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Buy Tickets
Ticketmaster is the exclusive ticket provider for all ticketed Tacoma Dome events.
WARNING TO FANS: Don't be duped! Tickets purchased from sources other than Ticketmaster may not be valid. The Tacoma Dome is unable to honor or replace invalid tickets. Ticketmaster is the exclusive ticket provider for all Tacoma Dome events and the only authorized re-seller for tickets is Ticketmaster Verified Tickets. If you are subject to fraud, you may not have any recourse to recoup your cash.
Box Office Hours
Monday - Friday: 10am - 5pm
Show days: Box Office opens at least two hours prior to showtime
The Tacoma Dome Box Office is generally closed on major holidays.
Types of Payment Accepted
Cash, Visa, MasterCard, Discover, American Express
Charge by Phone
Call Ticketmaster at 800.745.3000
Will Call
Tickets held at Will Call can be picked up on the day of the performance, approximately two hours before showtime. The customer must present a valid form of identification, the credit card used to purchase the tickets, and the confirmation number.
General Rules
No recording devices are allowed.
No smoking is allowed in the building. No re-entry is allowed unless otherwise noted on the event info page.
ADA Accessible Seating is located in various sections throughout the Tacoma Dome. Check with the Box Office for further information on specific locations and availability.
Admission for children varies per event, generally children two years and under are free if they sit on an adult's lap. Be sure to check with the box office regarding specific events before you purchase tickets.

subset: commoncrawl


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On Wednesday's Breitbart News Daily, Sirius XM host Alex Marlow discussed leaked Hillary Clinton emails with former Navy SEAL and Blackwater CEO Erik Prince. Prince saw a disturbing threat about Clinton's appetite for centralized power running through several of these emails.
Prince found an exchange in which Clinton applauded Chinese President Xi Jinping's consolidation of authoritarian power more evidence that "her analysis of all things foreign, foreign governments, is about as goofed-up as her supposed reset with Russia, where they didn't even get the translation right on the event."
"President Xi Jinping is definitely consolidating power in China, in a way not really seen since Mao, not since the founder of China after the revolution in '49," he warned. "He still has a very vigorous anti-corruption campaign going, and has locked up many opponents. It is a difficult challenge for China to deal with those things. But for someone as corrupt as Hillary, we just can't allow that level of decision-making because her decisions, these emails show again and again, are not based on facts, or freedom, or what's pro-America. It's always about what's pro-Hillary, and how does it benefit her, and her party, and her fellow travelers."
Marlow described another email in which Clinton expressed "a dream of open borders" and also admitted that "vetting refugees is impossible."
"She prides herself on being part of this globalist elite, jetting around, funded by the Clinton Foundation, and then by the taxpayers on U.S. government aircraft," Prince said. "Dreaming of open borders means that the freedoms, what is unique about America and Western civilization, and our religious freedom, and allowing people that come from all kinds of countries that don't believe in limited government, that don't believe in the freedoms of speech and religion that we do, it's antithetical."
"Literally, the Founding Fathers would have revolted violently, long ago, to that kind of talk," he elaborated. "They believed in the United States of America, not to the United States of North and South America. There were unique aspects of America, they fought for it, they sacrificed greatly for it, and literally Hillary wants to open the barn doors wide, and let anything and anyone come and try to benefit from America while undermining everything that our forefathers have built in the past."
Prince said his mission was to "browbeat weak-kneed Republican leaders" and tell them to "man up, stand up, and be counted."
"Do the right thing. Support Donald Trump," he urged. 'You may not love everything about him. There's nothing I've loved about every Republican candidate that I've ever had a chance to vote for. But the choice is so clear. You're either choosing America, or you're choosing oblivion."
Breitbart News Daily airs on SiriusXM Patriot 125 weekdays from 6:00 a.m. to 9:00 a.m. Eastern.


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STORMREACH—Only days after their triumphant return from up the Rachi River, Zach's Commandos have vanished once more! The doughty adventurers arrived with little fanfare, debarking from the cagey Chinxero's modest and unassuming craft. From there, they quickly approached the Morgrave expedition headed by Provost Baris Kaven. Never one to shirk his responsibilities to you, Dear Readers, this reporter quickly approached the good captain.
"Dunno what they wanted, don't care either," Chinxero was good enough to say. Undaunted, this reporter applied his powers of persuasion to further loosen the river-dog's tongue. "Took 'em upriver a few days, then waited while they went inland. Was surprised they came back, but I brought 'em home. The rest is their business, so I'll be on my way."
Before he'd gone too far, Chinxero was persuaded to share this information: "It's known well enough the river is dangerous. We were attacked on the way, by a few of those filthy Yuan-ti. Took one of my crew. Damn fools, those adventurers…but they know how to fight. Now quit follerin' me!"
So there it is, Dear Readers! Bloodshed on the river, and an epic battle between the civilization of Khorvaire and the wild savages of Xen'drik! One can only imagine the clash of steel and claw, the darkly imposing reptilian bulk of a Yuan-ti Abomination emerging from the muddy depths of the river, only to be cut down by the efficient marriage of spell and steel, the forces of night repelled by the flash of spellfire off the brightly forged steel of the Sovereign Host!
And, Dear Reader, it did not slip this reporters' notice that Chinxero let fall a new piece of knowledge, hidden in this melee: for leagues down the Rachi, the Yuan-ti menace has been pushed back, all but eradicated. For a group to boldly attack even Chinxero's modest vessel is nearly unheard of. Is it possible Zach's Commandos have traveled farther than thought possible? What jungle depths have they delved in these brief weeks? Ever questing for the truth, this reporter followed the group.
Provost Kaven's "assistant," a brightly-attired student, refused access to the Provost, claiming he was in a private meeting. Thinking only of you, Dear Readers, this reporter objected strenuously to this obstruction of the Press and was most brutally restrained by the more strapping individuals in the camp. After enduring their collegial hazing for some hours, I saw the Provost emerge from his tent, escorting none other than Zach's Commandos to the perimeter! The odd Karrnathi woman, who you will recall arrived in Stormreach with Kaven, left with the group after companionably shaking hands with her former paramour. What ache must have twisted the provost's heart, losing his companion to the siren call of adventure and glory!
What, you say? That there is no evidence of their love? I approached the Provost then, to discern what I could.
"What, Z? Ha! That's a tree you shouldn't climb, I assure you!" Clearly the armored response of a broken heart, the poor man.
But, Dear Readers, we have discovered this newcomer's nom de guerre, "Z," a most enigmatic sobriquet, indeed. But what of the party's purpose? Why the protracted powwow in the provost's pavilion? Where did they go, and with what have they returned? Kaven was more interested in diving into his academic studies once more, burying his lovelorn heart in his work, than in speaking to the press. Sympathetic to his loss, this reporter prepared to leave. But serendipity struck, Dear Reader, in the form of the very assistant who so rudely rebuffed our inquiries before. Emerging from the Provost's tent with a shiny object in hand, the lad seemed unable to restrain his fervor.
"Provost! Where did these coins come from," the youth exclaimed. "They are so clearly struck, and obviously from the sixth dynasty! These can tell us so much than this excava—" The Provost stopped the student with a sudden shove and a stifled shout, but already the sense of the matter had slipped.
Ancient coins from Xen'drik, unexpectedly discovered on the Provost's desk. Clearly Zach has led his team deep into the continent, exploring the cyclopean ruins of the long-dead giants! These coins, a parting gift from his lady, have given us, Dear Reader, the final clues to the mystery of this expedition. We can only guess what artifacts the adventurers have discovered, and where they will take them now. But fear not, Dear Readers! This reporter remains alert, as ever!


text: Does anyone else think that the Wii sucks at widescreen? The games look worse. But more importantly the wiimote curser is laggy... I was playing wiiplay on the duck/balloon shooter... I can get almost everyone of them on 4:3 but on 9:16 the remote is slow, and laggy. I thought at first it was because the tv was bigger, but since I have tried various tvs and widescreen just doesnt work well on anygame. I play 4:3 streched on a widescreen tv and it playes much better. Its not just my Wii eigther. I wonder how many people just think they suck at a game, and they have never tried full screen settings.


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Hiland Dairy Foods Company: Hiland Dairy Foods Company has delivered farm-fresh dairy products to customers throughout the Midwest since 1937. Today we've expanded beyond traditional dairy foods like our milk, cheese, ice cream and yogurt to offer a wide variety of wholesome nondairy beverages, including fresh fruit juices, Red Diamond Teas, almond and soy milk, YoPhoria Smoothies and much more. Today Hiland Dairy Foods is committed to corporate responsibility through innovation, stewardship and sustainability efforts. We care deeply about our people and communities as well as preserving our water, land and natural resources for future generations.
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This site is entirely user-supported. See how you can help.
Street View is the best available vantage point looking, if possible, towards the location of the building. In some locations, Street View may not give a view of the actual building, or may not be available at all. Where it is not available, the satellite view is shown instead.
Latitude: 52.108 / 52°6'28"N
Longitude: 0.679 / 0°40'44"E
OS Eastings: 583557
OS Northings: 248907
OS Grid: TL835489
Mapcode National: GBR QGH.Y6M
Mapcode Global: VHJHF.Q8BT
Entry Name: Place Farmhouse
Listing Date: 9 February 1978
Grade: II
Source: Historic England
Source ID: 1036663
English Heritage Legacy ID: 277959
Location: Glemsford, Babergh, Suffolk, CO10
County: Suffolk
District: Babergh
Civil Parish: Glemsford
Traditional County: Suffolk
Lieutenancy Area (Ceremonial County): Suffolk
Church of England Parish: Glemsford
Church of England Diocese: St.Edmundsbury and Ipswich
5377 Glemsford
Place Farmhouse
A C16 timber-framed and plastered house, refronted in the C18. Originally
it was probably on an L shaped plan. 2 storeys. 3 window range, double-hung
sashes with glazing bars. A central doorway has a wood moulded architrave
and a flat hood. Roof tiled, hipped, with a tall chimney stack at the
south-east end. A wing extends to the north-east at the rear. The interior
has square panelling and a plaster ceiling with moulded ribs and bosses.
Listing NGR: TL8355748907
This text is from the original listing, and may not necessarily reflect the current setting of the building.
Other nearby listed buildings


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My Windows 10 Nightmare
I spent the greater part of 5 hours trying to install the latest build of Windows 10 on my Surface Pro 3. I work in the computing center of a small private liberal arts college in Connecticut, but I am regarded by the people I work with as the resident Windows 8/8.1 expert. A self-proclaimed Microsoft fanboy, I installed the technical preview months ago on a virtual machine from my desktop with Hyper-V. For the first time ever I felt confident enough to install it on my primary machine. Spoiler alert: It was a big mistake.
I am currently typing this on my Surface that is running a—now "stable"—Windows 10 install. What preceded this however, was hours of frustration and fear of having lost data due to a bad install. I don't know whether or not luck was simply not in my favor, or if this issue is more widespread, but when Windows 10 finished installing I had so many problems logging in, booting without crashing, and simple boot order changes that I considered wiping the device altogether. Foolishly I didn't first make a backup ISO of my stable Windows 8.1 install, but I expected things to go without a hitch.
Problems aside, Windows 10 so far has impressed me more than I anticipated. Cortana works better here than it does on the phone, a thing I attribute to the Windows group's increased focus on desktop Windows 10 leaving WP8.1 on the backburner. However, my first impressions are simultaneously nightmarish and excited. I plan on documenting my experience further as someone who should—according to Microsoft PR—be getting the best possible experience of their services since I'm using all their platforms. Hopefully things only improve in this technical preview, but installation trouble aside Windows 10 is shaping up to be a really big win. Pun intended.
(Any an all photo materials used in this post unless otherwise noted are the full and exclusive right under trademark and copyright laws to their respective owners. These images were used under the Fair Use laws under which blogging is a permissible use of content within bounds. We submit our use here meets these legal bounds).


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The Festive season has well and truly caught up with me this year. I haven't even had time to sit down and recap…until now. I love the festivities, but hate how quickly it passes by. Even New Year snuck by me really quickly. I set myself one goal for this year and that is to be happy and I think that's a pretty good goal.
I was absolutely spoilt rotten this Christmas, my parents are absolute treasures. Every year my mum (my dad has no clue – my mum writes his name on the presents and he always asks me what it is whilst i'm opening it ha!) gets me a set of Hand Therapies from Crabtree & Evelyn and this year they didn't disappoint.
As always with Crabtree & Evelyn, the packaging is perfect. The 3 creams come inside a cracker shaped box which has a lovely vintage feel to it. The patterns always remind me of my nan, which is why I think I love it so much. I was intrigued when I opened this, as the scents are really unusual sounding combinations.


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Stabilize, preserve, and protect green wood with Preservation Solutions products!
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105° opening angle3/8" overlayIntegrated BLUMOTION soft-close actionOne-piece design (no mounting plate needed)Wraparound mountThree-dimensional adjustmentNickel-plated steel constructionScrew-on hinge-to-door attachment Screws not included (see listings below to purchase recommended screws)
*This item is in stock and typically ships within 1 business day of order placement*
BLUMOTION COMPACT combines Blum's softest close with their smallest hinge. Innovative BLUMOTION soft close technology is integrated right into the hinge cup. This maintains the compact hinge size while ensuring silent, effortless closing - regardless of door weight or closing speed. These BLUMOTION hinges utilize an overload safety feature to protect the soft close action from damage. For small or light doors, the BLUMOTION feature can be switched off on one hinge, and three-dimensional adjustment helps ensure that doors fit perfectly. With its small profile, economical cost, and soft-close action, the COMPACT BLUMOTION hinge is sure to please - whether in a client's home or your own. The 38N partial overlay series is a one piece assembly, which means no mounting plate is necessary. It is constructed of nickel-plated steel and has a 105° opening angle and a wraparound hinge-to-frame mount (use a truss head installation screw). This particular hinge is designed for 3/8" overlay with screw-on hinge-to-door attachment. Installation screws are not included - see listings below to purchase the recommended screws.
Monday - Friday | 8.00 to 5.00 (CST)
Monday - Friday | 8.00 to 4.30 (CST)


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Calgary school board candidate leaves 'Students Count' slate to run as independent
After a rough start to her campaign for public school trustee amid reports of offensive tweets, Bianca Smetacek announced Thursday she is leaving the Students Count slate to run independently.
In a media release, Smetacek said she felt issues in Wards 5 and 10, where she is running, were unique compared with the rest of Calgary and that she will run separately from a slate of candidates known as Students Count, which formed as a team this spring ahead of October's school board elections.
"I have listened carefully at countless doors to parents' concerns. I have spoken to voters in English, Hindi, Punjabi and Urdu. It's clear to me that many issues faced by students and parents in North East Calgary are different than in other parts of the city," Smetacek said in the statement.
When Postmedia contacted her campaign team for more information around the reasons for her exit, campaign manager Hadyn Place said she will not be commenting further.
In the news release, Smetacek added that her independent campaign will have an additional focus on supporting English Language Learning students and fixing busing issues.
In May, Smetacek joined public school trustee candidates Lisa Davis, Althea Adams and Sabrina Bartlett as part of the Students Count Team, all of whom said they shared similar concerns such as improving math skills, building better report cards and getting big money out of campaigns.
Days after that announcement, Smetacek was criticized on social media after she shut down her personal Twitter account amid reported screen grabs of offensive language in previous tweets.
In June, Mike Bradshaw and Sadiq Vailliani also joined the Students Count Team to run as public school trustee candidates.
Kelley Charlebois, who is organizing the slate of Students Count candidates, did not return Postmedia's calls Thursday afternoon.
Lisa Davis, a Students Count candidate running in Wards 6 and 7, would only say "we wish her well and we look forward to working with whoever gets elected in that area."
School trustee elections occur concurrently with the municipal elections on Oct. 16.


text:
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When you become a member, you can look forward to:
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text:
Two days ago I made a poll on my twitter, giving my followers the choice whether they wanted to see an updated everyday makeup look or my winter skincare routine. Yesterday the poll closed and… *drumroll* the makeup look won!
[Also you better all appreciate the picture I used above, because this is the first time EVER I show my bare face on the internet *dramatic music plays in the background*.]
This is a bit of a grungy look, but if you don't mind a bit of a heavier makeup look please do try it out! It is literally so simple, anyone could do it. All products are listed below.
After having moisturised my face I apply my primer with my hands, making sure I have covered every bit of my face. Then I used the Max Factor lasting performance [fun fact: I started wearing makeup at the age of 13/14 and this was the first foundation I ever used], applying it with the Zoeva 102 brush. I do try to apply a bit of foundation down my neck, because for some reason my face starts to get really pale during the winter, while the rest of my body remains a bit tanned #struggles.
After I have applied my foundation and concealer and my skin starts to look decent again I make my face matte again by using the Rimmel stay matte powder, still my all time favourite powder.
Now it is time to bring my face back to life by using the Makeup Revolution Golden Sugar 2 palette. I am so in love with this face palette, there hasn't been a day where I haven't used it, since I got it. It has everything you need! Highlighter, blush and contour and quite a nice variety of them. And all the shades are so pigmented, so be careful when applying.
Now that my base is completely done it is time to make my brows magically appear! As you can see in the top picture my brows are barely visible, even though the hairs are a dark brown colour. I have really thin and separated eyebrow hairs, which is why you can't really see them. That is why I use my trusty eyebrow pencil in combination with the gel.
After I have perfected my brows, which takes about a good 5 minutes, it is time to get into the eyeshadow out. I used a purple/bronze shade, in the picture you can see my blending brush hanging over it. With the blending brush I swipe the eyeshadow all over my lid, next I take a small brush to swipe a black eyeshadow along my lash line and that is all! It actually is as simple as that when it comes to the eyeshadow.
We are almost at the end of this makeup look! After having used my trusty lash curlers I take my Lancome Doll Eyes mascara. This is a high end product, but if you can afford and like them, I really recommend this one.
The right photo shows all the brushes I have used and use every day.
As I said before you can either stop here and leave the makeup like this, but for the sake of this being an explicit makeup look I applied a lipstick. The Urban Decay Vice lipstick in Rock Steady, a lovely creamy red colour. I haven't worn red lipsticks in months, but I am obsessed with this colour again!
And that is it, that is the finished makeup look. I hope you enjoyed reading this!
What are some of your everyday makeup look products?
Love, Larice
Products used:
Max Factor lasting performance
Rimmel London stay matte powder
Makeup Revolution Golden Sugar 2 Rose Gold blush and contour palette
Maybelline the nudes eyeshadow palette
Essence eyebrow gel


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Thursday, September 15, 2011
Lost Knight #2: The Gold Barris K.I.T.T.
Jim Suva at the Rockford Files blog sent me this photo. It was taken years ago and shows a gold painted K.I.T.T. in the front window of Barris' shop in North Hollywood. Parked beside it is the "Dagger DX" from "Knights of the Fast Lane".
Do you have any information on this car, or additional photos? If so, let us know!
1 comment:
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Additional Information
- Style: Women's Dress
- Colour: Shell
- Material: Rayon
- V neckline with lace through chest
- Long sleeve with buttoned cuff detail
- Scooped back hemline
Model Measurements
- Our model Steph is 177cm tall.
- Steph is wearing a size 8 Dress.
- Model's Bust: 86cm
- Model's Waist: 63cm
- Model's Hips: 93cm
Please note: This information is a guide and we recommend checking the brands Size Chart for further information.
FREE EXPRESS SHIPPINGNext day delivery to metro areas Australia wide*.
- Express Shipping (1-3 Days to most areas, $9.95 or FREE for orders over $50)
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BDO, as administrator and now liquidator of Farepak, has run up £1.16m in "forensic fees" since being appointed in October 2007.
The fees relate to investigations being carried out ahead of potential legal action against unnamed parties "in an attempt to secure further monies for the benefit of creditors, including customers".
Although BDO has not named those it hopes to bring actions against, reports last year claimed potential targets include William Rollason, the former chief executive and Nick Gilodi-Johnson, former managing director.
Both men have vehemently denied any suggestion of wrongdoing.
More than 150,000 people lost an average of £400 when Farepak went into administration in 2006. Many of the group's customers were from low-income families.
The company, to whom customers made monthly deposits in return for vouchers sent out before Christmas, collapsed after its owner, European Home Retail, used savers' money to fund the day-to-day running of the business.
BDO has, to date, earned more than £2.3m in two years from its work on Farepak, while customers and creditors have been told to expect a dividend payment of just 5p for every £1 they are owed.
A spokesperson for BDO said: "BDO's fee reflects the amount of time that has been spent in handling this work. Our work on the administration was discounted by 10pc and our work on the liquidation over the last two years has been discounted by 6.9pc. In addition to this, we have written off £100,000 of fees."
The Office of Fair Trading announced last week that it was launching an investigation into the corporate insolvency market. The OFT said it would probe the structure of the market and anything which "could result in harm" including excessive fees.


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Article Text
Introduction Acute coronary syndrome (ACS) is one of the leading causes of morbidity and mortality worldwide. Secondary cardiovascular risk reduction therapy (consisting of an aspirin, a β-blocker, an ACE inhibitor or an angiotensin II receptor blocker and a statin) is needed for all patients with ACS. Less than 80% of patients with ACS in Qatar use this combination after discharge. This study is aimed to evaluate the effectiveness of clinical pharmacist-delivered intervention at discharge and tailored follow-up postdischarge on decreasing hospital readmissions, emergency department (ED) visits and mortality among patients with ACS.
Methods and analysis A prospective, randomised controlled trial will be conducted at the Heart Hospital in Qatar. Patients are eligible for enrolment if they are at least 18 years of age and are discharged from any non-surgical cardiology service with ACS. Participants will be randomised into 1 of 3 arms: (1) 'control' arm which includes patients discharged during weekends or after hours; (2) 'clinical pharmacist delivered usual care at discharge' arm which includes patients receiving the usual care at discharge by clinical pharmacists; and (3) 'clinical pharmacist-delivered structured intervention at discharge and tailored follow-up postdischarge' arm which includes patients receiving intensive structured discharge interventions in addition to 2 follow-up sessions by intervention clinical pharmacists. Outcomes will be measured by blinded research assistants at 3, 6 and 12 months after discharge and will include: all-cause hospitalisations and cardiac-related hospital readmissions (primary outcome), all-cause mortality including cardiac-related mortality, ED visits including cardiac-related ED visits, adherence to medications and treatment burden. Percentage of readmissions between the 3 arms will be compared on intent-to-treat basis using χ2 test with Bonferroni's adjusted pairwise comparisons if needed.
Ethics and dissemination The study was ethically approved by the Qatar University and the Hamad Medical Corporation Institutional Review Boards. The results shall be disseminated in international conferences and peer-reviewed publications.
Trials registration number NCT02648243; pre-results.
- Pharmacist
- Qatar
- Acute Coronary Syndrome
- Discharge
- Intervention
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Strengths and limitations of this study
This is the first randomised controlled study that investigates the impact of clinical pharmacists as direct patient care team members at discharge and postdischarge on patients with acute coronary syndromes in Qatar and probably in the Middle East.
The study results will show the extent to which a pharmacist-delivered pharmaceutical care intervention is effective and feasible in the cardiovascular setting.
The study will help in setting and integrating an effective standard of care for discharge and follow-up procedures for cardiac patients and in improving the management of one of the most prevalent chronic diseases in Qatar.
The study limitation is that study results may not be generalisable to other countries.
Cardiovascular diseases (CVDs) are considered a leading cause of death, with an estimated 17.5 million deaths worldwide in 2012. Coronary heart diseases including acute coronary syndrome (ACS) account for 31% of all deaths.1 Patients with ACS have an increased risk of future recurrence of cardiovascular and non-coronary atherosclerotic events.2 ,3 Consequently, all patients post-ACS should be prescribed secondary cardiovascular risk reduction therapy also known as 'secondary prevention'. Unless contraindicated, this therapy should be started in all patients with ACS before hospital discharge.4 Internationally recognised clinical practice guidelines by the American College of Cardiology (ACC)/American Heart Association (AHA), European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE), strongly recommend optimisation of secondary prevention drug therapies following ACS.5–9 According to the ACC/AHA guidelines, all patients with ACS should receive indefinite treatment with aspirin, a β-blocker, an ACE inhibitor (ACEI) or alternatively an angiotensin II receptor blocker (ARB), and a statin. In addition, a platelet P2Y12 receptor blocker (clopidogrel or prasugrel or ticagrelor) may be prescribed.5 ,6 ,10 ,11 These evidence-based recommendations are predicated on many studies that have demonstrated the benefits of using the quadruple combination of secondary prevention medications (antiplatelet, statin, β-blocker, and ACEI or ARB) at discharge.12 ,13 Nevertheless, there is a corresponding documented evidence of underusage and of low adherence to secondary prevention medications among patients with ACS in many countries including the USA, Canada and Qatar.14–19 Non-adherence to and early discontinuation of ACS secondary prevention medications are associated with an increased risk of subsequent adverse cardiovascular events, hospital readmissions and mortality.20–26
The phase after hospital discharge is a vulnerable period and a critical one for patients with ACS.27 Often, patients are left unprepared at discharge and many do not receive sufficient education about their discharge medications or treatment plan.28 Evidence from the literature supports that restructuring the patient discharge process to include activities such as discharge medication reconciliation and counselling, and postdischarge monitoring and follow-up can decrease the frequency of these adverse outcomes.29–33
Clinical pharmacists are well positioned to provide pharmaceutical care interventions as patients transition between different healthcare settings. Their role has been well defined by many professional organisations including the International Pharmaceutical Federation (FIP), the WHO, the European Society of Clinical Pharmacy (ESCP), and the American College of Clinical Pharmacy (ACCP).34–36 For example, ESCP defines the role of clinical pharmacists as that which promotes the safe and appropriate use of medications with the aim of achieving the desired therapeutic outcomes.36 In addition, many studies have demonstrated the impact of pharmacist interventions which include patient education at discharge and/or follow-up in decreasing the rate of preventable adverse drug events, hospital readmissions and emergency department (ED) visits.31 ,32 ,37–39 Undoubtedly, the incorporation of pharmacists into the CVD healthcare team can improve the usage of CVD medications40 and increase patient adherence to drug therapy. This can also potentially decrease the number of hospitalisations, ED visits and mortality.41 ,42 The role of pharmacists in CVD management is well recognised by professional pharmacy bodies.34–36 In particular, the ACCP and the Institute for Healthcare Improvement have developed a best practices model for pharmacist-based discharge counselling for patients with heart failure and myocardial infarction which targets, but not limited to, medication use, barriers for adherence and the patient's role in self-care.43
According to the WHO 2014 report, CVDs accounted for 24% of all deaths in Qatar.44 Moreover, the annual report of Hamad Medical Corporation (HMC) in 2009 indicated that the highest number of reported deaths in Qatar was attributed to diseases of the circulatory system. The medication taking behaviour of the quadruple evidence-based secondary prevention medications was previously assessed in a cohort of 31 ACS outpatients at the Heart Hospital (HH). The self-reported continuation rates for secondary prevention medications 6 months after the last hospital discharge decreased from 100% to 77% for β-blockers, 90% to 79% for ACE inhibitors, 100% to 97% for statins and 84% to 52% for dual antiplatelet therapy. The most common reasons for medication discontinuation were patients' experiences of intolerable medication adverse effects, high number of prescribed medications at the time of discharge and the fear of experiencing a medication adverse effect.19 This creates a significant opportunity for the clinical pharmacists to improve CVD management and outcomes in Qatar.
To the best of our knowledge, this study is the first in Qatar to assess the effectiveness of a clinical pharmacist-delivered intervention among patients with ACS on cardiovascular-related outcomes. If proven to be effective, this intervention will potentially be adopted in Qatar and other cardiology centres in the region to ultimately improve cardiac care and outcomes in patients with ACS and to decrease ACS-related healthcare resource usage. Furthermore, the study will act as a catalyst to develop standards for discharge and follow-up programmes for patients with coronary heart disease in Qatar and other developing nations.
We hypothesise that an intensive structured clinical pharmacist-delivered intervention consisting of medication reconciliation and counselling at discharge and tailored follow-up postdischarge will decrease hospital readmissions, ED visits and all-cause mortality among patients with ACS at 3, 6 and 12 months after hospital discharge when compared with 'no-pharmacist intervention' or 'usual pharmacist care'. We also hypothesise that the effect of the intensive structured pharmacist intervention will increase patients' adherence to evidence-based secondary prevention medications for recurrent cardiovascular events and will decrease treatment burden as perceived by the patients.
This protocol describes a study that is currently being implemented at HH, one of the tertiary care hospitals under the HMC in Qatar.
The study is primarily aimed to evaluate the effectiveness of clinical pharmacist-delivered intervention at discharge and tailored follow-up postdischarge on decreasing hospital readmissions.
The secondary objectives of the study are to evaluate the effectiveness of the intervention on: (1) decreasing ED visits, and mortality among patients with ACS; (2) improving patient adherence to evidence-based secondary prevention therapy; and (3) decreasing treatment burden as perceived by patients with ACS.
Study design
The study is a prospective randomised controlled trial assessing the effectiveness of a structured intensive clinical pharmacist-delivered intervention consisting of medication reconciliation and counselling at discharge and tailored follow-up postdischarge on: (1) hospital readmissions including cardiac-related hospital readmissions; (2) ED visits; (3) all-cause mortality including cardiac-related mortality; (4) adherence to evidence-based secondary prevention medications and (5) self-reported treatment burden.
Study arms
The study will have three arms: (1) 'control' arm (control arm) which includes patients discharged during weekends or after the clinical pharmacists' working hours; (2) 'clinical pharmacist delivered usual care at discharge' arm (usual care arm) which includes patients receiving the usual care at discharge by the clinical pharmacists and (3) 'clinical pharmacist delivered intensive structured intervention at discharge and tailored follow-up postdischarge' arm (intervention arm) which includes patients receiving a structured discharge intervention in addition to two follow-up sessions (around 30 min each) at ∼4 and 8 weeks of discharge. The usual care delivered by cardiologists is similar across all the study arms and no modification of level of care was required by the present study.
Study site
The study is being implemented at HH, which is one of the new hospitals under the umbrella of the HMC. The centre is equipped with a 20-bed coronary care unit, a 12-bed cardiothoracic intensive care unit, a 24-bed surgical high dependency unit and 60 ward beds with continuous telemetry monitoring rooms. It provides inpatient and outpatient tertiary care services for more than 95% of the patients with ACS in Qatar.45 Around 3000 patients with ACS are admitted to the HH annually. These patients receive their secondary prevention medications from the hospital's outpatient pharmacy with a nominal charge of about 150 QR (Qatar Riyal) per prescription refill.
Eligibility criteria
Patients are eligible for enrolment into the study if they are at least 18 years of age and are admitted to and discharged from any non-surgical cardiology service at HH with a diagnosis of ACS regardless of whether it is their first ACS attack or not. Patients will be excluded from the study if any of the following criteria is met: severe visual impairment, severe hearing impairment, inability to communicate in either English or Arabic, mental or psychiatric illness, delirium or severe dementia, cognitive impairment, incomprehensible speech, planned discharge to a location other than home (eg, long-term care facility, nursing home, other medicine units, etc), plan for coronary artery bypass graft (CABG) surgery during hospitalisation, plan to leave Qatar in the next 12 months, and a terminal illness with a high likelihood of death in the next 12 months.
Screening and recruitment of patients
Trained research assistants (RAs) will identify potential participants through reviewing the HH's medical records according to the study's inclusion and exclusion criteria. The RAs will approach identified participants, provide them with information about the study and obtain written informed consent, including permission to access the patient's medical records.
After obtaining the informed consent, the RAs will document through medical chart review and patient interview the patient's baseline characteristics including demographics and comorbidities such as age, gender, country of origin, type of ACS, education level, medical conditions (eg, diabetes mellitus, heart failure, hyperlipidaemia, hypertension, renal dysfunction, obesity, depression, chronic obstructive pulmonary disease, cerebrovascular accident, etc), past and current smoking status, current prescription and over-the-counter medications, clinical parameters (eg, most recent blood pressure, pulse rate, lipid profile, blood glucose, weight, height), and inpatient treatment modality (eg, medical management vs CABG vs percutaneous coronary intervention).
At HH on arrival to the ED, patients with ACS are usually allocated to different treatment teams by the triage nurse based on the capacity of the teams. These treatment teams are denoted by the letters A, B, C and D; typically, each team has a clinical pharmacist as a member. This inherent process of randomly allocating patients to treatment teams serves as the basis of randomisation in this study. First, consenting patients who happen to be allocated to the teams that have the intervention clinical pharmacists will be naturally considered in the intervention arm. Second, consenting patients who happen to be allocated to the teams that have the non-intervention clinical pharmacists will be considered in the usual care arm. Finally, consenting patients who are discharged on weekends and after the clinical pharmacists' working hours will be naturally randomised into the control arm.
Assigning patients to the different teams is the usual practice at HH. Allocation or selection bias is unlikely to happen in the study due to the fact that the clinical pharmacists have no role in patients' allocation.
Description of the intervention
'Control' arm: in this arm, patients will typically receive routine discharge instructions and medication information by nurses and/or treating physicians during hospital discharge. This arm comprises of consenting patients who are discharged during weekends and/or at times outside the clinical pharmacists' working hours. These patients will not have any contact with the clinical pharmacists at discharge.
'Clinical pharmacist delivered usual care at discharge' arm: in this arm, the clinical pharmacist will provide the usual care to patients at discharge which includes:
Reviewing and reconciling patient's discharge medications.
Documenting and resolving any identified discrepancies and drug-related problems as appropriate.
Providing the usual general discharge counselling.
'Clinical pharmacist-delivered intensive structured intervention at discharge and tailored follow-up postdischarge' arm: in this arm, the clinical pharmacist will deliver a structured discharge intervention in addition to two coordinated follow-up sessions (around 30 min each session) at 4 and 8 weeks postdischarge. Specifically, the intervention clinical pharmacist will:
Provide structured counselling to the patient by: reviewing the patient's baseline knowledge and experience; educating them about coronary artery disease (CAD) and about the goals of therapy; reviewing important information pertinent to each medication (instructions of use, anticipated benefits, common side effects, appropriate actions to take in case side effects occur, etc); providing additional counselling and monitoring for medications requiring exceptional instructions if applicable (eg, warfarin); emphasising the differences between the patient's preadmission and discharge medication regimens; providing recommendations for alternatives in case of contraindications to any of the secondary prevention medications as per evidence-based guidelines; discussing the drugs and herbs that the patient should generally avoid; discussing risk factor control (eg, diabetes, hypertension, dyslipidaemia, etc); general lifestyle modification counselling including weight loss, appropriate physical activity, dietary modification, smoking cessation, etc; educating the patient on the importance of adherence to their medications; assessing the patient's potential barriers for medication adherence and for adopting lifestyle modifications (eg, literacy, language barrier, cost, polypharmacy, etc); and reviewing with the patient some strategies to improve medication adherence (eg, how to prevent or alleviate side effects, etc); assessing and addressing any patient's concerns; and if needed, asking the patient to 'teach-back' key features of their medication regimens to confirm comprehension of important medical and medication instructions.
Ensure that a follow-up plan for medication monitoring after discharge is communicated to the patient.
Provide the patient with a personalised medication timetable that lists indication, time and directions of use, in addition to the relative common side effects of each medication.
Offer the patient a pill box and teach him/her how to fill it using the medication timetable as a guide.
Give the patient information leaflets that are developed by the study team. Each patient information leaflet will be related to a specific medication or class of medications and will contain relevant medication information (eg, indication, directions for use, warnings, side effects, benefits, what to do in case of missed dose, storage recommendations, etc) in a lay language (English or Arabic) that is easily readable and comprehensible by the patient. The leaflets will be adapted from reputable drug information resources such as UptoDate and Micromedex.46 ,47
Schedule two follow-up sessions with the patients at 4 and 8 weeks postdischarge. These follow-up sessions will be delivered over the phone. During these sessions, the intervention pharmacists will: review the medications with the patient to identify any discrepancies between his/her current medications and his/her discharge medication list; identify any drug-related problems (eg, side effects, etc); confirm that the medications are filled. In case any of the medications is not filled or stopped, the pharmacist will: elicit the reason from the patient or contact the patient's physician as necessary; confirm that the patient understands each medication's instructions and any gaps in understanding will be determined and addressed; assess the patient's lifestyle (eg, diet, etc) and provide counselling as needed; assess the patient's adherence to medications and elicit reasons for non-adherence if applicable (eg, complicated regimens, cost, medication intolerable side effects, difficulty in remembering to take the medications, etc); re-emphasise the importance of adherence to secondary prevention medications in order to reduce the risk of recurrent cardiac events; in case of any identified non-adherence, the pharmacist will work with the patient to promote adherence by offering strategies such as simplifying medication regimens (eg, sustained release, etc), tailoring medication regimens according to the patient's daily routine (eg, identifying a daily activity that the patient regularly performs at about the time he/she should take his/her medications and explain to the patient to take medications at this time, encouraging the patient to use an alarm to remember the next dose), managing side effects, offering adherence aids, etc; and document the patient education during follow-up sessions on a newly created 'patient follow-up' form as well as in the patient's medical record.
Intervention clinical pharmacists
Three clinical pharmacists from HH are participating in the 'intervention arm' of the study. The selection of pharmacists in this arm was based on pharmacist availability during the study period, their willingness to participate, their credentials and their workload. Intervention pharmacists should hold a Doctor of Pharmacy (PharmD) degree and should have completed at least 1 year of residency programme or at least 2 years of pharmacy experience.
The study team provided the intervention pharmacists with a 3-hour orientation session. The session covered a refresher on the following: the current guidelines on the secondary prevention of ACS, non-pharmacological management, pharmaceutical care's basic concepts, communication and counselling skills, medication reconciliation, medication adherence assessment and strategies to improve medication adherence. The orientation also covered the study protocol and the study forms that the pharmacists would need to fill. In addition, the pharmacists were orientated to provide the intervention in a standardised fashion, while tailoring it to the patient's needs.
Study piloting
Prior to the beginning of the study, the intervention clinical pharmacists will pilot the feasibility of the study in the presence of the study team. Piloting will occur by delivering the intervention to two patients per pharmacist. With the patient's permission, a sample of the counselling will be audio-recorded and the pharmacists will be provided with individual feedback. Necessary refinements will be made to all the study logistics and study forms based on the piloting experience.
Ethical consideration and dissemination
All participants' folders will be stored in a password-protected database on the site laptop. Only the study personnel can access these folders. In addition, all data retained in the password-protected database will be maintained along with all related study documentation in a locked cabinet at Qatar University (QU) College of Pharmacy.
The results of this study will be presented in local, regional and international conferences as well as published in international peer-reviewed journals.
Outcome measures
All surviving patients in the three study arms will meet the study RAs who will be blinded to treatment group at ∼3, 6 and 12 months after hospital discharge. The outcome measures include:
Primary outcome: all-cause hospitalisations and cardiac-related hospital readmissions including hospitalisations for cardiac events, exacerbation of heart failure or arrhythmia. This outcome will be assessed by checking HH and HMC medical records.
Secondary outcome: ED visits including cardiac-related ED visits. This will be assessed by checking HH and HMC medical records. Any ED visit in which a patient is subsequently hospitalised will be counted as a hospital readmission.
Secondary outcome: all-cause mortality including cardiac-related mortality: this outcome will be assessed by checking HH and HMC medical records during the designated follow-up periods.
Secondary outcome: patient adherence to evidence-based secondary prevention medications for CAD will be measured using three strategies:
Patients' self-report of taking all and each individual prescribed secondary prevention evidence-based medications for CAD. This will be assessed by asking the patient to state which medications he/she is currently taking and then compare this list to the patient's discharge medication list. Any discrepancies (eg, change in or missing medication dose or frequency, or route of administration or omissions, additions substitutions or duplications) will be noted and causes for these discrepancies will be discussed with the patient to determine if they were intentional or not. Medication changes will be considered intentional if they were made by the patient's physician. If the patient in any study arm reports that a medication is discontinued by his/her physician, the physician will be contacted by phone or email to confirm and obtain the reason for the discontinuation. Patient will be considered adherent if the physician verified discontinuing the medication.
Administration of the Adherence to Refills and Medications Scale (ARMS).48
Patients' adherence to all and to each individual prescribed secondary prevention medications for CAD as per the prescription refill records at the HH outpatient pharmacy covering the period from the patient hospital discharge until the day of outcome assessment. The patient will be considered adherent by pharmacy prescription records if the proportion of days covered (PDC) for each of the secondary prevention medications (β-blocker, aspirin, statin, ACEI or ARB if applicable) from discharge is larger than 75%. A PDC value of more than 75% is selected based on previous studies that assessed adherence in postmyocardial infarction patients.49 If one of the medications is not prescribed at discharge, the PDC to only the prescribed medications will be used to determine the overall adherence. To be classified as having overall adherence, the patient must have a PDC≥75% for each medication. For example, if the patient's PDC for one of the medications is 80% but PDC for another medication is 50%, the patient would be classified as non-adherent. A patient will be considered non-adherent in case he/she is found non-adherent in any modality even if the same patient is found adherent by the other two modalities.
Treatment burden: will be assessed using the culturally adapted and translated Treatment Burden Questionnaire (TBQ).50 ,51
Participant flow through the study
For more information regarding the flow of participants during the study, please see figure 1.
Data analysis and sample size calculation
The trial will be analysed according to the CONSORT guidelines. Baseline demographic and clinical characteristics between the three study arms will be compared using one-way analysis of variance (ANOVA) for the numeric variables (such as age) and the χ2 test for categorical variables (such as gender). Alternative non-parametric tests will be used if needed. The primary analysis will involve comparing the main outcome of percentage of readmissions between the three study arms at 6 months using the χ2 test. Pairwise comparisons using Bonferroni's adjustment for the significance level will be used if needed. Logistic regression will be used to compute the unadjusted OR between the three groups (with the control arm being the reference group) along with 95% CIs. The number needed to treat (NNT) will be computed when significance is achieved in the main outcome between any two pairs of arms. This analysis will be carried out for the two time periods 3 and 12 months. Secondary analysis will involve obtained adjusted OR for the primary outcome where adjustment is done for any imbalances deemed clinically important in demographic and baseline clinical variables between the study arms. In addition, the primary outcome will be adjusted for the possible clustering effect within each team using mixed effects regression analysis. Also the secondary outcomes of all-cause mortality and adherence will be analysed in a similar manner.
The treatment burden will be compared between the study arms using the χ2 test followed by multiple logistic regressions or one-way ANOVA followed by multiple linear regressions. Intent-to-treat principal will be used for the analysis. Two sensitivity analyses will be performed one using multiple imputations by chained equations for the missing data and the other using per protocol methodology. Also the effect of adherence on the primary analysis will be assessed by adding this variable to the multiple logistic regression models. Statistical analyses will be conducted using the Statistical Package of Social Sciences (IBM SPSS) V.22. In all analyses, the level of significance will be set at 5%. The sample size is based on the primary analysis of comparing the main outcome between the three study arms. Assuming that the 6-month readmission among the patients on the control arm is about 20% with 125 patients per arm, we will be able to detect an effect size of 0.025 between the three groups corresponding to an absolute decrease of 10% between the intervention arm and usual care arm and 9% between this latter group and the control arm with a significance level of 5% and a power of 80%.51 Approximately 250–300 patients are admitted to HH per month with ACS of which 10–15% are discharged on weekends or after the clinical pharmacists' working hours. On average, length of stay of patients with ACS ranges from 72 to 96 hours. The recruitment phase of the study is over 12 months. Assuming that the RAs recruit 3 participants in each arm every week, the estimated sample size of 125 patients per arm would be achieved in 42 weeks.
The study is not without limitations. True randomisation of participants is not possible. Participants are allocated to the three arms by the triage nurse based on the capacity of the different teams. This is the most feasible and natural way of randomisation given the nature of practice in the study setting. Furthermore, the study involves only one hospital in Qatar; therefore, the study results may not be generalisable to other centres in the country. Nevertheless, HH is the main centre that offers cardiac services to Qatar's population which makes this limitation less concerning.
Contributors AZ was involved in drafting the protocol and is responsible for the treatment burden part of the project. AA has made substantial contributions to the conception of the research idea, design of the study, and was involved in drafting and critically revising this protocol for important intellectual content. NK contributed in major way in discussions related to the design of the research project, developing and adapting the tools related to treatment burden, and review of all the drafts throughout the project including the protocol. ZM assisted in writing the data analysis and sample size calculation of the protocol. RK had input in reviewing the protocol and is making substantial contribution in executing the study at HH. SA had input in reviewing the protocol and is making substantial contribution in executing the study at HH. MH is the lead principal investigator of the study leading its design and execution. She wrote the study protocol and manuscript.
Funding The work was supported by Qatar University Internal grant number QUUG-CPH-CPH-14/15–2.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study protocol, informed consent forms, recruitment procedures, data collection forms and all other relevant documents were reviewed and approved by the Qatar University (QU) and the Hamad Medical Corporation (HMC) Institutional Review Boards. Approval numbers are QU-IRB 527-EA/15 and 15319/15, respectively.
Provenance and peer review Not commissioned; externally peer reviewed.
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I was not looking forward to this film. After Alice in Wonderland and, more recently, Maleficent, a live action adaptation of Cinderella seemed like the worst thing in the world, and the trailers certainly didn't help either. Then I saw the film and my god was I wrong. The new adaptation of Cinderella is everything a Cinderella movie should be. It doesn't go down the darker paths of previous live action adaptations, instead remaining bright and hopeful, and a tad emotional too. I will admit, this film had me on the brink of tears during the first act, resulting in several 6-year-old-like panic attacks in which I continuously reassured myself that everything was going to be alright eventually and that my worries should be put at ease. This is what Disney does to me, people.
It features everything we love about the original Cinderella and translates it for a modern audience, but it does so without loosing any of the magic. I was just watching the original film again last night and while this isn't a shot for shot remake, *cough Psycho cough* it does feel very similar. Sure, there's less of the mice vs cat, and that dog is completely out of the picture, but that's hardly a bad thing, for the original spends WAY too much time focusing on them and not enough time with Cinderella. This version fixes that and turns it into a more human focussed story, and for that, I applaud them.
Speaking of Cinderella, Lily James is brilliant in the role. She could not have been cast better. Not only does she look the part, but she can act it too. She has a sort of likability about her, and as we all know, likability and kindness are, well, Cinderella's most noticeable traits. Her scenes with Richard Madden burst off of the screen, the two constantly bouncing off of each other. They're a marvellous pairing and they're quite a treat to watch, although the whole film could be described that way.


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It's already a week since International Missing Children's day and the Big Tweet. This was a bold experiment by Missing People to see if a new medium - Twitter - could be used to communicate an important and not always easy message to a wider audience. It was an approach with the potential to reach many people who were not previously aware of the issue and to create a new channel to be used in the search for the 100,000 children who go missing in the UK every year.
So was it a success? And what did Missing People and the families they support gain from this new tactic?
The results speak for themselves:
- By midnight last Wednesday, @missingpeople had over 7,000 followers, up from 1,500 before the campaign was launched.
- There were nearly 150 tweets for each of the 48 appeals sent out during the day.
- #IMCD trended by 8AM - this means that it wasone of the most 'tweeted' subjects in the country at the time.
- 27 celebrities tweeted about the campaign, including Stephen Fry, Sarah Brown, Victoria Beckham, Lily Allen, Alan Carr, Denise Van Outen, and Anna Friel.
- Visits to the website were up over 600%.
- There was also significant press coverage, including stories on the homepages of Yahoo! UK and Sky News, and interviews with Kerry Needham, mother of missing Ben Needham, on ITV Lunchtime News, Radio 5 Live and ITV Yorkshire.
In other words, every goal was hit, if not smashed! Twitter proved itself a hugely valuable tool for spreading the word, and the event generated more buzz than could ever have been hoped for.
But it isn't just about one day.
Cynics might point out that, in spite of all the buzz, coverage, and celebrity support, the Big Tweet didn't help find any missing children on the day itself. But I'm convinced it will.
The real success of the campaign was the way that many followers old and new engaged with the issue, calling out to their friends and to celebrities for their support, keeping the tweets flowing through a solid 24 hours and beyond. What's more, they've maintained their involvement, retweeting the ongoing daily missing appeals, and in some cases asking how they can get involved in other ways.
The Big Tweet was a resounding success on the day, and Twitter is now a key channel for Missing People. Most importantly, however, it has helped to create a platform for the future, and this is what social media does best. Now, when an appeal is sent out via @missingpeople, it reaches over 5,500 more people than before, all capable of spreading it still further. Followers can also provide other forms of support that are so crucial to the charity, such as volunteering or conducting local fundraising.
If you're not already following @missingpeople, I urge you to do so and to pass on the message to your friends, as there is definitely more to come. This is a perfect and very simple example of using social media to make a difference.
I can't wait for the headline: "Charity finds missing person by using Twitter" – it's not as far off as you may think. One tweet by the right person at the right time is all you need.
By Gifford Morley-Fletcher
Director of Strategy, Inbound Marketing
Base One, www.baseone.co.uk


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An educational program that once called the city of Bullard home is attempting to make a comeback, as the newly restructured Bullard 4-H Club is currently seeking new members.
"We're really excited we had the opportunity to come back in and restart the Bullard 4-H Club, said James Holloway, Bullard 4-H Club advisor. "I believe that through 4-H, students are able to learn and participate in a number of activities focused on STEM (science, technology, engineering and math). The club allows more depth in the Bullard community by interacting in certain activities they may be interested in."
Holloway, a 1996 graduate of Bullard High School, was a founding member of the Bullard 4-H program when it was introduced in the 1994-1995 school year, along with fellow classmates Hal Conover and Wes Stripling.
"When we started 4-H, it was simply a secondary outlet to where we could show our livestock and have more depth," said Holloway. "It was neat when we started the club because we were the older ones in the group, and he had a number of young members following us. It was a great way to have the interest of younger members in the field of agriculture."
Despite their best intentions in starting the organization, interest in the Bullard 4-H program slacked off around the 1997-1998 school year, a decline Holloway said was caused by the direction of the program.
"The advisory direction of the program was redirected to other means and not focused on 4-H," said Holloway. "I was not very happy about it because it was something I helped create and saw the opportunity for younger students to be involved. But at that point, I was already in college, so there wasn't much that I could do about it."
Now, Holloway and several of his supporters are back at it 20 years later, attempting to resurrect the Bullard 4-H Club and make it a successful organization once again.
"Our goal in restarting the Bullard 4-H Club is to get kids involved and educated in any area of STEM that interests within the bounds of 4-H," said Holloway. "We also want to help them learn more about their interests because 4-H offers a number of different program, including agriculture, shooting, robotics, and even computer programming and rocketry and aerospace. There's an interest for everyone in the Bullard 4-H Club."
Holloway compared and contrasted the differences in the Texas 4-H program now compared to when he was in high school two decades ago, citing the plethora of program students can now participate in, not just limited to agriculture.
"4-H is radically different today than when I was in high school," said Holloway. "Twenty years ago, it was about showing animals, parliamentary procedure, animal judging, sewing blankets and clothes, baking, and canning vegetable. Now, we have kids who are still interested in showing animals, but there are so many more opportunities to participate in.
According to Holloway, students participating in the Bullard 4-H Club are able to show their animals and compete in contest at the Smith County and Cherokee County Livestock Shows.
With the revamping of the Bullard 4-H Club, Holloway said he hopes to recreate a program that will be strong and will remain a facet of the community.
"I want to be a good, strong, solid chapter where anyone can participate and the parents can be just as involved as their children," said Holloway. "The growth of the program isn't as important to me as the depth; it's basically quality over quantity. Like the 4-H motto, I want our members to understand it's up to them to use their heads, hearts, and hands to make a difference in their community. By getting that across, I hope the new Bullard 4-H Club will be a longstanding organization within the community."
The Bullard 4-H Club will host its monthly meetings on the first Tuesday at 4:30 p.m., inside the Founder's Lecture Hall on the campus of the Brook Hill Upper School.
For more information about the Bullard 4-H Club, email email@example.com, call Holloway at (903) 504-8839, or visit the Texas 4-H website, www. texas4-h.tamu.edu.
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I'm a returning customer and I only use this website for many years now. There are many other flower to thailand websites but this one is the best price/quality/professionalism-wise. And trust me, I used at least 5 other ones :)
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Attys., if a type written MOA signed by the parties have hand written notes which are additional conditions in the agreement, can these handwritten notes considered as valid part of the agreement?
Thanks in advance.
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text: Boosting the dosage could extend the duration to some degree, but it didn't guarantee 12 hours of relief. Higher doses did mean more money for Purdue and its sales reps. The company charged wholesalers on average about $97 for a bottle of the 10-milligram pills, the smallest dosage, while the maximum strength, 80 milligrams, ran more than $630, according to 2001 sales data the company disclosed in litigation with the state of West Virginia. Commissions and performance evaluations for the sales force were based in part on the proportion of sales from high-dose pills.


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|Message view
|« Date » · « Thread »
|« Date » · « Thread »
|"Knut Anders Hatlen (JIRA)" <j...@apache.org>
|[jira] Commented: (DERBY-4849) Re-compilation may cause duplicate entries in the XPLAIN table
|Tue, 19 Oct 2010 13:37:28 GMT
[ https://issues.apache.org/jira/browse/DERBY-4849?page=com.atlassian.jira.plugin.system.issuetabpanels:comment-tabpanel&focusedCommentId=12922556#action_12922556 ] Knut Anders Hatlen commented on DERBY-4849: ------------------------------------------- Thanks Kristian. The fix looks good to me. I also ran the test six times without the fix, and it failed twice. There's one small issue with the test that I think could lead to intermittent failures. The main JUnit thread runs a wait loop while the helper threads are running, but when it terminates the loop and checks if everything went well, it doesn't really know that the helper threads have completed. If they haven't (for example because one of them used a little longer than expected to start up, or used a little longer in one of the iterations), the asserts in the test may fail. I added Thread.sleep(1500) at the beginning of MTSimpleSelect.run() to test this, and then I got a mismatch in the final assertSingleValueResultSet() -- expected: >277<, found: >278<. I think we can avoid this problem by calling Thread.join() on the two helper threads instead of running the wait loop. > Re-compilation may cause duplicate entries in the XPLAIN table > -------------------------------------------------------------- > > Key: DERBY-4849 > URL: https://issues.apache.org/jira/browse/DERBY-4849 > Project: Derby > Issue Type: Bug > Components: SQL > Affects Versions: 10.6.2.1, 10.7.0.0 > Reporter: Kristian Waagan > Assignee: Kristian Waagan > Priority: Minor > Attachments: derby-4849-1a-narrow_fix.diff, derby-4849-2a-broad_fix.diff, derby-4849-2b-broad_fix_with_test.diff, derby-4849-2b-broad_fix_with_test.stat, derby-4849-xplain_duplicate_stacktrace.txt > > > If happening at the right moment, a re-compilation request may cause duplicate entries in the XPLAIN statement tables. > I have only confirmed this for the SYSXPLAIN_STATEMENTS table, and I do not know if the other XPLAIN tables are affected. > The error is highly intermittent, and so far I have only been able to trigger it when testing the automatic index statistics update prototype. > See the attached stack-trace for some more details. -- This message is automatically generated by JIRA. - You can reply to this email to add a comment to the issue online.
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Thai food is a mainstay in many restaurants all over the world but nothing surpasses authentic Thai restaurant in Sukhumvit located in the capital city of Thailand. Thai cuisine is taken to new level with the finest high end ingredients combined with age-old recipes. Authentic Thai recipes are served in a fine dining venue where you will enjoy the fabulous cityscape of Bangkok.
In New York City, Thai food means sticky sweet noodles and spicy sour seafood because the city is pretty much devoid of authentic Thai cuisine. However, in the Queen's neighbourhood like Elmhurst and Woodside, authentic Thai food is a mainstay. Recent Thai spots in Manhattan and Brooklyn are now dedicated to serving authentic Thai cuisine that ranges from pineapple fried rice to khaosoi, a yellow curry and noodle soup and goongaobwoonsenn which is baked shrimp and glass noodle dish.
Most of the Asian restaurants that can be found in the United States tend to adapt their menus to the American palette so that Thai dishes are less spicy, sweeter and noodle-based without the complex flavours of the authentic recipes. Many flavours and ingredients are eliminated to satisfy the perceived preferences of the American customers. It is also rare to find regional Thai dishes like spicy sea foods and offal-forward dishes.
New Thai restaurants that have recently opened in New York City focus more on authentic Thai street food and the spicy sour recipes. People want to experience authentic Thai cuisine without the need to travel all the way to Southeast Asia. A. Napadol has moved from Thailand to New York. She has dreamed of opening a restaurant that will serve food she loved back home. Now, most of her American customers are asking for the special dishes and flavours that they have tasted when they visited Thailand.
Meanwhile, if authentic is what you desire, your best option is authentic Thai restaurant in Sukhumvit that serves Thai cuisine and Asian fusion in their food and drinks. Different Thai food favourites using the finest high end ingredients are paired with plenty of fine wines and signature cocktails. The ambiance at the rooftop restaurant is fabulous with the perfect backdrop of Bangkok's skyline.


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History research paper formats – get facts and figures right
Working on any kind of history project, demands complete knowledge of names, dates, facts and figures. If you are the kind of person who shies away from collecting all this kind of info for your history research paper, then you would probably be racking your brains for a way out. Any history research paper format is easy to follow, provided you have gone through some of the samples that are on this site. We have papers on various periods in history as well as about different regions of the world. Most of these research papers follow similar formats, which are again clearly visible in all our samples.
Try following this simple format when you write a detailed history research paper
1. Your thesis statement is the focus of your paper. It is the key element that the reader is presented with, at the beginning of your paper. When there is ambiguity of any kind in your paper, it is a clear indication that you have not thought through your topic. In other words, you have blindly picked up some topic, hoping that you can build on it as you go along. This is the worst kind of approach that you could have to your paper. If this is the case, then all history research paper formats could become an issue. Whether you are going to present your citations in APA or MLA style, you will end up failing because you don't have the topic of the research question, in proper perspective.
2. The body of the paper is the second and major part of the history research paper format. Here again, you need to make an outline before you start writing down all the information that you have. For instance if you are going to focus on the role of Napoleon and how he won and lost his wars, you need to know a lot about his early life and how he became a leader. This cannot be a paper wherein you briefly mention the series of events that took place. Instead, the research paper is an attempt to analyze the information that you have on a specific issue. If this info has been obtained from various sources, analyze the same in relation to the thesis statement you have made at the beginning of the research paper. All your substantiating statements and documents can further illustrate or support your points and bring your paper to a logical end.
3. Concluding section. This section could be likened to the ocean into which several tributaries of a river flow. It is the same with your history research paper. You think of all the info that you have and how it has helped you get an analytical view of the hypothetical statements that you have examined. Put all this together and your conclusion in ready.
Getting history research paper formats right would be quite a walkover if you take our help. Citations, references and supporting data are waiting to be delivered to you on a platter. Our charges are reasonable and you can rest assured that you get the best.


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WILKES-BARRE — A former Trucksville Volunteer Fire and Rescue firefighter who admitted to having sexual relationship with a junior firefighter showed up for sentencing Tuesday with a simple message for the court.
"Mistakes happen," Joshua James Ralston, 20, of 47 Main St., Dallas, told the judge.
Luzerne County Judge David W. Lupas was not impressed with the seeming lack of remorse, noting that Ralston pleaded guilty in December to two felony counts of statutory sexual assault. Prosecutors say Ralston on two occasions had sexual relations with a 13-year-old girl.
"I'm taken again by the lack of any sincere response by the defendant," Lupas chided the firefighter. "This isn't a mistake. It's a crime."
After the rebuke from by the judge, Ralston offered a brief apology, saying, "I'm truly sorry."
Lupas then ordered Ralston to serve 11½ to 23 months in the Luzerne County Correctional Facility followed by two years of probation.
According to prosecutors, the girl told police she had sex with Ralston in December 2016 and February 2017 at her home, while her mother was gone. During both encounters, Ralston was 19 and the girl was 13, according to police.
During questioning, Ralston admitted having sex with the girl despite knowing it was wrong. He told investigators that the girl "wanted it as much as I did" and that he had broken off the relationship twice because he knew it could lead to trouble, according to prosecutors.
Defense attorney Joseph Yeager argued for leniency because of Ralston's lack of criminal history. He also noted that in addition to being a firefighter, Ralston is a member of the U.S. Army National Guard.
But Senior Deputy Attorney General Bernard Anderson sought the maximum sentence, asserting that the youthful girl "doesn't even look 13." He also noted that Ralston's encounters with the girl, whom he first met at a camp where he was a counselor, took place two months apart.
"That's not a mistake, judge," Anderson said. "That's intentional conduct."
The victim's uncle briefly testified that junior firefighters look up to the adult firefighters, and that Ralston's breach of that trust was "just such an extra travesty in this case."
After admonishing Ralston for his seeming lack of remorse, Lupas said he intended to impose jail time to hold the defendant accountable.
"Whether this was consensual or not, it a criminal offense," Lupas said. "Obviously, you should know better."
A handcuffed Ralston declined to comment as sheriff's deputies escorted him out of the courthouse, bound for the Luzerne County Correctional Facility.
Contact the writer:


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The report provides an analysis of partnering deals. The majority of deals are discovery or development stage whereby the licensee obtains a right or an option right to license the licensors technology.
The Global Alzheimer's Disease Market Partnering Terms and Agreements since 2010 report provides understanding and access to partnering deals and agreements entered into by the world's leading healthcare companies.
- Trends in partnering deals
- Top deals by value
- Deals listed by company A-Z, industry sector, stage of development, technology type
The report provides understanding and access to the partnering deals and agreements entered into by the world's leading healthcare companies.
These deals tend to be multicomponent, starting with collaborative R&D, and commercialization of outcomes.
Understanding the flexibility of a prospective partner's negotiated deals terms provides critical insight into the negotiation process in terms of what you can expect to achieve during the negotiation of terms. Whilst many smaller companies will be seeking details of the payments clauses, the devil is in the detail in terms of how payments are triggered - contract documents provide this insight where press releases do not.
Inquire for this "Global Alzheimer's Disease Market" report at www.marketreportsonline.com/contac….php?name=444980.
This data driven report contains multiple links to online copies of actual deals and contract documents as submitted to the Securities Exchange Commission by companies and their partners, where available. Contract documents provide the answers to numerous questions about a prospective partner's flexibility on a wide range of important issues, many of which will have a significant impact on each party's ability to derive value from the deal.
The initial chapters of this report provide an orientation of partnering trends.
Chapter 1 provides an overview of the trends in partnering since 2010, including a summary of deals by industry sector, stage of development, deal type, and technology type.
Chapter 2 provides a review of the top 10 most active companies in the therapy area, including a comprehensive listing of the deals announced by each company.
Chapter 3 provides a comprehensive directory of partnering deals signed and announced since 2010. The chapter is organized by company A-Z, stage of development at signing, deal type (collaborative R&D, co-promotion, licensing etc), and technology type.
Each deal title links via Weblink to an online version of the deal record, and where available the contract document, providing easy access to each contract document on demand.
Chapter 4 provides a listing of partnering deals where a contract document is available alongside the deal record.
Access a copy of this research report at www.marketreportsonline.com/contac….php?name=444980.
Chapters 5 and 6 provide a summary of M&A deals since 2010 where the acquired company is active in the therapy area of interest.
Chapters 7 and 8 provide a summary of financings since 2010 where the financed company is active in the therapy area of interest.
In conclusion, this report provides everything a prospective dealmaker needs to know about partnering in the research, development and commercialization of technologies and products in the therapy area.
Global Alzheimer's Disease Partnering Terms and Agreements since 2010 report provides the reader with the following key benefits:
- In-depth understanding of deal trends since 2010
- Access to headline, upfront, milestone and royalty data
- Comprehensive access to multiple deals entered into by the world's biopharma companies since 2010
- Insight into key deal terms included in contracts, where disclosed
- Understand the key deal terms companies have agreed in deals
- Undertake due diligence to assess suitability of your proposed deal terms for partner companies
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