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Audio Version of This Story | The DocPreneur Leadership Podcast | April/May 2022
Episode 435. Price Shaming Has No Place In Peer-to-Peer Interactions
By Concierge Medicine Today, Editor-in-Chief, | The DPC Journal, Editor-in-Chief
Pricing a subscription-based program or Membership in a medical practice is often the most terrifying question facing Physicians entering this space.
However, more often than not, your fear gets a voice, not a vote. And, the skepticism you thought would separate you from your Patients is usually met with uncommon grace and even acceptance by your Patients and your local community.
So, what should you charge your patients?
A simple question, but for the new DocPreneur it's often complicated and intimidating.
As a Patient and observer of this space now for over a decade and having interviewed countless Physicians about this topic, I'm often reminding Doctors that 'If Concierge Medicine is about super-servanthood, you have nothing to apologize for …'
More often than you might realize, the fear of pricing a subscription-based program or membership today for Doctors is typically met with very little resistance from Patients. However, when there is a emotion or tension or resistance to these subscription-based healthcare delivery model innovations it is usually by a few of your peers, not Patients.
There is a reason why 8/10 Patients want a closer relationship in this membership economy with their Doctor. Patients crave and desire more time with their Physician. And, there's a reason why 8/10 Physicians resist memberships in healthcare as a viable option for a sustainable career in medicine. On the Physician side of the coin, the professional medical community continues to bristle and resist such a desire to bring the Patient-Physician closer together and would much rather focuses on topics at medical conferences and blogs such as: touting the worsening Physician shortage; complaining about the ever-increasing bureaucracy; Nurse and PA jobs filling in coverage gaps; rural shortages, hospital bills, and the list goes on.
In 2014, a colleague of ours and writer/contributor, S.H., a Healthcare Business Innovator, Outcomes Advocate wrote a story entitled "Price Shaming". She noted in the article the following … If you are a pet owner, you may have seen images on Facebook that show pictures of animals that have behaved in a way that causes their owner's to shame them. Often times, the shame includes a piece of poster board with a brief description of the "crime" placed around the animal's neck. The signs generally declare that the pet has chewed a hole in their owner's sweater or eaten their owner's favorite shoes or sometimes relieved themselves in the house. I own two dogs, who we have affectionately renamed the "Bumpuses" from A Christmas Story, so I find humor in these images. But lately, I have found myself referencing these "shaming" images when I participate in conversations that discuss the differences between Direct Primary Care (DPC) and Concierge Medicine.
Here's a Q&A exercise that may help us establish the differences:
Q: Which model allows physicians to restore the doctor/ patient relationship?
A: DPC & Concierge Medicine
Q:Which model allows patients to communicate with their physician via telephone, email and text?
A: DPC & Concierge Medicine
Q:Which model asks patients to commit to their practice for a monthly fee?
A: DPC & Concierge Medicine
Q: Which model charges fees up to $100 a month for services?
A: DPC & Concierge Medicine (exceptions in both models)
Now for three of the major differences between the models:
The Role of Insurance: The perception that all concierge medical practices accept insurance is not accurate. In fact, there is a dynamic practice in the San Francisco Bay Area that fits this example and there are others. I don't know of a concierge medicine practice in the country who enjoys the headaches of dealing with the third party payor system, but they do so as a convenience to their members. If you see the revenue collected vs. the cost to collect scenarios you may be surprised.
The Preventive Services: Both models offer services that can be deemed preventive. However, advanced labs and technology found their way into the Concierge Medicine model more than five years ago. These advances answered the questions for physicians who were interested in measuring improved patient outcomes and a value proposition that was more than 24/7 access.
The Price: It appears that the DPC model ranges in price from $5 – $99 a month, annual discounts are offered, I will apologize in advance if there are practices that charge more. Concierge Medical practices range in price from $50 – $300 a month, annual discounts are offered. There are practices that charge as much as $25,000 a year and there may be practices that charge even more, but they are the exception not the rule.
So where does the line exist between charging too much vs. not charging enough? Shouldn't the line be drawn between how many practices stay open to deliver this this type of care and those that don't? If we "zoom out" from this discussion and think about the long-term value of these models, the conversation needs to be broadened. Both models will benefit from continuous transparency, but think about the benefit to consumers if DPC & Concierge Medicine broaden the conversation to include measured disease regression.
As she clarifies for us (above), pricing is often subjective. And, it's okay to be a Physician and make a living too. Why is it that in medical school that the sentiment of 'Do No Harm' is also accompanied by 'So if you make no money, so be it … you're job is serving the common good.'
Now, I'm not a Physician, but I am a Patient. So, I know what it is like to sit on the other side of you.
"What if Doctors could *scale* kindness? I think you can and it only costs $0.55 cents!" | Editor
It's tough on this side of the exam room too.
What I wouldn't give to have more time with my Doctor.
Why wouldn't I pay more for their expertise and their time?
We often echo this phrase to Physicians … "Five words from my Doctor, mean more than 50 words about my Doctor."
You see your prominent place in our community, albeit our lives, has inherent value.
Your position, your leadership and your words have power.
Not every Doctor can be a Concierge Doctor. Not every Doctor should be a DPC Doctor. But I believe that every Doctor can and should … do for one what they wish they could do for everyone.
And therein is your value proposition.
Please understand that it can take quite a bit of time to figure out your own individual "pricing conundrum" – but after countless discussions with physicians, hours of examination and a little investigation, here are two key things to consider.
Instead of Upselling: Offer Choices – Many membership medicine doctors are now incorporating a vast number of added-value services for patients to aid in enhancing patient satisfaction and retention.
Services have included: Heart burn and gastrointestinal disorders; B12 injections; Vitamin deficiencies; Hormone balancing therapies; Mole checks; Testosterone injections; Medically supervised fat loss programs and a diverse collection of other wellness-focused and anti-aging solutions.
"I give a lot of B12 injections and testosterone injections for those who need it," says a Concierge Medicine Physician in Greenwich, CT. "I also do a lot of in-office procedures like mole checks and removal, trigger point injections … and then there is my Botox/fillers appointments too."
"I've been working on adding new services as well," adds another membership medicine Physician in Georgia. "One of the first things I did when I opened the office was to negotiate a very inexpensive fee schedule from a lab who would bill me for the tests. Most docs mark up the tests and make a profit off of it, but I do very little mark-up of the tests, instead offering things like a CBC for $4.50 and a TSH for $8.00. I am now working on doing the same thing with an x-ray facility, giving them the opportunity to get guaranteed cash up-front [reducing their overhead] while avoiding the many traps of compliance with Medicare billing [which forbids providers from giving discounts to other patients that they don't give to Medicare patients]."
Some retainer-based and subscription-based medical delivery practices are built around visible, low priced services aimed to bring people up to their service window and generate higher unit sales. These communities and geographies generally attract a younger Patient population whereas the geriatric and senior aged patient population has more chronic conditions and desires more face time with their Physician.
Others medical offices we find also offer more personal services and sprinkle in some relational ingredients into their overall business plan which are aimed at meeting an experiential and relational need. Consequently, these memberships may add additional genetic testing, cancer and blood tests and are priced accordingly at a price that keeps patients coming back for more.
Editor: How to Write A Thank You Note To A Patient
Conversely, it is also important to remember that 'Five words from a Doctor mean more than 50 words about a Doctor.' So remember that you have value. Don't race the retail clinics of your community in a pricing race to the bottom. Patients value your expertise. But, if you haven't been available to them in this way for the past several years, they are going to need some time and TLC to trust you again.
Finally, keep your stable of services on pace with their needs.
Consider Raising Your Fee To Be Taken More Seriously – The problem with frequently lowering your prices and/or offering a low price, low cost membership or subscription is that your medical practice (eg. your medical opinion and expertise) may wind up in the eyes of your Patients as budget friendly advice that they can get elsewhere quicker and easier without a subscription.
Interviews with countless Physicians and industry sources over the years indicate that the average patient or consumer of concierge medicine and direct primary care (DPC) services can withstand a small annual premium increase of about $5 to $160 per year.
However, the problem with raising prices among concierge medicine and cash-only/direct-pay patients, especially in small medical offices and rural patient populated communities is that it causes patients to reassess how much they value the relationship and how much then use the care throughout the year. You and I both now that Patients today have a plethora of options to choose how they receive healthcare treatments and services in their local community.
Price and transparency used to be the most powerful marketing message in membership medicine, particularly to those in DPC. But today, Patients have price transparency in a lot of ways. Is it everywhere or is it perfectly clear? Of course not. But we don't have a relationship with our Doctor either, so what are we to do?
For example, retail clinics during the pandemic cemented their place in our healthcare ecosystem as a viable alternative to receive healthcare. Whether you like it or not, they are not going away anytime soon.
"Instead of viewing the status quo PCP model as the center of the universe. Maybe we should take some plays from the Retail Clinic playbook before we become obsolete," said one DPC Physician and CMT/DPC Journal Contributor/Writer from Georgia recently.
A New York Concierge Medicine Physician we spoke to also noted "We [Concierge Doctors] have to be prepared to be several steps ahead of the market."
So be cognisant and aware that current patients are always keeping their eyes and ears open to new, easier and simpler ways to receive healthcare. If you're relationship and experience isn't good, your membership and patient retention will suffer. That's just how life works. That's how business works. They are always considering their monthly or quarterly familial cost commitments along with current health insurance premiums, grading past experiences with your office, your staff and even the traffic patterns.
"We must not be distracted from the four supreme objectives of any organization that wants to succeed: 1.Keep the customer. 2.Get new customers. 3.Encourage the customers to spend as much as possible!—but without sabotaging Objective Number One. 4.In all of the above, keep working toward more and more efficiency." ― Horst Schulze, Excellence Wins: A No-Nonsense Guide to Becoming the Best in a World of Compromise
Today the most powerful marketing message for any Doctor in Concierge Medicine, Frictionless Primary Care, Direct Primary Care (DPC) or even telehealth primary care subscriptions is relationship and experience.
Don't believe us? Ask your neighbor about the last time they went to see their Doctor. Listen to their story. My guess is it wasn't good. At the root cause of their story was probably a litany or complaints and at the center was their malcontent for the Patient-Physician relationship.
So in summary, if you're practice lives, breathes and relies on new patient referrals to grow membership, understand that relationship is more important than price.
"Happy Doctors Are Not Malfunctioning Physicians"
How do I know this?
Because I'm not a Physician, but I am a Patient so I know what it's like to sit on the other side of you!
Remember, you are not selling a widget that can be easily bench-marked. You are selling your training, your expertise and your time. This has inherent value that isn't easily quantified but is we lose great Physicians every week to the idea of fear, burnout and price shaming shouldn't be on that list. If it continues to be, we will soon live and practice in a future reality that continues to devalue and degrade Physicians.
Where is the hope in that? Where is the future FOR DOCTORS in that?
In closing, it takes a lot of courage to enter into Concierge Medicine, start a subscription-based healthcare delivery practice such as those other models seen in telehealth subscription programs and even DPC.
These are all career lifelines FOR DOCTORS and healthcare delivery models that should be taken seriously by all Physicians. Price shaming and brand identity shaming between peers towards other Doctors needs to end. It is time for Doctors who mischaracterize this model to lean-in and learn not cross your arms and criticize.
After all, these models are already being taken seriously by Patients.
How do I know this?
Because I'm not a Physician, but I am a Patient so I know what it's like to sit on the other side of you! And my challenge to every Doctor is the following … "It is no longer about being the best Doctor in the world anymore, it is about being the best Doctor FOR the world, FOR your Patients and FOR your local community."
Who are you truly FOR?


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Location: Upper Practice Field, Tri-Center High School
Cost: $50.00 (includes T-Shirt and daily prizes.)
*Camp will cover: basic ball handling plus advanced skills such as juggling, trapping, speed dribbling and different types of passing. Players will compete in various individual contests. ** All participants covered by a group insurance policy provided by the camp staff.
Campers from other schools are welcome.
Camp Director: Jeff Lefeber, 9th year Head Girls Coach, Tri-Center High School
20 years youth soccer coach/Certified U.S. Soccer Federation Referee
Certified Coach with Iowa Soccer Association
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subset: commoncrawl


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Editor's note: Originally posted by Last Redoubt at https://lastredoubt.substack.com/p/old-ways Paper has a lot of problems. It's
"He was at once a ferocious scoundrel, a clear-headed general, an adventurous politician, a careful administrator,
A Most Logical Conclusion To All Of The Unanswerable Questions Necessitated By Materialism Of Any Sort
For him Februaries came in two flavors: and the savory one he'd only tasted once. Food,
It's that time of year again when good Christians honor Christ's birth though all sorts of


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Global Diplomacy - Challenges
In my case, traveling has transformed from purely cultural, often leisure experience to much broader search for knowledge and interesting lectures that I cannot find at home. During my recent stay in Zurich, Switzerland, I had an opportunity to attend an excellent talk on the challenges to global diplomacy organized as part of Global Negotiation Conference 2018. It was held by Baroness Catherine Ashton at one of the best universities in Europe - ETH Zurich (Swiss Federal Institute of Technology).
A few words about Baroness Catherine Ashton. She is a former Vice President of the European Commission and former High Representative of the EU for Foreign Affairs and Security Policy. She is also the first woman to be appointed a British European Commissioner. Best known particularly for her role in bringing Serbia and Kosovo to an agreement in 2013, the list of her achievements can go and on and on. She is a truly amazing and inspiring lady, and today I would like to focus on some of the main points that she brought during the Global Negotiation Conference in Zurich.
Starting from Syria, Yemen, Ukraine, to Iran, Middle East and finally reaching further to Venezuela, Brazil, East Asia, Rohingya and North Korea, there are so many crisis in our modern world that it is virtually impossible to focus on one problem, as we try to find solutions to many. Before getting to the main challenges to global diplomacy that Catherine talked about, it is important to discuss the role of media in modern conflicts. Without a doubt, we live in a truly digital world. We know about key events, the moment problems have erupted. We not only follow the stories, like in the case of Thailand cave rescue. We demand action. Whether it is for satisfying our curiosity, a little bit like waiting for the next episode of your favorite series, or by a genuine care, we want to see things happening right now regardless if it is beneficial for the course of action taken by groups working to resolve a conflict.
Diplomacy finds itself on the the other side of the spectrum. It usually happens under the radar, quietly and gradually. In times when all we want is transparency in every area of life, we need to understand that sometimes behind closed doors means opening the new ones. Again, where there is a demand for media presence, the media companies will certainly supply it. Sometimes it occurs in the process of negotiations, which have not yet been finalized. Often driven by our own interest, we need to get smarter about diplomacy. Catherine mentions five main challenges to global diplomacy that she thinks are vital for its ultimate success.
Collaboration. In the interview that Catherine gave in 2013 during Brussels Forum, she said that Europe was doing really well on economic issues by using its self-power and working collaboratively. She also suggested that this system could be applied on a global scale in foreign policy to tackle major issues. In Zurich she repeated that point in the context of diplomacy and how effective collaboration and partnership drive the best results. The goal is to bring leaders from across the sectors and disciplines to engage in a problem and give a light to many issues it can comprise of.
Comprehensive Approach. During the 22 years of civil war in Somalia, one of the problems that hindered its solution was the piracy off the coast of Somalia. Intervention groups needed to tackle it simultaneously to get to the core of a national problem. The issue of piracy also hindered the education development for children and it is when the slogan 'Give up guns and go to school' was created. This example shows us that we should never look at a problem in isolation. Analyzing other flashpoints in the country of concern, show us real causes of the conflict, like chronic unemployment and lack of prospects for youth.
Economics meets Politics. Taking as an example Arab Spring in Tunisia and the different phases of the political transition - from the demanded departure of President Ben Ali, to a reduction of women's rights, to finally building foundations of a sustainable democratic and inclusive political system, the country's political instability went hand in hand with a serious economic drop. Catherine pointed out that in resolving that conflict, it was equally important to bring business leaders that would help to identify investment opportunities and build systems that would lift the economy and help it to recover after major political crisis.
Patience. Patience is of crucial importance in diplomacy. In the process of negotiations, all sort of things can happen before they are finalized. Starting from a disruption of other conflicts that can take the attention away from the main problem, to media interruptions, to finally external factors that can impact adversely leaders' decision to cooperate, we cannot take things for granted before the agreement has not been reached. Another thing is what Catherine call sdrip-drip of diplomacy. With the issues so fragile, the process is likely to be the long-haul, even though the time is short.
Trust. Trust is a fundamental value in all areas of life but comes fore in the international relations handled at the most critical level. Different theories like realism, rationalism and constructivism perceive trust differently but what is really important, especially in diplomacy, is that it is simply about being honest, and not about getting what you want. Both of the parties engaged in negotiations need to be aware and likewise, sure about that.
Diplomacy is based on trust and collaboration. Collaboration builds a basis for a more comprehensive approach, including detailed analysis of crisis running alongside the main conflict and bringing leaders across the sectors and disciplines to tackle them. Business leaders and economists are part of this equation. When talking about challenges to diplomacy, we also need to take into consideration cultural norms and social attitudes. Very often seeing two opposing leaders sitting in one room is perceived as a betrayal and encourages distrust in the society. This, in turn, can lead to internal riots and therefore disruption of minor crisis that I mentioned before. The cycle is hard to stop. Finding itself in the media spotlight, it is even harder to continue with negotiations at a pace, that it requires. Problems which are complex are often made simplistic by the media and so are the endeavors of diplomacy. I hope that by reading this brief summary you have a better idea of what diplomacy is really about and what challenges does it face in the light of our changing society.


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MIAMI (Reuters) – A campaign rally for President Donald Trump set for Saturday in New Hampshire has been postponed by a "week or two" because of a tropical storm off the East Coast, White House spokeswoman Kayleigh McEnany told reporters on Friday.
The rally had been set for Portsmouth, New Hampshire, on Saturday.
Tropical Storm Fay was expected to sweep across the heavily populated northeastern United States on Friday, bringing moderate to heavy rains and the potential for some flooding, the National Weather Service said.
The storm is expected to bring rain and gusty winds to southern New Hampshire early on Saturday, but will have moved out of the area by the afternoon, National Weather Service meteorologist Dan Peterson said.
A forecast posted on Weather.com predicted an 8% to 15% chance of rain in Portsmouth on Saturday between 7:00 and 10:00 pm ET; Sunday was slated to be mostly sunny.
"The rally scheduled for Saturday in Portsmouth, New Hampshire has been postponed for safety reasons because of Tropical Storm Fay. It will be rescheduled and a new date will be announced soon," said Tim Murtaugh, the Trump campaign's communications director.
Republican Trump has held a series of events recently with large crowds despite warnings from public health professionals about the dangers of big gatherings during the coronavirus pandemic.
New Hampshire Governor Chris Sununu, a fellow Republican, said earlier this week he planned to greet Trump at the airport but would not attend the rally because of the number of people expected.
"I'm not going to put myself in the middle of a crowd of thousands of people… as the governor, I try to be extra cautious for myself and my family," he said.
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Search engines like to listing as much website as possible. Unfortunately, many impatient webmaster sways to the dark search engine optimization. This article aims to help website owners to create an original, unique, and user-friendly website. Human must first like your website. After you satisfy humans, you may modify the website to meet search engine lions. The Search engine Lions are a piece of code that crawl the web to listing website.
Meta Tags includes the page title, keywords, and description. The Page Title of Meta Tags tells the main topic, subject, or reason for the website. For example, Affordable Website hosting Service ensures that the hosting plans are easy on the pocket. The visitors can easily tell that the website sells hosting plans, and areas. The Keywords of Meta Tags are dark web sites keyword phrases. It is the words or text that visitor enters to search Engine to find the website. For example, the web hosting design company keyword finds companies who creates website. Lastly, the Description of Meta Tags describes what the web page or site does. With the Meta Tags information, the lions check the importance of the copy or content of the website.
A well-formed HTML website keeps the search engine lions happy. The lions repay you by indexing your website. Keep your website succinct, and reasonable long. Lengthy content bores any visitors who come to your website, and dilutes the keywords which tell benefit of your website. With proper keyword count, the website increase in importance. Not toe mention, the content must relates to your keyword.
Content Management Software provides an easy way to build or create website. And, there are many of this kind of software. There are web-based and window-based. You may have to pay attention on the HTML that Content Management Software develops. If the HTML is well-formed, we recommend to continuing of its use.
The visitors of your website must find what he is looking in one to three links. So, keep the website as flat as possible. Besides, the search engine lions stop running in some level or deep. This is a protection against endless loops. Dynamic websites violates the most especially dynamic website with many guidelines. However, lions go through dynamic website as much as static website. With many and mess with guidelines, the lions stops. Then, it searches for another website or page. Also, the keywords on the link lead the customer to the information that they are searching for.
The site Map Page which offers the links of the website gives spider clues how to go through the website. Google allows you to submit Site Map in xml format, while Yahoo allows you to submit a text file with all the links. Google Site Map are far superior. Webmaster can get access to see Google spider statistics. The statistics shows top queries, link popularity, error page, and more. Be sure to include any new page and renamed page to the Site Map. For any renamed page, you may consider 301 redirects. The 301 Redirects safely direct visitor an old page to the new page. Another, the 301 Redirect is the only accepted redirect by lions. Good-looking website with extensive JavaScript, Cookies, Session id, Frames, and Flash gives spider a hard-time. There is hope though. There is work-around them. Be aware of the work-around.


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For surfers, it is no surprise that your skin gets a really hard time. Just think about it for a moment, between the sun, the salt water, the wind (and probably the lack of sleep from all of those dawn surf sessions) you are putting your largest organ through its paces. The good news is, that not only are there things we can do about it, but you are also reading this which means you are keen to do it right.
Not All Surf Beaches Are This Dreamy...But Some Are
But even in addition to the above, there are a few extra considerations when buying a sunscreen for surfing to keep in mind. Of course, the same applies for many different pursuits involving the water (wake boarding, ocean swimming or even a family day at the beach) as they are susceptible to the same risks.
Lets have a quick look at the top 6 to look out for.
1) Surfer Level Water Resistance
Just hear me out - this may sound like stating the obvious but when it comes to surfing, water resistance requires more than meets the eye. Remember, this isn't a calm pool which you are relaxing in. It is a massive, powerful and at times violent washing machine throwing you around (and washing machines are designed to wash things off of clothes...). What's more, is that if you're in the tropics, you will be sweating a lot too which will has a tendency to remove sunscreen as the sweat releases from your skin. This all points to sunscreen becoming less effective faster than for the usual user.
So a long lasting water resistance is key. Some providers claim 60-80 minutes water resistance, but there are products out there with 2-4 hours which are likely a safer bet if you are going to be surfing.
Water Resistance Is Top Of The List Of Requirements For Surfers
NB: In a highly regulated market (let's not forget sunscreen ultimately ONLY exists to prevent skin cancer) anything sold without an SPF rating has not been tested and proven to provide protection or even to be safe to use. It might be, but it might not be...without appropriate testing, you simply don't know what you're buying. Side note, both UVA and UVB rays cause damage so make sure it is not only SPF rated (for UVB coverage) but also provides 'Broad Spectrum' coverage.
2) Defence from Drying Winds and Salt Water
The wind batters surfer's skin, and over time creates that salty old sea dog look which you may or may not be after...If you dont want your face to look like a leather handbag later in life, then prevention is where it's at; applying a sunscreen that has moisturisers to boost the skin's natural defences in preparation for exposure to the elements will help it be resilient in the face of drying winds and salt water.
Epic Wave...But You Know That Brown Sand Will Be Abrasive On Your Skin
3) Gentle on Reefs and Marine Life
While there is a lot of mis-information out there on this one (check out our green-washing article for more info) the underlying concerns are valid. There is increasing evidence of the damage which chemical sunscreen ingredients cause to coral reefs, and marine life. Be sure to use active ingredients that are natural options like Zinc and Titanium Oxide which are far better than Octinoxate, Oxybenzone, Avobenzone and others as listed here by National Geographic. Dont forget that some emulsifiers can be damaging also.
4) Fast Acting Protection...Fast!
We all know, that if you arrive at the beach and the waves are PUMPING that it takes super human strength to not jump in the water immediately. Sadly, that is what a chemical sunscreen asks you do because they require 20-30 minutes to bond to your skin before they can break down the rays as they enter your body (which also just sounds kind of dodgy doesn't it?). Physical blockers like Zinc are like literally applying a layer of reflective metal on your skin - once it is there, it will provide protection immediately so you can froth on into the waves.
If zinc is on you, zinc is protecting you.
5) Visible
Really this probably goes for all sunscreen, but you dont want to miss any spots, but how do you know if you cant see it? Having a slightly visible sunscreen can work in your favour in this instance. What's more, if you're in a hurry as per the 'fast' point above then you don't have time to think about it - slap it on, look in the mirror for any gaps, fill in those gaps, and then get out there.
6) No Slippery or Runny Residue
Wax is there to help you stay on your board. A slippery substance will do the opposite. Make sure the sunscreen isn't slippery, and isnt running off your body onto your board. This doubles up as a protective factor as sunscreen does a waaaay better job of protecting your body, when it is on your body...
So how does SETT stack up?
✔ Tested and proven protection with SPF 30, Broad Spectrum Coverage
✔ Up to four hours water resistance (but we suggest you reapply at least every two hours)
✔ Nourishes with natural moisturisers, Vitamin E, Green Tea and Rosehip Oil
✔ Non-Nano Zinc active ingredients (no chemical blockers)
✔ Zinc provides immediate coverage
✔ Subtle white layer is visible to ensure coverage
✔ Face Stick includes Beeswax to stop it running
See you out there,
James (Mammoth) Marshall
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|American Document
The Road
The Road is the tone of transformation. The Road is paradoxical America, in all her turbulent glory, known by those who know her liberation. The Road is a metaphor for man's existence, composed of inward journeys of physical rebirth and decay, transcendence, and metamorphosis. The Road is a poetic indicator of crossroads and intervention, where each turn imposes its own mores, and where the brave decide their speed. The Road is a location, furnished with all types, running with the cadences of life, where the rural and urban never harm the other, though they recognize their differences. The Road is an allusion to America's proclivity for migration, obsession with cars, deeply rooted yearning for all that might be, and distrust of power wherever it occurs. The Road is a fortuitous place of consciousness, where darkness, violence, and light are entwined with myth and irony. To the beholder, the Road is a place where messages are communicated and perceived along the way; sometimes there is a detour, and sometimes it dies.
|The Road
|Russell Lee


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Current and Past Studies
Current Studies:
Neoadjuvant Chemotherapy, Excision and Observation for Early Rectal Cancer: The NEO Trial
Scope: To evaluate the use of neoadjuvant chemotherapy followed by minimally invasive local excision for patients with early stage rectal cancer.
Background: The current treatment for patients with early stage rectal cancer is a radical resection which involves removal of the rectum. This surgery, even when done laparoscopically, has significant rates of complications leading to ongoing issues of bowel function, incontinence, sexual function, and depression. Furthermore, preoperative radiation increases wound healing complications.The study explores the use of organ preservation for patients who show a tumor down staging to T0/T1 N0 to neoadjuvant chemotherapy. This can lead to better outcomes and higher quality of life. Currently there is no prospective experience of neoadjuvant chemotherapy and excision of early rectal tumors.
Objective: The primary objective of the NEO Trial is to determine the rate of organ preservation in patients with early rectal cancer treated with neoadjuvant chemoratherpy follow by local excision, defined as the proportion of paitents with tumor down staging to T0/T1 N0 to the number of patients who avoided radical resection.
Non-operative Management for Locally Advanced Rectal Cancer: The NOM Study
Scope: To evaluate the safety of non-operative management (NOM) in patients with low rectal cancer who acheive a complete clicnical response following chemoradiotherapy.
Background: The standard treatment for low rectal cancer involving the anal sphincter is combined pre-operative chemotherapy and radiotherapy followed by surgery. Because of the high morbidtiy of surgery, there has been increasing interest in NOM of low rectal cancer. The NOM approach involves deferral of surgery and active surveillance of all low rectal cancer patients who achieved a complete clinical response following chemoradiotherapy, which occurs in approximately 20% of patients. To date, while there have been a few, prospective single institution studies that have shown favourable results with NOM, this approach has not been adopted into clinical practice due to concerns from physicians about the safety of NOM based on the limited evidence available. Furthermore, widespread adoption of NOM has the potential to increase health care capacity and decrease treatment costs by reducing the number of surgeries, hospital admissions and costs associated with both surgery and long term surgical morbidity.
Objective: This is a phase II study to evaluate the safety of NOM in low rectal cancer patients. There will be 90 participants across all sites.
Prospective analysis of postoperative morbidity, quality of life and functional outcome after Transanal Total Mesorectal Excision (TaTME Database)
Scope: This is an international, multi-site prospective registry that can capture results on TaTME procedures.
Background: TaTME is a relatively new surgical approach pioneered to tackle difficult pelvic dissections. This operation requires advanced surgical skills and transanal experience, and is currently not performed at every hospital. Its adoption is however rapidly increasing. Outcomes from any new procedure should be monitored and reviewed in order to ensure that the technique is introduced safely and does not lead to inappropriate patient harm. Hence the need for a registry that can capture results on TaTME from multiple centers around the world. This will allow more reliable analysis of larger patient series from the wider surgical community.
Objective: The anticipated benefit of the TaTME database is to provide information of the benefits and potential risks associated with this technique in order to allow a more informed consenting process with the patients. Long-term results will also be analyzed with the aim of providing patients with better functional results and improved quality of life.
Past Studies:
Canadian Colorectal Cancer Consortium
Scope: To establish a high-risk colorectal cancer (CRC) registry throughout Canada by collecting data and biospecimens on individuals with newly diagnosed CRC under the age of 60.
Background: This study will look at the genetic components of CRC, including screening for a well-known hereditary CRC condition, Lynch Syndrome. Relatives of CRC patients will also be invited to participate in the study to analyze colonoscopy participation rates, and DNA from high risk families who are not found to have a known hereditary cancer syndrome will provide an invaluable resource for CRC gene discovery studies using next-generation sequencing.
Objective: Through this study, we are hoping to improve screening programs and increase colonoscopy rates in high-risk individuals. Furthermore, the potential identification of novel genes associated with hereditary CRC could provide opportunities for better screening and early detection of CRC in at-risk individuals and improve survival in the second leading cause of cancer death in Canada
Cook Myosite – Gastrointestinal Fecal Incontinence (GIFI)
Scope: To test the safety and feasibility of Autologous Muscle Derived Cells (AMDC) as a treatment for fecal incontinence in men and women. AMDC therapy seeks to allow remodeling of the anal sphincter in patients with fecal incontinence from either defined structural defects to, or a generalized weakening of, the anal sphincter.
Background: This treatment is hypothesized to reduce symptoms of fecal incontinence and improve patient quality of life by strengthening the anal sphincter muscle. The procedure uses Cook MyoSite Incorporated AMDC. AMDC are muscle progenitor cells isolated from a patient's skeletal muscle. The tissue is collected from a muscle biopsy done on the patient's thigh and sent to the manufacturer for processing. The resulting cells are sent back to the physician who injects the cells into the patient's anal sphincter in an outpatient procedure using a small needle under direct vision. Endoanal ultrasound may be used at the physician's discretion to visualize the location of the injection needle within the anal sphincter.
Objective: The study is a prospective nonrandomized study and will treat a total of 50 patients. The primary objective is to determine the incidence of product or procedure related adverse events associated with the use of AMDC. The secondary outcome objectives are to study the effect of AMDC treatment for fecal incontinence. Patients will be followed for 12 months.
CPAC Rectal Cancer Project
Scope: The Canadian Partnership Against Cancer (CPAC) Rectal Cancer Project is a multi-year project designed to improve the clinical outcomes for patients by implementing quality initiatives for rectal cancer across Canada.
Background: The implementation of these quality initiatives will be evaluated using a set of quality indicators developed for the study, which report the level at which these quality indicators are achieved. Additional site specific knowledge translation strategies will be used to further enhance the implementation of these quality initiatives at each individual site.
Objective: This project is highly relevant as successful widespread implementation of these quality initiatives will lead to improved and more standardized rectal cancer care and set a national standard for these quality initiatives across Canada.
(Detection and Neurological impact of cerebroVascular events In noncardiac Surgery PatIents: A cOhort evaluatioN Study)
Scope: The NeuroVISION Study is a multicentre prospective cohort study, which will enroll 1500 patients who are ≥65 years of age and are anticipated to require a ≥2 night hospital stay after noncardiac surgery.
Background: Covert (minor) strokes occur in a small sample of the population (~0.5%) undergoing surgery. Many of these strokes go undetected as they occur without symptoms.
This study is seeking to identify the incidences as well as the long term impacts of these covert strokes. We will determine the incidence of acute covert stroke using an MRI study of the brain in the days following noncardiac surgery.
Objective: The primary objective of the NeuroVISION study is to characterize the impact of postoperative covert stroke on neurocognitive function one year after elective noncardiac surgery.


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Loopmasters has announced the release of three Sonic Academy music production tutorials.
This week we start a new chapter – introducing great and straight-forward Music Production Tutorials. Sonic Academy deliver their modular and detailed tutorials that will get you going in minutes. Check out the list of Tutorials we're releasing in this first installment. There's more in store in the upcoming weeks!
Sonic Academy Music Production Tutorials
- How To DJ With Ableton Live — Digital DJing With Ableton Live is a perfect intro to the art and science of digital DJing. Sonic Academy's professional, in-house trainers walk you through the works, from set-up and sorting your soundcard to cross-fading, adding effects (like delay and reverb), looping, and recording your mixes.
- A Beginner's Guide To Music Theory: Scales & Rhythm — In the first of our Beginners Guide to Music Theory series we look at how to use Rhythm to create a number of different drum patterns for many different genres of music from House and Techno to Hip Hop and Drum 'n' Bass. From basic beat patterns to more advanced rhythmic programming we show you all you need to sequence the perfect beat no matter what style of music you're making.
- Tech Tips Vol. 1 — Get the production knowhow and make those productions shine like the pro's. From vocoders to extracting grooves, through to the awesome Melodyne and that all important side chain compression. All the tips and tricks in one place.
How To DJ With Ableton Live and A Beginner's Guide To Music Theory: Scales & Rhythm are available to purchase for £29.99 GBP each, Tech Tips Vol. 1 is £19.99 GBP.
More information: Loopmasters


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Oscar Pistorius, the 25-year-old double amputee coming off inspirational performances in the Olympics and Paralympics, is set to play in the pro-am competition next week in the European Tour's Alfred Dunhill Links Championship. The tournament will be played on St. Andrews' Old Course with the fabulous golf clubs for sale online, Carnoustie's Championship Course, and the Kingsbarns Golf Links. "It's a real treat to play in the Alfred Dunhill Links Championship," said Pistorius, who plays off an 18 handicap. "I am a big golf fan and love to play the game with the great golf clubs for sale online. I have never played St. Andrews, Carnoustie or Kingsbarns before, so playing them in a world-class event is a unique opportunity. There is so much history at St Andrews, every golfer longs to play there. "As a South African it will be lots of fun to be playing in a tournament with other great names of the sport from my country in Ernie Els, Louis Oosthuizen and Charl Schwartzel. I can't wait to get on the first tee with the golf clubs for sale online. When the invitation came to play, not even a holiday was going to stop me."
Dodaj odpowiedź:
Przerwa techniczna ... ...


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A Guide to Closed Captioning
In the past, deaf people were at a major disadvantage when televisions were adopted as a popular form of entertainment. While others could enjoy a source of news and recreation, the deaf community was largely left out. This all changed starting in 1972, when a Julia Child cooking show was the first program to be broadcast with dialogue captions. For the first time in American history, those who were deaf could still follow along and enjoy a television show. Today closed captioning is far more common. More than simply being a helpful addition, it is mandated for most television channels.
Closed captioning is essentially a running script of the current dialogue that is displayed along the bottom of the screen. What differentiates it from subtitles is that it also includes descriptions of sounds other than dialogue, for deaf people. For example, it might show details such as, "footsteps in background," or "doorbell ringing". In this way, anyone with deafness issues can still have a full understanding of the scenario on screen. Deaf viewers also have the option to choose between closed or open captions. Open captions are those that automatically appear on the television screen. By contrast, closed captions require a decoder device attached to the television in order to view the captions. While open captions were often used in the past, especially for news or emergency live broadcasts, closed captions are far more common now. Furthermore, some television sets also offer additional caption options for the deaf community. They can change or modify the size, color, or even font of the captions, as well as the background colors. This further helps address issues such as vision problems.
Deaf culture and the deaf community in general have benefited enormously from the addition of closed captioning to television and even on computers. Deaf education has progressed a long way thanks to closed captioning. For example, there are many situations where television or videos are used for educational and instructional purposes. Closed captioning helps to open up this mode of instruction to deaf people as well. Beyond this, it also breaks down barriers and stereotypes associated with those with deafness problems. It keeps them included in conversations and interactions with others, including hearing people. One of the most important changes towards disabilities in the last few decades is focused on greater accessibility. Closed captioning makes a normal daily life more accessible to people who are deaf or who have partial deafness problems. While it was certainly a novelty in the seventies, today closed captioning is a necessity. Deaf culture would be left quite far behind without it.
Technologies such as closed captioning, along with the 1990 Americans with Disabilities Act have promoted deaf education in many ways to encourage others to learn more about it. At the same time, they have also positively impacted deaf culture and allowed people in that community to realize their true potential. As deaf education continues to abound, we can be sure to witness many more technologies that help people to overcome their disabilities.


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It has been well accepted in the medical community that one of the primary causes of cervical cancer is infection by the human Papillomavirus (HPV). Several variants of HPV are known to play a role. Infection by one of these viruses in the uterine cervix is accompanied by the growth of active forms of oxygen in cells, also known as oxidants, which could damage DNA and other parts of a cervical cell. Eventually, this could lead to the initiation and progression of carcinogenesis of the uterine cervix.
Researchers at the Lublin Medical Academy in Poland evaluated 168 female patients with normal cytological smears who did not have HPV infection, and compared the results to 228 patients with cervical intraepithelial neoplasia who did have HPV. They then measured serum levels of vitamin E in all of these individuals by high-performance liquid chromatography. A statistically significant lower level of alpha-tocopherol was observed in the blood serum of HPV-positive patients with cervical intraepithelial neoplasia (CIN) compared to the controls.
According to this article, vitamin E, in addition to having antioxidant abilities, apparently has anti-proliferative actions. The researchers explain: alpha-tocopherol forms a complex with a protein receptor. This complex activates and/or increases the expression of the phosphatase gene A1 and A2 and dephosphorylation of Kinase C. Decreased activity of kinase C inhibits the activity of ornithine decarboxylase, and, in turn, the biosynthesis of polyamines that maintain uncontrolled cell proliferation.
Kwasniewska A, Tukendorf A, Semczuk M. Content of alpha-tocopherol in blood serum of human Papillomavirus-infected women with cervical dysplasias. Nutrition and Cancer 28(3):248-251, 1997.
Comments: The association of CIN with low levels of serum vitamin E is very interesting. Although formal studies evaluating the role of vitamin E supplementation in reducing the initiation and progression of CIN have not yet been published, it would seem reasonable to add 100 or 200 units of this vitamin to the regimen of women who not only have CIN, but who may be at higher risk of contracting this condition.


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The Jar-neymen
Another week, another one hits the jar!
Knifing Nena
Knifing Nena is part of the Acheron's Blue Snakes, an infamous gang in the hive cities of Armageddon. When her gang wandered upon a rogue K1t unit during there last terrain sweeps they also stumbled upon a gang of Dust Stalkers and a band of Orks; all out for the same loot.
Nena wasn't only the first to reach the K1t unit, but also after being blown off the machine by ork fire, she still was capable enough to charge the Dust Stalker leader, dodge 4 blows in close combat and deliver a smashing insult in return. Sadly the orks came nearer all the while and took control of the situation, ending Nena's story a little too early. She will always be in our memory as the bitch who did it.
What are you supposed to be … A jedi in the 41st millennium??
Nena is a model from Guido's Collection and is a Games Workshop Necromunda Esher ganger.
"I got this mini and the rest of the gang on a sweet deal a few month's ago" Guido says. Currently she is one of the few models in my collection that is not painted by myself. I thought I had a big collection of Necromunda models but it turned out to be only a memory 🙂
She's got a red mustache


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If you're in the Ravelry group or you get my email newsletter, you've already heard about this - it's time for the Second Annual Hat KAL/CAL!
Last year, I collected hats for Halos of Hope and donated them at Stitches Midwest.
to help them out. Everyone there was so wonderful to my dad and my family. You can read more about my family's experience here.
through August 15th, I'll be collecting hats (the center also welcomes
fingerless mitts and convertible mittens), so that I can donate them at
the end of August. There will be prizes involved, including a prize for
the person who sends me the most hats! You can knit or crochet any hat
you want and I have a thread on Ravelry where you can link to your favorite hat patterns.
My goal is to get 150 hats to donate to the center. So, if you have a
little extra time and want to make hats for a great cause, join us for another great hat KAL/CAL!


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Books Bought
The Elephants of Style by Bill Walsh
Books Read
Daemon by Daniel Suarez
A Long Way Down by Nick Hornby
Bad Monkey by Carl Hiaasen
The Rules of Attraction by Brett Easton Ellis
Books Heard
Loser by Jerry Spinelli
The High Place by James Branch Cabell
Extremely Loud and Incredibly Close by Jonathan Safran Foer
National Just Read More Novels Month which I run every January encourages people to read as many novels as they can in the 31 days of January. This year I managed to only read two, but I did listen to three, which I also count. This edition of Books First also covers two books I read in 2013 which I forgot to catalog on my year end round up.
The story is very fast paced even as it stretches credulity at every turn. Science fiction relies a lot on hypercompetent people, but the ones in Daemon would make Heinlein wince. Underlying it is a lot of crypto-libertarian philosophy about government and freedom and choice. It's really unclear which side of some of the rants the author is coming down on but they make for intriguing discussion.
Each of the four people has secrets and baggage which get unpeeled slowly over the course of the book. However, not all four are equally intriguing. This makes the book uneven overall and drags some sections down. Part of the narrative force is watching them open up to each other Breakfast Club style while seeing them get on with their lives.
Hornby is always intriguing to read but here he is stretching muscles and showing off just a bit. But still a good fast paced thought provoking read.
The hero is former Miami cop on a downward spiral in a petty feud with his Florida Keys neighbor. He is the only one willing to track down the arm which is hard to do as a restaurant inspector. He is joined by a slightly kinky medical examiner and the usual cast of Florida oddballs.
The story is uproariously funny whether you are familiar with the Keys or not. The book does aim for a sensibility that is more 'realistic' than many recent Hiaasen novels were he seemed determined to top himself again and again for outrageousness and the book is better for it.
Told in overlapping first person narratives, the story covers several months in the lives of oversexed and overmedicated college students at an expensive rural liberal arts college not unlike Bennington where Ellis went. The main story revolves around a romantic triangle between two guys and a girl which is different in that none of the three realize they are in a triangle. There is a lot of drama involving overdoses and bad sex and parents who just don't understand.
Even with the passage of time, it's tough to reconcile the sheer debauchery depicted with any realistic trajectory of the 1980s as wild as they were. The list of drugs these students take is literally encyclopedic. And there needs to a level of randomness below casual to describe all the hook-ups. IIRC, Spy Magazine was published the definitive chart of who had slept with whom and it just looked like someone scribbled all over the page.
However, it is compelling storytelling with biting prose. It's just not that interesting a story.
The story is sweet without being cloying as it details his troubles fitting in. He likes school perhaps a bit too much. He is painfully nonathletic and cluelessly oblivious to the taunts of his classmates. However, the book avoids taking the easy way out at a number of turns.
I can see why this book is so popular in schools. It is easily understandable without being preachy. Zinkoff is a character kids far less dorky than him can relate to. One can have worse role models.
But nothing quite turns out as it seems and supernatural contracts always have catches. What makes this novel interesting is how wryly cynical it is. The hero is a self-deluded philanderer whose wives tend to die under mysterious circumstances. For a novel written in the early 20th century, it is slyly bawdy and deeply sacrilegious.
There is also a certain self-knowing sense that is slightly reminiscent of The Princess Bride, although much darker. It makes for a very interesting story in context by a writer who seems to have been forgotten.
Oskar finds a hidden key and decides to find what it opens in hope that it reveals something about his lost father. There are a lot of odd plot holes that all seem to get eventually resolved but there is a certain tidiness to everything which is just too perfect.
The grandparents come from Dresden which is of course the setting of Kurt Vonnegut's Slaughterhouse Five. The book borrows or steals a major conceit of that book which is either a touching homage or outright theft depending on how charitable you want to be towards Foer. I'm not certain I'm inclined to give him the benefit of the doubt.


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Terms & Conditions
1. Introduction
1.1 These terms and conditions shall govern your use of our website.
1.2 By using our website, you accept these terms and conditions in full; accordingly, if you disagree with these terms and conditions or any part of these terms and conditions, you must not use our website.
1.3 If you register with our website, submit any material to our website or use any of our website services, we will ask you to expressly agree to these terms and conditions.
1.4 You must be at least 18 years of age to use our website; by using our website or agreeing to these terms and conditions, you warrant and represent to us that you are at least 18 years of age.
2. Credit
2.1 This document was created using a template from SEQ Legal (https://seqlegal.com).
3. Copyright notice
3.1 Copyright (c) 2022 Phileas Fox Nursery School.
3.2 Subject to the express provisions of these terms and conditions:
(a) we, together with our licensors, own and control all the copyright and other intellectual property rights in our website and the material on our website; and
(b) all the copyright and other intellectual property rights in our website and the material on our website are reserved.
4. Permission to use website
4.1 You may:
(a) view pages from our website in a web browser;
(b) download pages from our website for caching in a web browser;
(c) print pages from our website for your own personal and non-commercial use, providing that such printing is not systematic or excessive;
(d) stream audio and video files from our website using the media player on our website; and
(e) use our website services by means of a web browser, subject to the other provisions of these terms and conditions.
4.2 Except as expressly permitted by Section 4.1 or the other provisions of these terms and conditions, you must not download any material from our website or save any such material to your computer.
4.3 You may only use our website for your own personal purposes. You must not use our website for any other purposes.
4.4 Except as expressly permitted by these terms and conditions, you must not edit or otherwise modify any material on our website.
4.5 Unless you own or control the relevant rights in the material, you must not:
(a) republish material from our website (including republication on another website);
(b) sell, rent or sub-license material from our website;
(c) show any material from our website in public;
(d) exploit material from our website for a commercial purpose; or
(e) redistribute material from our website.
4.6 Notwithstanding Section 4.5, you may redistribute our blog in print and electronic form to any person.
4.7 We reserve the right to suspend or restrict access to our website, to areas of our website and/or to functionality upon our website. We may, for example, suspend access to the website during server maintenance or when we update the website. You must not circumvent or bypass, or attempt to circumvent or bypass, any access restriction measures on the website.
5. Misuse of website
5.1 You must not:
(a) use our website in any way or take any action that causes, or may cause, damage to the website or impairment of the performance, availability, accessibility, integrity or security of the website;
(b) use our website in any way that is unlawful, illegal, fraudulent or harmful, or in connection with any unlawful, illegal, fraudulent or harmful purpose or activity;
(c) hack or otherwise tamper with our website;
(d) probe, scan or test the vulnerability of our website without our permission;
(e) circumvent any authentication or security systems or processes on or relating to our website;
(f) use our website to copy, store, host, transmit, send, use, publish or distribute any material which consists of (or is linked to) any spyware, computer virus, Trojan horse, worm, keystroke logger, rootkit or other malicious computer software;
(g) impose an unreasonably large load on our website resources (including bandwidth, storage capacity and processing capacity;
(h) decrypt or decipher any communications sent by or to our website without our permission;
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(j) access or otherwise interact with our website using any robot, spider or other automated means, except for the purpose of search engine indexing;
(k) use our website except by means of our public interfaces;
(l) violate the directives set out in the robots.txt file for our website;
(m) use data collected from our website for any direct marketing activity (including without limitation email marketing, SMS marketing, telemarketing and direct mailing); or
(n) do anything that interferes with the normal use of our website.
5.2 You must not use data collected from our website to contact individuals, companies or other persons or entities.
5.3 You must ensure that all the information you supply to us through our website, or in relation to our website, is true, accurate, current, complete and non-misleading.
6. Limited warranties
6.1 We do not warrant or represent:
(a) the completeness or accuracy of the information published on our website;
(b) that the material on the website is up to date;
(c) that the website will operate without fault; or
(d) that the website or any service on the website will remain available.
6.2 We reserve the right to discontinue or alter any or all of our website services, and to stop publishing our website, at any time in our sole discretion without notice or explanation; and save to the extent expressly provided otherwise in these terms and conditions, you will not be entitled to any compensation or other payment upon the discontinuance or alteration of any website services, or if we stop publishing the website.
6.3 To the maximum extent permitted by applicable law and subject to Section 12.1, we exclude all representations and warranties relating to the subject matter of these terms and conditions, our website and the use of our website.
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(a) limit or exclude any liability for death or personal injury resulting from negligence;
(b) limit or exclude any liability for fraud or fraudulent misrepresentation;
(c) limit any liabilities in any way that is not permitted under applicable law; or
(d) exclude any liabilities that may not be excluded under applicable law.
8.2 The limitations and exclusions of liability set out in this Section 8 and elsewhere in these terms and conditions:
(a) are subject to Section 8.1; and
(b) govern all liabilities arising under these terms and conditions or relating to the subject matter of these terms and conditions, including liabilities arising in contract, in tort (including negligence) and for breach of statutory duty, except to the extent expressly provided otherwise in these terms and conditions.
8.3 To the extent that our website and the information and services on our website are provided free of charge, we will not be liable for any loss or damage of any nature.
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8.8 You accept that we have an interest in limiting the personal liability of our officers and employees and, having regard to that interest, you acknowledge that we are a limited liability entity; you agree that you will not bring any claim personally against our officers or employees in respect of any losses you suffer in connection with the website or these terms and conditions (this will not, of course, limit or exclude the liability of the limited liability entity itself for the acts and omissions of our officers and employees).
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9.1 Without prejudice to our other rights under these terms and conditions, if you breach these terms and conditions in any way, or if we reasonably suspect that you have breached these terms and conditions in any way, we may:
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(f) commence legal action against you, whether for breach of contract or otherwise; and/or
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10.1 We may revise these terms and conditions from time to time.
10.2 The revised terms and conditions shall apply to the use of our website from the date of publication of the revised terms and conditions on the website, and you hereby waive any right you may otherwise have to be notified of, or to consent to, revisions of these terms and conditions. If you do not agree to the revised terms and conditions, you must stop using our website.
10.3 If you have given your express agreement to these terms and conditions, we will ask for your express agreement to any revision of these terms and conditions; and if you do not give your express agreement to the revised terms and conditions within such period as we may specify, we will disable or delete your account on the website, and you must stop using the website.
11. Assignment
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12. Severability
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12.2 If any unlawful and/or unenforceable provision of these terms and conditions would be lawful or enforceable if part of it were deleted, that part will be deemed to be deleted, and the rest of the provision will continue in effect.
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13.1 A contract under these terms and conditions is for our benefit and your benefit, and is not intended to benefit or be enforceable by any third party.
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14.1 Subject to Section 9.1, these terms and conditions, together with our privacy and cookies policy, shall constitute the entire agreement between you and us in relation to your use of our website and shall supersede all previous agreements between you and us in relation to your use of our website.
15. Law and jurisdiction
15.1 These terms and conditions shall be governed by and construed in accordance with English law.
15.2 Any disputes relating to these terms and conditions shall be subject to the exclusive jurisdiction of the courts of England and Wales.
16. Statutory and regulatory disclosures
16.1 We are registered in Companies House; you can find the online version of the register at https://beta.companieshouse.gov.uk/company/07790706 and our registration number is 07790706
16.2 We are subject to regular inspections which is supervised by DfE.
16.3 We are registered as Nursery School with Ofsted in the United Kingdom and are subject to rules, which can be found at https://reports.ofsted.gov.uk/provider/16/EY495108
17. Our details
17.1 This website is owned and operated by Phileas Fox Nursery School.
17.2 We are registered in England and Wales under registration number 07790706 and our registered office is at St Mary's Square, London, W2 1SE.
17.3 Our principal place of business is at St Mary's Square, London, W2 1SE.
17.4 You can contact us:
(a) by post, to the address above
(b) using our website contact form;
(c) by telephone, on the contact number published on our website; or
(d) by email, using the email address published on our website.


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Product Details
Add some extra glam to your look with the Iconic Night Sky Earrings. These luxurious earrings is covered with white zirconias that is going to make you shine even more! The earrings are sold in pairs and has a length of 95mm and a width of 11mm. The earrings are also available in gold. Mix them together with the Iconic Triple Pave Ring.
Shipping & Returns
The delivery time and cost is indicated in the shopping cart under each shipping method. We offer free shipping when ordering over 70€/700SEK.
You must provide correct and complete address information in your order as we cannot guarantee that it can be changed after you complete your purchase. The customer is solely responsible that the name on the order matches the name on the letter/mailbox/postbox on the delivery address. The customer is solely responsible for any delivery errors due to lack of information or failure of the delivery address in its order.
Our transporters do not deliver during weekends or on public holidays.
Once your order is shipped from our warehouse you will receive an order complete email. Please contact us if you have not received your email within 3 business days.
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Care Instructions
Gold and silver plated jewelry is a great option when you're looking for an accessory or gift that doesn't break your bank. Gold plating is a thin layer of gold placed on to coat the surface, which in our case is brass or stainless steel. The jewelry has the same appearance as a gold jewelry but at a lower price.
The gold layer will slowly fade over time and the brass will be exposed. This is a natural process of a plated item and is not a product defect.
It's easy to keep the luster of your golden earrings, bracelets, rings and necklaces. As it's covered with a thin layer make sure to take extra care to make your jewelry live longer. Do not spray perfume, hairspray, body lotion or face mists while wearing your Jewelry. Take them off and put them back on when your skin or hair is dry again. Substances like oil, nail polish, nail polish remover, chlorine, perfume or sweat may react with metal/plated jewelry which may make it tarnish easily.
Make sure to remove your jewelry when showering, washing your hands and also when swimming. Clean your jewelry with a cotton roll to remove any dust and dirt after use.
- 925 silver plated brass
- Nickel Free


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This section contains 731 words
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"Fire and Cloud," Parts 4-6 Summary
Taylor tells his wife, May, to go and tell the mayor that he is sick, has to get out of bed and dress and will be a few minutes. Then she must go to Deacon Smith and tell him that Taylor is with the mayor and to wait in the basement with the other deacons. Then she must go to Hadley and Green and conduct them into Taylor's room, where he will talk to them. May argues that Jimmy must live and grow up among the white people and should not be put in jeopardy. Taylor convinces her to do as he asks.
May carries out Taylor's requests. Hadley and Green come to his room and try to convince him to march. They are worried that if he does not bring his congregants...
(read more from the "Fire and Cloud," Parts 4-6 Summary)
This section contains 731 words
(approx. 2 pages at 400 words per page)


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They suit up the game's best all-around player in outfielder and perennial MVP candidate Mike Trout, and yet the Los Angeles Angels just keep getting further away from the prize. In 2014, the Angels won 98 games and led all of Major League Baseball in runs scored. Since that glorious season, the Angels endured campaigns of 85 and 77 wins. The offense started to dry up, the defense was disastrous and the pitching non-existent. They exhausted the depth of their farm system by trading for veterans and signing high-priced free agents.
And yet, as long as they have Trout in the fold we're going to agree with the Lloyd Christmas synopsis from Dumb And Dumber: yes, we're saying that there's still a chance for the Angels.
Los Angeles Angels Next Regular Season Game
You could call the Los Angeles Angels of Anaheim the team to be renamed later and again later, and again later. The team has gone through 10 logos since its 1961 birth. The only title came for the Angels in 2002, but since then it's been very quiet.
They began as the Los Angeles Angels when entering the American League as an expansion franchise, owner Gene Autry opting to carry the nickname of the city's long-time Pacific Coast League team into the big leagues. In 1966 when the team relocated to Anaheim, they were reborn as the California Angels. They became the Anaheim Angels in 1997 and incorporated their current handle in 2005.
|MLB - League 2023
|Sunday, Oct 01, 2023
|Oakland Athletics
|Los Angeles Angels
Los Angeles Angels Game Schedule
The Los Angeles Angels of Anaheim game schedule is here and getting a ticket to an Angels game is something you shouldn't wait too long to do.
Crowds of 40,000 aren't uncommon at Angels games and since 2000, only the New York Yankees have drawn more fans to their games among Major League Baseball teams than the Angels. The Angels have drawn at least three million fans per season over the past 13 years and more than two million in every season since the millenium.
What Are The Current Los Angeles Angels Standings
Below you will find located the current Los Angeles Angels of Anaheim standings. The Angels have built up plenty of natural rivalries over the years and surprisingly, the majority of them exist outside of the confines of the American League West Division.
The one divisional rival that seems to draw the ire of the Angels are the Texas Rangers and it's a natural one, since those two teams have captured 10 of the last 13 American League West titles.
There's a close proximity rivalry built by the annual freeway series between the Angels and Los Angeles Dodgers, and there's a rivalry with the New York Yankees built around the fact that the Angels are the only team with a winning record against the Bronx Bombers over the past 20 years. But by far the most bitter rival of the Angels are the Boston Red Sox, who have won four of five playoff series between the two teams.
Los Angeles Angels Online Betting Tips
The Angels were a bit late to the party when it comes to analytical analysis and it's been said it caused a rift between manager Mike Scioscia and GM Jerry DiPoto that led to the latter's departure.
Among active big league hitters, Angels slugger Albert Pujols (100.8) owns the best career WAR, while outfielder Mike Trout (10.5) produced the best offensive WAR in baseball in 2016. Trout's career war of 48.5 is the best anyone in baseball ever posted prior to the age of 25.
Monkey Shines
There are plenty of rituals that take place around a Los Angeles Angels of Anaheim game. Every game begins with the Train song Calling All Angels playing over the sound system as the team takes to the diamond for the top of the first inning.
During the seventh-inning stretch, fans sing along to the Foundations Build Me Up Buttercup, and don't forget the Rally Monkey. Born in 2000 after the Angels rallied to win after showing a clip of a monkey from the film Ace Ventura: Pet Detective on the big screen scoreboard, the team hired a monkey and filmed clips that are shown whenever the Angels fall behind in a game.
Where Can I Bet On Los Angeles Angels Online
If you are looking to bet on the Los Angeles Angels of Anaheim online all of the information you will require is right here.
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Project-management training company, ESI International, announced release of its Top 10 Project Management Trends For 2013. A global panel of ESI International executives suggests expert leadership is lacking in all areas of project management, portfolio management and program management.
"This year's trends bring a murky problem into specific light," said J. LeRoy Ward, Executive Vice President, ESI International. "Leadership skills are lacking within the project community, and until project managers learn how to properly lead teams and their projects, project execution will continue to be a problem."
Video: ESI International Top Ten Project Management Trends for 2013
ESI's Top 10 trends
- Organizations will call for strong project leaders but focus on investments in hard skills
- Agile implementation will be viewed in some organizations as a failure, but for the wrong reasons
- Project management is not just for project managers anymore
- Large projects pose unique challenges that are increasingly tough to overcome
- Project management offices will focus on proving their worth and driving innovation
- The U.S. government will upgrade its PM certification in the face of rising criticism
- Improving vendor management practices will top the list of skills for project managers
- Continued poor project performance in many organizations will result in more PMOs being terminated
- Portfolio management will take on a greater role as funding continues to tighten and the number of projects grows
- Organizations will adopt Agile to accelerate time to market, but what they ultimately achieve may be a different story
"Many of this year's trends focus on the need to improve project skills, process and the overall management of our initiatives," said Ward. "It is clear that it is no longer possible to hire project managers and expect results. We need our PMs to be experts and take control of our projects to get maximum results."
ESI's top 10 trends in project management is put together annually by ESI senior executives and subject matter experts.


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Even though Steve Bannon is no Beau Brummel, the music of this early rock song must be ringing in his ears. It seems clear to all but the dumbest media talking heads that the Bannon plan of Trump's continued flow of tweeting is an attempt to make sure the Trump team controls the NARRATIVE. (See Ben Hunt's magnificent piece at Epsilon about the significance of narrative.) This is important for investors and traders because of Trump's ability to control the narrative makes us all focus away from the most events of the greatest possible consequence. Today, the airwaves were echoing the Trump tweet of the President-elect threatening to cancel the orders for two new Air Force One planes, the President's personal fleet.
The Donald tweeted that the planes were far too costly and Boeing was gouging the U.S. government. The Trump tweet followed criticism from Boeing executives about the negative impact that Trump's foreign and trade policy could have with Boeing's business with China. In predictable fashion, the media took the bait of the excessive pricing of Air Force One and failed to delve deeper into the trade concerns of Boeing and others. As Jon of Vine Street consistently says: "It just a three card Monte game," but that is a game in which the dealer certainly controls the narrative. This is going to be the setting for investors so I warn that it becomes mandatory to not lose focus on the important issues as the tweeter-in-chief tells us to look over there.
To the main stream media, Steve Bannon was heard singing:
Tags: Boeing, ECB, Germany, Italian referendum, Merkel, POTUS, QE, Renzi


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