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Let's see: Does the Bible say Jesus was born on December 25th? Nope.
Does the Bible say anything about putting up a tree and decorating it with lights? Nope.
Does the Bible say anything about a fat man in a red suit and flying reindeer? Nope.
Does the Bible say anything about singing Christmas carols and drinking eggnog? Nope.
Coca-Cola has more to due with Christmas than Jesus does. I like Tim Minchin's take on atheists celebrating Christmas:
We used to be fundamentalists . . . . I was in the ministry. When my wife and I told the kids we had become atheists they were ecstatic that they would not have to go to church or sunday school any more. Then we told them we would not be celebrating christmas and I thought they would mob me. So, yes . . we celebrate, though in my mind the whole thing (Xmas and new year) are really wound up on the 21st.
I like a few aspects of Christmas, but really hate others, so I kind of dread it. I get presents for a few people, and I like having dinner with my friends, and I always put up a few decorations. I even have a Nativity set! It was a cheap one that reminded me of the one my mother had, so I bought it. Last year, I put Darth Vader in it. :o] I don't see the harm of enjoying what you can of the holiday while ignoring the religious stupidity.
Otherwise, Christmas pretty much sucks. The stores will be ridiculously busy, traffic will be a mess, people generally will be at their bitchiest, and nobody is really very happy. Worst of all is the horrible Christmas music that I'll be hearing for nearly two solid months. I HATE Christmas music! Almost all of it is stupid, annoying, childish, and unimaginative, yet for some reason millions of people actually enjoy it, and stores feel compelled to play it nonstop over their in-store music system. It is that, more than anything else, that puts me in a bad mood when I have to shop any time between Thanksgiving and New Year's Day.
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subset: commoncrawl


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S4 E07 Cops & Robbers
Castle and Martha are trapped as armed bank robbers dressed in hospital scrubs and using names of TV doctors take hostages. Beckett was on the phone with Castle when the action started. The lead robber, who goes by Trapper John, will only talk to her. Looks like Beckett has gone from top homicide cop to instant hostage negotiator. Trapper John promises that if she messes with him, he'll kill Castle first.
Castle realizes this isn't an ordinary bank robbery. The hostage situation was planned so that the bad guys could have time to look through safe deposit boxes. If Castle can figure out who owns the box Trapper John is interested in, he may be able to figure out his plan. Speaking of plans, Trapper J wants a bus to take his crew and the hostages to the airport. He'll release a pregnant woman there, but everyone else will go along for the ride.
Using a reflection caused by Martha's bracelet, Castle is able to relay a Morse code message to Beckett outside regarding the safe deposit box. It belongs to a married couple named Agnes and Gideon Fields. They both access the box monthly. On the inside, a panicky hostage says he spotted some explosives in a robber's bag. Castle calms the guy down by promising that he'll figure out a way to save the day.
Ryan and Esposito discover that Agnes Gideon has been dead for at least a week. Her apartment had been professionally bugged. Back at the bank, panicky hostage guy has an epileptic seizure. Trapper John will let a paramedic help, but he pushes the delivery time on the bus from three hours to 20 minutes. Beckett dons an EMT uniform to tend to the sick man. She tells him that there are people out there who care about him and that's she'll get him out of there. Castle knows those words are really meant for him.
Castle slips Beckett a note about the explosives. The bus is stuck in traffic. There's no way it'll make it to the bank before the deadline. Trapper John promises he's going to kill Castle if the bus isn't there in one minute. Beckett assures this bad TV doc that if he pulls the trigger she'll personally walk in there to put a bullet through his skull. Just like that, Beckett has more time. Turns out she's a pretty good negotiator after all.
Even though they are on opposites sides of the bank doors, Castle and Beckett are completely in tune with their deductions. Like we said earlier, this is more than just a bank heist. The hostages are bound by the hands as the robbers prepare for their next move. Outside, Esposito calls Beckett to say that Agnes Gideon's only living relative is a former son-in-law named Ron Brandt. Then…
BOOM! An explosion rocks the inside of the bank. A look of sheer horror covers Beckett's face as she steps up to see the tragedy. The police storm inside to find all the hostages alive and well in the vault area. Beckett is relieved to see that Castle is safe, too. Outside, a worried Alexis has been trying to get her long distance boyfriend, Ashley, to comfort her on the phone. He was just too busy, so she was out there all alone. Not anymore. Alexis is overjoyed as Castle and Martha exit the bank and enter her emotional embrace.
An assortment of body parts lead the police to believe the robbers all died in the explosion. Castle doesn't buy it. These guys were too good. When Beckett sees a picture of Agnes Gideon's son-in-law, Ron Brandt, she realizes he's the hostage who had the seizure. The guy used his military contacts to orchestrate the entire operation. Then he blew the explosives early to kill off all the mercenaries he hired. One big question remains. What was in that safe deposit box?
Brandt abused his wife, Tanya, who faked her own death to escape from his clutches with their son. The safe deposit box was the only way Tanya could safely communicate with mom Agnes. Brandt now has all the information he needs to kidnap his son and kill his wife. They need to find the middle man who posed as Agnes's husband to make the safe deposit drops for Tanya. The clock is ticking.
The team realizes that the priest who performed the bogus funeral ceremony for Tanya is their middle man. The good father says the family is hiding in Ithaca. The local police storm the house and are able to take Brandt down. Needless to the say, the NYC team is overjoyed at the news. Esposito and Ryan are so jazzed that they're headed out on a four-hour drive to Ithaca.
Castle has other plans. Martha went to town to prepare a celebratory dinner for the family which, of course, includes Beckett. But gatherings like this won't be including Ashley in the future. Alexis lets him know that they are over. As for Castle, he's just beginning to rattle off all the times he's saved Beckett's life. It seems he's been keeping score. Even after this recent bank robbery adventure, Castle still holds the lead 9-8. How many life-saving moments can you remember?


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The artwork on this note card was created by 5768 WRJ Art Calendar artist Césan d'Ornellas Levine.
Search URJ.org and the other Reform websites:
Search URJ.org and the other Reform websites:
Saperstein & Gutmann: "Mr. President, by refusing to attend the opening ceremonies, you have the powerful opportunity to send a clear message to the Chinese government that America will not turn a blind eye."
Contact: Jonah Perlin or Sean Thibault
202.387.2800 | email@example.com
Washington, D.C., April 14, 2008 – Reform Jewish leaders joined the growing movement calling for President Bush's moral boycott of the opening ceremonies at the 2008 Olympic Summer Games in Beijing, China. Today, Rabbi David Saperstein, Director of the Religious Action Center of Reform Judaism joined with Dr. Cheryl Gutmann, Chair of the Commission on Social Action of Reform Judaism in writing directly to President Bush. The full text of the letter is as follows:
Dear President Bush,
On behalf of the Commission on Social Action of Reform Judaism, a joint body of the Union for Reform Judaism, which represents more than 900 congregations across North America encompassing 1.5 million Reform Jews, and the Central Conference of American Rabbis, whose membership includes more than 1800 Reform rabbis, we add our voice to the growing chorus of organizations urging you not to attend the opening ceremonies of the 2008 Olympic Games in Beijing this summer.
The modern Olympic Games, at their best, have been not just a symbol but a manifestation of peace, justice, and international cooperation. China was selected seven years ago in the hope that it would live up to those lofty goals. Sadly, in fact tragically, that has not been the case.
The opening ceremonies serve many purposes. On the one hand they celebrate the games and the Olympic spirit. On the other hand the host country puts on a spectacle that celebrates the achievements and spirit of the host nation. Mr. President, by refusing to attend the opening ceremonies, you have the powerful opportunity to send a clear message to the Chinese government that America will not turn a blind eye as a country on the world's largest stage repeatedly commits egregious human rights violations. To be clear, we are not calling for an Olympic boycott. We believe that our athletes should have the opportunity to compete at the highest international level, but it does not follow that you should lend your personal endorsement to the symbolic celebration at the start of these games. During the 2001 selection process, Chinese officials assured the International Olympic Committee (IOC) that hosting the Olympic Games would be an opportunity to improve the country's human rights record both at home and abroad, entering into what IOC President Jacques Rogge called a "moral agreement." Unfortunately, it has become all too clear that today, the Chinese government has done little to rectify these injustices and has in fact continued its participation in significant and systematic human rights violations.
In addition to oppressing religious minorities within its own borders, China remains the largest consumer of Sudanese oil and the largest supplier of weapons to the Khartoum government, both of which enable the janjaweedmilitia to perpetrate genocide on its own people in the Darfur region of Sudan. In Tibet, China silences peaceful protests and against its cultural genocide and stifles calls for autonomy and refuses to speak to or negotiate with the Dalai Lama, Tibet's religious and spiritual leader. While in Burma, China economically and politically supports the military junta, which has oppressed its own people for nearly twenty years by limiting freedom of press, association, and religion and during the recent peaceful mass protests led by Buddhist monks, continued its support of the regime. Also, support for the repressive regime in North Korea cannot be ignored. We urge that you choose justice by symbolically standing alongside the refugees of Darfur, the clergy of Burma, and the oppressed citizenry of Tibet by refusing to attend the opening ceremonies.
Rabbi David Saperstein
Director, Religious Action Center of Reform Judaism
Cheryl Gutmann, M.D.
Chair, Commission on Social Action of Reform Judaism
Search URJ.org and the other Reform websites:
The artwork on this note card was created by 5768 WRJ Art Calendar artist Césan d'Ornellas Levine.
Show your WRJ pride with this zippered canvas bag. Features the phrase "Well-behaved women rarely make history" and the WRJ logo.
$18 $15


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Two-termers: Council 'custom' surprises some
In his account of City Councilor Blake Caravati's January 9 announcement that he won't seek reelection, Daily Progress reporter John Yellig notes, "Custom dictates that councilors do not seek third terms." The revelation– unattributed and appearing as the third sentence of the top-of-the-fold news story– has many longtime Charlottesville political scenesters scratching their heads.
Former mayor and newly sworn-in Delegate David Toscano was surprised to learn about the custom. A veteran of three terms on Council, the last of which ended in 2002, Toscano reels off other exceptions to the rule: three-timer Frank Buck, as well as former mayor Bitsy Waters, who served only one term.
"The usual practice is to serve two terms," says Toscano. "'Custom' is too strong a word."
Could the custom be super secret, revealed only to the most well-connected insiders? "If that's true, I wasn't aware of it, and I guess that's why I ran for three terms," says Toscano.
Two years ago, former councilor Meredith Richards, apparently unaware of the custom, unsuccessfully sought a third term.
Vice Mayor Kevin Lynch, who was re-elected in 2004, also isn't up on the two-term custom. His theory: it's hard to be productive after 10 years in office, and councilors must ask, "Do you want to stretch it to 12 years or cut it to eight years?"
Lynch won't say whether he's going to follow custom and decline his shot at a third term in 2008. "It depends on what the political landscape is in a year and a half," he says. He's hoping for lots of new blood– people who think the way he does. "It's hard to predict what is going to be happening in a year and a half," he adds.
Caravati also likes the idea of new blood on City Council, but he cites the sacrifice of his personal life, rather than custom, as a reason for not running again. "Three nights a week, I'm not there," he says. "And the phone calls... Citizens don't mind calling in the middle of the night to tell you their trash didn't get picked up."
He doesn't rule out running for office again in the future. "I will keep involved," he promises. "You can't get rid of me."
Former Charlottesville Democratic chairman Lloyd Snook, however, says that two terms are the norm. "There's a reason for the custom," Snook explains. "After eight years, a lot of people feel burnout."
Snook adds, "Frankly, after eight years, you've ticked off enough people so that it's harder to get things done."
Departing Councilor Caravati mentions that there is definitely at least one other local re-election custom: "You have to go to Albemarle to find the custom," he says, "and that's 12 years minimum."
Former mayor Blake Caravati will not seek a third term on City Council, not because of custom, but to enjoy his private life again for a while. And if a promising seat becomes open, he'll be ready.


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I regularly see new Kickstarter appeals starting I'd consider investing in, but few as handsome as this: Drawmoreinc's Nobodies Vol.2. Launched just a few days ago, they've already met nearly half their target in pledges, understandably considering the high quality of the contributors. The (rather strident) mission statement reads:
This comic anthology is a full color 120+ page perfect bound comic by comic creators from all around the world. Creators contribute all new original stories to the book to go with our theme of "nobodies." We want to create art because we love it. We aren't scared of the bumps and bruises (that comes with the territory). We're here to make the work we want to read. There are no restrictions and anything goes.
This anthology is used to be a platform for relatively unknown comic creators to come together and show everyone else in the industry that we aren't meant to be taken lightly and we're here to stay.
The appeal page shows a lot of good-looking preview art, and plenty of links to further examples by the contributors. "Relatively unknown" is quite the catch-all term -- some of these creators already have something of a cult following online. And of course, a lot of people won't be able to resist the allure of the rewards of merchandise based on Shaky Kane's cover art, including art prints and a rather groovy 3D t-shirt.


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A civil case that begins Thursday in a courtroom here not only brands Florida as a hotbed of tobacco litigation, but also marks the advance of a huge stream of lawsuits against America's largest cigarette manufacturers.
About 8,000 plaintiffs are lined up to sue Big Tobacco in the Florida court system, a conveyor belt of cases that is likely to clog the calendars of state and federal judges for months, if not years, to come.
This wave of lawsuits from smokers, or their estates, stems from a 2006 ruling in the Florida Supreme Court that broke up a class action suit of more than 700,000 plaintiffs and quashed a $145 billion award against the tobacco industry, the biggest penalty in US civil court history.
While closing one door, the justices opened another, giving all plaintiffs one year to file an individual claim for damages against cigarette-makers.
The first case to make it to a full trial gets under way Thursday, when the widow of Stuart Hess, a locksmith from Cooper City, Fla., attempts to hold industry leader Philip Morris liable for his death in 1997.
"Florida has become a hotbed of litigation against the tobacco industry, and while the cases are difficult to litigate, it's interesting because so many are coming to the fore," says Cliff Douglas, executive director of the University of Michigan Tobacco Research Network. "We are easily talking years before anything is concluded because every successful individual case is going to enter several years of appellate litigation."
The Hess trial is sure to be closely watched by the next wave of plaintiffs, defendants, teams of lawyers, and judges. Another 25 cases or so are on district court dockets in Fort Lauderdale, Tampa, and Jacksonville to be heard before the end of April, and judges are trying to schedule time for dozens more before year's end.
In accordance with the 2006 high court ruling, each case will start from the same premise: that cigarette-makers were aware their products were "defective" yet misled the public over their health effects. The need is to prove that each individual plaintiff was harmed by an addiction to the products they smoked.
Nobody disputes that Mr. Hess, who smoked two to three packs a day from the age of 13, knew that cigarettes were bad for him. The question is what stopped him from quitting. His widow's lawyers will say he tried but couldn't because nicotine has addictive properties that Philip Morris tried to conceal. Kenneth Reilly, the lawyer for the cigarette-maker, will argue that Hess chose to smoke despite being aware of the dangers.
In essence, Hess's lawyers need to prove only that he was a nicotine addict for the action to continue to a compensatory damages phase.
"That shouldn't be too terribly difficult," Douglas says. "We already know that the vast majority of smokers are dependent on the product. In some fashion, all the cases will resemble that process".
The tobacco industry has the resources to fight the cases. Nonetheless, "the risk to the tobacco industry is significant," he adds. "It's still a lot of money, and that and the adverse publicity will raise the concern of companies' investors and shareholders."
Philip Morris USA, the defendant in the large majority of the Florida cases, is digging in for a long fight and has hired experienced outside counsel.
"Philip Morris USA intends to offer a vigorous defense for each individual case that goes to trial," says Murray Garnick, senior vice president and associate general counsel of client services for Atria, the cigarette company's parent. "Already we have learned that many of these plaintiffs have no legally valid claims. For those who proceed to trial, we believe each plaintiff must prove the essential elements of their claims and that we continue to have very strong defenses to these type of cases."
Big Tobacco has enjoyed some success in federal courts, which are handling about half of the Florida cases. Judges in three actions have ruled that the state court's 2006 ruling is not valid in their courtrooms, so about 4,000 cases are in suspension until the US Court of Appeals for the 11th Circuit rules on the matter later this year.
Those who follow the fight on a national level say the 8,000 Florida cases extend an already busy period of antitobacco litigation. According to Michigan-based Tobacco Control Law and Policy Consulting, tobacco firms faced a greater number and variety of legal actions between 1995 and 2005 than in previous years, with plaintiffs winning about 40 percent of the 75 cases and $115 million in compensation and healthcare-recovery costs.
Another long-running battle reached the US Supreme Court last month when justices ruled 5 to 4 not to shield manufacturers from fraud lawsuits over whether so-called light cigarettes really contained less tar and nicotine than full-strength products. It clears the path for another massive wave of lawsuits.
Howard Acosta, a St. Petersburg, Fla., attorney and member of the Tobacco Trial Lawyers' Association, has taken on about 400 of the upcoming cases.
The tobacco firms "never made it easy and have teams of lawyers working these cases," says Mr. Acosta, who won $3.2 million from Philip Morris in 2005 for a smoker diagnosed with lung disease in 2003. "But this is too important an issue not to fight. I've been involved in these cases since 1995, and I think I'm still going to be fighting them for some time yet."


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§ 422.604. Request for detailed information.
(a) General. After you receive our notice of assignment listing the beneficiaries for whom you have premium responsibility, you may request detailed information as to the work histories of any of the listed miners and the basis for the assignment. Your request for detailed information must:
(2) Be filed with us within 30 days of receipt of that notice of assignment. Unless you submit evidence showing a later receipt of the notice, we will assume the notice was received by you within 5 days of the date appearing on the notice. We will consider the request to be filed as of the date we receive it. However, if we receive the request after the 30-day period, the postmark date on the envelope may be used as the filing date. If there is no postmark or the postmark is illegible, the filing date will be deemed to be the fifth day prior to the day we received the request; and
(3) Identify the individual miners about whom you are requesting the detailed information.
(b) The detailed information we will provide. We will send you detailed information as to the work history and the basis for the assignment for each miner about whom you requested such information. This information will include the name and address of each employer for whom the miner has worked since 1978 or since 1946 (whichever period is appropriate), the amount of wages paid by each employer and the period for which the wages were reported. We will send you the detailed information with a notice informing you that you have 30 days from the date you receive the information to submit to SSA evidence of a prima facie case of error (as defined in § 422.602) and request review of the assignment if you have not already requested review. The notice will also inform you that, if you are seeking evidence to make a case of prima facie error, you may include with a timely filed request for review a written request for additional time to obtain and submit such evidence to us. Under these circumstances, you will have 90 days from the date of your request to submit the evidence before we determine whether we will review the assignment.


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Nerve Damage (Mass Market)
Harper, 9780061137983, 368pp.
Publication Date: March 25, 2008
Other Editions of This Title:
Hardcover (3/1/2007)
Paperback, Large Print, Large Print (5/1/2007)
Renowned sculptor Roy Valois receives the worst news since learning of his adored wife Delia's death in South America fifteen years ago. His doctor tells him he's dying—and a morbid curiosity about how he'll be remembered inspires Roy, with the help of a local computer geek, to hack into a newspaper's system to read his prewritten obituary. But the death notice includes a small discrepancy about his late wife—and by calling the mistake to the attention of the surprised obit writer, Roy has inadvertently sealed an innocent man's doom.
Suddenly Roy has a mission: to uncover the truth about the woman he can't stop loving—secrets guarded by powerful forces who believe murder is an acceptable price for keeping them buried. With his disease-ravaged body's final betrayal rapidly approaching, Roy must somehow stay alive long enough to find the answers: Who was Delia? How did she die? Why did she die?
Did she die?
About the Author
Peter Abrahams is the New York Times bestselling author of twenty-five books, including the Edgar Award-winning Reality Check, Bullet Point, and the Echo Falls series for middle graders. Writing as Spencer Quinn, he is also the author of the Chet and Bernie series—Dog on It, Thereby Hangs a Tail, and To Fetch a Thief. He and his wife live in Massachusetts with their dog, Audrey.


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ASSAF letter regarding DHET accreditation of SciELO SA..
This journal is DHET Accredited. Recent DHET and SciELO SA communication clarified.
Now included in PubMed Central (PMC).
Felicity M. Daniels1
Lorraine P. Fakude1
Ntombizodwa S. Linda1
Regis R. Marie Modeste1
Affiliations:1School of Nursing, University of the Western Cape, South Africa
Correspondence to:
Felicity Daniels
Postal address:
Private Bag X17, Bellville 7535, South Africa
Received: 08 Apr. 2015
Accepted: 30 Sept. 2015
Published: 09 Dec. 2015
How to cite this article:
Daniels, F.M., Fakude, L.P., Linda, N.S. & Marie Modeste, R.R., 2015, 'Nurse educators' experiences of case-based education in a South African nursing programme', Curationis 38(2), Art. #1523, 8 pages. http://dx.doi.org/10.4102/curationis.v38i2.1523
Copyright Notice:
© 2015. The Authors. Licensee: AOSIS OpenJournals.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.
Background: A school of nursing at a university in the Western Cape experienced an increase in student enrolments from an intake of 150 students to 300 students in the space of one year. This required a review of the teaching and learning approach to ensure that it was appropriate for effective facilitation of large classes. The case-based education (CBE) approach was adopted for the delivery of the Bachelor of Nursing programme in 2005.
Aim: The aim of the study was to explore nurse educators' experiences, current practices and possible improvements to inform best practice of CBE at the nursing school in the Western Cape.
Methods: A participatory action research method was applied in a two day workshop conducted with nurse educators in the undergraduate nursing programme. The nominal group technique was used to collect the data.
Results: Three themes emerged from the final synthesis of the findings, namely: teaching and learning related issues, student issues and teacher issues. Amongst other aspects, theory and practice integration, as well as the need for peer support in facilitation of CBE, were identified as requiring strengthening.
Conclusion: It was concluded that case-based education should continue to be used in the school, however, more workshops should be arranged to keep educators updated and new staff orientated in respect of this teaching and learning approach.
Case-based education (CBE) is an instructional design that involves interactive, student-centred exploration of realistic and specific situations (Uys & Gwele 2005). CBE refers not only to real-life patient cases but can include fictional, virtual or simulated cases (Thistlethwaite et al. 2012). According to Williams (2005), CBE includes the use of problems or cases to stimulate learning and for the acquisition of knowledge, skills and attitudes. For nursing, this means that constructed cases link learning with the reality in clinical practice.
A case may be classified according to the level of complexity depending on the level of the students' education; or according to its duration as a single educational intervention, covering a specific learning issue; or a longitudinal approach that spans over time, with the possibility of developing the case into steps that are appropriate according to the year level in a learning programme (Bowe, Voss & Thomas Aretz 2009). Specific cases are carefully designed by educators, based on the specific outcomes of the module or course. The purpose is to allow students to actively engage with 'real world' issues. This encourages students to solve problems in class, which are similar or mimic those that occur in the real world and could subsequently advance active learning, critical thinking, communication skills, and other professional competencies (Bowe et al. 2009). Problem solving in a classroom rather than in a real life setting also provides a safe environment in which students can learn.
The national imperative to improve the status of higher education in South Africa is embedded in the Department of Education's (DoE) National Plan for Higher Education (DoE 2001) which gives effect to the vision for the transformation of the higher education system as outlined in the Education White Paper 3 (DoE 1997). One of the goals of the National Plan for Higher Education is:
to provide increased access to higher education to all irrespective of race, gender, age, creed, class or disability and to produce graduates with the skills and competencies necessary to meet the human resource needs of the country. (DoE 2001:17)
to provide increased access to higher education to all irrespective of race, gender, age, creed, class or disability and to produce graduates with the skills and competencies necessary to meet the human resource needs of the country. (DoE 2001:17)
The National Plan also proposes computer literacy, information management, communication and analytical skills as important skills and competencies with which all graduates should be equipped, in order to function in a modern society.
Another goal of the National Plan for Higher Education is:
to promote equity of access and to redress past inequalities through ensuring that the staff and student profiles in higher education progressively reflect the demographic realities of South African society. (DoE 2001:17)
to promote equity of access and to redress past inequalities through ensuring that the staff and student profiles in higher education progressively reflect the demographic realities of South African society. (DoE 2001:17)
In order to meet these priorities, schools and departments at higher education institutions had to restructure their educational programmes offerings on a number of levels.
At the school of nursing, restructuring included increasing the intake of nursing students, and increasing the number of lecturers and clinical supervisors accordingly. Also in line with the increased intake of students, a review of various applicable teaching strategies was undertaken and, finally, a decision was taken to adopt CBE as the teaching and learning strategy to drive the Bachelor of Nursing programme. CBE was selected based on its potential to promote active participation and the development of critical, analytical and problem solving skills of nursing students. Nurse educators should be able to implement innovative teaching and learning strategies such as CBE in classes with a large number of students. However, their experience of facilitating CBE should be explored in order to identify strengths that could be enhanced and weaknesses that should be addressed.
National transformation of higher education in South Africa occurred not only in terms of ensuring programme enhancements, but also in terms of institutional mergers and programme collaborations across institutions during the early 2000s. Decisions regarding nursing education in the Western Cape ultimately led to only two universities being identified as the enrolling institutions for the undergraduate nursing programme, which would be offered in collaboration with the other two universities in the province. As a result of the nurse shortage in the Western Cape Province, a substantial increase in the student nurse enrolment targets was planned for the two enrolling institutions (DoE 1997).
The two nursing departments were tasked to review and strengthen their undergraduate programmes, develop and foster collaboration between higher education institutions in the region and ensure that the students would have a positive learning experience. This resulted in the submission of revised programmes to the South African Nursing Council. CBE was adopted as the teaching and learning approach for the revised undergraduate nursing programme offered at one of the universities since 2005. The programme was phased in gradually over a period of four years whilst the existing programme at the time was phased out.
A study conducted by Daniels and Khanyile in the Western Cape in 2010, found that nurse educators were dissatisfied with the use of CBE; and that challenges in respect of substantial staff turnover were experienced, as many members of the faculty were employed on a contract basis rather than in permanent positions. The high staff turnover necessitated continual updating of existing staff and orientation of new staff to CBE. In addition to the study by Daniels and Khanyile (2010), students' evaluations revealed inconsistencies in the facilitation of CBE in the various year levels of the programme, as well as in the subject disciplines. Nurse educators who facilitate CBE in the school of nursing reflected on students' feedback and confirmed that the abovementioned was congruent with their own experiences. After six years of implementation, it became necessary to explore experiences and the current practices related to the implementation of CBE and to establish possible ways of improving on its implementation, if necessary.
Educators who are involved in nursing education strive to enhance the learning process of the students, to ensure the preparation of nurses who are ready to practice as required in their place of work. CBE has been documented as one of the approaches that facilitates learning (Sangestani & Khatiban 2013).
Effective application of a case-based teaching and learning process requires high quality cases that facilitate higher-order learning and competent teachers who support students during the teaching and learning process (Ramaekers et al. 2011). CBE enhances the use of critical thinking, as suggested by Bowe et al. (2009), by providing opportunities to students for examining the cases under discussion and identifying emerging problems or issues presented in the case studies.
DeSanto-Madeya (2007:324) states that developing teaching strategies that can improve skills such as decision making, critical thinking and problem solving is a continuous challenge for nurse educators. In order to attain these skills, changes need to take place in the teaching and learning environment. This would be more feasible with student-centred rather than teacher-centred teaching and learning strategies. Another advantage of CBE is the potential for health professionals to develop clinical reasoning skills as it links theory to practice (Thistlethwaite et al. 2012).
CBE is not a new teaching and learning approach, and has been implemented in different fields of learning. As noted by Uys and Gwele (2005), CBE has many benefits, such as facilitating the students' active participation whilst providing real life situations to which theoretical knowledge is applied. Additionally, by using group work, CBE provides many opportunities for creativity, collaborative work, and integration of socio-cultural aspects of health care to be included in teaching and learning interventions. The students' challenges are addressed by the educators and debriefing is undertaken when students talk about daily life issues. At the same time reflection, communication and decision making skills are being enhanced (Uys & Gwele 2005).
A case, as applied in CBE, is either a real, semi-fictional or a fictional depiction of a situation that requires some type of decision making, and may be descriptive or narrative in nature. When using case studies in teaching and learning, the desired results include critical and creative thinking, active participation of learners, and the application of theory to practice, as referred to earlier. Effective cases encourage and facilitate integrative learning where a number of modules from different disciplines could be combined. In professions such as nursing, cases ensure the correlation of theory and practice, as the management of the case requires evidence of both theoretical and clinical enquiry (DeSanto-Madeya 2007; Sangestani & Khatiban 2013).
From the students' perspective, a case-based approach has been noted to provide more opportunity in the preparation of students for deep learning compared to the lecture-based approach (Harman et al. 2015; Ilgüy et al. 2014). Studies have found that the use of CBE benefited students, as they scored higher on assessment tasks that required analysis and evaluation and on patient assessment, diagnosis and treatment plans (Ilgüy et al. 2014; Raurell-Torredà et al. 2015). Furthermore, it was found that students were better at integration of theory and practice (Hansen et al. 2005; Harman et al. 2015); and developed independent learning, problem solving and critical thinking skills, with the opportunity to think more broadly (Harman et al. 2015).
The application of CBE has been noted to improve the learning process, as group participation and collaboration are enhanced (Harman et al. 2015). Achieving group participation and collaboration, as an outcome of the learning process, has been found to be difficult in traditional teaching and learning approaches. CBE has also been reported by students as being enjoyable and interesting (Hansen et al. 2005; Williams 2005).
The application of the case-based teaching and learning approach at the school of nursing in the Western Cape follows four steps, namely:
As co-operative learning is applied during the teaching and learning process, students are encouraged to meet outside class sessions for preparation before case presentations.
The aim of the study was to explore nurse educators' experiences, current practices and possible improvements to inform the best practice of CBE at the nursing school in the Western Cape.
The results of this study have the potential to assist with developing strategies aimed at enhancing the teaching and learning of student nurses, and more specifically with the implementation of CBE in the circumstance of a large number of students. An improved approach to implementing CBE, based on the results of this study, may improve the alignment of theory to practice. It is anticipated that by improving student learning, patient outcomes will improve, as students would have developed the skills to apply critical judgement in patient care.
A two day workshop was held in 2012 and a participatory action research design was applied, as it provided an opportunity for participant collaboration and reflection (Baum, MacDougall & Smith 2006). A participatory action research cycle was followed consisting of the steps of reflecting on present experiences, a reflective discussion, an analysis of the benefits of the workshops and best practice recommendations. As reflected in Figure 1, the selection of a participatory action research methodology was most appropriate, resulting from its ability to amalgamate action and reflection, as well as theory and practice (Baum et al. 2006).
The population and sample comprised all nurse educators (nursing lecturers and clinical supervisors) who facilitated theoretical and clinical teaching and learning in the Bachelor of Nursing programme at the school of nursing at a university in the Western Cape. All nurse educators (nursing lecturers and clinical supervisors) were invited to participate. A total of 40 nurse educators voluntarily agreed to participate and attended the workshop.
On day one of the workshop, participants were asked to capture in writing their current experience and practice of facilitating learning using CBE. The question was posed, 'What are the current experience and practice in CBE at the school of nursing?' This was the first step in the action research cycle. The participants' personal exploration of their experiences highlighted their strengths and challenges in terms of facilitation of CBE.
The second step of the action research cycle required participants to reflect on and share their experiences in a group discussion.
A presentation on case-based education followed the above two steps. Thereafter, participants were divided into Group A and Group B for the remainder of the two days of the workshop. One group was formed by nurse educators from year one and two of the Bachelor of Nursing programme and the second group comprised nurse educators from the third and fourth year.
Based on the participants new understanding of CBE, a second question was posed, 'What do you view as the most important practices that we, as nurse educators should adopt as best practice in CBE at the school of nursing?' This required participants to reflect on practices of CBE in the school of nursing. The nominal group technique (NGT) process was used in the discussion and analysis of the second question and included the following steps, documented by Potter, Gordon and Hamer (2004):
This was the third step of the action research cycle.
The last step of the action research cycle involved the identification of best practice for the facilitation of CBE. These emerged as themes from the NGT process.
The data gathered from the discussion of the first question were analysed qualitatively using thematic content analysis and were presented with the aim of emphasising the participants' experiences of the use of CBE. During the thematic content analysis, themes and subthemes were extracted from the documented experiences of the participants, providing a clearer understanding of the experiences. The data from a NGT were collated and ranking for each group was presented.
There were different levels of understanding and practice amongst nurse educators with regard to the case-based method of teaching. Expressed learning needs or expectations of the workshop varied according to the year level of teaching, as well as to the specific category of lecturers and clinical supervisors. This section presents, firstly, the results from the nurse educators' discussions about their current practices and challenges in the implementation of CBE and, secondly, the developed themes from the NGT discussions which are the improvement plans and best practices.
The participants reported using a number of strategies in the implementation of CBE, which maximised the benefits of CBE – such as group work, self-study and reflection. They reported that CBE extended beyond theoretical learning in the classroom to include the learning of clinical skills in the clinical settings outside the classroom. One of the participants affirmed that:
'the use of different real cases facilitate varied learning opportunity, as this is viewed as good in assisting the students in comprehension of the realities of life out there. (Group B)
'the use of different real cases facilitate varied learning opportunity, as this is viewed as good in assisting the students in comprehension of the realities of life out there. (Group B)
Both lecturers and clinical supervisors are involved in the accompaniment and clinical supervision of students. However, although the lecturers conduct clinical assessments, the bulk of clinical assessments are undertaken by the clinical supervisors. Clinical teaching and learning for Bachelor of Nursing students occurs in simulation laboratories and during placement for clinical practice. Most responses from the participants related to the clinical placement environment where active, meaningful learning took place, and which supplemented the learning that had taken place in class. In the clinical settings students, as adult learners, learn most of their skills independently. In the skills laboratory, a very structured method called the skills lab method (SLM) is followed. As noted by Jeggels, Traut and Kwast (2010), the SLM is an innovative strategy used by the school of nursing in the Western Cape for clinical skills training, in well-equipped clinical skills laboratories, using simulated patients.
The SLM is complemented by real life experience in clinical practice, where the educators assume responsibility to accompany and work side-by-side with the student (Group B). They encouraged the students to participate in the doctor`s ward rounds by presenting patient cases, as noted by one participant:
'By encouraging the students to read available material [documents] at the clinical site, it promotes problem-solving skills allowing the students to provide patient-centred care, skills that enhance the application of CBE as applied in the programme.' (Group B)
'By encouraging the students to read available material [documents] at the clinical site, it promotes problem-solving skills allowing the students to provide patient-centred care, skills that enhance the application of CBE as applied in the programme.' (Group B)
In health professions education, the integration and application of theory and practice is fundamental to the development of clinical competence. Participants reported implementing strategies to enhance the integration of theory and practice as indicated by one participant:
'In the skills lab, the facilitators [lecturers and clinical supervisors] focus on determining students' pre-knowledge about particular skills that will be demonstrated and integration with theory to simulate real life scenarios.' (Group B)
'In the skills lab, the facilitators [lecturers and clinical supervisors] focus on determining students' pre-knowledge about particular skills that will be demonstrated and integration with theory to simulate real life scenarios.' (Group B)
Group work is one of the major teaching techniques used in theoretical as well as clinical teaching and learning situations. It allows students to support one another in developing the necessary skills for future application with a variety of health care professionals in the clinical setting. Additionally, simulated patient encounters (SPEs) are used for the development of clinical and communication skills and for enhancing integration of theory and practice. Participants also reported using several other techniques, including but not limited to sharing their own experiences with each other, by referring to their own real life experiences.
During the tutorial groups, or clinical placement, students' challenges were addressed either by reflection and self-discovery, or by a restorative function, during which the educators played a supportive role. Reflection is in line with the foundational philosophy of CBE (Uys & Gwele 2005). In addition to class discussions, the educators provide lecture input to assist the students to apply their knowledge and improve integration of the content. This occurred at opportune times during the CBE process, but most often it is undertaken at the end of the class contact session.
One of the challenges reported by the participants was related to time constraints for the educators and students themselves. Participants acknowledged that despite group facilitation being the main technique and a core responsibility of the educator, when facilitating student learning, they reported that they often did not have enough time to facilitate this process as well as they would have wanted to, resulting from a lack of time and the 'packed' learning programme:
'The students are thus encouraged to meet in their groups outside of the classroom [session].' (Group B)
'The students are thus encouraged to meet in their groups outside of the classroom [session].' (Group B)
This is undertaken after or before class sessions as is characteristic of CBE (Uys & Gwele 2005). Educators encourage students to take responsibility for their learning as self-directed learners and to strengthen the collaboration with group members. It is, however, often challenging for students to meet as a group, resulting from their workload.
Another challenge identified by the participants was the students' limited pre-knowledge which inhibited effective learning; in addition to limited effort which some students demonstrated when they read word for word from the textbook when presenting a case (Group A). Furthermore, it was reported that the educator's skills in facilitating learning within CBE was not always adequate; one of the clinical supervisors reported that at times one did not know whether or not educators and students 'were on the same page' (Group B). In this regard, it was reported that some educators were not skilled to guide the students in the process of discovery. Assessment strategies of this approach were also reported as a challenge by the majority of the nurse educators.
The second part of the workshop used the NGT to collect data related to the best practices that can be adopted in CBE at the school of nursing. Seven items emerged from the data analysis of the nominal group technique process as reflected in Table 1. Both groups identified integration of theory and practice as the most important component that should be adopted in the implementation of CBE. They also identified the importance of the facilitation process as being crucial to successful CBE. The participants' feedback indicated that different participants had a different understanding of their teaching practice of CBE. Although the most important item was the same for both groups, it was noted that only two of the seven items were similar for both groups. It was also noted that both groups identified themes related to the educator whilst only group two identified aspects related to student (Table 1).
The vertical themes of Groups 1 and 2 are ranked based on the NGT priority listing. The horizontal themes represent the similarity of themes across the two groups whilst maintaining the ranking. The core themes are the outcome of further synthesis of the horizontal themes, as reflected in Figure 2. The synthesised core themes include teaching and learning related issues, student issues and educator issues.
The responses of the participants pertained to activities and tasks that participants regarded as their responsibilities as educators. Those responsibilities included the role of a nurse educator (lecturers and clinical supervisors) in managing the process of learning in the CBE approach. The participants' experiences related to both theory and clinical teaching. The most important aspects that were identified by both groups in terms of the teaching and learning session in CBE were:
Participants reported that activities such as role play, facilitation of small groups, interactive group discussions and presentations should be used to assist students with integrating a relevant case to particular subject matter (Group B). Most participants regarded activities such as dividing the students into small groups, explaining the pre-requisite knowledge, identifying appropriate resources, and assisting the students to gather required resources for their presentations as important.
Participants highlighted that it is important to guide students to understand the specific outcomes of every contact session (Group B) and provide triggers or questions about the case. During students' presentations, links to real life experiences would be pointed out for students to note, which enhances integration of theory and practice as noted by one participant:
'I encourage active learning of student[s] in analysing the situation [case] by seeking [the] student to cooperate and provide feedback; I evaluate the student to establish if the student comprehends the case. I believe this actually stimulates critical thinking in the student.' (Group B)
'I encourage active learning of student[s] in analysing the situation [case] by seeking [the] student to cooperate and provide feedback; I evaluate the student to establish if the student comprehends the case. I believe this actually stimulates critical thinking in the student.' (Group B)
Having identified assessment as a challenge in the implementation of CBE at the school of nursing, it was noted that to further improve the implementation of CBE, additional workshops were needed with a specific focus on assessment strategies.
In the teaching and learning process, the role of the educator is crucial, and in this study, the issues related to the educator, which potentially affected effective implementation of CBE, were identified as personal and professional development, and practice issues and work environment.
During discussions, the participants emphasised the importance of being knowledgeable about the subject or content that was taught, as well as the CBE facilitation process, as it influenced the educator's ability to competently manage the learning process. It is, therefore, important to strengthen these educator related aspects in order to enhance the teaching and learning process. Ramaekers et al. (2011) noted that one of the important conditions for CBE is having competent teachers who support students throughout the teaching and learning process.
The educators agreed that the work environment where they functioned should be supportive and that there should be frequent in-service sessions or workshops on CBE.
The third aspect to be considered for effective implementation of CBE was the selection of students into the programme. It was mentioned by participants that the capabilities of students accepted into the programme should be carefully considered as they would need to cope in a CBE environment. The participants proposed that the students who were selected for the programme should be motivated and able to engage in self-dircted learning, as these are criteria for effective CBE.
Participants in the study highlighted various strategies that are employed in the implementation of CBE at the specific nursing school. These included the use of group work, reflection and student presentation. This is consistent with what has been reported in literature on the use of CBE as a teaching and learning approach (Harman et al. 2015; Raurell-Torredà et al. 2015; Williams 2005). As noted by Harman et al. (2015) and Ramaekers et al. (2011), the educator is responsible for facilitating learning and for providing opportunities for students to develop critical skills. In this study, the participants reported being challenged by inadequate skills to facilitate learning in CBE. This was highlighted as important for best practice. The participants indicated the need to strengthen their facilitation skills through further in-service training sessions. Improving the competence of the educators to facilitate CBE will, thus, improve student learning (Williams 2005) as students are better supported by competent teachers (Ramaekers et al. 2011).
Similar to previous studies such as Harman et al. (2015), time constraints were noted by participants as being a challenge. Furthermore, the pre-knowledge of students was reported to be limited, hence the emphasis on the caliber of the students to be recruited and selected in the programme. However, this limitation could easily be linked to a lack of organisational skills and accountability on the part of the student, as was noted by Harman et al. (2015). Students in higher education are expected to use higher-order thinking and take responsibility for their own learning. It is important, therefore, that these skills are developed by students from an early stage in the programme. The educators should strive to develop students who are independent and responsible for their own learning (Harman et al. 2015).
As part of the last step of participatory action research applied in the study, participants determined the follow up actions required. It was agreed that the educators would continue to learn more about CBE and strive towards improving their facilitation of CBE. Future planned activities were recommended to strengthen the implementation of CBE at the school in question, and included:
It is anticipated that information and skills gained in these workshops will enhance the implementation of CBE in the school.
It was agreed that the cases presented in the student's module guides required revision. Furthermore, peer support in relation to CBE facilitation was proposed, which could be undertaken by visiting each other's classroom sessions and providing feedback. It was also suggested that starting with a simple and well-structured case study, and gradually adding complexity by introducing more contextual features and structure, as seen with problem-based learning (PBL), seems to be a logical way to slowly transition students from a predominantly dependent student mode to more autonomous learners who are ready for practice. Educators should challenge students to develop clinical judgment and problem-solving skills, by asking students the 'why' questions, where appropriate.
The workshop presented in this paper was conducted as part of an ethically approved broader study which evaluated the Common Teaching Platform for undergraduate nursing in the Western Cape, and aimed at improving the offering of the Bachelor of Nursing programme (Registration No. 10/4/24). The participants were informed about the purpose of the workshop and the intent to publish its outcomes; they also consented voluntarily to participate after the process was explained to them. Anonymity and confidentiality were maintained, by ensuring that the participants' names were not revealed. Data collected in the study were only available to the researchers, and kept safely throughout. Participants' comfort was ensured by providing an appropriate venue.
In order to increase the rigor of the study and the qualitative data collected, trustworthiness was established by ensuring confirmability, dependability, transferability, and credibility of the data and findings (Creswell 2014). Some of the strategies employed to bolster the trustworthiness of the study were: member checking, debriefing, source triangulation, and auditing of the analysis by cross checking from the authors.
This study was conducted at one institution that offers an undergraduate nursing programme in South Africa. The findings of the study cannot be generalised as this was conducted as a qualitative study and was contextual in nature. However, a detailed description of the study procedure provides an opportunity for the study to be replicated in other settings.
The workshop proceedings served three purposes. Firstly, it allowed the collection of data from the participants with regard to their views of current practices in CBE and, secondly, it allowed the participants to identify the best practices to be adopted by the school of nursing. Thirdly, presentation and active discussion were part of staff capacity development, with regard to each individual's report of his or her experience of his or her own practice in relation to colleagues in the same discipline, year level, or immediate context. This is part of the development as it identified ways of improving one's practice as an educator facilitating CBE. This aspect of staff development is essential, as the educator's preparation for the new role is crucial for success (Uys & Gwele 2005).
Professor M.G-L played an important role in facilitating the workshop and sharing expert knowledge about CBE, as well as PBL. The lecturers who were involved, in teaching the Bachelor of Nursing programme and the clinical supervisors involved in the clinical supervision and accompaniment of these students, thank you for participating in the workshop.
The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.
All authors participate in the workshop facilitation. N.S.L. drafted the article, F.M.D. and R.R.M.M. revised, corrected and expanded on the article, and L.P.F reviewed the article.
Baum, F., MacDougall, C. & Smith, D., 2006, 'Participatory action research', Journal of Epidemiology and Community Health 60, 854–857. http://dx.doi.org/10.1136/jech.2004.028662
Bowe, C.M., Voss, J. & Thomas Aretz, H., 2009, 'Case method teaching: An effective approach to integrate the basic and clinical sciences in the preclinical medical curriculum', Medical Teacher 31(9), 834–841. PMID: 19811189, http://dx.doi.org/10.1080/01421590902922904
Creswell, J.W., 2014, Research design: Qualitative, quantitative and mixed methods approaches, 4th edn., Sage, Los Angeles.
Daniels, F.M. & Khanyile, T.D., 2010, 'Evaluating the effectiveness of the regional collaboration on the common teaching platform for undergraduate nursing in the Western Cape', PhD thesis, School of Nursing, University of the Western Cape.
Department of Education (DoE), 1997, A programme of the transformation of higher education, Education White Paper 3, Government Printers, Pretoria.
Department of Education (DoE), 2001, National plan for higher education. Pretoria, Government Printers, Pretoria.
DeSanto-Madeya, S., 2007, 'Using case studies based on a nursing conceptual model to teach medical-surgical nursing', Nursing Science Quarterly 20(4), 324–329. PMID: 17911329, http://dx.doi.org/10.1177/0894318407307159
Hansen, W.F., Ferguson, K.J., Sipe, C.S. & Sorosky, J., 2005, 'Attitudes of faculty and students toward case-based learning in the third-year obstetrics and gynecology clerkship', American Journal of Obstetrics and Gynecology 192, 644–647. PMID: 15696016, http://dx.doi.org/10.1016/j.ajog.2004.10.595
Harman, T., Bertrand, B., Greer, A., Pettus, A., Jennings, J., Wall-Bassett, E. et al., 2015, 'Case-based learning facilitates critical thinking in undergraduate nutrition education: Students describe the big picture', Journal of the Academy of Nutrition and Dietetics 115(3), 378–388. PMID: 25441959, http://dx.doi.org/10.1016/j.jand.2014.09.003
Ilgüy, M., Ilgüy, D., Fişekçioğlu, E. & Oktay, I., 2014, 'Comparison of case-based and lecture-based learning in dental education using the SOLO Taxonomy', Journal of Dental Education 78(11), 1521–1527. PMID: 25362693.
Jeggels, J.D., Traut, A. & Kwast, M., 2010, 'Revitalization of clinical skills training at the University of the Western Cape', Curationis 33(2), 51–59. PMID: 21469516, http://dx.doi.org/10.4102/curationis.v33i2.1096
Potter, M., Gordon, S. & Hamer, P., 2004, 'The nominal group technique: A useful consensus methodology in physiotherapy research', New Zealand Journal of Physiotherapy 32(3), 126–130.
Ramaekers, S., van Keulen, H., Kremer, W., Pilot, A. & van Beukelen, P., 2011, 'Effective teaching in case-based education: Patterns in teacher behavior and their impact on the students' clinical problem solving and learning', International Journal of Teaching and Learning in Higher Education 23(3), 303–313.
Raurell-Torredà, M., Olivet-Pujol, J., Romero-Collado, A., Malagon-Aguilera, M.C., Patińo-Masó, J. & Baltasar-Bagué, A., 2015, 'Case-based learning and simulation: Useful tools to enhance nurses' education? Nonrandomized controlled trial', Journal of Nursing Scholarship 47(1), 34–42. PMID: 25346329, http://dx.doi.org/10.1111/jnu.12113
Sangestani, G. & Khatiban, M., 2013, 'Comparison of problem-based learning and lecture-based learning in midwifery', Nurse Education Today 33(8), 791–795. PMID: 22503681, http://dx.doi.org/10.1016/j.nedt.2012.03.010
Thistlethwaite, J.E., Davies, D., Ekeocha, S., Kidd, J.M., MacDougall, C., Matthews, P. et al., 2012, 'The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23', Medical Teacher 34(6), e421–e444. PMID: 22578051, http://dx.doi.org/10.3109/0142159X.2012.680939
Uys, L.R. & Gwele, N.S., 2005, Curriculum development in nursing: Process and innovation, Routledge, London.
Williams, B., 2005, 'Case based learning — A review of the literature: Is there scope for this educational paradigm in prehospital education?', Emergency Medicine Journal 22, 577–581. PMID: 16046764, http://dx.doi.org/10.1136/emj.2004.022707
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NATIONWIDE — Construction is underway on new health clubs, YMCAs and JCCs nationwide. Here are some of the projects planned or under construction:
A new Jewish Community Center will be built on 15 acres of land in Cincinnati, OH. The proposed multi-million dollar facility will cover 148,000 square feet and feature a fitness center, aquatics center, gym and an expanded senior center. Construction will begin in January 2006, and the center will open in late summer of 2007.
Cayuga Medical Center and Ciaschi Development are teaming up to introduce a medical fitness center in Ithaca, NY. The 65,000-square-foot complex will house a 35,000-square-foot fitness center with large exercise areas and three pools.
The YMCA of Metropolitan Minneapolis and the City of Andover have partnered to build a $20 million YMCA in Andover, MN. The YMCA (pictured in the rendering above) will feature a health and wellness center, aquatics center and children's gym.
The new South Loop Fitplex, a 30,000-square-foot health, fitness and spa center was recently completed. The fitness complex is located within a new luxury residential development in Chicago's South Loop.


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1 bedroom accommodation in Port Frejus
- Bungalow31 m²
- People: 3
- Bedrooms: 1
- Bathrooms: 1
- Min. Stay: 3 - 7 nights
1 bedroom accommodation in Port Frejus
Property Manager
Property Manager
- Languages:
- English, French, German, Spanish, Italian, Dutch, Czech, Hungarian, Romanian
- Internet
- Air Conditioning
- 1 Bathroom
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A family holiday or a weekend on the Côte d'Azur Staying at the Cap Hermès residence, gives you the chance to enjoy the activities on offer at the residence and the resort of Port-Fréjus:
- The outdoor swimming pool with paddling pool and equipped solarium, open from June to September.
- F. Léotard nature base 300 metres away with multisports grounds, playground, biking trails, fitness trail...
- Galliéni Tennis Club, horse-riding school 3 kilometres away.
- Water and theme parks, Port Fréjus is a listed as "Art and History Town"
- Hiking on the marked paths in a natural, unspoilt environment.
On the Côte d'Azur in Var department, between the Maures and Esterel massif, Port-Fréjus is a town brimming with history. Its marina situated on a magnificent Mediterranean bay, is built in the style of a Roman palace.
- Frejus is bordered by very beautiful beaches that will allow you to practice several nautic sports for the whole family : scuba diving, jet-ski, windsurfing, kayak, parasailing, fishing.
- Town brimming with history, discover Frejus' important spots : the Roman period monuments such as the amphitheatre, the aqueduct, or the port, former famous Roman port ; the chapel decorated by Jean Cocteau, and the medieval area.
- Numerous family outings are possible in Frejus : visit of the Port-Frejus' zoological park with more than 110 species of wild animals, adventure moments thanks to the two amusement parks of the city, Aqualand 2 kilometres away, and Luna Park open in summer.
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Beds made on arrival
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Wi-Fi in the apartments: Wifi Basic Access is included from 11.14.2015. Note: Wifi Full Access is against extra fee.
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A. It is easiest to think of these as barrel-shaped insert nuts,
except they self-anchor and are removable. Usable horizontally,
vertically or at any angle in between, they accept
common 1/2-13 threaded bolts and will wedge in throughholes
in material as thin as 5/8" (depending on the strength of
the material) or in blind holes 1-1/4" deep.
With a pull-out
strength of at least 200 lb* in hardwood, the anchors have a
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screw drive and an external rubber O-ring that uses friction
to hold it in place during installation. With 3/8" of internal
thread travel, the anchors are designed to secure materials of
known thickness using a fixed-length fastener (for example,
fastening 3/4" thick material with a 1" long machine screw).
Ideal for fastening thin material, they are useful for fixing
jigs, guides, etc. Best used with non-hex head drive
fasteners, as the force applied with a wrench may overpower
the anchor, loosening or dislodging it.
The 3/4" bench anchor secures in any 3/4" diameter hole;
the 20mm bench anchor secures in any 20mm hole. Both are
made in Canada with all-steel construction.


text:
G3600 A4 engines provide a wide range of power options to fit your gas compression application. G3600 A4 engines bring the highest uptime in the industry and long operating intervals between overhaul. Operators that use G3600 A4 engines in their fleet enjoy virtually no unscheduled downtime, the right power for their application, the lowest operating costs, and emissions compliance. Ideal applications for G3500B engines include centralized gathering stations, gas processing, transmissions, and storage applications. Cat G3606 gas engine with ratings: 1398-1499 bkW (1875-2010 bhp) @ 1000 rpm are NSPS site compliant capable.
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Meets U.S. EPA Spark Ignited Stationary NSPS Emissions for 2010 with the use of an oxidation catalyst
Lean-burn engines operate with large amounts of excess air. The excess air absorbs heat during combustion reducing the combustion temperature and pressure, greatly reducing levels of NOx. Lean-burn design also provides longer component life and excellent fuel consumption.
Side covers on block allow for inspection of internal components
ADEM A4 engine management system integrates speed control, air/fuel ratio control, and ignition/detonation controls into a complete engine management system. ADEM A4 has improved: user interface, display system, shutdown controls, and system diagnostics.
Large variety of factory-installed engine attachments reduces packaging time.
Every engine is full-load tested to ensure proper engine performance.
GERP is a PC-based program designed to provide site performance capabilities for Cat® natural gas engines for the gas compression industry. GERP provides engine data for your site's altitude, ambient temperature, fuel, engine coolant heat rejection, performance data, installation drawings, spec sheets, and pump curves.
More than 2,200 dealer outlets Cat factory-trained dealer technicians service every aspect of your petroleum engine Cat parts and labor warranty Preventive maintenance agreements available for repairbefore-failure options S•O•SSM program matches your oil and coolant samples against Caterpillar set standards to determine: - Internal engine component condition - Presence of unwanted fluids - Presence of combustion by-products - Site-specific oil change interval
Over 80 years of natural gas engine production Ownership of these manufacturing processes enables Caterpillar to produce high quality, dependable products - Cast engine blocks, heads, cylinder liners, and flywheel housings - Machine critical components - Assemble complete engine
For all your petroleum power requirements, visit www.catoilandgasinfo.com.


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Cosmic Connections Radio Show with Madeline Gerwick: An Economic Update and What's Happening in June
05/09/2008 12:00 am PDT
Dr. Pat Baccili
Dr. Pat Baccili helps individuals and organizations break through their limiting Crust so they can reach their unlimited potential. Her specialty is assisting people face t...Find out more »
Madeline Gerwick
Madeline C. Gerwick is an internationally - recognized, business, economic, and personal astrologer, speaker, and author. She has a BA degree with honors in economics, ...Find out more »


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Aaliyah Screen Saver 2.00
Free Aaliyah Screen Saver - Screen saver with hundreds of pictures of Aaliyah.
FreeSetup.exe file was thoroughly tested by our system on May 26, 2011 by the three antivirus programs and passed. Is absolutely clean, enjoy!
This archive is 100% safe to download and install.
Have a look at the full Aaliyah Screen Saver 2.00 antivirus scan reports.
(2.23MB, Extension: EXE)
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Look at the free or trial alternatives and similar apps to Aaliyah Screen Saver software by the tags. It's possible also to find substitutes for the most popular titles in the Screensavers Source category.
History updates (Complete changelogs since the listing on this site)
2.00 [12-06-06]
Useful independent reviews and opinions of the users
Predicted future versions and notices:
The doDownload.com constantly monitors the update of all programs, including information from the Aaliyah Screen Saver 2.00 changelog file, however sometimes it can happen that data are not complete or are outdated.We assume that author continue's to develop 2.1 version with further advanced features, and soon you will be informed. Equally important 3.0 upgrades of the program we will continue to monitor. Full Aaliyah Screen Saver description has been compared with the overall software database and our algorithm has found the following applications (are showed below).


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Not just an icon among musicians but a national treasure, it's impossible to know how the UK music scene would have looked without Marshall Amps. The likes of Jimi Hendrix and Pete Townshend relied on a Marshall stack amp not just to deliver the volume they needed but a true voice for the electric guitar. To this day nothing else sounds quite like a Marshall guitar amp, so the 1959, JTM, JCM and Silver Jubliee amps remain in production for a new generation.
Expanding beyond the British 'Rock and Roll' sound, Marshall's extensive range of combos, bass amps, heads and extension cabinets are used around the world for their clarity, volume and versatility.
The need for loud amps isn't quite so great these days and players can get away with a cranked combo along with PA wedges. So the DSL and JVM amps offer valve tone that goes down below 50 watts and is altogether more portable. If you only need that sweet tube distortion for practice and recording then Marshall offer guitar amps that go down to 5 watts and below, get the Marshall sound down without dealing with complications caused by the amp being too loud in the room.
To mark the 25th Anniversary of Marshall Amps back in 1987, Jim Marshall designed the Silver Jubilee amp series which quickly became a much sought-after, Limited-Edition run of classic Marshall amps. Chrome front-plating with a silver vinyl covering gave these amps a striking stage appeal, which also helped mark Jim's 50th year in the music industry. In 2013, Marshall re-released these iconic amps in the form of the 2555X Amp head and 2551AV Cabinet.
If you're just starting out or need an affordable practice amp then Marshall have voiced the MG Carbon range to make that unmistakable character available in a solid state combo. There's built in effects too, so no need for loads of effects pedals. For the truly portable there's the MS-2 Micro amp, Marshalls amp tone in something not much bigger than a pack of cigarettes!
Marshall even offer a range of clothes, accessories and merchandise so you can get the Rock'n'Roll look to match your amplifier or stack! It's only a matter of time before we see Marshall Guitars on the scene...we can only hope!
Not many brands have such a rich heritage and history as Marshall, hence when guitarists around the world choose their amps to deliver timeless guitar tone at the back of the big stage, in the studio or at home.


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Marina (ID: 14136)
Date of birth:February 09, 1985
Height:5' 4" (164 cm)
Weight:110 lb (50 kg)
Hair color:Blonde
Eyes color:Green
Marital status:single
Profession:manicure expert
English language:beginners' level
Others foreign languages:No
Seeks partner:34 - 55 years old
Total photos:9
Bikini photos:0
Hobbies and interests:
I think that I am very curious lady because I like to go to museums, theaters, discos. Sometimes I like to sit at home reding magazines and newspapers.
About me:
I am a very cheerful, lifeloving and kind lady. I like sea, sunny weather, noisy companies and walking in the evening city. I have lots of friends and that's why I like to spend my free time with them somewhere in the nature.
Looking For Men Type:
I would like to meet a serious, lifeloving, well-educated and cheerful gentelmen with good sense of humor with whom it will be easy and cozy to live and who will love and understand me.
Copyright 2003-2016 © www.city-meeting.com.
DBA: Syedyshev group services LLP. All rights reserved.
General comments or questions: Contact Us


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Diana E. Knauf
Diana E. Knauf
Online Monday-Friday during the quarter. (Please email for an appointment.)
|Rm 5338
Hi – I am Psychology professor Diana E. Knauf, and I have been at Shoreline Community College since 1998. I recently returned from spending a couple of years working virtually from Shanghai, China.
I teach:
- Psychology 100 (General Psychology)
- Psychology 200 (Lifespan Development)
- Psychology 208 (Adulthood: Aging and Development)
- Psychology 210 (Human Sexuality)
- Psychology 245 (Social Psychology)
I advise students who are interested in Psychology or planning to transfer to a Psychology program to obtain a bachelor's degree. I am also one of Shoreline's first eAdvisors, providing advising to eLearning students and Psychology majors by way of email and web applications.
I believe that the goal of learning is to gain information and skills that allow us to live better out in the real world. It is also important to me that students have fun while learning what they need to know. I have sometimes been referred to as the Dr. Ruth of Shoreline, teaching Human Sexuality (Psychology 210) both as a stand-alone course, and also as a part of an Interdisciplinary course (courses that combine more than one discipline). With colleagues Rachel David (Women's Studies) and Brooke Zimmers (Interpersonal Communication), Intersextions explores the connections between sex, power, communication, gender and relationships.
I received my Ph.D. in Applied Developmental Psychology from Fordham University in New York City. My research interests include: street harassment, mastery motivation and cross-cultural psychology. Publications are available on request.
Psychology links:
American Psychological Association
Association for Psychological Science


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Exercises to Avoid When You Have Diabetes
Regular physical activity is an important part of a healthy lifestyle when you have diabetes. It is good for your cardiovascular system and can help control blood glucose levels. However, there are times when you need to be careful about exercising with diabetes. If you have certain diabetes complications, there are exercises that you should avoid. Michael See, MS, RCEP, Clinical Exercise Physiologist at Joslin Diabetes Center, discusses certain situations that may require you to modify your fitness program
The following complications may affect your exercise routine:.
Proliferative diabetic retinopathy (PDR)—Patients with diabetes and active PDR should avoid activities that involve strenuous lifting; harsh, high-impact activities; or placing the head in an inverted position for extended periods of time.
Diabetic peripheral neuropathy— Diabetic peripheral neuropathy may result in loss of sensation and position awareness of your feet. Repetitive exercise on insensitive feet can lead to ulceration and fractures. "Limit your choice of exercise to low impact or non-weight bearing activities," says See.
Advanced kidney disease— Individuals with diabetes and advanced kidney disease can engage in moderate intensity activities, but should avoid strenuous activity.
High blood glucose levels— Individuals with type 1 diabetes should avoid exercise if fasting blood glucose is higher than 250 mg/dl and ketones are present. Caution should be used if glucose levels are higher than 300 and no ketones are present. Individuals with type 2 diabetes should avoid exercise if blood glucose is higher than 400 mg/dl. Monitoring blood glucose before, after and possibly during physical activity is necessary to keep blood glucose within an appropriate range.
Always consult with an exercise or health care professional before beginning any fitness program.
Related Links
To make an appointment with a Joslin exercise physiologist, please call (617) 732-2400.
Staying Healthy With Diabetes -- Physical Activity & Fitness explains how physical activity can lower your blood glucose, provides information about weight loss, managing highs and lows during physical activity, exercising when you have other physical problems and how to avoid the road blocks to fitness.
Click here to purchase this book from the Joslin Store.
Page last updated: September 18, 2019


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Abortion bill close to clearing the House
By David Saleh Rauf, Kolten Parker & Jayme Fraser
Austin Bureau
AUSTIN — House Republicans tentatively passed one of the nation's most stringent packages of abortion restrictions Tuesday.
The Texas House voted to give initial OK to House Bill 2, a proposal that would ban abortion at 20 weeks and impose stricter standards for clinics. Critics of the bill say the added burden would cause the majority of providers in Texas to close.
"Now is not the time to play political football with women's health," said Rep. Sarah Davis, R-West University Place, the sole Republican to vote against the bill. "Abortion is a terrible way to end a pregnancy, but it is a constitutionally protected right," Davis said.
A final House vote is set to take place Wednesday. The Senate is expected to take up the measure early next week.
Impassioned debate preceded the vote Tuesday, including heated standoffs between lawmakers and graphic testimony from both sides of the aisle.
State Rep. Senfronia Thompson used props to describe "back alley" abortions, which she says women will be forced into if the bill passes.
The bill's author Rep. Jodie Laubenberg, R-Parker, said her goal was to stop abortion after 20 weeks, "based on the pain, based on the science and technology we have now." She does not believe new standards for clinics will force them to close.
For complete coverage, go to www.expressnews.com


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Beaumont to increase water service rates
Beaumont City Council voted Tuesday, July 15, to amend the city's code of ordinance Section 22.02.001 to reflect an increase in water service rates by 5 percent.
The increase will take effect Oct. 1 and will fund a major capital improvement effort to enhance the water and sewer system. The effort includes $15.5 million to complete projects currently under construction and $3.5 million to fund new clarifiers at the sewer treatment plant, the council agenda states. The city also plans to refund $63.9 million in outstanding revenue bonds in order to achieve a lower interest rate and savings, according to the agenda.
"The proposed rate increase of 5 percent is required to fund the new debt service after considering the estimated savings from the refunded issues as well as the debt related to the Automated Metering Infrastructure and Leak Detection project and the recently financed equipment," City Manger Kyle Hayes said. "The rate increase is projected to produce an additional $2.15 million in revenues annually."
In other city business, after considering bids from 13 vendors, the council voted to award a $242,298 contract to ARC Abatement of Houston for asbestos abatement and demolition of the Castle Motel at 1125 N. 11th Street.
The number and severity of code violations resulted in the structures being tagged as unsafe for both tenants and the public. Since the buildings were vacated, the motel has only deteriorated further and continues to be open and accessible, despite attempts by the owner to secure it. It has been determined that for health and safety reasons, it is necessary to demolish the structures, the council agenda states.
At this time no date has been set to begin demolition, an ARC representative told the Examiner.


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3-year-old boy dies after being left in a hot vehicle Saturday on the far West Side
Fourth Torchy's Tacos location coming to San Antonio
San Antonio restaurant inspections: Sept. 20, 2019
Report: Trump 'less than thrilled' Don Jr. is dating Guilfoyle
Here's what the Area 51 storming looks like
The Navy says those UFO videos are real
Local shares then and now pictures of San Antonio on social media
George Strait's hilltop castle in The Dominion listed for $8,900,000
Fall Texas getaways start at $18 per person at these affordable rentals
Spurs round out coaching staff
Posts filtered on Category
Gipsy Kings announce San Antonio show
The internationally acclaimed, Grammy Award-winning Gipsy Kings will return to the Majestic Theatre on Monday, May 9 at 7:30 p.m. Together for more than 25 years, the French export has sold 20 million …
Maverick Music Festival announces first bands
SAN ANTONIO – The Maverick Music Festival — which will run April 8-9 at La Villita — announced some of its big names Monday. Set to perform are the Flaming Lips, Public Enemy, the Drums and the …
Accordion queen at La Botanica on Sunday afternoon.
SAN ANTONIO – Eva Ybarra, the grand dame of the conjunto accordion, will be performing a happy hour gig on Sunday on the St. Mary's Strip at La Botanica, the vegan restaurant and patio bar. Ybarra y …
Deftones to play the Lone Star Brewery
SAN ANTONIO – Expect to hear new material from Deftones when the alt-metal band arrives March 19 at the Lone Star Brewery. The band, whose history in the Alamo City dates to the '90s when it performed …
Jazz great Jackie King reportedly gravely ill
SAN ANTONIO – Left-handed jazz guitarist Jackie King, respected around the world and often at Willie Nelson's side, has suffered a massive heart attack following a recent stroke. The news was posted …
Beloved West Side rock 'n' roller dead at age 65
SAN ANTONIO – Beloved West Side musician Danny Esquivel died Wednesday morning from complications of liver disease and diabetes. He was 65. More than 50 years ago, he was the baby-faced kid playing …
The Kiss Army meets the Spurs Nation today
SAN ANTONIO – It's going to be fun and maybe a little crazy today when Kiss frontman Paul Stanley arrives at AT&T Center for the grand opening of the new family-friendly, rock-themed restaurant …
All-star show tonight benefits Children's Hospital of San Antonio
SAN ANTONIO – Flaco Jimenez, Michael Salgado, Rick Orozco, Semeneya, Mike Robles and Mike Garofalo lend their talents tonight (Nov. 18) at Arjon's International Club for a benefit show for Children's …
Stevie Wonder frightfully good on Halloween at AT&T Center
SAN ANTONIO – Stevie Wonder brought his acclaimed Songs in the Key of Life Tour to the revamped AT&T Center on Halloween night for a crowd of 6,500. It was his first ever concert appearance here. …