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Accessories & Fit Kits
Having your vehicles in brakes in proper working order is vital for your safety. And having the brake pads fitted with the proper pins, springs, coils or clips for your transport type is vital. Contact James Walsh Motor Parts on (056) 772 2810.
Brake Discs
Brake discs work in conjunction with other components to ensure that you can bring your vehicle to a stop. They usually do not need as much changing as brake pads, this depends on driving conditions and driving style, but it is just as important to have them checked out and if they need changing, have them replaced as soon as possible. Each make and model has its' specific components and James Walsh's can help you get the correct discs for you. Trusted brands sold at James Walsh's include Mintex and Borg & Beck, Blue Print. Call (056) 772 2810.
Brake Drums
Brake drums work on the same principle as brake discs, shoes press against a spinning surface. In the breaking system of your vehicle, that surface is called a drum. Many cars have drum brakes on the rear wheels and brake discs on the front. Trusted brands sold at James Walsh's include Mintex, Borg & Beck & Blue Print. To find out more call us on (056) 772 2810.
Brake Shoes
Brake shoes and brake drums go hand in hand. Trusted brands sold at James Walsh's include Mintex, Borg & Beck & Blue Print.
Brake Pads
Brake pads are absolutely essential to the efficient working of any vehicle. Brake pads are the component that applies pressure and creates friction to the brake rotors, and this stops the wheels. How long should my brake discs last? Well it can differ with every vehicle and also depend on the way it is driven, where it is driven and, of course, how often it is driven. Signs that you need to replace your brake pads include loud screeching, warning light on the dash of your vehicle, your vehicle vibrates and by a visual check. We have access to brake pads of the highest standard and sell trusted brands such as Mintex, Borg & Beck & Blue Print, so call us on (056) 772 2810 for all your brake pad needs.
Wheel Speed Sensor
The wheel speed sensor is attached to the hub of a drive tire and is responsible for monitoring multiple vehicle functions such as traction control, anti-lock braking systems, and obviously, the vehicle's speed. To make further enquiries please call us on (056) 772 2810.


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Behavioral Design offers ideas and techniques for persuading user behavior. Some of these techniques encourage behavior, others discourage it. Some work best on behaviors that happen once, while other techniques work best on behaviors that happen often. For each tool and technique in the Behavioral Design Toolbox, there is a purpose — and for each purpose, a tool.
Reinforcement Learning
Reinforcement Learning increases the frequency that someone performs a behavior. RL focuses on how a habit can be induced by carefully controlling the rewarding consequences of an action. RL predictably improves how much and how often people engage with an app or product, and for how long they'll retain using that app. It works on behaviors that people already do, as well as behaviors they do not yet do.
A Trigger (also known as a Cue), is a prompt to perform an action. When used together with Reinforcement Learning, they increase the frequency of a behavior (it's the T in the TAFR Model). Triggers work because, often, users automatically perform certain behaviors in response to signals from their internal and external environments.
Chapter 1 explores how the association of a particular trigger with a particular action is the fundamental unit of a habit. Chapter 2 teaches you and your team how different types of Triggers work, and how you can use them to change user behavior and make your app habit-forming.
Optimal Challenge
Optimal Challenge prescribes that at a given moment and for a given person, there exists an optimal amount to challenge or push, someone to perform an action. Challenge less, and you may not help the person achieve their goals. Challenge more, and you may induce fatigue and user burnout.
Optimal Challenge proposes that not only does this "sweet-spot" exist, but that it is detectable, predictable, different between people, and changes with respect to time. Optimal Challenge can be used to induce both a behavioral increase or a behavioral decrease.
Stimulus Devaluation
People learn, through experience, that certain actions will lead to positive outcomes: that's the core of Reinforcement Learning and the TAFR Model. But how do you un-wire that learning?
Stimulus Devaluation provides a technique for destroying a learned Trigger-Action association by introducing delay and friction between an Action and its associated Reward. The resulting experience still allows a user to perform their desired action while destroying the habit-forming nature of the experience. Stimulus Devaluation works best to decrease behaviors that people already perform, especially those for which they've been positively reinforced using the TAFR Model.
Stopping Rules
An object in motion tends to stay in motion, and our behavior works the same way. Our nervous systems naturally look for "stopping cue" signals from our environment that tell us we've completed an action.
Stopping Rules prescribes that stopping cues can be controlled to increase or decrease certain behaviors. One commonly seen example of Stopping Rules is to remove all of the normal stopping cues from an environment. Without stopping cues, users consume much, much more. Ubiquitous infinite scroll social feeds, pioneered by Pinterest, but now seen on Twitter and Facebook to leverage this effect: the more users view content, the more content is loaded for their consumption.
Choice Architecture
When presented several options of how to behave, people often perform the default behavior. It's no mark of weak-will or laziness, it's part of how our brain takes shortcuts to help us make decisions efficiently.
Choice Architecture prescribes that, as a Behavioral Designer, you can design someone's environment as to create specific, intentional default actions they will take. Popularized by Sunstein, Thaler, & Balz, Choice Architecture (also known as Nudge Theory) pervades our daily life and is one of the most successful and widely-used Behavioral Design techniques. It's best used to guide users towards a particular desired choice when faced with several possible actions they could take, and it can be used to both increase and decrease behaviors.
Ambient Communication
Often, you'll need to present complex or dense information to someone. Ambient Visualization prescribes that using non-text communication, such as color, size, texture, pattern, motion, sound, vibration, or time can help you communicate complex content to users quickly and intuitively.
It relies on the brain's other, non-verbal information processing streams to understand the environment faster than reading alone might afford. It can be combined with other Behavioral Design techniques, such as Reinforcement Learning, Optimal Challenge, or Triggering, to increase their efficacy. It's often used successfully to persuade people to perform an action they need to only do once, such as a signup form or completing a purchase.
Optimal Information Flow
People process information differently from one another. For example, steps in a signup workflow that might be intuitive to one user might be wildly disorienting to another user. Someone might be able to mentally juggle many complex ideas simultaneously. Another person might focus best on one idea at a time.
Optimal Information Flow proposes that there exists, for each person, an optimal ordering of steps for a process and an optimal density of information they can be presented with before they struggle to perform your desired action. This technique works best on actions that you need people to perform once or infrequently, such as a signup form or completing a purchase.
Soft Incentives
Where Reinforcement Learning increases the frequency of recurring behaviors by variably providing a reward immediately after someone performs the desired action, Incentives work by promising a future reward for an action taken today.
Soft Incentives describes how your App may use the future promise of emotional or community-based value to encourage a single, challenging, one-off behavior today. Soft Incentives largely rely on our desire for personal accomplishment, congruence with our narratives of identity, or the approval of our friends.
Sunk Cost
When we begin to financially, emotionally, or logistically invest in things, we grow to value them more: even beyond how much we actually like them or how actually useful they are to us.
The Behavioral Design technique of Sunk Cost leverages the cognitive bias of Sunk Cost Fallacy, for which people inaccurately over-value experiences, relationships, or products because they've already given them time, money, information, or opportunity. Sunk Cost is a critical feature of Behavioral Designer Nir Eyal's "Hook"\cite{eyal2014hooked} Model (which shares many commonalities with the TAFR Model) and is captured in his "Investment" phase of the Hook Model. Sunk Cost can be a particularly effective way to increase the frequency of a behavior that users are already performing by introducing a "ratchet" effect in which they become more likely to keep using you Product because they over-value the importance of their previous use and investment.
Optimal Group Structure
If your App connects people to one another, how do you know the best way each user would prefer to experience this social component?
Different users exhibit different preferences for their interactions with each other: some feel most motivated alone, others in small groups of peers, and some in the full gaze of the public. Optimal Group Structure proposes that there exist predictable, optimal scopes and natures of interactivity between app users that will best motivate them to change their behavior.
You may have heard of the hypothesis that students have "learning styles," and that students learn best when the material is adapted to that style (That hypothesis has been soundly repeatedly falsified). But there is a larger truth to that myth. Not everyone thinks the same way or wants the same thing. Many design teams use personas to help design for different user groups, skill levels, or user needs. New machine learning techniques are making it possible for designers to produce even more adaptive products.
Cognitive Load Balancing
By and large, the human mind is capable of juggling only a few tasks at once and capable of remembering up to about 10 things at once.
If your App requires the user to simultaneously interact with many different events, people, concepts, or ideas, Cognitive Load Balancing prescribes techniques for how you might best display only fragments of the whole information set to a user at once and effectively switch between those fragments. Limiting how much mental work the user must do at any time can improve their quality of experience and increase their ability to properly perform the target action you need them to do.
Why Start with Positive Reinforcement?
As we'll explore in Chapters 2 and 3, Reinforcement Learning isn't new. Beyond our intuitions of why and how positivity should influence behavior, Reinforcement has been proven effective for inducing behavior change for decades. Since its first academic explorations in the early 1950s, teams have published thousands of reports exploring the underlying brain anatomy, neural circuitry, and behavioral implications of Reinforcement. This rigorous exploration – and its continued utility in product design – grants Reinforcement a "Best Practice" status amongst Behavioral Design interventions and those interested in changing behavior.
While the Behavioral Design Toolbox contains many techniques, we've decided to constrain this first Volume to a dive deep on Reinforcement – and how you and your team and can leverage it to build habit-forming products. If you would like to read more about Behavioral Design you can signup HERE to get a FREE copy of our eBook when it's released.

subset: commoncrawl


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Are you thinking about buying an SUV for your family and you are trying to find a midsize option? The Ford Edge is a popular pick for people like you, and Ford outfitted this vehicle with all kinds of performance features.
Are you looking to choose the engine that you like best for the SUV that you choose to drive? There are two engine options available for you when you choose to drive the Ford Edge. You can pick between these two engines and know that you will get one that is powerful and fuel efficient, no matter which one you pick.
If you are trying to find an SUV that has features that put it a little above the other options out there, you will appreciate the Ford Edge and its Start-Stop technology. This vehicle lessens the emissions that it lets out by shutting off its engine when it is stopped.


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There is an implicit acceptance that an evidence-based culture underpins the practice of laboratory medicine, in part because it is perceived as the scientific foundation of medicine. However, several reviews of specific test procedures or technologies have shown that the evidence base is limited and in many cases flawed. One of the key deficiencies in the scientific literature on diagnostic tests often is the absence of an explicit statement of the clinical need, i.e., the clinical or operational question that the use of the test is seeking to answer. Several reviews of the literature on specific procedures have also demonstrated that the experimental methodology used is flawed with, in some cases, significant bias being introduced. Despite these limitations it is recognized that a more evidence-based approach will help in the education and training of health professionals, in the creation of a research agenda, in the production of guidelines, in the support of clinical decision-making, and in resource allocation. Furthermore, as knowledge and technologies continue to be developed, an evidence-based strategy will be critical to harnessing these developments.
Evidence-based medicine has been hailed by some as a new paradigm for medical practice (1), whereas others claim that it is unscientific, with a heavy emphasis on a statistical and more managerial approach to decision-making that challenges the nature of clinical expertise and clinical decision-making (2). The proponents of an evidence-based approach point to the fact that clinical experience is a vital part of becoming a competent physician but that experience should be based on robust observation; robust in this context means the collection of data in a reproducible and unbiased way. Critics of the evidence-based approach point to the need for large randomized controlled trials as the only means of meeting rigid criteria on acceptable evidence and the demise of the expert opinion (3). However, the rhetoric that surrounds the debate on evidence-based medicine needs to be put into context, recognizing that the burgeoning levels of knowledge and the increasingly multidisciplinary nature of healthcare are placing increasing demands on all practitioners (4).
Interestingly, to date evidence-based medicine appears to have had limited impact in the sphere of laboratory medicine. Furthermore, there are some data to suggest that adherence to criteria for the use of robust evidence in scientific papers on the use of diagnostic tests is poor (5). Laboratory medicine also provides some of the more overt examples of practice lacking a good foundation of evidence—perhaps the best examples being the variations seen in testing strategies between different hospitals for the same clinical presentations (6)(7). It is therefore hardly surprising that there are ardent critics of laboratory medicine and a considerable body of literature devoted to the inappropriate use of diagnostic tests (8)(9)(10). Perhaps the greatest challenge to laboratory medicine is the suggestion that diagnostic tests are not perceived to have a major impact on patient outcomes (11). Whereas most would consider this an extremely misguided viewpoint, it does indicate the degree of ignorance or misunderstanding that surrounds the value of diagnostic tests and poses one of the major challenges for today's laboratory professionals.
Definitions and Concepts
Evidence-based medicine
The generally accepted definition of evidence-based medicine is that given by Sackett et al. (12), namely "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of patients". This definition can readily be applied to laboratory medicine, recognizing (a) that a request for a diagnostic test represents part of a decision-making process; (b) the relevance to the clinical situation at hand; (c) the need for critical appraisal of evidence in terms of quality; and (d) the continuing evolution of evidence, particularly for new tests.
Diagnostic tests
It has always been recognized that the use of a diagnostic test is an intervention (13). A diagnostic test should be requested only when a question is being posed and when there is evidence that the result will provide an answer to the question. There are several reasons why a physician will order a diagnostic test (14); however, the nature of the question being asked and the decision to be made often will depend on the clinical setting in which the patient is found.
Outcomes research
Outcomes research, an important facet of evidence-based laboratory medicine, has been the subject of debate (13)(15)(16) over the past three decades. An outcome can be defined as the result of an intervention and may be a health outcome or an economic outcome (17)(18). This definition of an outcome may, in light of the limited perception of the contribution made by a diagnostic test (11), be a contributing factor to the paucity of good evidence on the effectiveness or benefit of diagnostic procedures in laboratory medicine.
The expectations for outcomes may be different for healthcare providers and patients (16). The patient is interested in receiving prompt and effective treatment, the relief of symptoms, and improvement in the quality of life. The service provider will also focus on the delivery of effective care, with the promptness of delivery varying between different countries but within the framework of optimum use of resources and minimization of long-term costs. Recognizing that any outcome will be a cascade of many synergistic decisions and actions, it may be more appropriate to focus greater attention on the use of diagnostic tests in the individual elements of the decision-making process. This may help to tease out the key constraints to delivering the desired patient outcomes while highlighting the value of the diagnostic test. In a recent editorial, Scott (19) stressed the importance of identifying a measurable outcome linked with the diagnostic procedure in question [point-of-care testing (POCT) in this case] (20).
Thus, the outcome of a diagnostic test can be considered as any part of the decision-making process that leads to an improved outcome. This approach was first described by Fryback and Thornbury (21), who set out the elements of clinical decision-making in relation to the efficacy of diagnostic tests. Thus, in terms of clinical benefit a test may improve the diagnostic process and/or the therapeutic strategy, and thus the overall health outcome. The outcome of a diagnostic test may be an operational or an economic benefit. Thus, in the example of the patient with chest pain, the first "questions" or decisions to be made relate to the recognition of cardiac pain and the urgency for referral. These early decisions are appropriate because we know that early intervention improves overall patient outcome.
Health technology assessment
Health technology assessment is a tool that examines systematically the consequences of the application of health technology to support decision-making in policy and practice. Technology encompasses drugs, devices, and procedures together with the organizational and support systems, therefore including diagnostic tests and differing modalities of delivery. However, the assessment focuses on the way in which the test or device is used rather than on whether it "works"; the latter is assumed and is the remit of another evaluation process (e.g., the Medical Devices Agency in the United Kingdom). The key principles of health technology assessment are outlined in Table 1⇓ .
Health technology assessment can be seen as the means by which evidence is developed to support decision-making, and it embraces much of the discipline of health services related or applied research. It may require original or primary research on the one hand, or a systematic review of established literature.
Context of the Evidence-based Culture
There are several reasons advanced for the development of a more evidence-based culture in medicine and the increasing commitment to outcomes research and health technology assessment. Not surprisingly these reflect the demands made on healthcare systems today (22), including some of the pressures listed in Table 2⇓ . All of these pressures translate into a common currency of cost pressures. It is worth exploring some of these pressures in a little more detail, focusing on issues related to implementation of new technology, decision-making, quality, and cost.
There is no doubt that healthcare professionals are expected to deal with an increasing burden of knowledge as well as having access to increasing amounts of new technology, both diagnostics and interventions. Earlier commentators have pointed to the numbers of scientific journals published each year and the limited time given to updating of knowledge (23). One of the strongest arguments for maintaining a health technology assessment program is the recognition that the process of evaluation and implementation of new technology is cumbersome, with long delays between clinical effectiveness being established and adoption into routine practice (24). There are examples in the literature, e.g., the implementation of thrombolytic therapy (25), that also demonstrate the importance of maintaining a continuous awareness of developments in the field to avoid unnecessary delays in the implementation of an effective new technology. It might also be argued that a lack of awareness of current literature leads to wastage of resources on additional evaluation projects when the answer is known. There are also examples in the literature where a new technology has been implemented ("technology creep") and subsequently considered to be ineffective or to lead to unnecessary interventions (26).
Quality in clinical practice has risen on the political agenda (22)(27), and the evidence-based culture has begun to play a greater role in policy-making on a global scale (28). The practical implications of the quality agenda have been a stronger focus on training and assessment of competence (29), on continuing education for maintenance of competence (30), and the introduction of clinical guidelines (31).
The rising cost of healthcare is also a topic high on the agenda of many governments and which is thought to contribute to the reduction in the number of hospital beds and the downsizing of laboratories (22)(32). It is also undoubtedly a stimulus for the literature on the appropriateness of laboratory testing and the demands for proper evaluation of new technology as a prerequisite for introduction into the healthcare system. However, it is also true that resource management is a major problem in the overall context of healthcare delivery, with little evidence that value for money plays a part in determining the investment in laboratory medicine for a given patient episode or disease state. For example, an examination of the economic impact of introducing a molecular-based test for Chlamydia and the influence on disease prevalence illustrates the complexity of resource allocation while demonstrating the central role of good evidence in decision-making (33).
How to Practice
Practicing evidence-based laboratory medicine has four dimensions: (a) identification of the question; (b) critical assessment of the best evidence available, embodying the principles of health technology assessment; (c) implementation of best practice; and (d) maintaining best practice; the latter embodies the principles of clinical audit (34). This is summarized in Fig. 1⇓ , which illustrates this as being a continuous process. There are many publications that provide guidelines on evaluation of the effectiveness of interventions (35)(36), although there are few that deal specifically with diagnostic tests. However, guidelines for the systematic review of diagnostic tests help by providing information on the critical appraisal of evidence (37)(38)(39)(40).
Define the question
The starting point is the identification of the clinical question that is being asked; the ability, with the aid of the test result, to make a decision is therefore the outcome. There are many examples to illustrate this point, but it is not always recognized that a test can be used to make a "rule in" or "rule out" decision. Much of the literature in laboratory medicine has focused on "rule in" decisions, but "rule out" can often be an important step in a decision-making cascade. Silverstein and Boland (41) have suggested that when medical care costs are analyzed, the focus is directed to "high cost decisions"; they give the example of the decision to admit a patient. This may be a decision faced regularly by the primary care physician and may be addressed through a "rule in" or "rule out" question, depending on the actual diagnostic performance of the test. However, few diagnostic tests have been evaluated for the effectiveness in a "rule out" decision strategy. Examples where this approach has been proposed include urine testing for leukocyte esterase and nitrite, which can be effective in "ruling out" urinary tract infection but not "ruling in"; such a test can then be used to determine what samples are sent to a central laboratory for culture—with important operational and economic implications (42). Similarly it has been suggested that myoglobin could be used to "rule out" myocardial infarction, but not to "rule in" (43); in the past myoglobin has not been considered a useful marker of myocardial damage because of its lack of tissue specificity. This also illustrates the point that scientific reasoning may not always yield the correct interpretation in relation to clinical outcome—a point illustrated in the case of therapeutic interventions (44). The clear identification of a question can be particularly important when comparing the potential of a new test. Thus, the fact that serum cystatin C demonstrates a correlation with a reference clearance test superior to that of serum creatinine in itself does not prove that the test will offer a clinical benefit (45).
Hierarchy of evidence
Evidence on the performance of a diagnostic test can be considered in a hierarchy, all of the elements of which are important to making a decision (Fig. 2⇓ ). This approach was first proposed for a diagnostic test by Fryback and Thornbury (21) and applied to diagnostic radiology (41).
Technical performance
The foundation of any evidence is technical performance, and this can have an important bearing on diagnostic performance. In addition to precision, accuracy, analytical range, and interferences, other pre-analytical factors such as biological variation and sample stability can influence the utility of a test. In general terms, laboratory professionals are extremely good at validating technical performance, although pre-analytical factors are less commonly documented (46). Pre-analytical factors can limit the benefits of a test in routine practice, e.g., the biological variation in the markers of bone resorption.
Diagnostic performance
Diagnostic performance provides an assessment of the test in terms of the objective for using the test, namely the sensitivity, which defines the proportion of people who are correctly identified by the test as having the disease, and the specificity, which defines the proportion of people who are correctly identified by the test as not having the disease. Although these are parameters of any test irrespective of the population on which the test is used, the significance of the test is also determined by the prevalence of the condition in the population being studied. It has been suggested by Irwig et al. (38) and Moore (23) that the likelihood ratio combined with the pretest probability is a clearer way of identifying post test probability and thereby integrating the relevant information into a clinical decisions pathway. Batstone (47) has suggested that the number needed to diagnose (NND), derived from 1/[sensitivity − (1 − specificity)], provides a useful comparison between tests and helps to encompass the financial implications in decision-making.
Clinical benefit
However, it is the clinical impact or benefit of the test and the contribution to decision-making that provide the greatest challenge; the majority of evidence available in the literature on the use of diagnostic tests deals with technical and diagnostic performance. For example, Hobbs et al. (48), in a systematic review on POCT in general practice (primary care), found that few papers addressed clinical impact, the majority focusing on technical performance.
The clinical impact can be divided into the effect that use of a test or procedure will have (a) on the diagnostic strategy, i.e., compared with the use of other tests, in improving diagnostic performance; (b) on the therapeutic strategy, i.e., use of therapies, optimization of therapy, avoidance of harm, and so forth; and (c) on the health outcome. Thus, one can evaluate the impact of the detection of microalbuminuria in terms of (a) earlier detection of diabetic nephropathy and (b) better management of diabetes and co-morbid conditions, e.g., hypertension, with a view to (c) reducing the rate of development of renal failure. Some more examples of clinical impact are given in Table 3⇓ .
Operational benefit
The use of a diagnostic test may have an operational, as distinct from a clinical, impact; this often is considered an economic impact, which it may be because use of resources always resolves down to economic considerations. However, identification of an operational question may help to determine the optimal organizational aspects of a care strategy, e.g., disposition of staff and use of beds, as part of a wider economic analysis. Operational benefits may include reduced length of hospital stay, reduced staff time utilization, reduced utilization of estate (facilities), and reduced utilization of other resources. It may be important to focus very specifically on the decisions that can follow from the identification of such a benefit, e.g., length of stay in relation to bed requirement. The decision-making will probably address two issues, namely bed utilization and clinical risk associated with early discharge. Rainey (49) considered length of stay as a medical outcome; however, this "definition" lacks the clarity of the decisions that need to be made.
Economic benefit
The economic impact of the use of a diagnostic test and the broader issues of cost-benefit analysis are poorly understood tools in decision-making in healthcare. However, this is extremely important when the new test or procedure is more expensive than the existing modality of testing, as often is the case. It is also a wasted opportunity if the test brings real benefits to the patient and the healthcare organization. In these considerations, it is important not to focus solely on the test but on the complete patient episode or outcome (19)(50), determining where the investment is required and the gain achieved.
Although the outcome of any evaluation of a test has to be recognition of the benefit, the starting point has to be identification of the question (or the clinical need). However, many studies fail to address the question, whereas others suffer from the use of poor methodology.
Systematic Review
Whereas the validation of a new test requires primary research, the accumulation of data from several studies in a systematic review can provide additional benefits. Indeed, it could be argued that ongoing systematic review can provide a robust means of maintaining awareness of developments in a specific field. The benefits of a systematic review are summarized in Table 4⇓ and are mainly concerned with handling of large amounts of data, minimizing the effects of bias introduced into individual studies, and increasing confidence in the result.
A systematic review of current evidence through the use of meta-analysis can identify methodological deficiencies as well as provide an up-to-date systematic review (51). The summary ROC curve can be used to combine studies, illustrating differences that may exist and determining their potential level of significance (52). Good examples of the use of summary ROC curve analysis for two clinical decisions are given in the reports by Guyatt et al. (53) and Olatidoye et al. (54). The work of Olatidoye et al. (54) demonstrates that the variability in diagnostic performance can be large and that this can present a dilemma to the evaluator. It also illustrates the need for multiple studies. Variability in performance may reflect differences in design, choice of patients, and clinical setting, all of which can lead to significant bias in the results (5)(55).
Quality of evidence
Given that evidence informs a decision to be made, then it will be robust only if the evidence is of good quality. There have been many publications describing the quality of evidence that is acceptable (5)(40)(56)(57)(58)(59) and identifying ways in which evidence can be gathered free of bias. In broad terms, bias can be introduced into evidence either from the choice of study population, the design of the experimental work, or the way in which the results are reported. The key priorities in designing a study to generate good quality evidence are summarized in Table 5⇓ .
The selection of the patient population for study has a critical bearing on the results produced and should be relevant to the question being asked. Thus the diagnostic accuracy of a test will be overestimated in a group of patients already known to have the disease when compared with a group of healthy individuals (59). Bias may also be introduced if the selection of patients for a trial is not randomized or if some patients are excluded from the trial; the latter may be the very patients on whom the quality of the decision hinges and may differentiate one test from another. Lijmer et al. (55) in a study of bias in 11 meta-analyses on 218 studies of diagnostic tests found that the largest effect on diagnostic accuracy occurred in case-control studies, suggesting that the mild cases, which are difficult to diagnose, were excluded, thereby causing overestimates of the sensitivity as well as specificity.
When assessing the diagnostic performance of a test, it is important to use a robust reference method. The reference method should be used in both the test and the control populations; this requirement cannot always be met, sometimes for ethical or cost reasons. However, it is recognized that failing to apply verification can lead to bias in the results. In some situations, to overcome this problem different reference methods have been applied to the test and control populations; again this can introduce bias, and it generated the second largest effect in the study by Lijmer et al. (55). As an example, in a study on the use of C-reactive protein (CRP) in the diagnosis of appendicitis, surgery and pathology were used as the reference for patients with high CRP, whereas verification was limited to clinical follow-up in the patients with low CRP concentrations (60).
It has also been suggested that blinding the evaluator of the new method to the results of the reference method will also improve the validity of the result. However, in the study by Lijmer et al. (55), it had little impact on the diagnostic accuracy of a test; conversely, in situations where the reference procedure is imperfect this effect may be increased. Valenstein (61), however, urged that rather than use an imperfect reference standard, one should focus on a more practical and measurable outcome; he used the example of the imperfect means of predicting the condition of a patient's myocardium, urging the use of a measurable outcome such as response to therapy or death in hospital. An imperfect reference procedure raises the prospect of interoperator variation, which can also contribute to bias (62). A good example is the diagnosis of myocardial infarction, where the evaluation of new biochemical markers introduces the bias associated with the use of other markers in the diagnostic triad but also recognizes the fact that there is interoperator variation in the ultimate reference procedure—the autopsy (63).
It is evident from the literature that study design related to outcomes has been investigated more in relation to the use of a pharmaceutical intervention than a diagnostic intervention. Thus, Moore and Fingerova (64) have identified other characteristics of study design that will introduce bias to the results. The ideal approach, however, is identical whether it is a diagnostic or a therapeutic intervention and whether it is an assessment of diagnostic performance or outcome, and that is the use of prospective blind comparison of test and reference procedure in a consecutive series of patients from a relevant clinical population (60).
Studies designed to assess clinical, operational, and/or economic outcomes require a clear definition of the outcome measure. In certain clinical studies, this may require the use of a surrogate because the true outcome can only be assessed over several decades; examples include the use of hemoglobin (Hb)A1C as a surrogate for normoglycemic control and the DEXA scan for normal bone mineral density. An alternate outcome may be the "avoidance of disease" as was used in the Diabetes Control and Complications Trial (65); the approach currently underpins our assessment of wellness. It is also important to be aware of confounding factors that might also influence the outcome measure; thus in the study by Kendall et al. (66) on the use of POCT in the emergency room, the "time to result" was reduced, but the "length of stay" in the emergency room (potentially a very relevant outcome measure) was not influenced. The demonstration of reduced time to result, however, is still valid and points to another step in the process as being the impediment to reducing the length of stay.
It is also clear that publication of results also introduces bias; there is a greater tendency to publication of positive findings. Easterbrook et al. (67) showed in a study of a large number of submissions to a local ethics committee that eventual publication was more prevalent in studies where there were significant findings. Dickersin et al. (68) also found that there was an association between significant results and publication, the bias originating with the authors rather than journal editors. Chalmers et al. (69) have defined three stages of publication: (a) organizing and undertaking of the research; (b) acceptance or rejection of a manuscript depending on the presentation of positive or negative findings; and (c) the bias that may result from interpretation, reviews, and meta-analyses. The authors also make recommendations on how publication bias can be minimized.
Reference has already been made to the fact that there often are delays in the implementation of new technologies despite the availability of good evidence, whereas on the other hand, technologies are implemented in the absence of evidence. It is acknowledged that even when there are health technology assessment programs set up to resolve some of these problems, the implementation of findings is still one of the major problems in the effectiveness of the programs (70). There may be several reasons for this, including (a) the absence of formal continuing education programs, and (b) the mechanisms for allocating resources. It is possible that initiatives that have been set up to identify and implement good practice, such as the National Institute for Clinical Excellence (71) coupled with the development of clinical governance (27) in the UK, will improve implementation because both initiatives are founded on the culture of evidence-based practice.
Clinical audit
The establishment of a new practice, as well as established practice, should always be subject to regular audit (72); this underpins the commitment to maintenance of good practice, one of the important tenets of clinical governance. The audit will assess whether the new technology has been implemented satisfactorily and whether the outcomes found bear out the findings of the original research. The outcome of the audit may identify the need to modify practice or may lead to the identification of a new research question. Experience has shown that auditing established practice as, for example, a means of controlling demand for a laboratory service, can identify unmet clinical needs as well as abuse and inappropriate use of laboratory services. Thus, evidence-based laboratory medicine in all its facets is the foundation of a continuous quality improvement program (Fig. 3⇓ ).
Implications of an Evidence-based Culture
The foregoing discussion has been focused primarily on decision-making, but it is quite clear that the practice of evidence-based laboratory medicine can have an important influence on many aspects of professional practice.
Training and maintaining performance
It has been suggested that the principles of evidence-based medicine will provide a better foundation for training because it focuses more on the evidence to support the type of decision-making required in clinical practice (73). It is also clear that performance deteriorates with age (74) and that traditional means of continuing education are less effective than an evidence-based approach (75). Thus, through participation in activities to maintain the evidence database and participation in audit activities, professional performance can be maintained and kept up to date.
Research and development agenda
The continuous process of practice review, the generation of new knowledge, and the availability of new technology combine to generate a powerful development agenda. The use of evidence-based practice guidelines will ensure that an effective program can be developed to meet patients' needs in a timely and cost-effective fashion.
To establish the role of laboratory medicine in clinical decision-making, it is important to develop the type of evidence that focuses on these decisions. This requires an explicit recognition that medical research can be delineated into that which creates basic knowledge and that which is associated with the application of that knowledge. Applied research itself can then be differentiated into the application of knowledge in the development of diagnostic procedures and therapeutic interventions and that which focuses on the use of such innovation in decision-making (76). Evidence can then support decision-making in relation to diagnosis and therapeutic intervention, together with operational issues, including the appropriate utilization of resources.
Value for money
The increasing cost of healthcare is one of the major pressures affecting both purchasers and providers of care. It is also evident that on the one hand, there is a perception that the cost of laboratory medicine is high, whereas on the other there is limited perception of true value for money—both in terms of the true cost and the framework in which value can be judged. The most obvious is the focus on the debate between the cost and value of POCT; invariably, and not unexpectedly, the cost of a point-of-care test is greater than its central laboratory counterpart, with the clinical and operational benefits accruing to other sections of the provider system (77). Thus, the value will only be appreciated outside of the laboratory, thereby requiring a wider perspective or review of value than the confines of the laboratory service.
An alternative description of evidence-based medicine is a commitment to life-long problem-based learning (73). A commitment to the activities outlined in Fig. 4⇓ working within a framework as outlined in Fig. 1⇑ will ensure that a high quality of service is maintained; these attributes are embodied in the principles of laboratory accreditation (78), professional self-regulation (79), and ultimately clinical governance (27), representing commitment to provision of the highest quality of service to the patient.
Application of the principles of evidence-based medicine to laboratory medicine highlights the importance of establishing the role of diagnostic procedures in clinical decision-making. The discipline is crucial to creating and delivering the research and development agenda in the laboratory while also providing a foundation for the training of laboratory professionals. The continuing application of an evidence-based approach to practice will also meet the quality expectations of patients.
- © 2000 The American Association for Clinical Chemistry


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Let the Word Dwell in You Richly
- Date: September 4, 2019
- Teacher: Pastor Star R. Scott
- Scripture: "Let the word of Christ dwell in you richly in all wisdom; teaching and admonishing one another in psalms and hymns and spiritual songs, singing with grace in your hearts to the Lord." (Colossians 3:16)
- From Tongues Of Fire II
Psalm 119, verse 11, says, "Thy word have I hid in my heart [out of the abundance of the heart…]: that I might not sin against thee". Because when I hid the Word in my heart in abundance, that is all that will come out. Well, we learn something here, don't we? The Word, Hebrews says, is a discerner of the thoughts and the intentions of the heart. It judges that desperately wicked heart, the Word. "I hid Your Word, that I won't sin against You."
Verse 63 says, "I am a companion of all of them that fear thee, and of them that keep thy precepts." We need to get around the right people, don't we? Who are you hanging out with? "Well, I like to be around the people that I have things in common with, and the people that have this kind of taste, and go on this kind of vacations, and like this kind of sports," and whatever it is. That is not how you choose your companions. That is the wrong crowd if they are not first and foremost fearing You and keeping Your precepts. "I want to hang with the people who are doing the Word, who fear God. Those are my friends. Those are my companions." As that becomes part of the course that directs our lives, we are going to begin to see the heart change. We are going to begin to see the words change that come out of our mouths.
"You will never (verse 6) be ashamed when you have respect unto all of His commandments." Verse 24, "Thy testimonies also are my delight and my counselors." We see that this is what orders the steps of us on a daily basis. Verse 92, "Unless thy law had been my delights, I should then have perished in mine affliction." Verse 97, "O how love I thy law! it is my meditation all the day. Thou through thy commandments hast made me wiser than mine enemies..." (Psalm 119:97-98). We begin to see the need of eating this Word, and letting it become that joy and rejoicing of our hearts.
Verse 128, I love this passage. "Therefore I esteem all thy precepts concerning all things to be right; and I hate [the world's wisdom]." I hate it! I don't just disagree with it. I hate it! It is offensive to me, all of this secular thought that has crept into the body of Christ. "Order my steps," verse 133, "in thy word: and let not any iniquity have dominion over me." "Great peace have they which love thy law: and nothing shall offend them" (Psalm 119:165). To reestablish the value of this Word in our lives, maybe it would be good to sit down and read Psalm 119 every day for a while and let God's Word begin to be big in our eyes again.
He admonishes us in Ephesians to be filled with the Spirit, and then to speak to ourselves in these psalms and hymns and spiritual songs (Ephesians 5:18-19). In the parallel passage in Colossians, Chapter 3, he says, "Let the word of Christ dwell in you richly in all wisdom; teaching and admonishing one another in psalms and hymns and spiritual songs, singing with grace in your hearts to the Lord. And whatsoever ye do in word or deed, do all in the name of the Lord Jesus, giving thanks to God and the Father by him" (Colossians 3:16-17). "The Word to dwell in you richly." What are we putting in there in abundance? "Thy Word have I hid in my heart, that I might not sin against You."
In Ephesians, he talks about the fullness of the Holy Spirit. In Colossians the fullness of the Word of God. The fullness of the Holy Spirit and the fullness of the Word of God will cause us, then, to minister one to another in psalms and hymns and spiritual songs, singing and making melody speaking words unto edification. It becomes as simple as what we choose to fill ourselves with, filled with His Spirit, and being filled with His Word will cause us to minister grace to all who hear us.


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Founded in 2000, Homesmart is a real estate brokerage of over 15,000 agents nationwide. The company is the number 5 brokerage ranked nationally by RISMedia's Power Broker and RealTrends 500 reports based on its 2017 performance. The company has achieved its growth and success by offering its agents the systems and technology they need to accelerate their business.
Jonathan and Melissa Edmiston opened Homesmart Expert Realty in Chapel Hill, NC in October 2018. After being in the real estate industry for over 19 years and seeing the changes taking place, they decided that the Homesmart model was the best one available to provide agents with more of what they needed to be successful. Whether you are a broker, buyer or seller, they look forward to working with you!
HomeSmart. Real Estate Made Easy.


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Volusion is an e-commerce platform providing everything you need to build and host an online store. The software offers numerous features, including a multitude of themes, a one-page checkout tool, many navigation styles, built-in promotional tools, and more.
Ontraport is a platform that fully integrates all your business tools into one place, allowing you to focus on what's important! This seamless solution can include a anything from CRM, Wordpress hosting, email, payment processing to powerful business automation.
PieSync is easy to use and helps you build your business by increasing productivity. Our two-way contact integration will decrease data errors and ensure that you and your team will have access to the most up to date customer information.


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Theall Group LLP
Toronto ON
Theall Group LLP is a commercial litigation firm committed to providing our clients with superior legal representation in complex disputes, both international and domestic. We have broad experience at all levels of the Ontario and Federal courts. Our practice includes acting for large multi-nationals and governments, with practice concentrations in the automotive and commercial insurance industries, and in the areas of product liability, risk management, class actions, and arbitration. We act exclusively for policy holders and brokers with respect to insurance coverage disputes.
Ontario Court of Appeal: insured's failure to provide up-to-date address not breach of duty to cooperateCanada | 02 July 2019
The Ontario Court of Appeal recently reconfirmed that an insured's duty to cooperate with defence council appointed by its insurer is not subject to a standard of perfection. This case serves as a strong reminder that a breach of the duty to cooperate must be substantial. It shows that, in practice, without real consequences arising from an insured's conduct, there can be no substantial breach of the duty to cooperate.
Coverage 'thrilla' in Manila – court finds underinsured endorsement provides worldwide coverageCanada | 25 June 2019
A recent Alberta Court of Queen's Bench decision demonstrates that policyholders must carefully consider the interplay between an insurance policy and its endorsements. One consideration is the distinction between endorsements that provide standalone coverage and those intended only to modify an existing policy's terms. However, most important is the overarching principle that any limitations of coverage should be clearly stated.
Ontario court rejects well-established rules for interpreting insurance policy exclusionsCanada | 14 May 2019
The Ontario Superior Court of Justice recently concluded that insurance policies should be interpreted differently when multiple insurers are involved. This decision runs contrary to the basic rules of contractual interpretation and conflicts with well-established precedent. If followed, it could lead to commercially unreasonable results and erode the benefits of coverage available to insured parties.
Injury claim between cohabiting family covered by homeowner's policy despite household exclusionCanada | 07 May 2019
An Ontario court recently found that a personal injury claim by a daughter against her mother was covered by homeowner's insurance. While the insurance policy contained an exclusion for claims arising from injury to "any person residing in [the] household", the court concluded that the daughter was a tenant under the policy and therefore the exclusion did not apply. This case serves as a reminder that policyholders' intentions when purchasing insurance can be critically important.


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We were called by Police about a climber reported overdue from a reconnaissance visit to a crag. Just as we were taking the call he phoned in to say he was safe & well and we stood down.
Incidents — Esk Buttress
Permanent link to this article: https://www.wmrt.org.uk/incidents/esk-buttress-upper-eskdale-tue-13th-jun-2017/
Permanent link to this article: https://www.wmrt.org.uk/incidents/esk-buttress/


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pass by Hollywood hotspots like the Walk of Fame, Whiskey a Go Go, the Viper Room and Chateau Marmont. Help other wbstudiotour shoppers by submitting your promo code here. 0.0 / 0 Voted coupon type coupon code (19) online sales (34) discount type off (3) off (21 submit A, coupon, do you have more warner brothers studio tour best discount codes that we don't? Studio, tour, hollywood, the second part of your Hollywood experience the 2-hour celebrity homes tour takes place, chauffeuring you around the exclusive. Riverside Drive Burbank,. Your small-group minibus allows you to visit neighborhoods that are off-limits to larger coaches so you can see as many unbelievable mansions as possible. The grand finale of the, studio, tour is a visit to Stage 48: Script to Screen, an interactive sound stage where you can learn about the production process of a film or TV show, step into an actual set. Rowlings Wizarding World has been brought to life on the silver screen over the past 15 years. Stop by Rodeo Drive to see the designer stores and sparkling jewelry shops that outfit A-list actresses for awards shows, and zip by the Beverly Wilshire Hotel, featured in Pretty Woman.
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Artist: Hitomi Shimatani
Release Date: June 6, 2007
Label: Avex Trax
Personal Rating: 4/5
1. Neva Eva
2. Hakuchuumu
3. Neva Eva (Instrumental)
4. Hakuchuumu (Instrumental)
I figured that I should really start working on the artists with a large discography so here's today's review on a Hitomi Shimatani release!
I think that this was during the time when Hitomi was still exploring some new genres with her music. So Neva Eva pretty much sounds more unique than her past releases since it displays a great selection of background music with all of the guitars playing. At least nothing sounded out of place or awkward in this song so Neva Eva actually made me pretty satisfied.
I also thought that Hakuchuumu was a pretty strong B-side. Even though I greatly preferred the A-side, Hakuchuumu also had some great points. Like when you could hear the really strong brasses playing and supporting Hitomi's vocals in the background. (Ever since listening to Shoko Nakagawa's debut album, I've been more aware of the background music.)
Personal Rating: 4/5


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Margaret, I'm on Trt, and my wife is 43 going through Peri- (early/pre) menopause. She started trying about a drop a day to see if her libido would improve, and it did, dramatically, and also her moods and patience. After about a month of feeling 30again, she started noticing lite facial hair developing, decreased breast size, and return of all previous symptoms. So she went off it. About a month later, she started St.JohnsWart, and everything improved tenfold. Now she feels 20 instead of just 30 on testosterone. She literally glows with smiles and energy, and has an extremely high libido. Maybe try that first. Good luck.
Researchers found that the simple act 'expressing power through open, expansive postures' (i.e. standing up straight and proud) can increase Testosterone and decrease cortisol (58), along with improving feelings of power and tolerance for risk. Easy! Your mother was right – don't slouch. This could be a handy trick before making a speech or going on a date!
DAA (D-Aspartic Acid): When it comes to potent ingredients, D-Aspartic Acid is probably one the most potent ones currently available for boosting testosterone levels. This ingredient is used by sportsmen and bodybuilders alike to boost performance and gains, while it has also been shown to aid infertile men. DAA works with the brain, which stimulates the release of the luteinizing hormone that produces testosterone and also the secretion of growth hormone. Testosterone Synthesis also increases along with the other effects.
The same study showed that drinking did, however, lower semen count and quality. And I want to remind you – this is an article on improving testosterone levels, not general health as there are a lot of studies that show drinking leads to an assortment of health issues. This acute spike in Testosterone could be due to the effect alcohol has on libido, and also the energy influx in the liver?
To date, no large, double-blind, randomized controlled studies of a link between testosterone treatment and prostate cancer have been completed. In its 2004 report, the Institute of Medicine (IOM) committee studying the need for clinical trials of testosterone-replacement therapy noted that only 31 placebo-controlled studies had been done in older men, with the largest one enrolling just 108 participants. Most of these studies lasted only six months.
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Hormonal Imbalance can affect your personal and work relationships. Some of the most noticeable symptoms prompting patient's to seek out medical care are a complete lack of energy and sheer fatigue, loss of sex drive, erectile dysfunction or soft erections, loss of lean muscle mass and bone strength, rapid weight gain, excessive adipose fatty tissue, disturbed sleep patterns, depression, moodiness, social withdrawal, reduced ability to recover from workouts, flabby muscles, lack of strength and endurance.
This is over simplified but should offer you some clarity to what you are experiencing – If you are getting Testosterone Cypionate injections every 2 weeks, then you are on the roller coaster. I have great results with weekly injections and some folks need bi-weekly injections. It's all how your body reacts but every 2 weeks is just plain too far apart as the product is relatively ineffective after 10 days. Measurable at 10 days? Somewhat but still ineffective at that point.
Herein lies the problem. DHT is an extremely powerful androgen, significantly more potent than testosterone. Somehow, fenugreek causes increases in muscle mass and libido while reducing DHT. I often argue on the site that it is not exactly increased testosterone that you want. You want the blessings of a high testosterone level: physical fitness, libido, and high energy levels. If fenugreek can bestow these upon you, why do you need the testosterone?
When we face stress, our adrenal glands secrete cortisol to prepare our bodies and minds to handle the stressful situation — the primal fight-or-flight response. In small dosages, cortisol is fine and even useful, but elevated cortisol levels for prolonged periods can do some serious damage to our bodies and minds. One area that seems to take a hit when cortisol is high is our testosterone levels. Several studies have shown a link between cortisol and testosterone. When cortisol levels are high, testosterone levels are low; and when testosterone levels are high, cortisol levels are low.
Some foods, vitamins, and herbs can help boost your testosterone levels. Be sure to talk to your doctor, if you're concerned about low testosterone. These alternative and natural treatments aren't proven to be more, or as, effective as traditional testosterone therapy. Some may also interact with any medications you may be taking and cause unintended side effects.
Testosterone, historically believed to be important only for male sexual function, has over the past decades transformed from niche hormone to multi-system player.22 There is increasing recognition of the harmful consequences of hypogonadism (also known as testosterone deficiency) wide spectrum of beneficial health effects of testosterone therapy and.23, 24
The FDA approved testosterone therapy only for men having a low testosterone (hypogonadism) as the result of a diagnosed medical condition (ie, genetic defects), or as a side effect of cancer chemotherapy.3 However, testosterone frequently has been prescribed off-label to men who have had no diagnosed medical condition, other than an age-related decrease in circulating testosterone, also known as "low T".
I have been searching quite a while for a testosterone booster that could help me in a few different ways yet not to be too expensive. Over the years, I have experienced a low irritability tolerance(meaning it doesn't take much to send me "over the top") and have moods swings due to negative situations. I would like to be more at peace with myself & around others(without trying to fake it).I don't usually have a lot of energy at work & rely on energy drinks. I also have a lower sex drive due to what I believe is low blood flow. I am 43 years old and am not over weight, but could stand to tone up and lose a little around the waist. If this site is legit, I would like to know your opinion on what I have disclosed & what you recommend.
As a urologist, I tend to see men because they have sexual complaints. The primary hallmark of low testosterone is low sexual desire or libido, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should get his testosterone level checked. Men may experience other symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a smaller amount of fluid from ejaculation, and a feeling of numbness in the penis when they see or experience something that would normally be arousing.
Dr. Abraham Morgentaler, an associate professor of surgery at Harvard Medical School and the director of Men's Health Boston, specializes in treating prostate diseases and male sexual and reproductive difficulties. He has developed particular expertise in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment strategies he uses with his own patients, and why he thinks experts should reconsider the possible link between testosterone-replacement therapy and prostate cancer.
Today we take a look at some of the physical and psychological benefits that come with having optimal testosterone levels (I'll talk about what "optimal" means regarding T later this week). You probably know about some of the benefits already, but some of the ones I discuss may surprise you. When appropriate, I'll report any health benefits that I experienced during my own 90-day testosterone boosting experiment.
Joe Costello is a Nutrition & Wellness Consultant, certified by the American Fitness Professionals & Associates (AFPA), author, and internet blogger. Joe has more than 9 years of experience in the sports nutrition industry and over 3 years of experience as a supplement and nutrition blogger. As a certified NWC who specializes in dietary supplements, Joe strives to deliver accurate, comprehensive, and research-backed information to his readers. You can find more of Joe's work including his E-Books about fitness and nutrition at his official website joecostellonwc.com, or connect with him on LinkedIn, Facebook, Instagram, Vimeo, or YouTube.
14. Volek JS, Volk BM, Gómez AL, Kunces LJ, Kupchak BR, Freidenreich DJ, Aristizabal JC, Saenz C, Dunn-Lewis C, Ballard KD, Quann EE, Kawiecki DL, Flanagan SD, Comstock BA, Fragala MS, Earp JE, Fernandez ML, Bruno RS, Ptolemy AS, Kellogg MD, Maresh CM, Kraemer WJ. Whey protein supplementation during resistance training augments lean body mass. J Am Coll Nutr. 2013;32(2):122-35. PMID: 24015719
If a young man's low testosterone is a problem for a couple trying to get pregnant, gonadotropin injections may be an option in some cases. These are hormones that signal the body to produce more testosterone. This may increase the sperm count. Hedges also describes implantable testosterone pellets, a relatively new form of treatment in which several pellets are placed under the skin of the buttocks, where they release testosterone over the course of about three to four months. Injections and nasal gels may be other options for some men.


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About Us
3D GURU is a place to learn about 3D printing and 3D design. We seek to unleash your creative side by exposing you to content that instructs and inspires.
3D GURU is a collective of content developers that are called to share the cool things they can do with you so you can do cool stuff too!
3D GURU was created by Adrian Martinez. Adrian is a Quality Assurance and Lean Six Sigma Continuous Improvement professional that applies his skills to solve problems, improve processes and designs at work and in his free time. Basically he is a Maker and can't leave anything alone. Adrian wants to help make tools to design 3D objects and make them more accessible to all so we can take the things we imagine and make them real.


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|Part of a series on financial services
Types of banks
Funds transfer
This article may need to be rewritten entirely to comply with Wikipedia's quality standards. (March 2017)
This article needs additional citations for verification . (March 2017) (Learn how and when to remove this template message)
Postal savings systems provide depositors who do not have access to banks a safe and convenient method to save money. Many nations have operated banking systems involving post offices to promote saving money among the poor.
The unbanked are adults who do not have their own bank accounts. Along with the underbanked, they may rely on alternative financial services for their financial needs, where these are available.
A post office is a public department that provides a customer service to the public and handles their mail needs. Post offices offer mail-related services such as acceptance of letters and parcels; provision of post office boxes; and sale of postage stamps, packaging, and stationery. In addition, many post offices offer additional services: providing and accepting government forms, processing government services and fees, and banking services. The chief administrator of a post office is called a postmaster.
In 1861, Great Britain became the first nation to offer such an arrangement. It was supported by Sir Rowland Hill, who successfully advocated the penny post, and William Ewart Gladstone, then Chancellor of the Exchequer, who saw it as a cheap way to finance the public debt. At the time, banks were mainly in the cities and largely catered to wealthy customers. Rural citizens and the poor had no choice but to keep their funds at home or on their persons.
The United Kingdom (UK), officially the United Kingdom of Great Britain and Northern Ireland, and sometimes referred to as Britain, is a sovereign country located off the north-western coast of the European mainland. The United Kingdom includes the island of Great Britain, the north-eastern part of the island of Ireland, and many smaller islands. Northern Ireland is the only part of the United Kingdom that shares a land border with another sovereign state, the Republic of Ireland. Apart from this land border, the United Kingdom is surrounded by the Atlantic Ocean, with the North Sea to the east, the English Channel to the south and the Celtic Sea to the south-west, giving it the 12th-longest coastline in the world. The Irish Sea lies between Great Britain and Ireland. With an area of 242,500 square kilometres (93,600 sq mi), the United Kingdom is the 78th-largest sovereign state in the world. It is also the 22nd-most populous country, with an estimated 66.0 million inhabitants in 2017.
William Ewart Gladstone was a British statesman and Liberal Party politician. In a career lasting over 60 years, he served for 12 years as Prime Minister of the United Kingdom, spread over four terms beginning in 1868 and ending in 1894. He also served as Chancellor of the Exchequer four times.
The Chancellor and Under-Treasurer of Her Majesty's Exchequer, commonly known as the Chancellor of the Exchequer, or simply the Chancellor, is a senior official within the Government of the United Kingdom and head of Her Majesty's Treasury. The office is a British Cabinet-level position.
The original Post Office Savings Bank was limited to deposits of £30 per year with a maximum balance of £150. Interest was paid at the rate of 2.5 percent per annum on whole pounds in the account. Later, the limits were raised to a maximum of £500 per year in deposits with no limit on the total amount. Within five years of the system's establishment, there were over 600,000 accounts and £8.2 million on deposit. By 1927, there were twelve million accounts—one in four Britons—with £283 million (£16,593 million today) on deposit. [1]
The British system first offered only savings accounts. In 1880, it also became a retail outlet for government bonds, and in 1916 introduced war savings certificates, which were renamed National Savings Certificates in 1920. [2] In 1956, it launched a lottery bond, the Premium Bond, which became its most popular savings certificate. [2] Post Office Savings Bank became National Savings Bank in 1969, later renamed National Savings and Investments (NS&I), an agency of HM Treasury. While continuing to offer National Savings services, the (then) General Post Office, created the National Giro in 1968 (privatized as Girobank and acquired by Alliance & Leicester in 1989).
A savings account is a deposit account held at a retail bank that pays interest but cannot be used directly as money in the narrow sense of a medium of exchange. These accounts let customers set aside a portion of their liquid assets while earning a monetary return.
A government bond or sovereign bond is a bond issued by a national government, generally with a promise to pay periodic interest payments called coupon payments and to repay the face value on the maturity date. The aim of a government bond is to support government spending. Government bonds are usually denominated in the country's own currency, in which case the government cannot be forced to default, although it may choose to do so. If a government is close to default on its debt the media often refer to this as a sovereign debt crisis.
War bonds are debt securities issued by a government to finance military operations and other expenditure in times of war. In practice, modern governments finance war by putting additional money into circulation, and the function of the bonds is to remove money from circulation and help to control inflation. War bonds are either retail bonds marketed directly to the public or wholesale bonds traded on a stock market. Exhortations to buy war bonds are often accompanied by appeals to patriotism and conscience. Retail war bonds, like other retail bonds, tend to have a yield which is below that offered by the market and are often made available in a wide range of denominations to make them affordable for all citizens.
Many other countries adopted such systems soon afterwards. Japan established a postal savings system in 1875 and the Netherlands government started a systems in 1881 under the name Rijkspostspaarbank (national postal savings bank), this was followed by many other countries over the next 50 years. The later part of the 20th century saw a reversal where these systems were abolished or privatized.
In Austria, the Österreichische Post used to own the Österreichische Postsparkasse (P.S.K.). This financial institute was bought and merged by the BAWAG in 2005.
Austria, formal name: the Republic of Austria, is a country in Central Europe comprising 9 federated states. Its capital, largest city and one of nine states is Vienna. Austria has an area of 83,879 km2 (32,386 sq mi), a population of nearly 9 million people and a nominal GDP of $477 billion. It is bordered by the Czech Republic and Germany to the north, Hungary and Slovakia to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the west. The terrain is landlocked and highly mountainous, lying within the Alps; only 32% of the country is below 500 m (1,640 ft), and its highest point is 3,798 m (12,461 ft). The majority of the population speaks local Bavarian dialects as their native language, and German in its standard form is the country's official language. Other regional languages are Hungarian, Burgenland Croatian, and Slovene.
Österreichische Postsparkasse (P.S.K.) was a postal savings bank in Austria. It was owned by the Austrian Mail and thus by the government. It merged on 1 October 2005, with the BAWAG to form BAWAG P.S.K..
BAWAG was a bank in Austria founded in 1922. On October 1, 2005, it merged with the separate Österreichische Postsparkasse (P.S.K.) to form the "Bank für Arbeit und Wirtschaft und Österreichische Postsparkasse AG", shortened as BAWAG P.S.K.. In October 2017, BAWAG Group AG, the holding company of BAWAG P.S.K., became a listed company on the Vienna Stock Exchange. Largest shareholders are Cerberus Capital Management (35.1%), GoldenTree Asset Management (25.7%) and Harbor International Fund (4.2%).
Brazil instituted a postal banking system in 2002, where the national postal service (ECT) formed a partnership with the largest private bank in the country (Bradesco) to provide financial services at post offices. The current partnership is with Bank of Brazil.
Brazil, officially the Federative Republic of Brazil, is the largest country in both South America and Latin America. At 8.5 million square kilometers and with over 208 million people, Brazil is the world's fifth-largest country by area and the fifth most populous. Its capital is Brasília, and its most populated city is São Paulo. The federation is composed of the union of the 26 states, the Federal District, and the 5,570 municipalities. It is the largest country to have Portuguese as an official language and the only one in the Americas; it is also one of the most multicultural and ethnically diverse nations, due to over a century of mass immigration from around the world.
Empresa Brasileira de Correios e Telégrafos, abbreviated as ECT, also known as Correios, is a state-owned company that operates the national postal service of Brazil since the seventeenth century.
Bradesco is one of the biggest banking and financial services companies in Brazil. Bradesco was the largest private bank in Brazil until Banco Itaú and Unibanco merged in 2009. Bradesco is headquartered in the city of Osasco, in the metropolitan area of São Paulo, at Companhia Cidade de Deus, and has 5,314 branches, 4,834 Service Branches and 38,430 "Bradesco Expresso" Units, the correspondent bank through partnerships with supermarkets, drugstores, department stores and other retail chains. It is currently the third largest Brazilian bank by total assets. The bank is the world's thirtysecond largest in market capitalization in 2014.
In Bulgaria, the postal banking system was a subsidiary of Bulgarian Posts until 1991, when Bulgarian Postbank was created. In the years that followed, Bulgarian Postbank was privatized and the relationship between post offices and bank offices became weaker. Postal banking services ceased to be available in post offices in 2011.
Canada Post offered banking services via its Post Office Savings Bank, created by the Post Office Act in April 1868, less than a year following the nation's confederation. A century later, the Post Office Savings Bank was shut down in 1968-69. [3] Since at least the early 2010s, postal banking has been discussed and studied periodically, with postal unions backing the idea. [4] [5]
In the People's Republic of China, the Postal Savings Bank of China (zh:中国邮政储蓄银行) was split from China Post in 2007 and established as a state-owned limited company. It continues to provide banking services at post offices.
In Finland, Postisäästöpankki ("Post Savings Bank") was founded in 1887. In 1970 its name was shortened to Postipankki ("Post Bank"). In 1998 it was changed to a commercial bank named Leonia Bank. Later, it was merged with an insurance company to form Sampo Group, and the bank was renamed Sampo Bank. It had a few own offices, but also post offices performed its banking operations until 2000. In 2007, Sampo Bank was sold to the Danish Danske Bank.
France's La Poste, similar to the UK's Post Office, offer banking services called "La Banque Postale".
Deutsche Postbank has a postal banking system. Deutsche Postbank was a subsidiary of Deutsche Post until 2008, when 30% of Deutsche Post's shares were sold to Deutsche Bank. [6] Postal banking services are still available at all branches of Deutsche Post and Deutsche Postbank.
Greek Postal Savings Bank provided banking services from post offices until 2013 when it was replaced by New TT Hellenic Postbank a subsidiary of Eurobank Group.
In 1919 the Postal Savings Bank notes were issued under the decree of the Revolutionary Governing Council of the Hungarian Soviet Republic by the Magyar Postatakarékpénztár (Hungarian Postal Savings Bank).
India post, operated by Government of India, under Indian Postal services providing small savings banking and financial services, including National Savings Certificates.
Postal savings in Indonesia began with the establishment of the Netherlands Indian Post Office Savings Bank (Dutch : Postspaarbank) in 1897. During the Japanese occupation of Indonesia, it was replaced by the Savings Office(Japanese:貯金局 Hepburn:Chokin-kyoku, Nihon-shiki: Tyokin-kyoku) and savings were encouraged by the military administration to support the Greater East Asia War. The Savings Office became the Post Office Savings Bank again (Indonesian : Bank Tabungan Pos) after independence, before renamed into the current State Savings Bank, or Bank Tabungan Negara (BTN) in 1963. Between 1963 and 1968, it became the Fifth Unit of Bank Negara Indonesia during the single-bank system, made to support the guided democracy.
Currently, BTN offers a savings plan that allows its users to deposit in post offices.
In Italy, the Postal savings system is run by Poste italiane, the Italian postal service company. Poste italiane run this service along with Cassa Depositi e Prestiti.
In Ireland, An Post ran Postbank between 2006 and its closure in 2010, that was a joint venture with Fortis Bank Belgium.
Israel's postal service Israel Postal Company offers utility payment, savings and checking accounts, as well as foreign currency exchange services from all post offices. [7]
Japan Post Bank, part of the post office was the world's largest savings bank with 198 trillion yen (US$1.7 trillion) of deposits as of 2006, [8] much from conservative, risk-averse citizens. The government was criticized for using these funds to engage in uneconomical infrastructure projects—what in America would be called pork barrel spending. The state-owned Japan Post Bank business unit of Japan Post was formed in 2007, as part of a ten-year privatization programme, intended to achieve fully private ownership of the postal system by 2017. [9]
Kenya Post Office Savings Bank (KPOSB/Postbank) [10]
Korea Post, operated by South Korean government, has its postal banking and postal insurance business since 1982. Banking counter and ATM is available in all post office, excluding postal agencies and delivery centers. Korea Post ATM is connected with all national and regional banks via KFTC. Banking counter is also opened for Korea Development Bank, Industrial Bank, Citibank Korea, and Jeonbuk Bank customers.
In 1881 the Dutch government founded the Rijkspostspaarbank (National Postal Savings Bank). In 1986 it was privatised, together with the Postgiro service, as the Postbank N.V. Postbank merged with a commercial bank that would eventually become ING Bank.
Post Office Savings Bank was established in 1867 by the New Zealand government to give New Zealand investors a place to deposit their savings. [11] [12] This included the provision of children's savings accounts known as Post Office Squirrel savings account. The Post Office Savings bank was split into PostBank in 1987 and was acquired by a commercial bank two years later ending the bank.
In 2002 the New Zealand government created a new state owned post bank called Kiwibank as part of the New Zealand Post to again establish a postal savings system. [13]
Postbanken was founded in 1948 after major political battle as Norges Postsparebank, however the maximum amount allowed to be saved per person was set to NOK 10,000. In 1948 the bank had services provided at 3,600 post offices and post outlets. It was sold in 1999 and became part of the commercial bank DNB ASA.
The Philippine Postal Savings Bank (PPSB), also known as PostalBank, is the state-owned postal savings system in the Philippines. It is the smallest of the Philippines' three state-owned banks and is governed separately from PhilPost. In late 2017, state bank Land Bank of the Philippines acquired PPSB at zero value and made it as a subsidiary. It is now known as Overseas Filipino Bank.
In Portugal, the CTT own 100% of the Banco CTT, which has been operating since 2015 throughout Portugal.
POSB Bank of Singapore, stands for Post Office Savings Bank. Now part of DBS Bank (Development Bank of Singapore).
Postbank (South Africa), operated by the South African Post Office (SAPO). Offers transactional, savings, investments, insurance & pension banking services. [14]
In Sri Lanka, National Savings Bank and Sri Lanka Post provide banking services through post offices.
In Taiwan, the Chunghwa Post provides savings accounts and Visa debit card services in the Free Area of the Republic of China.
Between 1 April 1929 to 31 March 1947, the Post and Telegraph Department of the Ministry of Commerce and Transportation of Thailand has run Saving Office before becoming Government Savings Bank (GSB) [15]
Lien Viet Post Joint Stock Commercial Bank or LienVietPostBank (LPB), formerly known as LienVietBank, is a Vietnamese retail bank that provides banking products and services through its own transaction points across 42 cities and provinces and 1,031 postal transaction offices nationwide. LienVietPostBank is considered to be in the top 10 biggest banks in terms of assets and equity [2] and ranked 36th in VNR500 -Top 500 largest private companies in Vietnam in 2013. The Bank is striving to become the bank for everyone in Vietnam by focusing on banking products for households and small and medium enterprises especially in the agriculture sector, and expanding its activities to rural and remote areas via the post.
The Post Office Ltd offers savings accounts based on its brand, and is operated by the Bank of Ireland, a commercial bank, and Family Investments, a friendly society.
The Post Office branded services are similar to some of National Savings and Investments' services, and include instant savings, Individual Savings Accounts, seasonal savings and savings bonds. [16] [17] [18] [19] Post Office Ltd also provides a Post Office card account that accepts only direct deposits of certain state pension and welfare payments, permitting cash withdrawals over the counter. [20] This last account is offered in partnership with the Department for Work and Pensions until 2010, through investment banking and asset management company JP Morgan. (This contract has recently been awarded to JP Morgan to run till 2015)
In the United States, the United States Postal Savings System was established in 1911 under the Act of June 25, 1910 (36 Stat. 814). It was discontinued by the Act of March 28, 1966 (80 Stat. 92).
An Post is the state-owned provider of postal services in the Republic of Ireland. An Post provides a "universal postal service" to all parts of the country as a member of the Universal Postal Union. Services provided include, letter post, parcel service, deposit accounts, 'Express Post', an all-Ireland next-day delivery service, and EMS, the international express-mail service.
Japan Post was a government-owned corporation in Japan that existed from 2003 to 2007, offering postal and package delivery services, banking services, and life insurance. It was the nation's largest employer, with over 400,000 employees, and ran 24,700 post offices throughout Japan. One third of all Japanese government employees worked for Japan Post. As of 2005, the President of the company was Masaharu Ikuta, formerly Chairman of Mitsui O.S.K. Lines Ltd.
Kiwibank Limited is a subsidiary of the state-owned enterprise New Zealand Post Limited, New Zealand Superannuation and the Accident Compensation Corporation. Kiwibank provides some of its banking services through its PostShops and more recently through financial services only branches as well. Kiwibank is owned by the New Zealand government, with New Zealand Post owning 51% and the Accident Compensation Corporation and New Zealand Superannuation Fund owning the other 49%. The company's Board of Directors was chaired by former New Zealand Prime Minister Jim Bolger from 2001–2010. The current Chairperson of the Board of Directors is Susan Macken.
Post Office Ltd is a retail post office company in the United Kingdom that provides a wide range of products including postage stamps and banking to the public through its nationwide network of post office branches. The company is owned by the British Government's Department for Business, Energy and Industrial Strategy, through Postal Services Holding Company Limited.
Danske Bank A/S is a Danish bank. It was founded 5 October 1871 as Den Danske Landmandsbank, Hypothek- og Vexelbank i Kjøbenhavn. Headquartered in Copenhagen, it is the largest bank in Denmark and a major retail bank in the northern European region with over 5 million retail customers. Danske Bank was number 454 on the Fortune Global 500 list for 2011.
The Deutsche Bundespost was a German state-run postal service and telecommunications business founded in 1947. It was initially the second largest federal employer during its time. After staff reductions in the 1980s, the staff was reduced to roughly 543,200 employees in 1985. The corporation was dissolved in 1995 under the first and second postal reforms that took place in the German Post Office. Following the reforms, the former Deutsche Bundespost was broken into three publicly traded corporations: Deutsche Post AG, Deutsche Telekom, and Deutsche Postbank AG.
Postbank – eine Niederlassung der DB Privat- und Firmenkundenbank AG is a German retail bank, which was formed from the demerger of the postal savings division of Deutsche Bundespost in 1990. Since May 2018, it operates as a brand of Deutsche Bank's retail arm. It serves 13 million customers in around 1,000 branches and 700 advisory centers.
Postbank or Post bank may refer to any of the postal savings systems in these countries (alphabetically):
The main elements of Japan's financial system are much the same as those of other major industrialized nations: a commercial banking system, which accepts deposits, extends loans to businesses, and deals in foreign exchange; specialized government-owned financial institutions, which fund various sectors of the domestic economy; securities companies, which provide brokerage services, underwrite corporate and government securities, and deal in securities markets; capital markets, which offer the means to finance public and private debt and to sell residual corporate ownership; and money markets, which offer banks a source of liquidity and provide the Bank of Japan with a tool to implement monetary policy.
The Postbank was a large Dutch bank, which went on to become part of ING Group. It had 7.5 million private account holders and was one of the largest providers of financial services in the country. It provided current and savings accounts, loans, mortgages, insurance, investments and pensions. As opposed to other banks, it had no branches but operated completely through land mail, telephone and online banking, although some operations have traditionally been available through post offices.
PostBank, was a bank owned by the New Zealand Government as the government's postal savings system. The origins of the bank were established in 1867; it became PostBank in 1987 and was disestablished and the branches were rebranded when it was acquired by Australia and New Zealand Banking Group in 1989.
Retail banking, also known as consumer banking, is the provision of services by a bank to the general public, rather than to companies, corporations or other banks, which are often described as wholesale banking. Banking services which are regarded as retail include provision of savings and transactional accounts, mortgages, personal loans, debit cards, and credit cards. Retail banking is also distinguished from investment banking or commercial banking. It may also refer to a division or department of a bank which deals with individual customers.
La Poste is a postal service company in France, operating in Metropolitan France as well as in the five French overseas departments and the overseas collectivity of Saint Pierre and Miquelon. Because of bilateral agreements, La Poste also has the responsibility of mail services in Monaco through La Poste Monaco and in Andorra alongside the Spanish company Correos.
Banking in Germany is a highly leveraged industry, as its average leverage ratio as of 11 October 2008 is 52 to 1 ; its short-term liabilities are equal to 60% of the German GDP or 167% of its national debt.
Postbank, legally known as Eurobank Bulgaria AD, is a universal bank in Bulgaria.
LienVietPostBank is a Vietnamese retail bank based in Hanoi.
Kenya Post Office Savings Bank, often referred to as Postbank, is a Savings Bank in Kenya. Unlike other commercial banks in Kenya that are licensed and regulated by the Central Bank of Kenya, PostBank is regulated by the Kenya Post Office Savings Bank Act Cap 493B. This gives it a unique feature where interest income earned by depositors in exempt from tax.
India Post Payments Bank (IPPB) is a Government of India owned payments bank operating under the Department of Posts, Ministry of Communications, which aims to utilize all of India's 155,015 post offices as access points and 3 lakh postal postmen and Grameen Dak Sewaks to provide house to house banking services. The first phase of the bank with 650 branches and 3250 post offices as access points was inaugurated on 1 September 2018. Over ten thousand postmen have been roped into the first phase.
BancoPosta is a unit of the Italian Post Office that provides financial services, including savings, prepaid cards, exchange brokerage services, investment services, insurance, and various payment services. BancoPosta does not have a banking license and cannot directly provide loans to third parties, but is involved in the promotion and placement of public loans granted by banks and financial intermediaries. The bank services are available at all post offices in Italy.


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Cathay Restaurants
1423 Woodroffe Ave
Food Safety Inspection
Cathay Restaurants is a Cantonese and Szechuan cuisine known to be one of Ottawa's oldest and most iconic Chinese takeout and delivery restaurants around.
- Cuisine:Chinese
- Service:Delivery and Takeout
- Major Intersection:Woodroffe Ave And Meadowlands Dr W
- Website:Website
- Hours:
- Mon: 2pm - 11pm
- Tue: 3pm - 11pm
- Wed: 3pm - 11pm
- Thu: 3pm - 11pm
- Fri: 3pm - 12am
- Sat: 3pm - 12am
- Sun: 3pm - 10pm
Tell us more about Cathay Restaurants Nepean!
Cathay Restaurants Reviews, Nepean
Reviewed on: 2013-03-09
Cathay Restaurants
Great Ottawa style Chinese food. The owners are relatively new but they managed to keep one of the cooks. Sure miss Amie though.
Reviewed on: 2013-01-14
Cathay Restaurants
i enjoyed my food i always buy from cathy
Order: combo 4
Reviewed on: 2011-11-05
Cathay Restaurants
love the crunchy fat egg rolls. using this takeout for 10 years. they dont have a pork dish i like. good almond cookies and dont forget the fresh soft drinks.
Order: all dinner for2,3


text:
Hercules Stands GS-432B+ 3-Way Guitar Stand
Stand for Electric Guitar
- With space for up to 3 instruments
- Simple height adjustment
- Auto Grab System for secure hold
- Suitable for nut widths of 40 - 52 mm
- With adapter for smaller nut widths up to 28 mm
- Height: 905 - 1,130 mm
- Load capacity: 30 kg
- Size (folded): 780 x 150 x 150 mm
- Weight: 2.98 kg
Note: Not suitable for instruments with nitro lacquer.
Further Information
|Foam, Metal
|for 3 Instruments
|Suitable For:
|For Guitars With Pyroxylin Varnish
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