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Sunday, August 11, 2013
36 comments:
They probably do, but check their website link in the post. They had tons of milky stuff, panna cottas, puddings you name it.
Thanks! Blogging while living in Paris is SO different. I don't have to make up stuff.
It's all here to taste, sample and grow fat!
What's not to love?RepliesI like cheese almost as much as pastry. If you get back to the shop would you please taste comté for me? DL posted about a harrowing trip in the winter where turned over his vehicle to get some comté. I found some at TJs, but would like to hear what you have to say. It is like gruyere or emmental only better.
ReplyDeleteCarol, it's great to see some treasures nearby in your new neighborhood.
French cheeses are definitely on another plane/t from those from other parts of the world.
Please do keep sampling and showing us the beautiful objets of your admiration.
Perhaps these shops and the boulangeries will keep you going until the patisserie bakers return from their holidays. Thank you for your email. I did have another ham and cheddar sandwich for lunch today.
xoCarol,You are my bible on Paris and looking at the old posts for each month'm getting to know a different town from what I experienced and it is amazing, I have my moleskine full of addresses and things to see and to taste .
and I want to thank You because in these days of leisure summer, my favorite is reading your blog .. I also downloaded a free Donna Leon (it org books) that soon I will start to read.
About french cheeses ,bah...i love a lot got cheese ,but for my taste the best are others ,but I must admitt that every country,more or less, have something excellent.
Waiting for a new amazing post,thank You!- Anonymous10:18 AM
When we returned from Provence in June, I was in love with two things: the "cheese-men" in the marches (wonderful pictures) and chevre drizzled with lavender honey. (To be honest, there were a whole lot of other things I was in love with, too.) This Saturday is our anniversary so how will we celebrate? We are signed up for a cheese making class at the Cheese School in San Francisco. You know you have crossed a threshold when that is your romantic focus, eh, eh!
ReplyDelete Hi Carol!
How are you?????????? I have been trying to keep up with reading everyone's posts , but we have been busy in the shop..Peter's health isn't the best...... So my apologie over, I am salivating.... and your blog looks fabulous as usual.......I Crave cheese, cheese and mre cheese especialy how deliciously you present it.......... Thanks for letting us peek at what we can't get here!!!!!!!!!Maryanne xo- Anonymous9:50 PM
I've been following Paris Breakfasts for a long time and always begin my day with it because I enjoy it so much. At the moment you've been featuring French cheeses and the sublime way the French make their jambon baguette sandwiches. (Consider the French ham sandwich and the American ham sandwich and the respective national waistlines!)
Dana Just lock me in the shop on Friday night and don't come back until Monday morning.....and bring a stretcher! Slowly, slowly, Australians are also learning to appreciate chesses that aren't 'plastic', pre-sliced, individually wrapped, but that actually have flavour and texture...and smell!
ReplyDeleteCan smell this shop from here. Seriously, I'm like you. Love cheese. When I was living in Scotland, the thought of chèvre made me cringe. Now after 20 yrs in France, the thought of not getting my hands on chèvre cheese makes me panic. I adore the stuff! And the others of course. Cute cheese in the shape of France. The skin is so good for you!


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- Research
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Gauging food and nutritional care quality in hospitals
Nutrition Journal volume 11, Article number: 66 (2012)
Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals.
Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal.
Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones.
Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.
Changes in population age distribution and lifestyle require that these institutions undergo modifications, in order to meet the current demands of society such as increased life expectancy and new disease profiles [1–4]. As part of the national health systems, these changes had an impact on the hospitals. The emergence of novel technologies, the constant need for recycling of knowledge and abilities due to reformulations of scientific paradigms, and the hospital costs implied in this recycling justify the need for assessment of quality and efficacy in this health segment [5].
Nutritional status in hospital inpatient has been the object of many studies [6–11], but there are only a few literature works on quality indicators concerning hospital food and nutrition services (HFNSs) as well as food and nutritional care actions conducted by dietitians in health institutions [12–15]. Hospital expectations often place the food and nutrition service as an undervalued support service [16], even though changes and improvements in hospital diets and nutritional care can prevent nutritional aggravations [7, 8, 12, 17] that have a negative impact on the length of hospital stay and hospitalization costs [10, 11, 18–20]. Moreover, such amelioration can also impact patient's perception of the hospitalization experience positively [21, 22].
European research on food and nutritional care in hospital has recognized that it is necessary to define responsibilities, promote staff qualification, enable patients' participation in nutritional decisions, and integrate the health care team into nutritional care [14]. A comparative study on nutritional care management involving two hospital institutions, namely a French hospital and a Brazilian hospital, has detected fragmentation of dietitians' actions due to existence of different interlocutors and to the unpredictability inherent to food preparation procedures [23].
Food and nutritional care actions regarding both patient assistance and food quality must be well delineated and become an effective practice in health institutions. Different management sectors, namely the clinical and administrative areas, should be involved in the process, and actions should be recognized and evaluated by regulating agencies concerned with hospital quality control.
Standardization of nutritional care practice in the United States was implemented by the American Dietetic Association (ADA) in 1987. In 1993, the Clinical Nutrition Management executive committee selected professionals who later developed and assessed the standard nutritional practices that should be employed for management of the clinical nutritional area, which gave rise to a standard reference for this field [24]. Knowledge about the actual state of food and nutritional care is a crucial stage for delivery of good quality hospital assistance. This kind of diagnosis enables future comparisons and allows for evaluation of implemented changes, which is essential for action planning [25].
This study aimed to detect and compare actions relative to food and nutritional care quality in hospital in public and private hospitals.
Thirty-seven hospitals were investigated. Twenty-seven hospitals were located in municipalities of the state of São Paulo, more specifically Campinas and Ribeirão Preto, whereas ten hospitals were located in the city of Florianópolis, capital of the state of Santa Catarina. Both Campinas and Ribeirão Preto are important scientific-technological health centers with various services of nationwide recognition. The cities included in the present work are home to various public (federal and state) and private universities. Campinas, Ribeirão Preto, and Florianópolis have an estimated population of 1,039,297; 547,417; and 396,723 inhabitants, respectively.
In the states of São Paulo and Santa Catarina there are 2.29 (0.58 public and 1.71 private) and 2.66 (0.67 public and 1.99 private) hospital beds/ 1,000 inhabitants, respectively. The metropolitan region of Florianópolis holds a larger concentration (72.7%) of public beds (2.61 of the 3.59 hospital beds/1,000 inhabitants are public), while the metropolitan region of Campinas has a larger proportion (74.6%) of private beds (1.47 of the 1.97 hospital beds/1,000 inhabitants are private) [26].
The following inclusion criteria were considered: hospitals located in the studied municipalities, regardless of the type – general, specialized, public, private, small (up to 50 beds), medium-sized (between 51 and 150 beds), or large (more than 150 beds) – that agreed to take part in the research. Psychiatric hospitals, day hospitals, nursing homes, and shelters were not included. Hospitals that did not have a dietitian responsible for the Hospital Food and Nutrition Service (HFNS) were excluded because this is compulsory according to the Brazilian law and hospitals that refused to participate in the study were not included, either. Although the healthcare team is responsible for nutritional screening and other actions, the piece of this investigation was to evaluate the dietitians actions of the hospitals food and nutritional services. An informed consent for the participation in the research was obtained from both the interviewee and a representative of the participating institution. The project was approved by the Research Ethics Committee of Faculdade de Medicina de Ribeirão Preto, University of São Paulo.
Data was collected by means of a structured interview, using a questionnaire designated Instrument for Evaluation of Food and Nutritional Care in Hospital – IEFNCH [27]. This questionnaire contained open and closed questions that helped diagnose hospital activities supporting food and nutritional care. The questions were directed to the hospital nutrition service coordinators during two visits that had been pre-arranged with the institution. The present IEFNCH was based on instruments published in similar works [13–15, 24, 28–30]. After the application of IEFNCH, a data bank containing information about various aspects of the institutions under study was built. We organized these data as criteria, according to these references used to qualify this instrument [27]. The size of the HFNS was measured by the number of hospital beds per dietitian, the number of HFNS staff members (kitchen staff) per dietitian, the number of produced meals per HFNS staff member, and the number of produced meals per dietitian. In these cases all dietitians that worked in these hospitals were considered, which include, clinical dietitian, dietitian who works in the management of meal production and the dietitian coordinator, if there was one.
Activities carried out by the HFNS were divided into two corpora of criteria, one relative to nutritional care quality (NCQ) and another concerning quality of the actions related to hospital food service (FSQ). Descriptive statistics was accomplished for the NCQ and FSQ criteria in terms of the legal nature and location of the institution. Differences in the criteria between public and private hospitals were considered substantial, moderate, and small when they were equal to 30%, less than 30 to 15%, and less than 15%, respectively (Table 1).
The criteria were subdivided into 8 groups of actions, designated NCQ and FSQ indicators (4 groups of actions for each corpus). These indicators, consisting of between 3 and 6 criteria, were measured as a percentage of existence of that group of actions in a certain institution. Each indicator thus corresponded to 25% of the total NCQ and FSQ value. Food and Nutritional Care Quality in Hospital (FNCQH) was determined as the mean percentage that each institution complied with the NCQ and FSQ indicators, and comparisons in terms of the legal nature, type (general or specialized), size, and location of the hospital as well as the presence of a clinical dietitian were made. It was considered "clinical dietitian" the professional who works in the infirmary with the patient's nutritional care. The existence of actions was assessed; however, the extent of their coverage was not evaluated.
Descriptive statistical data analysis was also performed, and ANOVA models were employed for comparison of NCQ and FSQ among the studied institutions. Such model assumes that the residues obtained from the difference between values predicted by the model and the observed values have normal distribution with average 0 and constant variance. In situations in which this assumption was not confirmed, transformed-response variables were utilized [31]. Models were adjusted with the aid of the software SAS version 9.
Sixty-seven point six percent of the sample consisted of private hospitals, including philanthropic institutions (10 hospitals), whilst 32.4% were public hospitals, 18.9% of which were university hospitals and 13,5% were government institutions. In Florianópolis the majority of the sample was comprised of public hospitals (70,0%), whereas the cities of the state of São Paulo had a larger number of private institutions (81.5%) (Table 2). However, in terms of the public beds, Florianópolis had 79%; Ribeirão Preto had 67% and Campinas had 51%. Considering beds in specialized hospitals, we had 13,0% in Campinas (90,0% public beds), 7,3% in Ribeirão Preto (38,5% public beds) and 19,4% in Florianópolis (88,4% public beds). The investigated hospitals corresponded to 82.4% of the hospital beds available in the referred municipalities (Campinas 82.5%; Ribeirão Preto 87.5%; Florianópolis 76.0%), which represented a coverage of 5,566 beds [26]. There were 2 hospitals in Florianópolis, 2 in Ribeirão Preto and 2 in Campinas that did not accept to participate. There were 2 more hospitals in Florianópolis that were not included because one was being renovated and the other did not have a dietitian at that moment; and one in Campinas did not have a dietitian when we were collecting the data of the investigation.
As for HFNS human resources ratio, the average number of hospital beds per HFNS staff member and per dietitian was 3.81 (SD 1.98) and 68.04 (SD 43.26), respectively. Both indicators had a large coefficient of variation (Cv) (52.01% and 63.58%, respectively). Concerning meal production per staff member and per dietitian, the average number of produced meals was 20.55 (SD 14.61 and Cv 71.08%) and 320.65 (SD 173.67 and Cv 54.16%), respectively. There were a significant statistical difference between public and private hospitals to the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01) (Table 3). These variables were also significantly different for the hospitals located in Florianópolis, as compared to institutions situated in Campinas (p < 0.01) and Ribeirão Preto (p = 0.04).
Evaluation of the presence of actions related to criteria of the NCQ corpus revealed that the difference between public and private hospitals varied between 1.7% and 50.7%, and that the average of this difference were 17.4% (SD 14.9%). The actions with the most differences (≥30%) between public and private institutions were presence of routine visits to patients, evaluation of nutritional status, and existence of mechanisms for patients to require changes to the diet (Table 4), all of which predominated in the former type of health institution.
In all the studied cities, actions related to inpatient dietary coverage were rarely present in public and private hospitals (between 12% and 35% of the institutions developed these actions). A slightly better situation was found in terms of actions concerning assessment and nutritional status monitoring, which existed in 33.3% to 66.7% of the public hospitals. Nutritional guidance at discharge was one of the actions that were most present in both public and private institutions. As for the remaining actions, they occurred in approximately a third of the private hospitals.
When it comes to municipalities, hospitals in Florianópolis stood out particularly for entry of nutritional care information in the medical record and existence of a printed form specially designed for nutritional care.
As for actions related to integration of the health care team into nutritional care activities, over 70% of the HFNS of public and private hospitals participated in events held outside the institution, evidencing engagement of the service with nutritional issues. On the other hand, actions related to insertion of the dietitian into the health care team were more frequent in public hospitals; for instance, routine visits to inpatients and requirement for nutritional care interconsultation with the HFNS took place in public institutions more often.
Information about the diet energy supply, present in approximately half of the hospitals, and the choice of nutritional supplement offered by the HFNS, which occurred in approximately one third of the institutions, indicated that HFNS actions supporting dietotherapy must be implemented and valued, since they are essential for efficient delivery of inpatient nutritional care.
Evaluation of the criteria of the FSQ corpus revealed that the difference between public and private hospitals in terms of the presence of actions related to meal production was 17.3% (SD 13.5%) on average, varying between 1.0% and 39.3%. A higher number of private hospitals had a good practice manual, a diet manual, an instrument for staff evaluation, and a periodic training programme (Table 5).
Management control actions were strongly influenced by the legal nature of the institution, many of which reflected in the differences found between public and private hospitals. Among the actions that were detected in most of the institutions, HFNS participation in other hospital administrave spheres and cost control can be mentioned. In contrast, less than a third of the hospitals conducted evaluation regarding user satisfaction. It is noteworthy that less than half of the institutions had a standard diet prescription form (nutritional contents of food preparations furnished by the Service). There was a larger difference between public and private hospitals with respect to the meal production qualification actions. In the same way, it is important to note that few public institutions carried out staff qualification actions.
The mean percentage of compliance with the NCQ criteria in private and public hospitals was 41.6% (SD 19.8) and 51.8% (SD 16.1), respectively, and the median was 39.2% and 53.0%, respectively. As for FSQ criteria, compliance values were 49.1% (SD 20.7), median of 46.7% and 42.4% (SD 16.6), median of 42.7%, respectively.
Among the variables analyzed in Table 6, NCQ was positively influenced by hospital type (general) and presence of clinical dietitian. FSQ was affected by hospital size: medium-sized and large institutions were significantly better than small hospitals.
HFNS human resources, measured in terms of number of hospital beds and produced meals, are heterogeneous and characterized by a wide coefficient of variation, thus suggesting that there are no preset parameters for human resources ratio in this area.
The relation number of staff members per hospital bed, an indicator of hospital human resources in Brazil, varies between 1.0 and 7.2, while in public institutions this indicator varies from 4.0 to 9.0 [32]. Using this same relation for the number of HFNS staff members per hospital bed, an average of 0.27 (SD 0.09) and median of 0.25 is obtained. Differences found between human resources ratio in public and private hospitals with respect to the number of hospital beds per dietitian and the number of HFNS staff members per dietitian evidences a more favorable situation in public institutions in terms of graduated professionals. The difference among the investigated cities is probably a consequence of the larger concentration of public hospitals in Florianópolis. In a study on eight hospitals of four different Brazilian states [33] was observed a relation varying from 50 up to 150 patients per dietitian, associated with a situation of very precarious in same action analised about nutritional care.
Viabilization of nutritional care through evaluation of nutritional status and establishment of actions that suit their clinical and nutritional status along the duration of hospital stay depend on the relation number of hospital beds per dietitian [34]. Even if screening criteria are created and nutritional care levels are defined [35], values of 30 and 15 hospital beds per dietitian are recommended for general hospitals and more complex units, respectively [30]. The study that evaluated how nutritional risk is assessed and managed in European hospitals with twenty one thousand patients, found a range between 21% and 73% of the units from different regions that reported nutritional screening routine. The presence of dietitian, nutrition team and the screening nutrition routine increased the probability of to identifing nutritional risk [36].
More heterogeneous conditions were detected for the productivity indicator (number of produced meals per staff member). The number of meals produced for other segments such as hospital staff members and visitors may distort the aims of the HFNS and redirect human resources from the nutritional care sector to meal production. An increase in administrative demands may also deteriorate inpatient nutritional care actions [16, 33].
Comparison between public and private health institutions in terms of NCQ criteria reveals that there are more actions related to nutritional care in public hospitals (routine visits to patients, evaluation of nutritional status, mechanisms for patients to require changes to the diet, entry of nutritional care information in the medical record, among others). Such actions may avoid or detect nutritional problems that can be handled during the hospital stay, thereby preventing nutritional aggravations [37]. This difference can be attributed to the presence of a larger number of clinical dietitian in public hospitals and to the fact that there are more university hospitals of public legal nature. The lack of nutritional assessment, diet prescription, and entry of nutritional information in medical records has also been detected in another work on Brazilian and Italian hospitals [16, 33, 38].
Some actions are lacking in both public and private institutions, with a difference smaller than 15% between them. Such lack of NCQ actions denotes little technical qualification for very important actions. Only half of the hospitals provide information about energy supply, whereas only a third has appropriate forms for registration of nutritional care, participation of the dietitian in meal distribution, and production of nutritional supplements by the HFNS. The legally prescribed nutritional support team [39] exists in a quarter of the hospitals only. These data reinforce the need for professional qualification and nutritional care action descriptors for the hospital segment [38].
Differences in FSQ criteria demonstrate that there is greater concern about staff evaluation and standardized procedures such as good practice and diet manuals in private institutions. Slight differences emerge when most of the NCQ and FSQ criteria are compared between public and private hospitals and among municipalities, which highlights the need for establishing general quality standards for an HFNS.
Among the FSQ actions, up to a third of the hospitals have duty shift in the area of meal production, carry out staff evaluation, and conduct formal evaluation of the HFNS regarding user satisfaction. There are actions that call for closer attention, since they take place in less than a third of the hospitals. For instance, despite being present in most of the public hospitals and in half of the private institutions, supervision of patient nutrition in the ward would very much facilitate establishment of mechanisms for patients to require changes to the diet if patient food ingestion was directly observed. Unfortunately, this contact between the dietitian and the patient has been overlooked [33, 40]. As for differences concerning the responsibility of the HFNS for purchases, they are due to regulations regarding this procedure in public hospitals.
Request of nutritional care by physicians and other professionals by means of interconsultations demonstrates recognition of this type of action by the multiprofessional team. Nevertheless, this takes place in less than a third of private institutions. In public hospitals, the situation is slightly better, though below the desired frequency. Similar results indicating that food and nutritional care is still incipient in health institutions have also been reported by De Seta et al. [33].
Herein, the legal nature of the institution did not influence the food and nutritional care quality, in spite of the larger number of dietitian present in public hospitals. Evaluation of HFNS human resources ratio did not necessarily imply in better quality, since it also depends on professional qualifications and skills. Nevertheless, hospitals with clinical dietitians had substantially better NCQ, and 80% of the 15 institutions that hired a dietitian were public. The presence of a specialized professional in this area may make all the difference in terms of nutritional care quality not only because of qualification, but also because of the existence of institutional policies valuing these actions. However, it is noteworthy that an array of conditions should also exist, so that this type of care can be improved [37, 41]. Professional qualification, institutional policies for the sector, nutritional care quality programmes such as accreditation and institutional evaluation [42], and sufficient number of professionals [34] can better qualify food and nutritional care in hospitals.
The more complex structure of general hospitals favors NCQ. A higher demand due to the diverse nutritional problems that may arise in general institutions may contribute to this result. Although there are no significant differences in relation to FSQ, data for general (49.8%) and specialized (34.5%) hospitals suggest that more complex units are more qualified in this area. Results concerning hospital size can be analyzed in the same light. Larger hospitals have higher FSQ. Additionally, size does not significantly influence NCQ, but scores rise with increasing hospital size. Furthermore, university hospitals may influence hospital nutritional care positively, once they are placed among general institutions. It should be borne in mind that five of the seven university hospitals included in this work are large.
The significant difference between the NCQ scores of hospitals located in two cities of the same state (both cities proportionally having the same number of university hospitals) and the lack of any difference as compared to institutions located in Florianópolis, where public hospitals are the majority, suggest that other factors operate when service qualification is being analyzed. Even if no differences among these municipalities exist in terms of staff qualification, differences regarding professional skills may be present.
Food and nutritional care quality in hospital must be evaluated and qualified for improved efficacy of health institutions. The legal nature and size of hospitals may interfere in the examined segments, human resources score, NCQ, and FSQ. However, results from the present analysis lead to the conclusion that nutritional care is still incipient, and that actions concerning patient care and food service take place on an irregular basis in hospitals. This study allowed for attainment of a qualitative panorama of these actions and human resources indicators concerning hospital food and nutrition services.
The fact that coverage of the assessed actions was not verified is a limitation of the present work, which might have generated biased data. For instance, it is possible that some hospital units have excellent nutritional care teams while the care delivered to inpatients of some wards is deficient. The other limitation of the study was the frequency that these actions were developed. Both are important aspects that can influence in the quality of care. Some criteria influenced by the legal nature of the hospital may have given rise to some distortions.
Put together, our results show the performance of the actions developed by the HFNS. Although we cannot measure the coverage and the frequency of the actions, this study made a profile of the food and nutritional care in hospitals, an important step in guidelines for nutritional care in hospitals.
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Zuchhi PB: OJNV Funcionários por leito: estudo em alguns hospitais públicos e privados. Rev Adm Saude. 2002, 4 (14): 1-7.
De Seta Mod G, Henriques P, Sales GLP: Nutritional care in public hospitals of four Brazilian states: contributions of health evaluation to health surveillance services. Cien Saude Colet. 2010, 15 (Supl. 3): 3413-3422.
Byham-Gray L: Managing Human Resources, Nutrition Dimension. 2010, www.NutritionDimension.com,
Duchini L, Brito TA, Jordao AA, Diez-Garcia RW: Assessment and monitoring of the nutritional status of hospitalized patients: a proposal based on the opinion of the scientific community. Rev Nutr. 2010, 23 (4): 513-522.
Schindler K, Pernicka E, Laviano A, Howard P, Schütz T, Bauer P, Grecu I, Jonkers C, Kondrup J, Ljungqvist O, Mouhieddine M, Pichard C, Singer P, Schneider S, Schuh C, Hiesmayr M, Nutrition Day Audit Team: How nutritional risk is assessed and managed in European hospitals: a survey of 21,007 patients findings from the 2007–2008 cross-sectional nutritionDay survey. Clin Nutr. 2010, 29 (5): 552-559. 10.1016/j.clnu.2010.04.001.
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Donini LM, Riti M, Castellaneta E, Ceccarelli P, Civale C, Passaretti S, et al: A survey on diet manuals in Italian hospitals. Ann Ig. 2009, 21 (6): 575-585.
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Diez-Garcia RW, Padilha M, Sanches M: Hospital food: proposals for qualification of the Food and Nutrition Service, evaluated by the scientific community. Cien Saude Colet. 2012, 17 (2): 473-480. 10.1590/S1413-81232012000200020.
Kondrup J: Proper hospital nutrition as a human right. Clin Nutr. 2004, 23 (2): 135-137. 10.1016/j.clnu.2004.01.014.
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This study was supported by FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo) and FAEPA HCFMRP-USP.
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RWDG was the mentor of the work, was involved in the protocol and study design, data collecting and analysis, carried out the statistical analysis and wrote the manuscript. AS and RPCP participated in the planning of work, discussion and data collection in Florianópolis. VALM participated in the planning of work, discussion and data collection in Campinas. EZM made the statistical analysis and corrected the manuscript. All authors read and approved the final manuscript.
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Diez-Garcia, R.W., de Sousa, A.A., Proença, R.P.d.C. et al. Gauging food and nutritional care quality in hospitals. Nutr J 11, 66 (2012). https://doi.org/10.1186/1475-2891-11-66
DOI: https://doi.org/10.1186/1475-2891-11-66


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From fuel prices to terrorism threats, in recent years the list of woes sapping profits from airlines and driving some into bankruptcy could fill volumes. But in one sense, a single problem says it all: too many planes.
Excess capacity undercuts fare structures and deflates the key metric of revenue per available-seat-mile (ASM). Carriers with the most planes become the biggest losers.
So when America West Airlines merged with bankrupt US Airways Group Inc. in September 2005 and put America West's managers in charge, part of their plan was to pare their combined fleet, slashing expenses and "sizing" the new US Airways to compete vigorously as a low-cost carrier. Among airlines that offer limited amenities, it would enjoy the same skies so friendly to LCCs (low-cost carriers) such as Southwest and JetBlue. Slashing labor costs was central to the bankruptcy process, of course. But the new, merged US Airways also was at the forefront of another industry trend — capacity reduction — practiced by airlines both bankrupt and solvent, both low-cost and full-service.
A year has passed since CEO Doug Parker and CFO Derek Kerr, former high-school friends from Michigan, flew US Airways out of Chapter 11 (see "The Long Haul," CFO, February 2005). Its strong profit levels so far have surprised even them, as a number of factors fell into place: an $860 million recapitalization exceeded their target by $330 million, synergies have run ahead of schedule, and traffic has increased industrywide. More important, US Airways's renegotiations with General Electric's leasing arm have enabled the airline to cut its fleet by 15 percent, to 359 planes.
"Without the bankruptcy process," says Kerr, "we would have ended up having 60 too many aircraft."
Significantly, Tempe, Arizona-based US Airways insisted that the planes be reassigned to foreign markets, helping cut overall domestic industry capacity. That was important because fare increases take better hold in an environment without excess seats. And US Airways's fleet reduction has helped lead a recent shrinking trend among nearly all American carriers. "Because of that, you've seen 8 to 9 percent price increases stick across the industry," says Kerr.
In a rare case of harmonic convergence among fierce competitors, in fact, industry goals and individual airline goals are served by reducing ASMs. United Airlines emerged from bankruptcy in February with 107 fewer planes. Delta Air Lines and Northwest, still in Chapter 11, have sharply pared their fleets, too (see "The Bankruptcy Diet" at the end of this article).
No Folding Required
For years it was assumed that if industry capacity were to shrink by the needed 20 percent or more, it would be because some major carriers folded, according to airline analyst Helane Becker of The Benchmark Co. "If you look, that much has come out of the system. It just hasn't been in the form of an airline going out of business." Reduced capacity underlies the airlines' return to profitability in the face of soaring fuel costs this year — in US Airways's case, resulting in profits far beyond its postbankruptcy forecast.
For passengers, of course, fewer planes and more demand mean crowded flights. In a stark example of how empty seats are the exception rather than the rule — compared with four years ago — Becker points to the United plane that was diverted in mid-August from a London-to-Washington flight because of a passenger's suspicious activity. It was flying 92 percent full, now a typical load. "The planes involved in September 11 had just over a 20 percent load factor," she notes, which is almost unheard-of today.
Any airline would be happy with US Airways's financial results in its first year out of reorganization. It watched its market capitalization grow to $4 billion from near zero, while second-quarter net income soared to $305 million. "The merger model we used projected that we would make $150 million for the full year," says CEO Parker. The entire industry did well by doing less fare-discounting, which offset soaring fuel costs, but US Airways benefited more than it expected from merger synergies. (Some labor and other merger-related issues are still unresolved.)
Parker's enthusiasm for the US Airways reorganization — raising "the greatest amount of new equity that any airline has put together at one time" — is what led him to call Delta CEO Gerald Grinstein last July about possibly combining the two airlines. "Consolidation makes sense," Parker says, "and it makes the most sense when one of the airlines is in bankruptcy." Delta said it was not interested, but Parker insists that if any such merger opportunity presents itself, "we don't want anyone to dismiss us out of hand just because we have our hands full."
Cash for Flexibility
Another priority in US Airways's recapitalization was cash. "We really structured the acquisition to reduce the transaction risk by building the upfront cash and not having demands on those dollars," says Parker. The airline has accumulated $2.2 billion in unrestricted cash. "We have more cash than most of our competitors, which is really important in this business, particularly in difficult times," he adds. The importance of staying liquid was a lesson learned after 9/11, when fixed costs ate up cash as airlines first were grounded and then flew nearly empty. The foiled terrorist plot in London this past August, the CEO says, "highlights once again how important it is to have a strong balance sheet."
The entire industry got the message. "If you look at every airline's balance sheet, you see more cash," analyst Becker says. "American has a $5 billion cash hoard on $20 billion of revenue for 25 percent. The unrestricted cash at US Airways is almost 30 percent. That's not a bad thing in this environment."
Associate professor Robert Shumsky, a transportation specialist teaching at the Tuck School of Business at Dartmouth, notes that financial strength is for naught "unless you have an employee base that focuses on keeping costs low."
In the past, that focus was not a US Airways hallmark. CFO Kerr and CEO Parker see the reborn airline's task as creating a cost-aware culture from scratch. "US Airways was thrown together by the combining of airlines," says Kerr. "The culture on the America West side was low cost, but the US Airways side was not quite there."
A step in that direction is its new stock symbol: LCC. The choice was aimed at employees more than investors. "It's aspirational," says Parker. "It's meant to be a statement of where we want to be."
Roy Harris is a senior editor at CFO.
The Bankruptcy Diet Domestic fleet size before and after airlines reorganized | ||||
Airline | Prebankruptcy Fleet* | Filed | Current Fleet* | Shrinkage |
United Airlines | 567 | 12/02 | 460 | 18.8% |
US Airways | 419 | 9/04** | 359 | 14.3% |
Delta | 522 | 9/05 | 457 | 12.5% |
Northwest*** | 433 | 9/05 | 371 | 14.3% |
*Mainline **2nd filing; 1st filing was 8/02 ***Includes international fleet Source: The companies |


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text: Marlboro Music, the venerable chamber-music retreat in the foothills of Vermont, recently lost two of its mainstays. The violinist and conductor Blanche Honegger Moyse, who died on Feb. 10 at the grand age of one hundred one, was one of Marlboro's co-founders; she is fondly remembered in the Brattleboro Reformer. And the violinist and violist Philipp Naegele, who was present for the first Marlboro gathering in 1950 and spent more than fifty summers there, passed away on Jan. 31 at the age of eighty-three; Marlboro's own website memorializes him. When I visited Marlboro in 20o8, I didn't have a chance to meet Madame Moyse, but I did get to know Philipp. The youngest son of the German painter Reinhold Nägele, a beneficiary of the Kindertransport in 1939, he was an extraordinarily learned and thoughtful man whose passion for music animated almost every sentence he spoke. He was especially devoted to Shostakovich and had long campaigned for the Shostakovich quartets to be brought into the mainstream chamber repertory. (The Russians were the only truly musical people, he told me.) He also had an intense and idiocyncratic appreciation for the Austro-German late-Romantics — Mahler, Strauss, Schreker, and others. I remember him arguing, late one night at the Marlboro coffee shop, that Salome was in fact a feminist opera, although the youthful din made it hard for me to make out all the particulars of the thesis. When I last saw him, at Marlboro last summer, he spoke of a profound experience he'd had listening to Mahler's Seventh Symphony while recovering from heart surgery. He heard it as a "quasi return to life," its convulsions and mysteries giving away to "visions of transcendent joy and vitality," as he wrote in a subsequent e-mail. Whenever I hear the piece in the future, I will think of Philipp alone in his hospital room in the dead of night, listening to Mahler and coming back to life.


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The Art of the Title has an interview with David Fincher, creative director Tim Miller, and designer Neil Kellerhouse about the opening title sequence of The Girl with the Dragon Tattoo.
We were exploring things like, 'How shiny should the skin be? How visceral and uncomfortable can we make it? How abstract can we get? Is that a flower? Is it a vagina?' — that sort of thing.
During David's visits to the studio we would brace for impact, because he has a reputation for being incredibly picky. The first time I met him, I asked one of his friends, 'How picky is David?' And he said, 'You've heard of pixel fuckers? Well David breaks each pixel down to its separate RGB components and fucks them one at a time.' So there was some fear every time we would send something in, but 99% of the time we were just told to keep going.
(via @capndesign)


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By Sean Whaley, Nevada News Bureau
CARSON CITY – Nevada's unemployment rate fell to 11.8 percent in September, a decline of three-tenths of a percentage point from the 12.1 percent rate reported for August and a significant improvement from September 2011's reading of 13.6 percent, a state agency reported today.
The seasonally-adjusted rate remains above the 11.6 percent figure reported in May, which was a three-year low.
September's household survey showed more Nevadans are working, partly contributing to the decline in the rate of unemployment, said Bill Anderson, chief economist for Department of Employment, Training and Rehabilitation. The 11.8 percent rate equates to a seasonally adjusted 161,600 individuals still unemployed, he said.
Bill Anderson, chief economist for the state Research and Analysis Bureau. Image provided by Nevada News Bureau.
The number of Nevadans out of work fell by 4,300 in September, which is partly due to some falling out of the workforce, as well as people obtaining employment.
"Nevada's economy and our labor markets are on the mend," Anderson said. "We're moving forward at a modest pace. It's best not to get too worried about what happened in July when the rate jumped a few tenths of a point. And I'd also suggest not to get too excited about the decline in the rate from August to September. You average it all together and we're slowly on the mend."
Unfortunately there are lagging sectors in the private employment picture, most notably in construction, which are holding back the state's overall numbers, he said.
Gov. Brian Sandoval said he is encouraged by September's job growth and the slight decrease in the jobless rate.
"I am also pleased that export activity is up one-third over last year and that Nevada is taking an increased role in the world's economy," he said. "This news further validates our efforts to reach out to foreign countries, which we will continue to do."
Sandoval led a trade mission to the People's Republic of China and South Korea in September.
Amongst the state's three largest population centers, the Las Vegas metro area is home to the highest unemployment rate in the state, at 11.5 percent, which is not seasonally adjusted and so not comparable to the statewide adjusted rate. This is down from 12.3 percent in August and, more importantly, from the 14 percent reported a year ago.
In Reno/Sparks the rate fell 0.7 of a point, to 10.8 percent. A year ago, the region's jobless rate stood at 12.9 percent. Carson City is home to a 10.9 percent rate, down from 11.5 percent in August and 12.8 percent last year.
"The news is encouraging, as a year ago, there were an estimated 188,300 Nevadans counted as unemployed," Anderson said. "Monthly measures are subject to wide swings, and it is perhaps best not to put too much weight behind that volatility; however, when evaluated as a whole, the economy is slowly moving in a positive direction."
Typically during the month, about 7,500 jobs (not seasonally adjusted) are added in the state, the majority of them in the public sector coinciding with the start of a new academic year. This year, however, 14,600 jobs were added, resulting in a seasonally adjusted gain of 7,100. Through the first three quarters of the year, private sector jobs are up by more than 12,000 compared to the same period last year.
Additionally, more jobs are expected to be added during the holiday season, making modest gains over last year, Anderson said. From September to December 2011, Nevada added 4,100 jobs, however prior to the recession, seasonal job gains approached 9,000 during the holiday hiring period.
The good news on the jobless front is expected to continue, he said, after the agency reported Thursday that initial claims for unemployment insurance fell in September to their lowest level in five years, dropping to under 14,000 in a month for the first time since September 2007.
Initial jobless claims are a leading indicator and suggest improvement going forward in the near term, Anderson said.


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LONDON, England (CNN) -- More than 100 British lawmakers have signed a motion criticizing the BBC and Sky News for refusing to show an emergency appeal for Gaza.
Protesters hold a banner outside the entrance of BBC Broadcasting House in central London.
British terrestrial broadcasters ITV, Channel 4 and Channel 5 televised the appeal, made by the Disasters Emergency Committee (DEC) on Monday night.
The BBC and Sky News defended their position by saying that airing the appeal would compromise their reputation for fairness and impartiality.
However, Richard Burden, the Labour MP who tabled the early day motion, said 112 MPs had signed it by Monday evening, The British Press Association reported. The motion rejects the "unconvincing and incoherent" justifications given by the BBC and Sky.
In quotes carried by PA, Burden said: "The fact that well over 100 MPs from different parties have signed this Commons motion shows the breadth of concern about the position which the BBC and Sky are taking.
"The arguments that BBC managers have been putting forward in defense of their refusal to screen this appeal have shown themselves to be even more unconvincing and contradictory as time has gone on.
"Viewers and listeners can see the difference between a humanitarian appeal and politics -- even if the BBC and Sky management cannot."
That view was echoed by thousands of protesters at the weekend who demonstrated at BBC buildings across the UK. On Saturday, about 5,000 people demonstrated in front of the BBC's Broadcasting House in central London, while 50 people protested at its Scottish headquarters in Glasgow the following day.
On Monday night, PA reported that about 15 students -- members of the School of Oriental and African Studies' branch of Stop the War Coalition -- occupied the reception area of a BBC building in central London and demanded to speak to a senior member of the corporation.
Protesters outside the building waved a banner reading "Hands off Gaza" and decorated with blood-red handprints. They chanted: "BBC -- shame on you," PA said.
The Disasters Emergency Committee (DEC) includes the British Red Cross, Oxfam, Save the Children and 10 other charities. A spokesman for the umbrella group told CNN at the weekend that the DEC is "disappointed that the BBC declined to support the Gaza appeal. It might limit the reach of our key message to the general public."
The spokesman, who asked not to be named, said the BBC had to make its own decision about impartiality. "That is a decision they must make. We have no view on that subject," he said.
CNN has not been asked to screen the appeal.
All About British Broadcasting Corporation • Gaza


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GENEVA — The first meeting meant to discuss the contentious issue of a Syrian transitional government broke up less than an hour after it began Monday following a tense session that one delegate described as "a dialogue of the deaf."
The Syrian government has said it will not discuss replacing President Bashar Assad as the leader of a country his family has ruled since 1970.
The opposition insists he must step down in favor of a transitional governing body with full executive powers that would lead the country until elections are held.
The U.N. envoy, Lakhdar Brahimi, managed to get both sides to sit in the same room over the weekend to discuss humanitarian aid to besieged areas of the besieged central city of Homs and a possible prisoner exchange. But the opposition said little progress has been achieved.
On Sunday, after three days of talks, a tentative agreement was reached about the evacuation of women and children trapped in Homs before aid convoys go in, although as of Monday night there had been no progress on the ground.
Brahimi cited security problems for part of the delay. The opposition delegation does not control armed groups inside Syria, including al-Qaida-backed militants, who do not feel bound by agreements reached in Geneva.
On Monday, the two delegations were supposed to begin discussing thorny political issues such as Assad's future.
As the meeting got under way, the government delegation put forward a paper focusing on the need to combat terrorism and halt funding and shipments of weapons to rebels fighting to topple Assad, delegates said.
Bouthaina Shaaban, an Assad adviser, called the paper an "expression of good will" in search of common ground and said she was surprised the opposition rejected it.
"Either these people have no capacity to express their love and care for Syria, or they are ordered by foreign powers to ignore what is most important and most urgent for their country," she said.
The opposition called the paper a deviation from the main goal of the talks: a transitional government.
Murhaf Joueijati, a member of the National Syrian Coalition opposition group's negotiating team, criticized the government negotiators. "They began to get even more confrontational and began to lecture in a very dictatorial manner," he said.
"We thought there was no point in continuing this since it was going to be a dialogue of the deaf," he said.
Brahimi broke up the meeting and was scheduled to meet with both sides separately later Monday.
The inability of the two sides to discuss Assad's future was expected.
One of the key guiding principles for the talks in Geneva —which are aimed at stopping three years of bloodshed in Syria that has claimed over 130,000 lives, and forced millions from their homes — calls for the creation of a transitional government that both sides accept.
"Today we will start talking about a new Syria, about transition from starvation to freedom, from torture to human rights and rule of law," an opposition spokesman, Monzer Akbik, said Monday.
But Syria has said any discussion of a transitional government excluding Assad would cross "a red line," insisting the talks should focus instead on combatting terrorism.
Militants, including foreign fighters, have flocked to Syria to join the fight to topple Assad. The most powerful rebel groups include two the U.S. has formally designated as foreign terrorist organizations: the Iraqi State of Iraq and the Levant and Jabhat al-Nusra.
In setback to the rebels last year, the U.S. suspended deliveries of nonlethal aid to the Syrian opposition after al-Qaida-linked militants seized warehouses that had been under the authority of a key U.S.-backed leader.
But on Monday American officials said those deliveries, including communications equipment, are being resumed, for now only to non-armed opposition groups.
Regarding Homs, Akbik said the women and children there should decide whether they want to leave or stay after they have received aid.
He accused authorities of blocking a convoy of 12 trucks trying to get into the embattled city and said, "We will judge the regime by what it does, not by what it says."
Shaaban dismissed the aid effort for Homs as a distraction aimed at bolstering the opposition's credentials.
"This is to make a big fuss about taking two trollies to Homs," she said. "Is this why we came to Geneva? Or we came here to solve the problem in Syria?" she said.
Syrian state TV said a Syrian official and a U.N. representative were meeting in Homs to discuss how to evacuate women and children from rebel-held areas there. It was unclear when the evacuation would start.
Homs Governor Talal Barrazi said the only obstacle facing the flow of food into rebel held areas are "some cases of snipers fire by terrorist groups."
In a statement released by his office, Barrazi said it is willing to evacuate civilians who want to leave the old quarter of Homs to "any place they want to go to" and they will get food and medical supplies.
"We are waiting for an answer from international organization representatives to specify the number of those who want to leave," Barrazi said.
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Oslo - Nations working on a deal to fight climate change should cap the size of delegations and use majority voting to overhaul negotiating rules that stifle progress and harm the interests of the poorest nations, researchers said on Sunday.
Almost 200 nations will meet in Doha, Qatar, from November 26 to December 7 to try to extend the Kyoto Protocol, the existing plan for curbing greenhouse gas emissions by developed nations that runs to the end of 2012.
They have been trying off and on since Kyoto was agreed in 1997 to widen limits on emissions but have been unable to find a formula acceptable to both rich and poor nations.
The number of national delegates hit a peak of 10,591 at the Copenhagen summit in 2009, when governments failed to agree a global accord to slow climate change after opposition from a handful of countries, up from 757 at a first meeting in 1995
Limiting the delegates per country would be a step towards greater fairness, the researchers from the University of East Anglia, the University of Colorado and PricewaterhouseCoopers wrote in the journal Nature Climate Change.
Brazil holds the record, with almost 600 delegates at Copenhagen, while many of the poorest nations cannot afford to send more than a handful of delegates and so have less influence on the negotiations, they said.
Many studies show that developing nations, most dependent on agriculture, are most at risk from a changing climate.
"There is negotiation by exhaustion," Heike Schroeder, lead author at the University of East Anglia in England, told Reuters. Small delegations were unable to follow multiple strands of negotiations that often last late into the night.
The researchers also suggested that a shift to majority voting could help unlock progress at talks where decisions on slowing global warming now have to be made by consensus.
"Current United Nations structures are highly inequitable and obstruct progress towards international climate policy cooperation," the authors said.
Still, many countries oppose majority voting since it would curb their influence over decisions for limiting emissions that could cost trillions of dollars in the coming decades. Decisions without the backing of top emitters would lack legitimacy.
"Majority voting would be a threat to some," Schroeder said. "But our parliaments don't work (with consensus), why not extend that to the realm of multilateral negotiations?"
The Doha delegates will review progress towards a global deal to slow climate change, such as more floods, droughts, heatwaves and rising sea levels. The deal is meant to be reached by the end of 2015 and enter into force in 2020.
However, delegations already have conflicting and changing expectations of the talks.
China, the biggest emitter of greenhouse gases ahead of the United States, has shifted to put more emphasis on foreign affairs and less on economics. The United States has moved to increase participation by members of Congress.
Britain has moved to put more stress on energy while developing nations such as Bhutan or Gabon, for instance, were consistent in focusing on environment, forestry and agriculture. - Reuters


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Surgeons restore some hand function to quadriplegic patient
Surgeons at Washington University School of Medicine in St. Louis have restored some hand function in a quadriplegic patient with a spinal cord injury at the C7 vertebra, the lowest bone in the neck. Instead of operating on the spine itself, the surgeons rerouted working nerves in the upper arms. These nerves still "talk" to the brain because they attach to the spine above the injury. Following the surgery, performed at Barnes-Jewish Hospital, and one year of intensive physical therapy, the patient regained some hand function, specifically the ability to bend the thumb and index finger. He can now feed himself bite-size pieces of food and write with assistance.
The case study, published online May 15 in the Journal of Neurosurgery, is, to the authors' knowledge, the first reported case of restoring the ability to flex the thumb and index finger after a spinal cord injury.
"This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is," says surgeon Ida K. Fox, MD, assistant professor of plastic and reconstructive surgery at Washington University, who treats patients at Barnes-Jewish Hospital. "Instead, we go out to where we know things work -- in this case the elbow -- so that we can borrow nerves there and reroute them to give hand function."
Although patients with spinal cord injuries at the C6 and C7 vertebra have no hand function, they do have shoulder, elbow and some wrist function because the associated nerves attach to the spinal cord above the injury and connect to the brain. Since the surgeon must tap into these working nerves, the technique will not benefit patients who have lost all arm function due to higher injuries -- in vertebrae C1 through C5.
The surgery was developed and performed by the study's senior author Susan E. Mackinnon, MD, chief of the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine. Specializing in injuries to peripheral nerves, she has pioneered similar surgeries to return function to injured arms and legs.
Mackinnon originally developed this procedure for patients with arm injuries specifically damaging the nerves that provide the ability to flex the thumb and index finger. This is the first time she has applied this peripheral nerve technique to return limb function after a spinal cord injury.
"Many times these patients say they would like to be able to do very simple things," Fox says. "They say they would like to be able to feed themselves or write without assistance. If we can restore the ability to pinch, between thumb and index finger, it can return some very basic independence."
Mackinnon cautions that the hand function restored to the patient was not instantaneous and required intensive physical therapy. It takes time to retrain the brain to understand that nerves that used to bend the elbow now provide pinch, she says.
Though this study reports only one case, Mackinnon and her colleagues do not anticipate a limited window of time during which a patient with a similar spinal cord injury must be treated with this nerve transfer technique. This patient underwent the surgery almost two years after his injury. As long as the nerve remains connected to the support and nourishment of the spinal cord, even though it no longer "talks" to the brain, the nerve and its associated muscle remain healthy, even years after the injury.
"The spinal cord is the control center for the nerves, which run like spaghetti all the way out to the tips of the fingers and the tips of the toes," says Mackinnon, the Sydney M. Shoenberg Jr. and Robert H. Shoenberg Professor and director of the School of Medicine's Center for Nerve Injury and Paralysis. "Even nerves below the injury remain healthy because they are still connected to the spinal cord. The problem is that these nerves no longer 'talk' to the brain because the spinal cord injury blocks the signals."
To detour around the block in this patient's C7 spinal cord injury and return hand function below the level of the injury, Mackinnon operated in the upper arms. There, the working nerves that connect above the injury and the non-working nerves that connect below the injury run parallel to each other, making it possible to tap into a functional nerve and direct those signals to a non-functional neighbor.
In this case, Mackinnon took a non-working nerve that controls the ability to pinch and plugged it into a working nerve that drives one of two muscles that flex the elbow. After the surgery, the bicep still flexes the elbow, but a second muscle, called the brachialis, that used to also provide elbow flexion, now bends the thumb and index finger.
"This is not a particularly expensive or overly complex surgery," Mackinnon says. "It's not a hand or a face transplant, for example. It's something we would like other surgeons around the country to do."
Source: Washington University in St. Louis
Other sources
- Surgeons restore some hand function to quadriplegic patientfrom Science DailyTue, 15 May 2012, 20:30:59 UTC
- Doctors 'rewire' hands of paralysed manfrom The Guardian - ScienceTue, 15 May 2012, 19:00:32 UTC
- Nerve transfers restore hand function after cervical spinal cord injuryfrom Science BlogTue, 15 May 2012, 16:50:07 UTC
- Paralysed man moves hand after opfrom BBC News: Science & NatureTue, 15 May 2012, 15:01:59 UTC


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Come Enjoy the Museum with your Students!
Museum Programs Available
Teacher self-directed museum visit
Grades K-12
Cost: $5.00 per student
Suggested Length: 1 to 2 hours
Through this program teachers create their own visit to the museum.
Guided Tour
Grades K-12
Cost: $6.00 per student
Length: 1 1/2 hours
Through this program a guide helps students explore the museum's exhibits. A scavenger hunt may be included.
Hands-On Programs
Make a Clock Workshops
Grades K-adult
Cost: varies by clock chosen
Create your own working clock to take home. Choose from a variety of clock bases to create a custom clock. For more information, including clock choices visit the Make a Clock Workshop page.
Time and Season
Grades 3-8
Cost: $7.00 per student
Pre-visit material included
Length: 1 ½ to 2 hours
From Egyptians to Native Americans, all cultures developed ways of timekeeping that was conducive to their lifestyle. This program encourages students to learn about the different timekeeping methods developed and how the concept of time relates to everything that we do. As part of the museum visit, students will create an hourglass to take home. A guided tour may be included.
Animal Shape and Find
Grades K-2
Cost $6.00 per student
Length: 1 to 1 1/2 hours.
Shapes are found in everything, whether in nature or in objects in the classroom. This program encourages young visitors to seek out and identify a variety of shapes within the museum's exhibits. It is an interactive and fun way for younger students to view and learn through the exhibits. As part of the museum visit, students will engage in a scavenger hunt of shapes and animals found within the exhibits with the assistance of a museum guide.
Have more questions about planning your visit to the museum? Check our our FAQ page!


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Hello guys! We would like to inform you that we have discontinued updating this theme. Therefore please be advised that this theme will not work with the latest WordPress updates and we would like to highlight that its strongly recommended to use the theme with the appropriate WordPress version which is mentioned in theme details. Some of you would be disappointed about it, but you need to understand that this theme is outdated and don't really match the modern design of nowadays. That's why we decided to keep up with the times and create more great new looking themes for you which will definitely be working with latest WordPress versions. Maybe its time for you to upgrade your website with one of our new themes? We will keep providing best support for our customers and even for old themes but with appropriate WordPress version. We appreciate your understanding regarding this matter and thank you for choosing our themes!
Theme Description:
Politician Responsive WordPress Theme uses a great deal of white/dark space to create a clean feel to this site. The elements of this web design are nicely spaced out to create a clean overall design. The light/dark background and elegant typography combines to make a very fresh design. This website is far from minimal, yet uses very clean edges, accentuated by the contrasts between content areas and backgrounds to create a highly clean web experience.
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- WordPress 3.6 Ready!
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VERSION 1.1.2 (August 22, 2013) 01 - compatibility with WordPress 3.6 version 02 - quick update for Twitter widget
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text: Good Deed's own soft, Made-In-America ring spun 100% cotton pique white polo is micro-layered for unique coverage not typically found in light-weight white fabrics. The fashion collar, wood-toned buttons and square seamed placket are stylish professional details to the design. This polo displays the embroidered AmeriCorps logo on the left breast.


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Please visit our Open House at 2304 Sangster RD in MILL BAY.
Open House on Sunday, December 18, 2016 2:00PM - 4:00PM
*OPEN HOUSE Sun Dec 18th 2-4pm*Views, Views, Views of Mill Bay, Saanich Inlet & Gulf Islands from this brand new executive home. Modern contemporary design built w/ high level finishing details by Larry Nylen Construction Ltd. An open bright floor plan w/ ceilings to 14' in living room w/ an immense amount of windows to capture the breathtaking views & allow an immense amount of natural light. The dream kitchen features quartz countertops, a stainless appliance package & island which is certainly a focal point of this amazing home. Master bedroom suite & deluxe ensuite will also excite the most discerning buyer. Lower level provides a 4th bedroom, a family room as well as a flex room for all ages. Fully landscaped low maintenance lot.


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Since parenthood came into my life, so has weight gain. It hasn't been all that bad but I think I weigh a bit more now than I did in the days after I pushed that child out. Why? Because the gym is now a long-distant memory. Since we clearly like to eat, the gym was once my very good friend four or five times a week pre-child. Now, I'm lucky to even get a long walk to the park. If I still have energy after a day of chasing after a 1 year old, I'll may pop in a yoga DVD, but I now realize that "5 Minute ABS" only works when you are doing more than just "5 Minute Abs". I refuse to stop eating or drinking wine but I miss those carefree days of hitting the gym whenever I wanted to sweat off my stress and weekend steak and potatoes.
So how does Mariah Carey fit into this post? Well, recently, Mariah debuted her "post baby body" – a phrase I'm kinda getting sick of seeing on magazine covers. Yeah, yeah, she did it through diet and exercise and did gain like a million pounds while on bedrest with her twins but she has a FLAT STOMACH AGAIN! How about this chick – she did a Vickis Secret bra and panties modeling shoot a few weeks after giving birth. I was still wearing my "belly band" at that point.
But, it's never too late to try and lose a bit of that baby weight, huh? This ceviche is the perfect way to attempt to do so without getting depressed that all you are eating is salad and brown rice. This ceviche is a bit different than the ones you may have had in the past. Normally, ceviche's fish/shellfish is "cooked" by lime or lemon juice acid that it marinates in. This particular ceviche requires one to actually cook the seafood first. It is inspired by street food we had in Brooklyn several years ago. We have remembered it all this time – it was the type of NYC street food that is very hard to find these days (one that is probably illegal and delicious). With street food becoming a weird trendy thing, possibly because of the invention of the Vendy Awards and the infiltration of slick food trucks, it is sometimes hard to find street food that isn't overdone or trying too hard. This particular hot summer day, we discovered a woman on her stoop with a little table containing a large, plastic vat, a tupperware filled with avocados and two bottles of hot sauce. For $2.50 we received half a perfectly ripe avocado filled with shrimp ceviche in a spicy tomato sauce. It was served on a white napkin with a plastic fork. The avocado skin served as it bowl. We happily sat on the neighbors stoop inhaling this amazing snack.
Five years later, we finally got around to trying our hand at the ceviche. After a bit of research, we discovered that this ceviche is closer to an Ecuadorian ceviche which is different from the Peruvian type most are accustomed to. The main difference between the two is 1) a tomato-based marinade with a "soup like" consistency 2) most often made using shrimp that is cooked/boiled first and 3) served with popcorn and fried plantains. We played around a bit with our recipe, adding some things that are probably not traditional. For instance, the tomato base of the Ecuadorian ceviche "sauce" is often made with ketchup and doesn't have olives. We used some Goya tomato sauce and added olives for briny-ness. We also had some baby octopus that needed eating up, so we threw that in there too.
A few weeks of this as a weeknight meal and I may not have a stomach like Mariah or legs like that Victoria's Secret model but who cares. It's the trying that counts, right?
- 1 lb. shrimp with shell on (about 15 to 20)
- 1/2 lb baby octopus (optional)
- 1 8oz. can of Goya tomato sauce
- juice of 3 to 4 limes
- 1/4 cup of orange juice
- 1 teaspoon sugar
- 1/2 red onion, thinly sliced and then chopped into small pieces
- 1 cayenne pepper, very thinly sliced (optional)
- big handful of cilantro, chopped
- 1 cup of alcaparrado (or just some pitted spanish green olives) + a bit of the olive brine
- 2 perfectly ripe avocados (or 1/2 avocado per serving)
- Boil your shrimp with the shells on – about two to three minutes. Remove from water and allow to cool. The take the shells off the shrimp. Keep whole or cut down the middle.
- Meanwhile, add the octopus to the boiling water if using and boil for two to three minutes. Remove and allow to cool.
- In a separate bowl, add the tomato sauce, pepper, onion, cilantro, alcaparrado or olives, lime and orange juice along with the sugar. Stir and taste. Add a bit of the olive juice for a hint of saltiness. Taste for seasoning. Add more lime juice if you want or even a pinch of garlic powder if you feel it needs that kick. This sauce is to be to your liking so play around with the ratios till it tastes like you want it!
- Add the deshelled shrimp and octopus to the tomato sauce. Stir.
- Cut ripe avocados in half and remove the pit. Scoop a small bit out from the center of the avocado to allow a bit more room for the ceviche to lay in. You can top the ceviche with that extra avocado if you like. Poor the ceviche on top of an avocado half. Top with a bit more of the cilantro. Serve with rice to make it a bit more of a meal. Enjoy!


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Via the Examiner, I've been looking for tea leaves for you all day but this, unfortunately, is the best I can do. I don't even regard it as tea leaves: I think Tribe is just pre-spinning the outcome so that, if the mandate is struck down, he can call Roberts a disappointment who betrayed his education in a fit of ideological pique, etc etc etc. But we're starving for insight and this is, in its own lame way, an insight into Roberts's thinking. As is this:
Eastman, a critic of the health care law, said he wouldn't be surprised to see Roberts side with the Obama administration and uphold the law. "He's a creature of the Washington administrative state. That's his background," the professor said, noting that Roberts has spent almost his entire professional life in Washington.
Scalia's background is Beltway-heavy too yet his vote against ObamaCare seems a fait accompli.
More unconvincing tea leaves? Okay, how about the idea that Roberts's vote in the Arizona case with Kennedy and the liberals presages a similar outcome on ObamaCare?
What the Arizona compromise will augur for the most closely watched case of the term is anyone's guess. Yet the justices' evident search for common ground in the immigration ruling and a few other cases this term could portend a healthcare decision that does not predictably cleave along political lines…
Overall, the judgment was modest, the tone cautious. It underscored the federal role in regulating immigration and largely rejected the effort by Arizona – and, by extension, several other states – to institute sweeping measures to stop people from illegally crossing the border.
The justices' regard for national authority on dilemmas that cut across state boundaries could end up echoing in the healthcare ruling.
"Both problems transcend states' borders and are too big for the states to solve on their own," Duke University law professor Neil Siegel said, stressing that he did not want to predict how the court would rule on Thursday.
Jeffrey Rosen is pushing this line too over at TNR but you could just as easily argue that Roberts and Kennedy threw the left a bone in the Arizona ruling because they're ready to tear their hearts out with O-Care. A party-line conservative majority on immigration on top of a party-line conservative majority on ObamaCare would have handed liberals a double-barreled weapon in arguing that the Roberts Court is hopelessly politicized. They'll still argue that if they lose on O-Care, of course, but their point will be weakened because of the Arizona case.
Exit tea leaf: Even at this late date, Obama's still warning his fundraising audiences about ObamaCare being struck down. How come?
Visit msnbc.com for breaking news, world news, and news about the economy


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By STACY THACKER, Associated Press
CHICAGO (AP) _ A train roars by as Native American children and instructors climb up a railroad embankment in Chicago, headed toward a barren patch of land that they'll transform into a garden with edible and medicinal plants.
Some carry potted plants or spades to break up the earth hardened by the summer sun, eager to connect with their natural surroundings. They're continuing an important cultural tradition that can be difficult to maintain for native people who, decades ago, left reservations for urban areas like Chicago, which now has one of the 10 largest native populations in the U.S.
"Even though we're in the city, we're not landless," said Janie Pochel, 28, an instructor who identifies as Lakota and Cree.
The garden project, known as Urban Ecology, is sponsored by the American Indian Center on the city's North Side. The first garden began 10 years ago in front of the center and has grown to include two more gardens in the city, including one lining an embankment of the Union Pacific railroad. There, the group is working on growing an oak savannah, like the one that inhabited the area years ago.
"If we're going to change kids' ideas about who they are as native people, who they are as tribal people and what that means, we had to connect kids with land _ and that began with plants," according to project coordinator Eli Suzukovich III, who is also known as Little Shell in Chicago's relatively small but tightknit native community. "We get them thinking about how that plant lives, its cultural significance, and then from that one plant would radiate out to the larger land context."
The American Indian Center is one of a few organizations across the country to plant gardens. The Indian Health Centers in Milwaukee and Detroit focus in part on teaching the community about healthier eating habits in the face of increased diabetes risks. Native Americans are twice as likely to be diagnosed with diabetes, according to data from the U.S. Department of Health and Human Services Office of Minority Health.
Detroit's garden also focuses on cultural relevancy like the Chicago center's garden, which was planted in hopes to bring back some remnants of life as it was on the reservation, where medicinal plants were more likely used and a trip to the pharmacy wasn't necessary. Plants like blue flag, an iris, can be used for fevers and Echinacea can be used as a vitamin source.
Prompted by the federal Indian Relocation Act of 1956, many Native Americans left for bigger cities _ such as Chicago _ in search of better economic opportunities. Some were successful in making a living in the city, while others weren't and eventually went back to reservation life. Today, there are about 27,000 people of native descent living in Chicago, a city that ranks among the nation's biggest populations of American Indians and Alaska Natives, according to the 2010 U.S. Census.
Suzukovich said the center hasn't gotten any pushback for their gardens from the city, state or railroad company, and the reaction to the gardens has been positive.
Union Pacific spokesman Mark Davis said the railroad has an agreement with the center for the use of the land. He added that the company grants access to property along a rail line on a "case by case basis," saying safety is one of the considerations.
Raven Roberts, 29, who identifies as Micmac, Potawatomi and Oneida, says she has heard younger people in the program getting excited when they know what kind of traditional medicine the plants produce.
"So many things were taken from us," she said, "and it's kind of like we're reclaiming ourselves and who we are."
Contact Stacy Thacker at www.twitter.com/stacy_thacker.


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'Something wicked this way comes'
Returning home from battle, the victorious Macbeth meets three witches on the heath. Driven by their disturbing prophecies, he sets out on the path to murder.
Our contemporary production of Shakespeare's darkest psychological thriller marks both Christopher Eccleston's RSC debut and the return of Niamh Cusack to the Company
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(visited by Chris Hockaday, Lina Hockaday, Kobus Visser and Oubaas Stadler)
15-Apr-2006 -- Having been bitten by the confluence bug (actually bugs, see 25S 30E), I decided I needed another one under my belt. Confluences in South Africa were disappearing thick and fast, so I did a quick search to see which ones were still unexplored. Using the new Google Earth feature, I couldn't believe my eyes when I saw one of them was less than 40 km away from my new in-laws' farm.
Upon reaching the farm on Good Friday, my father-in-law tried contacting farmers and border police in the area to find whose farm the Confluence lay on. We were met with bad luck at every turn, however, as people were either away for the long weekend, or their telephones were out of order. We decided to try our luck anyway, and head out, trying to find someone along the way to get permission.
So the next morning, my new wife, father-in-law, brother-in-law and I embarked on our adventure. Our luck turned once we got under way, because when we approached our planned deviation from the 'road', we spotted a bakkie (us. truck) just within the borders of the farm. It turned out to be the farmer's son, and after explaining our mission to him, he said we were welcome to carry on.
Unfortunately our map resolution was quite poor, so we had no idea of the mountainous terrain up ahead – quite out of character for the Kalahari! Thankfully, we had a solid farm vehicle – a mid-90's Land Rover Defender with about 10% original parts, which took the slopes in its stride. Blindly following the GPS, we took turns on the farm roads as appropriate and I couldn't believe my luck as the distance to go crept ever closer to zero.
As we passed the 1 km threshold, luck departed us again, and we got a flat. No problem though – three men can change a tyre very quickly when the scorching heat is urging you to get going again as soon as possible! Before long we were off again, and within another twenty minutes or so we were there.
It was a bit hard to drive and navigate to the Confluence, so my wife and I hopped out at 100 m to go and finished the trek on foot. Once we found our target we called the Defender over, so I could take photos from the back of it, without it spoiling the landscape. Hardly as scenic as my first Confluence, but that's not what the Project is about.
My biggest frustration came when trying to take a photo of the GPS coordinates. Try as I might, I couldn't get my camera to record the position. Eventually, I asked Kobus to take a still shot with his video camera, which thankfully turned out perfectly. I only realised later on the way back that it was probably the UV filter on my camera that was preventing the polarised LCD from showing up properly.
Shortly after taking our photos and heading back, we came across the farmer, who told us an easier way out was to continue south. So we followed him back to the farmhouse – no treacherous ravines involved - and before long we were heading home. Five and a half hours and more than 140 km (remember the confluence was only 35 km away in a straight line!) we were back at the farm, sunburnt to a crisp, but very satisfied.
Three more left in SA, and all within range of the farm...
Thanks to Nic Milne for lending me his GPS for the weekend.