eventually finished tied for 36th place. Taylor was the top amateur finisher and immediately became the world's highest ranked amateur, a ranking he still holds.
The team's ultimate goal is to win the national championship. After losing in the NCAA quarterfinals last year against Arkansas, the Huskies aren't shy about stating their goals.
'That's our goal,' Thurmond said of winning the national championship. 'We openly talk about it. That's what we're shooting for, and we certainly have a good chance at it.'
The women's team has yet to begin its 2009-10 season, and players and coaches are antsy to get the year off to a good start and put last year's disappointing season behind them.
'I think we're all excited,' head coach Mary Lou Mulflur said. 'I feel like we have a lot of talent, and we have a lot of people that are fully committed to what we're doing and want to win. I expect us to have a good year.'
The women, just like the men, did not graduate any players and will return the entire starting lineup for the 2009-10 season.
'I know we're a year older, but hopefully we're a year smarter,' said Mulflur, who will enter her 27th season as head coach.
The team has a bitter taste from last year's season, which concluded with the Huskies missing the NCAA championships by five strokes in the NCAA qualifying tournament. The way it ended last year, there's no doubt in Mulflur's mind that her players should be ready to compete and win.
'They are definitely hungry,' she said. 'They do not want the year to end like it did last year.'
Mulflur will look to senior Molly Aronsson for leadership. Aronsson, who was second last year with a 75.83 scoring average per round, has worked extremely hard this offseason and is poised to make a big impact on the team this year, both as a player and a leader.
'She has worked harder this summer than any summer in her college career,' Mulflur said. 'Molly is really starting to emerge as a leader for us. She's got a lot of positive energy, and she plays with a lot of emotion. I fully expect her to have a great year.'
Also returning is last year's top performer, junior Anya Alvarez. Alvarez led the team last year with a 74.87 scoring average per round. She also led the team in scoring average per round her freshman year.
Senior Christina Yoon and junior Karinn Dickinson, both starters last year, will also return. Sophomore Sadena Parks, who began to find her game at the end of last year, also returns.
Mulflur is confident this year's depth and experience will help them have a good season. She is anxious to put last season behind her and turn those bad experiences into a winning season this year.
'I'm confident with the players we have,' she said. 'I feel like whoever we put in there can play and compete for us, and it also makes competition everyday more important. Our depth will be one of our strengths. That will be a big factor for us this year.'
2017-18 Pac-12 Year in ReviewJul 23 '18
From The Daily: She Can Dig ItNov 12 '09
TODAY | 11:00am PTLive
Airing on:
- Pac-12 Network
- Pac-12 Arizona
Pac-12 PlaylistTODAY | 7:00pm PTLive
TOMORROW | 5:00pm PTLive
Airing on:
- Pac-12 Network
- Pac-12 Oregon


text:
(without my husband!!)
& a regular old screwdriver.
Whitney, that looks great! I love the fabric!ReplyDelete
I am way impressed with your building skills. This is awesome. I too like to stand when I am crafting. I found you on a monday blog hop and can't wait to read more.
That's fantastic! Great job!ReplyDelete
You should come link it up to my Making It party! (Please)
WONDERFUL idea!!! Way to go! Thanks for linking up to my Thrilling Thursday party. Hope you will join in again next week :)
~Lori @ Paisley Passions
I'm SO inspired! Thanks for Linking Up!
omg, this is just what i needed to see! i recently acquired an old sewing table which i love b/c it opens up very long, but it doesn't have a lot of storage. this system for storage underneath is genius, and i am totally gonna borrow your idea! yay for you and yay for me! so glad i saw your link up at fun to craft. love the hooks on the side, too!ReplyDelete
That is fabulous! Congrats on your new workspace.ReplyDelete
So cute! I like the trash basket hanging there, great idea! And I love the fabric you used on the ironing board...great job!ReplyDelete
Thank you so much for taking the time to comment here. I love hearing from you and try really hard to respond to all messages. You can also email me anytime at firstname.lastname@example.com.


text:
Ontario SPCA sets record straight on cat surrendered in Kingston
Kingston, ON (June 30, 2016) – The Ontario SPCA would like to correct misinformation that has been presented to the public about a cat in Kingston that was surrendered on June 24.
The cat, named "Jack," was brought to a local veterinary clinic by its owner for medical treatment for a condition that left the cat in chronic pain with poor quality of life. The veterinarian treated the cat, but could not alleviate Jack's condition, and further treatment was required. The owner refused any further treatment and took the cat home.
When a veterinarian recognizes an animal is in distress and the owner refuses to provide care for that animal, by law a veterinarian is required to report this to the Ontario SPCA. The Ontario SPCA commends this veterinarian for doing their job and abiding by the law.
The Ontario SPCA followed up on this concern and the owner voluntarily surrendered their animal to the Society. The owner signed an official surrender form, required for documenting that he was giving ownership of his animal to the Society.
As the new caregiver of the animal, it is the Ontario SPCA's responsibility to ensure that the animal did not suffer and was provided the appropriate care. Based on the medical condition of the animal at that time, euthanasia was the most humane option.
Melissa Kosowan
Ontario SPCA
Ontario SPCA and Humane Society:
Protecting animals since 1873, Ontario SPCA is Ontario's Animal Welfare organization. A registered charity comprised of over 50 Communities.
Since 1919, when Ontario's first Animal Welfare legislation was proclaimed, the Ontario SPCA, with the help of its Communities, has been entrusted to maintain and enforce Animal Welfare legislation. The Act provides Ontario SPCA Agents and Inspectors with police powers to do so.
Ontario SPCA provides leadership in animal welfare innovations including introducing high-volume spay/neuter services to Ontario and opening the Provincial Education and Animal Centre.
Adopt • Learn • Volunteer • Donate
Charitable Business Number 88969 1044 RR0002


text:
Shijuku Japanese food ~ For Mom's birthday
Celebrated mom's birthday at this Japanese food restaurant ~ Shinjuku
Brought this food voucher from ezivoucher.com… got 14 types of food… only RM 28.80. …..
When I reached there… there was an old couple already eating… so that made us the second couple…
After us there was another couple…
That were the total customers of the night… however, the workers took forever to prepare the food and serve it >.<
It was a Thursday night… which explains why there were only 6 customers only….
The food package does not really that worth it… everything is only off cheaper ingredient
The sushi is totally cheat one lor…all the cheap ingredient…. not nice at all…
This was consider the most expensive of all ~ Scallop 🙂 but I don't really like it… mom loves it 🙂
The edamame was good… fresh enough…
Oh~! Before I forgot… they used "old" wasabi.. which I believed they bought a big pack and been using it for long time till the taste also degraded already… mom said the wasabi they used not spicy at all one… the colour served was dark green… fresh one should be in light green colour ma… =_____=||
Mom said the best of all was this kimchi soup…. well… I think so… cuz this was served hot…
I wasn't feeling very well that night… so everything I ate also not nice… but according to mom.. the food wasn't that nice only… compared to all the japanese food we tried before… lol… so… won't be going back anymore… 🙂
Last but not least, happy birthday mom~!
December 27, 2010 2 Comments
Jurin @ Gurney Plaza
Finally got the chance to try this famous Japanese food… last week I wanted to try it but it was closing time.. so I didn't manage to eat it…
So… the past Saturday went to try it… also almost closing time… so.. ate till a bit rush.. lol…
Ordered 6 dishes… I can say the Chicken Katsu Don was very salty.. not nice … the salmon slices were quite thick.. not nice also… the seaweed on ebiko sushi was a bit too thick as well… the best of all is the Ma Por Tofu! lol…
oh oh! The miso soup also not bad la.. lol… not so salty compared to Azuma's… got more ingredients inside compared to Sushi King's and Sakae Sushi's… 😛
then the fried soft crab smells very nice cuz they fried with garlic.. niceee 😀
In conclusion, overall the food not like what I'm expecting.. just that the food was served in a very fresh method.. made on demand… anyhow, Azuma is better! But the two definitely not up to par with Sushi Zenmai in One-Utama!
Pictures time:
#2: Chicken Katsu Don
#3: Don't-know-what-roll-d
#4: Fried soft crab
#5: Ebiko Sushi
#6: Ma por tofu
#7: Salmon slice
>> I can have the salmon all by myself.. friend didn't want to eat.. said scared of salmon d cuz been eating a lot >.< sai meng.. cis 😛
Liddat also cost us RM 160… =__=||| That time dine-in @ Azuma with family also only RM 160 for 4 pax… >.<
March 12, 2010 No Comments
Rasa Sayang Buffet Dinner 9-Jan-2010
Wasn't in good mood lately.. that is why this took so long for me to post it up… =___=|||
Anyway, I have never been to Rasa Sayang Hotel's buffet dinner cuz it is wayyyyy too expensive for me… There was once on Dec 2009, they have promotion with Buy 1 Free 1. Missy and I thought of going… BUT… we were taken back as I heard bad comments on the food.. the food wasn't filled on time even the tray was empty … the oysters and lobsters were very small.. etc… therefore we weren't there…
This time around.. got an invitation from a friend.. so.. I just went for it…
It was really amazing to see so much food there… omg! From Indian food: tandoori chicken to roti canai to satay, … to baked food which included: baked oyster, baked potato, baked vege, baked duno what, … to western cuisine: fresh cheese, cold platter, pumpkin soup, beef-don't-know-what, etc .. to chinese cuisine: steam rice, fried rice, yong tau hu, curry chicken, fried soft crab, fried vege, sharks fin soup, herbal black chicken soup, etc… to pastries: cakes, dough, mini tarts… to salad bar… to live cook… to fresh live seafood: oyster, lobster, prawn… to Japanese food… to desserts: ice-cream, ice-kacang…
Spices on the tables.. served as a decoration:
The wasabi was very cute:
>> but not after people started to scoop it 😛
Ok, let the pictures say it all:
OMG! Soooooooooooooooooooooooooooooooooooooooooooo much food!!! Gosh! Lazy to put all the pictures up.. lol.. paiseh paiseh 😛
There were stories on these oyster or I called it as fresh seafood section. First time my friend went to pick them up.. there was a long queue.. cuz a group of people just came in.. so waited for his turn patiently… when almost his turn.. he heard d guy in front told his friend: "Hey faster take. Later no more" >.<
When it was my turn to take the cheese which was beside the fresh seafood.. came another guy (Not sure was it the same gang) said the same thing : "Faster take.. take more. Ah bo later need wait them refill" =_______=||| Need to be like this meh?!!!! So cheapo. Come on la! You dine in at a 5 star hotel and you paid RM 200+ for a dinner. How could "No Stock" happen? omfg! So embarrassing! This also reminded me of someone. Someone who will say the same thing when he/she dine in here. *sigh*
As for lobster, many people just took out the meat and left the shell on the tray. WTF! Really no brain ler. Just take the shell and the flesh together la. Not really giving you big problem right? Gosh!
I can have 4 servings only which included fresh oyster, lobster, mixture of food, ice-cream with plenty of toppings, sashimi, salad, 3 x cheese….. and I didn't even try the pastries (honestly I don't like pastries), ice-kacang, yong tau hu, live cook, sushi (cuz I'll be very full), tandoori chicken, roti canai, satay
ya ya… I know I'm really a small eater and it is really a waste to bring me there… and what is even worse? I got a bad stomach which after my meal ..I felt so bloated and till I reached home I still had a bad stomach… thought I could sleep without thinking much… but I was wrong! I couldn't even sleep the whole night.. tossed here and there… and my stomach didn't get well till the next morning… *sigh*
Thanks to my friend I get to try this expensive buffet.. but also this meal.. I know I can't eat too expensive buffet… bad stomach.. bad bad 🙁
Well.. according to a colleague… she said that normal price is around RM 200 each person after including all the taxes… I was like OMFG!!! RM 200? DAMN! Shouldn't have gone… should have gotten some other food… 😛
Lucky I didn't have to pay and got to try the once-in-a-life-time-torturing-meal 😛
The best of the dishes: cheese platter… at least got 5 different types of cheese are available… but some I didn't like… and can mix with apricot, macadamia, walnut, almond, salad cream, biscuits… reminded me of the Cheese Platter Pei San prepared for us.. hers got strawberries, kiwi, biscuits, spicy dips… yummy…miss Australia now 🙁
By the way, at the entrance of the restaurant, they got sell spices.. but the prices were really shocking. Chilli powder RM 7/100gm =___=||| Imported from India a? So expensive!!
Overall, the food was really nice. It was full house that night. Hmmm… Penang people really spend their money in food… hmmm… I will pay them a visit again… only IF is FOC 😛
January 23, 2010 7 Comments
20 days to go…and is counting down now
Sis will be leaving us and go to a far far land from here… it is her first time to leave us all by herself… *sigh* Kinda start to miss her now…
Sis never leave us before… not even for study purpose… It's me who always run away from this family… went to KL study, work, then to US for work and travel with Sher, then back to KL again…only on recent years I'm back to Penang. well…I'm not those kind of person will stick at one place for long.. not when I'm young….lol…. I definitely want to fulfill my own dreams when I'm still able to do it….
Like I said, this is the first time sis will be leaving us, leaving Penang and go to a far far land…well…not that far compare to US…but still very far… is @ middle east…. MIDDLE EAST for God sake… *sigh*… want to take plane to find her also not that cheap… *sigh*
We share the same common interest for sis and I… it is kinda funny that we know what we each other want when ordering food… we have the same and dislike on food, clothing (definitely my taste is better than her..lol :P), the way we think is also more a less the same….just a certain time we have different view….
eg: we both love tom yam, spicy food, Japanese food,
– we both dislike chocolate made food…
>> difference: I don't like crab but she love it.
Oh ya! Sis and I were born at the same day… May 3… different time… different year… but same day… people who know both of us always tease mom on how clever she was…counting the date so accurate… lol….so…since young we are sharing the same birthday cake, EVERY year… lol… but I don't mind…cuz I'm not a cake lover…if is Haagen Dazs cake then is different story…
The relationship between me and sis is always good…well.. I have to admit…we used to quarrel a lot..even for now we still quarrel… but… the bond is still there… hey! She is my only sister… sure I love her dearly no matter what! It is fun to have her company… although there was once we don't hang out after she gave birth…but the news of her leaving… make us come close together again…..
She will be leaving on 9-June-2009 12 noon… to….. Tabuk, Saudi Arabia….. safe journey sis. I will be missing u very very much
May 20, 2009 6 Comments


text:
SOURCE: Technology Credit Union
May 01, 2017 11:00 ET
COO and EVP Jeannine Jacobsen Named a Silicon Valley Business Journal 2017 Woman of Influence; Tech CU also a Winner of the Hermes Creative Awards, AVA Digital Awards and a Credit Union Journal Best Practices Award
SAN JOSE, CA--(Marketwired - May 01, 2017) - Tech CU (Technology Credit Union) today announced four significant award wins for the company. COO and EVP Jeannine Jacobsen was named a 2017 Woman of Influence by the Silicon Valley Business Journal. Tech CU won two Hermes Creative Awards -- a Gold award for the company's website redesign and an Honorable Mention for the 2015 Annual Report. Additionally, Tech CU received two awards honoring its website redesign: a Gold award from the AVA Digital Awards and a Best Practices award from the Credit Union Journal.
Silicon Valley Business Journal's Women of Influence
The Silicon Valley Business Journal's Women of Influence award program shines a spotlight on local business women, community leaders and philanthropists. More than ever, women are making a huge impact on Silicon Valley's economy. Every year, the Business Journal recognizes the accomplishments of these women through an awards dinner and special publication.
"Jeannine is an essential member of our team. Her transformational leadership style has allowed her to both support Tech CU in achieving its goals, while also ensuring that her employees are given the opportunity to fulfill their potential," said Todd Harris, President and CEO of Tech CU. "Her 'we - not me' philosophy has enabled her to drive impactful change across the entire organization. I'm honored to call her a colleague and a friend."
Hermes Creative Awards
The Hermes Creative Awards is an international competition (administered by the Association of Marketing and Communication Professionals) for those involved in the concept, writing and design of marketing and communication programs. Tech CU was honored with a Gold award for the company's website redesign and an Honorable Mention for the 2015 Annual Report.
AVA Digital Awards
An international competition that recognizes excellence by creative professionals responsible for the planning, concept, direction, design and production of digital communications, the AVA Digital Awards honored Tech CU's website redesign with a Gold award.
Credit Union Journal's 2016 Best Practices Award
Designed to help credit unions learn from one another, the Credit Union Journal's Best Practices Award program recognizes tested, results-driven strategies developed by credit unions to boost growth, improve efficiency, cut costs and drive revenue. In late 2016, Tech CU was honored for its website redesign.
"We're excited to have been recognized from such prestigious groups for our website design," said Kate Duggan, SVP of Marketing at Tech CU. "Our goal is to continuously improve our member experience. This includes making personal finance more accessible, while offering a seamless banking experience. These awards are a testament to the team's focus on constantly improving and growing our brand."
Tech CU (techcu.com) is a $2 billion credit union serving more than 85,000 members throughout the San Francisco Bay Area -- including employees of such companies as Tesla, eBay, Applied Materials, Nvidia and Facebook. A federally insured, not-for-profit organization, we put the financial interests of our members ahead of shareholder profit by helping members achieve their financial goals on their terms and by sharing the benefits of our growth. Founded in 1960 by a group of forward-thinking employees at Fairchild Semiconductor, today we continue to be an industry leader, providing innovative financial products for all stages of our members' lives, including personal banking, wealth management, private banking, commercial lending and business banking. Tech CU consistently achieves high marks for its customer satisfaction and maintains a 5-star rating from Bauer Financial, the nation's largest independent rating service for financial institutions. And, with mobile and online banking, 65,000+ surcharge-free ATMs worldwide (more than Chase, Bank of America and Wells Fargo combined) and convenient branch access to our financial experts, Tech CU makes 24/7 banking easy and empowering.
Contact:Jessica Cheney Public Relations(419) email@example.com
Contact:Jessica Cheney Public Relations(419) firstname.lastname@example.com
See all RSS Newsfeeds


text:
Boomer, with the help of handler Deputy David Thomas, is kicking ass and taking names.
The two black German shepherds are among 15 finalists in the awards' law enforcement/arson category; winners of each category will net $1,500 for their chosen charity, and the overall Hero of the Dog Year winner adds another $5,000 to the charity's pot.
"In almost two years with the Harris County Sheriff's Office, K-9 Boomer has helped take more than $6 million worth of illegal drugs off the streets, and assisted in the arrest of 26 suspects accused in crimes involving narcotics, evading arrest and/or burglary," according to an HCSO press release. "K-9 Tommy, a new addition and rising star on the [HCSO] team, has aided in cornering 36 suspects, found an elderly missing man, and located important evidence in a sexual assault case." (To put this in perspective, our own dog has aided in the cornering of a handful of squirrels and located several small bones that were evidence of a long-ago discarded piece of fried chicken.)
As with all HCSO K-9s, Tommy and Boomer went through a "rigorous 14-week HCSO training course with their handler to learn tracking, scouting, building searches, vehicle stops, and drug or bomb training," according to the press release. "Most law enforcement K-9s are German Shepherds or Belgian Malinois, cost $12,000, and retire after five to eight years of service."
If you like this story, consider signing up for our email newsletters.
You have successfully signed up for your selected newsletter(s) - please keep an eye on your mailbox, we're movin' in!
But these two deputy dogs need your help to win -- Harris County residents are encouraged to cast their vote by July 30. Winners of each category will be announced August 6, and the Hero Dog of the Year winner will be announced at the AHA's swanky gala at the Beverly Hills Hilton October 6.


text:
My dad purchased this 1957 861 Powermaster Tractor in 2013. We decided to turn it into a father-son restoration project. Fortunately, the original tractor was in good shape body wise; our goal was to bring the old tractor back to its glorious state. We completely took apart the tractor piece by piece to restore it.
After several months of late hours, the project was completed. We took pictures throughout the process to see before and after pictures. The end result was a true project to be proud of. The tractor is used regularly now on both of our properties and is something that can be handed down from generation to generation.
Daniel Johnson
Brownsville, Kentucky


text:
Today's News
Ozzy Osbourne stopped breathing and his heart stopped beating for more than a minute following Monday's all-terrain vehicle mishap, according to wife Sharon. "He had stopped breathing for a minute and a half and there was no pulse," she told London's Daily Mirror. "But thank God, the security guard was there to revive him... and [get] him breathing and his pulse going again." Ozzy who fractured his left collarbone, eight ribs and a neck vertebra in the accident is expected to make a "steady" recovery.


text:
- You can click here for more: Wik's opposite of your searching words alphabetic list
- Similar word as approve: confirm, approve, ratify, endorse, affirm, homologate, accept, admit, adopt, favour, approve, favor, ratify, countenance, approve, like, approve, appreciate, enjoy, applaud, care, concede, deem suitable, countenance, uphold, deem suitable, sanction, think fit, see fit, consent, approve, assent, settle for, agree, accede.
- Opposite of approve Verb: censure, condemn, criticise (UK), criticize (US), denounce, deny, despise, disapprove, dislike, disregard, disrespect, hate, neglect, refuse, scorn, disagree, disallow, invalidate, oppose, reject, contradict, decline, destroy, discourage, disprove, dispute, dissuade, protest, renounce, repudiate, veto, differ, dissent, object.
- Useful links
- You can find all opposite of your word from here.
- What is the wik – Wik's Home


text:
From the moment I discovered Philosophy I was struck by its critical emancipatory potential – its emancipatory potential following from its critical force. For all its biases, Western philosophy teaches a collection of answers to some pretty profound questions. The question in our present postcolonial context is whether the constituency of our intellectual endeavours – specifically also the students that we are teaching – are able to understand the questions, which we are addressing with our answers. Knowledge – and thereby I mean understanding – is a function of the sociology that necessitates it. As Van Binsbergen puts it: 'it is pointless to study the contents of a philosophy in isolation – in vitro – without constant reference to the particular sociology of knowledge by which it came into being and by which it is perpetuated'. What is necessary for true understanding is being able to self-reflectively connect (1) knowledge of the sociological ground of knowledge production with (2) the modes of knowledge so produced and pursued. My research pilgrimage reflects a wrestling with ethical and political conceptual toolkits and an persistent need and repeated attemtps to put them to work within the context of our lived experience. The prevailing theme throughout is the relation between the Self and the Other and how their entanglement is complicated by the fact that they are always and necessarily bound to specific contextual forces and limitations.
Hence my GENERAL RESEARCH FOCUS falls within the field of practical philosophy, which should be understood in the two-pronged Aristotelian sense as referring to "Ethics" on the one hand, and "Politics" on the other. My doctoral research (completed in 2005) remains a pertinacious influence. Therein I came to a more specific understanding of ethics in terms of the work of two contemporary French philosophers, Michel Foucault and Emmanuel Levinas. In the work of Foucault, ethics is reconceptualized as the self-transformative labour through which the individual crafts him-/herself into an ethical subject. It therefore concerns the self's relationship to him-/herself mediated by external frames of meaning-giving reference such as parental, societal and/or religious guidelines or prescriptive codes. Ethics as understood by Levinas, on the other hand, is primarily defined in terms of the self's responsibility to others. Ethical action becomes possible when I put the interest of the other person before my own. Following Spinoza, Levinas argues that the pursuit of one's own interest is absolutely necessary for persistence in being, for survival. The possibility of ethical action only becomes possible, however, when this drive to self-actualize is momentarily suspended – a moment of radical passivity – when one becomes capable of recognizing the needs of the other person. By way of a functional analogy, I attempted to think these two seemingly opposing approaches to ethics dialectically and came to the conclusion that self-concern is a necessary condition for other-responsiveness. In short, with the aid of an innovative comparative methodology, I came to the realization that self-centred and other-centred ethics are two essentially interdependent sides of the same coin.
To come to a deeper understanding of these two complex positions, my subsequent research focused on them independently of each other, while incorporating the insights gained through the comparative approach. It resulted in two mutually independent but complementary lines of critical scholarship: (1) a FOUCAULTIAN investigation of the political dimension of ethics, which supposes a critical engagement with the world beyond the self; and (2) a LEVINASIAN investigation of the conditions of possibility of ethical action. In the process, the discovery of the inextricable entanglement of the ethical and the political, of theory and practice, led to the emergence of a third line of scholarship: (3) the ETHICO-POLITICAL side. In short, my research may be understood as the consistent development of the complexities and complementarities of the political and ethical dimensions of self-other relations.
(2) THE POLITICAL (FOUCAULTIAN) SIDE: this line of inquiry was first pursued at the Jan van Eyck Academie, Maastricht, NL (2005-2006). It takes as its point of departure Foucault's Nietzschean conviction and injunction that life itself should be taken as a work of art. An aesthetics of existence entails a stylization of one's being through transgressive, self-transformative labour that facilitates resistance to normalizing power. It is therefore primarily concerned with the political or engaged dimension of ethical self-labour. Such an inquiry necessitates an engagement with the present. What are we today? How does our historical present – understood as a time in which neo-liberalism reigns supreme – impact upon our possibilities for being and acting in the world?
OUTPUTS: My inquiry into the culture and subjectivity of neoliberal governmentality (Phronimon, 2011) may be understood under this rubric. Like most concepts in Foucault's diagnostic toolkit, governmentality is an analytical notion closely linked to changing historical rationalities of power, rather than a rigid descriptive mechanism that establishes one rationality of governing once and for all, that is the same for all times and places, and that infuses political orders in predictable, regular and uniform ways. This article utilizes a historical approach in which one epoch, notion or governing rationality is understood in terms of that which precedes it, acknowledging some continuity while respecting and reflecting on discontinuity and differences.
Other outputs that fall under this rubric include my analysis of the present state of the Humanities in SA (Journal of Humanities, 2012), as well as my critical attempt to grapple with the public role the intellectual today (Litnet, 2009).
(2) THE ETHICAL (LEVINASIAN) SIDE: this line of inquiry formed the focal point of my Veni-research project (2007-2012), which took as its point of departure Levinas's conviction that a preconscious (passive) obligation towards others, rather than a conscious choice, is decisive for ethical action. Levinas's ethical metaphysics is essentially a meditation on what makes ethical agency possible – what is it that enables us to put the well-being of another before our own.
OUTPUTS: The edited volume, Radical Passivity. Rethinking Ethical Agency in Levinas (Springer, 2009) is certainly one of the crowning achievements of my research on the concept of 'radical passivity', through which I managed to secure a niche research agenda that have earned me respect among the top Levinas scholars in the world. The list of contributors to this volume attest to this (incl. Adriaan Peperzak, Alphonso Lingis, Betina Bergo and Sean Hand) as well as the peer recognition I have received by way of citations, invitations to inter- and national research fora and to contribute to edited books and journal issues in the field. One of the book reviewers hailed the volume as one of the first incisive works of what is undoubtedly an imminent wave of critical secondary literature on Levinas.
Another output is the Monokl article (2010) in which I excavate the subject's oscillation between self-concern (activity) and other-responsiveness (passivity). The last few decades have been characterized by an overwhelming preoccupation with ethical concerns in a diversity of fields (including but not limited to Philosophy). Levinas's thinking was certainly instrumental in the current resurgence of ethics, which has established concern for the Other as the virtually uncontested cornerstone of ethics. This article offers a critical revaluation of Levinas's work distinguishing between his later work (with its emphasis on the Other) and his early works (with its emphasis on the self as necessary condition for assuming our responsibility towards the Other). Such a revaluation therefore provides a critical framework for fostering the recovery of ethics in and beyond the limited sphere of Continental philosophy.
Other outputs that belong in this category are the two articles (Filozofia, 2012 and Philosophia, 2016) in which I attempt to comprehend Levinas's conception of Being and the interrelatedness of ontology and ethics, of Being and Otherwise-than-Being. The article on the enigma of ethical responsiveness published in Humanities & Social Sciences in 2016 also fits within this framework.
(3) The above two-pronged approach brought me face-to-face time and again with the necessary entanglement or conjunction of the ethical and the political and resulted in what may be termed the ETHICO-POLITICAL SIDE. Do these ethico-theoretical conceptual tools function in the socio-political world of action? And, inversely, how does the socio-political reality of praxis mar the practicability of theory? My 2009 book chapter in which I undertake a Levinasian analysis of the functioning of the veil – as concealment of the face; the 2014 article on the impact of Facebook on the face – as screening of the face by way of intermediality; as well as the 2009 article on the public role of the intellectual may be grouped here. Most significant in my opinion is the 2016 article published in the British Journal of Phenomenology in which I investigate to what extent a productive encounter between Levinas's thought and non-Western postcolonial ethical frameworks and conceptions of difference and alterity is possible. In this article a question re-emerges in my research that was first articulated almost 15 years ago in my very first research output published in 2002. In that first article, two discourses were analysed, each of which outlining a certain interaction or proposed interaction between Africa and the Western world by way of global capitalism: "What I am interested in, philosophically speaking, is how this translates into different interactions between the Self and the Other, and with that I inevitably arrive at my ethical question: How does non-reductive communication between the Self and the Other become possible? In following Levinas I have started with the premise that when confronted by the Other I am ethically obligated to respond, but a response invariably amounts to a violation of his/her alterity. I found myself facing an insurmountable dilemma: both silence and response amount to violence. At this critical juncture I … attempted to deconstruct the two poles of our binary opposition, with the hope of going, with Nietzsche, beyond the proverbial 'good and evil' duality". It would seem, then, that my research has come the proverbial full circle although the inherent contingency of context, of identity and alterity, means that the circle can never the closed, that this line of research inquiry is far from – if ever – exhausted!


text:
New Holland Ag
New Holland Equipment for sale, Tractors & Telehandlers, Light Construction Equipment for sale at H&M Equipment Co, Inc.. Serving your new and used equipment needs from Amsterdam, NY.
Find utility vehicles, tractors, excavators, construction equipment and more!
We proudly serve the Schenectady & Albany, NY areas with top quality equipment and excellent customer service. New Holland equipment is built with quality craftsmanship you can rely on. At H & M Equipment Co, we sell a variety of equipment to meet all of your project needs.
Equipment Rentals in Schenectady & Albany, NY
From tractors & telehandlers in an array of models & styles to light construction equipment such as skid steer loaders, compact excavators, compact wheel loaders and more. Click the links below for more information about tractors, telehandlers, and light construction equipment or give us a call today.


text:
11/01/2016 - 12:30pm
4500 Hubbs Hall
Event Description:
Speaker: Author, Susan Casey, Voices in the Ocean
Susan Casey is an award-winning journalist and editor, ocean lover, and the bestselling author of The Wave, The Devil's Teeth, and most recently, Voices in the Ocean. A powerful and engaging voice for our environment, Casey inspires audiences to pursue change and look at the world beneath the waves.
For more information on this event, contact:
Event Calendar:


text:
The Iran Plan
The Washington Post leads with word that the Bush administration is looking into a military strike against Iran. According to an unnamed source, two options are being considered: a quick strike against nuclear facilities along with a threat to continue if Iran wages terrorist attacks in response; or a more expansive bombing of Iranian government facilities and other targets. According to the paper, the Pentagon and CIA have been examining possible targets; the British government has started planning to protect its embassy offices and citizens in the event of a U.S. attack; and Israel has a contingency plan in place for attacking Iran if the U.S. doesn't get around to it.
The New York Timesleads with an internal report by U.S. Embassy and military command in Baghdad revealing a graver situation in Iraq than depicted by top politicians and military officials. The Los Angeles Times leads with plans by cable and telephone companies to possibly start charging Internet companies to make their data run faster along clogged telecommunications networks. Though differential pricing schemes are common in business, such plans are contrary to the egalitarian nature of the Internet, where currently all content is treated equally. Many worry the buck would be passed down to the average Internet user, and new fees would apply to access different kinds of content.
Everyone agrees that the planning by the administration is a tactic to pressure Tehran to quit its alleged nuclear development program, but analysts have differing views on whether it's just bluster or much more than that. The Post's story follows the posting of Seymour Hersh's latest article on the New Yorker's Web site. That piece, which will appear in the April 17 issue of the magazine, reveals that the administration has not ruled out using tactical nuclear weapons. In addition, says Hersh, Bush has been chatting with certain senators—including "at least one Democrat"—about Iran options. Also according to the piece, U.S. troops have been told to go to Iran and secretly get information on possible targets. One "former defense official" is quoted in Hersh's article about the plans to strike Tehran: "I was shocked when I heard it, and asked myself, 'What are they smoking?' " The LAT and NYT also mention the Hersh report.
The internal staff report that the NYT leads with is a province-by-province breakdown of the security, economy, and politics of the region—and it's far from rosy. The report rates the stability situation in a full one-third of Iraq's provinces as "serious"; in another it is "critical." Sectarian friction is reported as common in regions that American officials have called nonviolent. The report—not classified material—has been shown to some people on Capitol Hill but has not been widely distributed.
Back to the LAT's lead for a minute: The story of the battle for "net neutrality"—whose proponents want to prohibit the broadband providers from charging Internet companies so their data gets special, speedier treatment—is not brand new. But on Friday Sens. Olympia Snowe, R-Maine, and Byron Dorgan, D-N.D., released a draft bill that protects network neutrality. (The reader has to wade more than a dozen paragraphs into the LAT story to reach that actual news—all the ink before that is mostly devoted to explaining this admittedly complicated issue.)
Everybody fronts the latest round in the leak story. The NYT reviews records from around June and July of 2003—the period during which Scooter Libby was authorized to tell Judith Miller about Baghdad's supposed quest for uranium from Africa—and connects some interesting dots. By the time the president gave the "apparent order" to reveal that previously classified information, the info was already being discredited by several other administration officials. The Post also mentions this point in their A1 story on the matter.
The LAT weighs in with a look at how strategic leaking advances an administration's agenda. Not all leaks are treated equally by the White House; the paper reports on specific incidents when the Bush administration's reaction to leaks has depended on whether the information leaked was beneficial to the president's plans.
Another Shiite mosque was bombed Saturday, killing six people and injuring 19. Other attacks killed 14 additional people around Iraq Saturday.
In Afghanistan Saturday, a car bomb exploded outside a NATO base, killing two and wounding seven. The Taliban took credit. The attack was the second in two days on foreign military bases in the country.
The LAT fronts a story on a petition drive under way in South Dakota, where volunteers hoping to reverse the country's most stringent abortion ban are being surprised by the support they're gaining in their efforts. Even many conservatives seem to think their legislators crossed a line by passing a law defending an "unalienable right to life." In just two weeks, a third of the signatures needed have been collected to get a November referendum on the ban.
The Rolling Stones played a concert in China Saturday for the first time ever. Government censors, however, banned the band from playing five songs, including "Brown Sugar" and "Let's Spend the Night Together." Tickets were so expensive that the audience was predominantly rich foreigners, a fact that was not lost on Mick Jagger. "I am pleased the Ministry of Culture is protecting the morals of expatriate bankers and their girlfriends," he said.


text:
Wow, we cannot believe the school year is almost over! We have been blessed to have your children be part of the Noonday family this year. Over the past year we have watched your children grow and mature. They have learned age appropriate academic skills and Biblical principles. Each one knows that God loves them and so do we!
Please remember: Wednesday is the Noonday Stars performance.
Sign up for summer camp! June 25 - 29 & July 23 - 27
We wish you all a safe and fun filled summer break, and look forward to the next school year to see what God has in store for us.


text:
Emma is qualified in Preparing to Teach in the Lifelong Learning Sector and teaches creative writing, life-writing, literacy, numeracy and other forms of creativity to adults. She runs creative and life-writing classes locally and delivers specific workshops to accompany her shows where she enables others to create, tell and perform their own stories. Emma is available to provide teaching work to organisations and has worked with vulnerable adults such as adults with learning disabilities, mental health problems and other vulnerabilities. She has provided courses for Calderdale Adult Learning, The Basement Project (Halifax) and Halifax Women's Centre. Contact her for a full CV or more information.
Participants' feedback to creative writing courses 2015-2016
'A very interesting course helpful to both beginners and those who are more advanced.'
'The atmosphere was very gentle, encouraging and conducive to building confidence.'
'I have more confidence now in writing rather than just thinking about writing.'
'The group is relaxed and considerate and this is due to Emma's approach.'
'I've thoroughly enjoyed the course and am looking forward to the next one.'
'The course materials have been very helpful and act as reminder if I am needing to get back on track.'
'I have really appreciated Emma's encouragement and the pace of the sessions, both of which have enabled me to achieve a more fluent writing style and habit.'
'I am more able to develop written work using all the tools and devices we have learnt.'
'This course has done for me just what I needed – prompting, confidence and encouragement.'
Participants' feedback to Creative Life-Writing courses in Todmorden 2014-2015
'Thoroughly enjoyed it.'
'A very big thank you for the encouragement and for suggesting different ways of starting things which I'd never have thought of or done on my own.'
'A lovely and encouraging teacher.'
'I enjoyed sharing my work with others – not done that before.'
'I definitely write more now.'
'Emma was lovely, intelligent, sensitive, calm and inclusive.'
'It's encouraged me to be imaginative, to reflect on family and past.'
'The course gave me reason to write.'
'Supportive and talented tutor.'
'Transformative and life-affirming.'
'It was great to share lives through writing and connect with others through creativity.'
'Please do another course!'
Participant feedback to Beyond Dreams Life-Writing Workshop 2014:
"Well structured, interesting mix of participants and delivered with zeal and sensitivity. If the purpose of the session was to unblock creative energy and encourage people to respond freely to their Muse then it was completely successful. Taking a group of strangers from a state of reserved inertia through to relaxed sharing was a great achievement, and the session was facilitated with just the right balance between giving direction and allowing creative juices to flow… Enjoyable and rewarding session which I am glad I attended."
Paul Mulcock, Hebden Bridge, June 2014
See Events for details of workshops and classes Emma is running. Contact her to enquire about booking her for teaching work: email@example.com


text:
Popular Now
Popular Now
Popular Now
Popular Now
01803 865913
+44 1803 865913
Series: Guide per il Reconoscimiento delle Specie Animali delle Acque Interne Volume: 12
By: U Ferrarese and B Rossaro
97 pages, 45 figs
Consiglio Nazionale delle Ricerche
Language: Italian
There are currently no reviews for this book. Be the first to review this book!
Your orders support book donation projects
We find their customer service to be excellent
Search and browse over 110,000 wildlife and science products
Multi-currency. Secure worldwide shipping
Wildlife, science and conservation since 1985


text:
Following the growing complaints and inquiries about the inconvenience in license and vehicle plate issuance, Land Transportation Office (LTO) chief Edgar Galvante said that they will be prioritizing the Overseas Filipino Workers (OFW) regarding the distribution due to current shortage of license cards.
Concerned OFWs will have to submit their passports, employment contract, plane ticket and papers issued by either the Philippine Overseas Employment Administration or the Overseas Workers Welfare Administration to be prioritized.
The Land Transportation Office (LTO) has reported the availability of plastic license and vehicle registration plates on the second quarter of 2017, according to Inquirer.
The shortage of plastic cards, as reported, was a result of the Commission of Audit (COA) declining payments to the previous supplier, Amalgamated Motors Philippines Inc. This was due to absence of proper contract.
Meanwhile, the supply of car plates was cut short after the COA disallowed the contract won by the joint venture of Power Plates Development Concept and Dutch Company J. Knieriem BV in 2013.
It was also said that the Bureau of Customs took hold of 600,000 vehicle plates in April due to the venture's failure to pay taxes and duties. The plates were then turned over to the LTO. It was in August that the LTO reported a 7 million shortage of vehicle registration plates.
Of note, the Supreme Court has issued a temporary restraining order to LTO and Department of Transportation after allegations by Parañaque Rep. Gustavo Tambunting and Abakada Rep. Jonathan dela Cruz about the LTO bidding out the project without the necessary appropriation.
Source: Inquirer.net
Latest News
Mitsubishi PH receives five awards from the city of Santa Rosa / News
Mitsubishi Motors Philippines Corporation is feeling good today, following the five awards it got from Santa Rosa City, Laguna.
Just how on Earth did this BMW M5 double its value after 16 years? / News
An auction in the US just sold a 2002 BMW M5 in six figures.
This CEO says we're inches from seeing solid-state batteries on EVs / News
Henrik Fisker told The Verge his company is just months away from developing the first EV solid-state battery.