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- Research article
- Open Access
- Open Peer Review
A study to investigate the effectiveness of SimMan® as an adjunct in teaching preclinical skills to medical students
© Swamy et al.; licensee BioMed Central Ltd. 2014
- Received: 28 February 2014
- Accepted: 9 September 2014
- Published: 19 November 2014
Following the GMC's report on Tomorrow's Doctors, greater emphasis has been placed on training in clinical skills, and the integration of clinical and basic sciences within the curriculum to promote the development of effective doctors. The use of simulation in the learning environment has the potential to support the development of clinical skills in preclinical medical students whilst in a 'safe' environment, but currently there is little evidence on its effectiveness.
Seventy nine year one medical students were divided into two groups. A pre-test was conducted by both groups, after which one group performed chest examination on their peers whilst the other group examined the SimMan® manikin. Both groups subsequently performed a mid-test and crossed over so that the group that conducted peer examination examined the manikin and vice-versa. Finally a post-test was conducted. The students were scored for formative feedback whilst performing examinations. Students completed a feedback questionnaire at the end of the session. Data were analysed using a one-way ANOVA, independent t-test and 2- proportion Z test.
When the two groups were compared, there was no significant difference in their pre-test and post-test knowledge scores, whereas mid-test knowledge scores increased significantly (P < 0.001), with the group using SimMan® initially scoring higher. A significant increase in the test scores was seen in both groups after using SimMan® (P < 0.001). Students' confidence increased significantly in differentiating between normal and abnormal signs (P < 0.001). Students highly valued the use of the manikin in the session with 96% of students reporting that it enhanced their learning experience.
The study demonstrated a significant improvement in the students' knowledge after examining the manikin and students also reported an increase in their confidence. Students' feedback was generally very positive and they perceived the incorporation of manikin-based examinations useful to prepare them for future patient contact. The use of simulation in this context supports an integrated learning approach when used as an adjunct to peer examination, and can benefit the acquisition of clinical skills in preclinical medical students.
- Clinical skills
- SimMan®
- Preclinical medical students
Over recent years, the early introduction of clinical skills teaching, and the integration of patient-focused clinical and basic sciences, has gained greater importance in undergraduate medical education. At Durham University, first and second year medical students practice clinical skills on each other under direct supervision from tutors, and receive immediate feedback on their performance during the clinical skills training sessions. They are introduced to a range of generic clinical skills, such as communication, clinical examination, and practical procedures, all of which are assessed during the summative Objective Structured Clinical Examinations (OSCEs). Students are trained so that they can subsequently perform these skills competently and confidently on patients. However, the challenges faced by preclinical students (Phase 1 medical students) are that they must learn and develop these clinical skills with limited exposure to patients, and also be able to apply these skills appropriately when they move on to clinical rotations. Several studies have documented that this transition from preclinical to clinical phases is stressful for medical students [1–4]. One of the areas in which both students and instructors feel there are difficulties is in the competent performance of clinical skills at an early stage in their clinical rotations [1].
Simulation-based education is seen to supplement the clinical education of medical students in a safe and supportive manner. It is a rapidly developing area which provides the learner with opportunities to repetitively practice, develop and transfer clinical skills without any fear of harm to patients, in a controlled setting. It is being used to augment learners' knowledge and help them shape the acquisition of clinical skills [5–8]. Although simulation does not exactly duplicate clinical challenges or experiences with real patients in a genuine clinical setting, it complements students' learning, and literature suggests that it can be used to prepare students for contact with real patients [5].
Laerdal SimMan® [9], a moderate fidelity manikin, is currently used widely in the later years of medical education. Students have evaluated its use positively in a number of studies, such as teaching undergraduate medical students in the context of management of medical emergencies [10–12], and the development of preclinical skills [13]. It provides learners with the opportunity to experience a learning environment as close as possible to clinical practice by providing physical representations of patients. It gives them the benefit of exposure to pathological states with the holistic experience of examining and treating a patient, without exposing them to real patients. Thus it can be used to bridge the gap between preclinical and clinical settings.
The aim of the study was to explore the role of SimMan® as an adjunct to peer examination in the teaching of clinical skills to preclinical medical students.
Ethical approval was obtained from the School of Medicine, Pharmacy and Health, Durham University (ESC2/2013/PP003).
One hundred and four first year medical students at Durham University were invited to participate, of which seventy nine students volunteered and were included in the study. All students were taught the clinical skills of respiratory and cardiovascular system examination, and had previously performed these examinations on their peers.
Clinical conditions with corresponding signs used in the study
Clinical conditions
Chronic obstructive pulmonary disease
Increased respiratory rate, cyanosis and wheezy coarse crackles
Pulmonary regurgitation with atrial fibrillation
Murmur, irregular pulse and increased heart rate
Anonymized data was analyzed with specific statistical analyses, described within the results for each stage of the study. Quantitative data was analyzed using a one-way ANOVA and an Independent t-test. Qualitative data from confidence questions were analyzed using a 2-proportion Z test and Fischer's exact test. A P-value < 0.05 was considered statistically significant in all tests. Qualitative data from the free text comments on feedback questionnaires was analyzed using thematic analysis. From the free text comments, the relevant data was coded into themes for each of the questions. Two authors (MSw and MS) independently coded the data and any differences were then discussed to reach an agreement.
Knowledge test scores from Group A (Group using peer examination initially) and Group B (Group using SimMan® initially)
Standard deviation
Statistical analysis (one-way ANOVA) indicated that there was a significant difference between the pre-test and mid-test scores of Group B (F = 27.120, P < 0.001) and between mid-test and post-test of Group A (F = 39.857, P < 0.001). Further analysis (Independent t-test) confirmed that there was a significant increase in the mid-test scores (after performing examination on the manikin) when compared with the pre-test scores in the Group B (Independent t-test, t = 6.354, P < 0.001). In addition, post-test scores (after performing examination on the manikin) of Group A were significantly higher when compared with mid-test scores (Independent t-test, t = 6.928, P < 0.001) in the Group A. Thus students scored higher in the knowledge test after examining the manikin when compared to students who performed the examination on each other.
Performance scores during chest examination
SimMan® (Mean ± SD)
Peer examination (Mean ± SD)
Group A
14.85 ± 2.94
15.87 ± 4.39
Group B
13.33 ± 4.01
16.43 ± 2.93
The mean confidence increased from the pre-test to mid-test, and then further increased in the post-test for both groups. The number of students who were confident in examining a patient increased significantly after examining their peers when compared to those after performing examination on the manikin, for both groups [Group A, pre-test (15) vs. mid-test (27), P = 0.007 and Group B, mid-test (18) vs. post-test (31), P <0.001)]. Students in both groups felt that they were more confident in differentiating between normal and abnormal signs after performing examination on the manikin [Group A, mid-test (13) vs post- test (28), P = 0.02 and Group B, pre-test (3) vs. mid-test (19), P <0.001)], but were more confident at performing examination in a clinical setting after peer examination [Group A, pre-test (4) vs. mid-test (24), P < 0.001 and Group B, mid-test (24) vs. post-test (33), P = 0.01)].
Evaluation results of students' feedback questionnaire
Strongly disagree
Strongly agree
1. I feel the use of SimMan® to practice examination was useful
2. SimMan® improved my knowledge for performing examination
3. SimMan® reinforced the importance of being able to recognize normal findings
4. I received useful feedback on my performance
5. The session which included both SimMan® and peer examination enhanced my learning experience
6. The session which included both SimMan® and peer examination made me feel more prepared to examine real patients
7. The session was enjoyable
- 1.
I feel the use of SimMan® to practice examination was useful. Please state why?
- a)
Students who responded positively:
- (i)
Abnormal signs and external equipment useful
"It was really helpful to hear/feel what was abnormal which I wouldn't necessarily be able to do with my fellow students comparison"
"Allows you to examine abnormalities at this early stage. Being able to hear abnormal findings allows you to better recognise normal"
"Was good practise, useful as well seeing the monitors and dealing with clinical signs"
"It is useful to examine in a more clinical context, with issues occurring around SimMan and to listen to abnormal sounds"
- (ii)
Improved clinical contextualisation
"It was realistic and placed me in a clinical like scenario. It allows me to challenge myself with a new setting"
"It is useful to examine in a more clinical context, with issues occurring around SimMan and to listen to abnormal sounds"
"He is able to simulate real life abnormal patients which is very useful for our hospital practice."
- (iii)
Increased perceived level of confidence
"I couldn't remember any examination procedure but after the SimMan session I am more confident when carrying out the real patient examination"
"Improved my confidence in examining a patient. It showed me what to expect when looking and listening for abnormalities"
- (iv)
Absence of realism
"It's not a real patient and so if you get it wrong there's no shame"
"Freedom to palpate"
"Also not the shyness/inhibitions associated with friends"
"Being able to examine a patient that isn't a peer. It makes the experience more
"Very clear clinical signs and easier to examine than a real patient because I was less nervous"
- b)
Students with negative/neutral response:
- (i)
Absence of realism
"Otherwise the lack of interaction with the patient makes it difficult. Also SimMan is immobile which makes examination awkward"
"but it was difficult to practice communication skills"
"It was intimidating and could not perform a full examination e.g. cap refill, clubbing which threw me and I panicked. There is no interaction with the 'patient'."
"The stats monitor was good but otherwise can't recreate human experience."
"It was difficult to imagine he was a real patient. And doing the normal tests – checking for clubbing was difficult as unrealistic".
- (ii)
Lack of exposure
- 2)
SimMan® improved my knowledge for performing examination. Please state why?
- a)
Students with positive response:
- (i)
Learnt about abnormal signs
"It improved my knowledge of what heart murmurs and wheezing sounded like"
"He allowed us to hear what abnormal heart and lung sounds sounded like"
"I feel I'd be better at identifying abnormal"
"There's some clinical knowledge we haven't been taught but I picked them up during the SimMan® session."
- (ii)
Interpret monitor parameters
"I actually got to clearly relate my findings to the monitor's data e.g. I linked heart value auscultation with an ECG".
"Also importance of taking pulse even though got it on a screen."
- (iii)
Useful Feedback
"Getting feedback on how to examine a non-healthy person – sometimes you can't do the same things"
- (iv)
Prepared students for future patient contact
- b)
Students with negative/neutral response:
- (i)
Other methods were as good or better
" It showed me what to expect when looking and listening for abnormalities"
"Enabled me to understand the difficulties of performing CVR and respiratory examinations on more critically ill patients"
"The setting was like in a hospital. The SimMan has oxygen mask attached and he can be programmed to have simulated clinical problems. This allows me to understand the difference between normal and abnormal"
"For abnormal knowledge it was good but the rest could be taught in either setting"
"Not the same as a real person but useful to hear/feel abnormalities"
- (ii)
Lack of exposure
"Interesting, but I feel it would be more useful with continued exposure since a one-time exposure to clinical settings is intimidating more than it is useful"
- 5.
The session which included both SimMan® and peer examination enhanced my learning experience. Please state why?
The majority of the students agreed or strongly agreed that the session which included both the manikin and peer examination enhanced their learning experience. The remaining students were unsure.
"Good mix"
"Really good"
"Best of both worlds"
Students found the experience of examining in different settings useful as there was deliberate practice and feedback on performance, it encouraged reflection and identified areas of improvement whist providing an opportunity to examine and identify normal and abnormal signs. Some students commented that it helped them remember the examination procedure/steps better, improved the appreciation of the importance of clinical examinations, increased confidence, encouraged checking for abnormality, and provided useful revision.
" Either alone has limitations but together they cover everything "
"SimMan as it was really realistic"
"Use of SimMan to see abnormalities as it simulates reality in a pretty accurate manner"
"More exciting to investigate abnormalities, however this may be due to novelty"
However, some students disliked the absence of realism in SimMan®.
"Difficult to show empathy"
It was interesting to note that one student commented, "Cannot replace real patient contact but it's the next best thing" and another student felt "SimMan's clinical setting portrayed was more accurate but is intimidating rather than useful unless it is repeated".
The session stimulated students' interest in recognising abnormalities, working with simulated patients, revision and clinical skills/practice.
"Very enjoyable. Recommend for next year"
"Using peer examination and SimMan® is the best way forward, provides different things"
"Integrate into OSCE"
In this study we have compared two teaching modalities - peer examination and examination using SimMan®. It was found that students' knowledge required to perform respiratory and cardiovascular examination improved significantly after they performed examination on the manikin. However, it is interesting to note that repeated exposure to peer examination did not improve students' knowledge. In addition, the manikin was as effective as peer examination in increasing students' confidence. These findings are similar to other studies that have reported an improvement in preclinical medical students' knowledge and confidence after simulation [12, 13]. We found a significant increase in students' knowledge after examining the manikin in both groups whereas in the study conducted by Swamy et al. [13], there was a similar, non-significant trend in the group initially using peer examination. One of the advantages of simulation is that it allows application of theoretical knowledge to practice [11]. When students perform examination on each other, they become familiar with normal examination findings but they are aware that they are examining a healthy person. SimMan®, on the other hand provides students with the variability of examining both normal and abnormal clinical signs, which reflects more closely what they are likely to encounter in clinical practice. During examination this encourages students to actually look for signs rather than just comment that they were either present or absent. The manikin provides them with the opportunity to apply their knowledge and thus reinforces normal findings; focusing them towards looking for abnormalities or deviations from normal. One student aptly summarised this, saying "I was able to explore the abnormal and know the abnormality. In peer examination normal is always 'assumed' rather than checked. SimMan® you don't know for sure that you are examining a normal patient". Hence most students found the manikin useful for practicing examination and felt that it added clinical contextualisation.
Students felt that the manikin improved their knowledge because they not only learnt about abnormal findings but also were provided with an opportunity to apply knowledge and interpret clinical signs, thus reiterating the knowledge required to examine a patient. Students also considered the feedback they received to be useful. Students felt they were more aware of the issues around examining a patient after examining the manikin. We found that the number of students who reported they were confident increased significantly for differentiating between normal and abnormal clinical signs after simulation whereas this decreased for examining a patient in a clinical setting. It may be that examining in a new setting without previous exposure to the modality, and having to recall steps, apply their knowledge and to be able to explore abnormalities, can be challenging to students.
SimMan® has drawbacks during examination. Students are not able to communicate as effectively as they would with a live subject. Also when using the manikin some aspects of the examination cannot be performed, for example, the head of the manikin cannot be turned when looking for JVP, neither can the wrist be bent to examine for flapping tremors, hence some students gave negative responses for using the manikin to practice examination. Some students specifically commented that it impacted negatively because they were examining the manikin for the first time. This may explain why students scored higher during peer examination when compared to examining the manikin. In the study by Swamy et al. in 2013 [13], it was found that graduate-entry students scored higher or equal to peer examination whilst performing chest examination on the manikin. This could be because they were mature students and thus the drawbacks felt by the students of examining the manikin were not as much of a hindrance. However, some students were less stressed because there was no shame or shyness or inhibition that may be associated with examining peers or patients. Students suggested that the session could be improved by increasing the time allocated, providing more teaching, and increasing the number of stations. They recommended frequent use of the manikin. Although SimMan® and other simulators like Harvey® and Ventriculoscope have their own advantages and disadvantages, SimMan® provides a more realistic and holistic experience of examining a patient [13].
Learners' engagement with the repetitive practice of skills and assessment with specific informative feedback in a controlled setting has been shown to help in the acquisition of expertise [5]. Students evaluated the session incorporating both peer and SimMan® very positively. Together they can establish a strong foundation of clinical skills through experiential learning which can eventually be developed in clinical practice. Also it prepares students for future encounters with the manikin which is likely to increase in medical training, and helps them to acquire advanced clinical skills without having any negative impact on their learning experience at that stage.
Some limitations of this study include the fact that this is a carried out with a single cohort of medical students from a single school. SimMan®, a simulated patient cannot replace the learning experience that is derived from real patients in clinical practice. But, providing real patients may not be practical in preclinical years with respect to feasibility, accessibility and availability [13]. However, it encourages learning in an environment that does not compromise patient safety and can be useful to prepare students for clinical practice.
The manikin provides students with an opportunity to experience examining patients during their early years of training. It reinforces the importance of eliciting normal findings and helps application of knowledge and skills in a safe environment. The findings of this study show that the manikin can be used as an adjunct in facilitating the acquisition of clinical skills during the early years of training as it improves students' knowledge and confidence. The majority of the students found it useful to practice examination. It can be used to formatively assess student performance. Thus, an integrated learning approach using SimMan® as an adjunct to peer examination can benefit preclinical medical students' ability to acquire clinical skills.
The authors thank Mrs Alison Bradley and Mrs Pamela Stasiak, Durham University for their technical support in conducting the session.
Authors' Affiliations
- O'Brien B, Cooke M, Irby DM: Perceptions and attributions of third-year student struggles in clerkships: Do students and clerkship directors agree?. Acad Med. 2007, 82 (10): 970-978. 10.1097/ACM.0b013e31814a4fd5.View ArticleGoogle Scholar
- Moss F, McManus I: The anxieties of new clinical students. Med Educ. 1992, 26: 17-20. 10.1111/j.1365-2923.1992.tb00116.x.View ArticleGoogle Scholar
- Radcliffe C, Lester H: Perceived stress during undergraduate medical training: a qualitative study. Med Educ. 2003, 37: 32-38. 10.1046/j.1365-2923.2003.01405.x.View ArticleGoogle Scholar
- Mosley TH, Perrin SG, Neral SM, Dubbert PM, Grothues CA, Pinto BM: Stress, coping, and well-being among third-year medical students. Acad Med. 1994, 69: 765-767. 10.1097/00001888-199409000-00024.View ArticleGoogle Scholar
- Issenberg SB, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ: Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005, 27 (1): 10-28. 10.1080/01421590500046924.View ArticleGoogle Scholar
- Ewy GA, Felner JM, Jull D, Mayer JW, Sajid AW, Waugh RA: Test of a cardiology patient simulator with students in fouth-year electives. J Med Educ. 1987, 62 (9): 738-743.Google Scholar
- Gordon MS, Evy GA, DeLeon AC, Waugh RA, Felner JM, Forker AD, Gessner IH, Mayer JW, Patterson D: "Harvey", the cardiology patient simulator: pilot studies on teaching effectiveness. Am J Cardiol. 1980, 45 (4): 791-796. 10.1016/0002-9149(80)90123-X.View ArticleGoogle Scholar
- Karnath B, Frye AW, Holden MD: Incorporating simulators in a standardized patient exam. Acad Med. 2002, 77 (7): 754-755. 10.1097/00001888-200207000-00046.View ArticleGoogle Scholar
- Laerdal: [http://www.laerdal.com/gb/SimMan3G#/Specifications]
- MacDowall J: The assessment and treatment of the acutely ill patient–the role of the patient simulator as a teaching tool in the undergraduate programme. Med Teach. 2006, 28 (4): 326-329. 10.1080/01421590600625130.View ArticleGoogle Scholar
- Weller JM: Simulation in undergraduate medical education: bridging the gap between theory and practice. Med Educ. 2004, 38 (1): 32-38. 10.1111/j.1365-2923.2004.01739.x.View ArticleGoogle Scholar
- Halm BM, Lee MT, Franke AA: Improving medical student toxicology knowledge and self-confidence using mannequin simulation. Hawaii Med J. 2010, 69 (1): 4-7.Google Scholar
- Swamy M, Bloomfield TC, Thomas RT, Singh H, Searle FS: Role of SimMan® in teaching clinical skills to preclinical medical students. BMC Med Educ. 2013, 13: 20-10.1186/1472-6920-13-20.View ArticleGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6920/14/231/prepub
Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


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News & Events
October/November 2016
'The Abandoned House'
Visual Arts member, Deborah Collum, is holding an exhibition of her work at Number 8 Community Arts Centre, Pershore between 27 October and 16 November.
November 5th and 6th 2016
Contemporary Arts Fair
Visual Arts members are pleased to be exhibiting at the popular Contemporary Arts Fair held this year at Stratford-upon-Avon Town Hall on November 5th and 6th.
More details on Facebook and website
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subset: commoncrawl


text:
I really wasn't going to join in the mystery madness/fun this time around….but the pictures of the link up lured me in. And, I had a few chunks of black on white left over from another of Bonnies quilts.
Do you recognize Star Struck? I must have had a really good time collecting those black and white prints….I did 2 of these and still have leftovers.
So today I pulled fabric from stash….I am not straying too far from the colors Bonnie is using. I have green, turquoise and coral-red and in lieu of the grey I found a really pale jade. Not sure if I will make it full size, maybe just a throw.
There are lots of tempting colors and combinations….check them out at Bonnie's quiltville.


text:
Monster High
Monster High 3D. . HD Wallpaper and background images in the Monster High club tagged: monster high clawdeen cleo frankie deuce draculara.
Submitted by haynay24
Keyword: monster, high, clawdeen, cleo, frankie, deuce, draculara
This Monster High fan art contains anime, comic book, manga, and cartoon.
2 comments
carlie445 said:
posted over a year ago.
bbyrne2383 said:
posted over a year ago.


text:
Written on 20 November 2017
- Nizoral 2% with Ketoconazole for Fungal Infections of the Skin
- Eczema and Psoriasis as Warning Signs of Systemic Fungal Infections
- Sugar or Complex Carbohydrates in Viral and Bacterial Infections
- Sugars or Honey Before Bed, Insomnia, and Ramping Up of Fungi in the Scalp
- pH of Body and Blood Is Essential to Maintaining Optimum Microbe Balance and Physical Health
Dear Ones,
I have some thoughts on ramping down viruses in the body. I'd like to know if anyone has tried any of these and can let us know whether they do or don't work? Please don't hesitate to add comments about that.
Nizoral 2% with Ketoconazole for Fungal Infections of the Skin
One of my general practitioners, a traditional medical doctor, once suggested using Nizoral anti-dandruff shampoo on the skin to ameliorate the look of eczema and psoriasis.
The active ingredient in Nizoral 2% … ketoconazole … is an antifungal and anti-yeast medicine, so either eczema or psoriasis, or maybe both of them, must have a fungal flareup component.
I've tried using Nizoral shampoo diluted with water, about 1 part Nizoral to 1 or 2 parts water, and find that it helps with eczema and psoriasis. My doctor was right.
I found Nizoral shampoo itself to be hard on my skin unless I washed it right off again, right after I had put the diluted solution on the affected skin during a shower. For me, washing it right off again worked best.
Eczema and Psoriasis as Warning Signs of Systemic Fungal Infections
I've noticed that these two skin symptoms seem to be associated with systemic invasion of fungi, which are manifest on the skin … especially the facial skin … but may extend down through the throat and into the lungs, and also up the nose, into the Eustachian tubes and from there, into the tympanic cavity in the inner ear …
Image: Anatomy of the Eustachian tubes, one end of which connects to the back of the nasal cavity and the throat, and the other end of which connects to the tympanic cavity in the inner ear: http://entkidsadults.com/wp-content/uploads/2013/11/Eustachian-air-pressure-equalization-tube-999×1024.jpg ..
Thus, I feel, it's important to recognize psoriasis and eczema for what they are: Warning signs of overgrowth or 'bloom' of fungi inside (and not just on the surface of) the body, and to adjust the diet to quell and control this overgrowth.
Sugar or Complex Carbohydrates in Viral and Bacterial Infections
According to 2016 research by Medzhitov et al, (1)
- Avoiding eating sugar and complex carbohydrates when infected with flu (virus) led to death.
- Avoiding eating sugar and complex carbohydrates when infected with bacteria offered protection against death.
Many bouts with flu have both a viral and a lesser bacterial infection component. If sputum (phlegm coughed up) is green or yellow, then there is a bacterial component. So then, would that mean, take a middle road on sugar and complex carb intake during such a combined illness?
If sputum is white or clear, then there is a viral component. (2) So then, would that mean, avoid sugars and complex carbs during such an infection?
Sugars or Honey Before Bed, Insomnia, and Ramping Up of Fungi in the Scalp
I've noticed … again last night … that eating a teaspoon or two of honey before bed causes overstimulation of the cellular activity of the skin of the scalp.
On the physical plane, the feeling I get is that of pressure on the top of the head, as if a weight shaped like a cap were pushing down on my head. I get this feeling when lying prostrate, but not while sitting up.
On the astral plane, this is associated with overstimulation of the crown chakra (at the top of the head), overstimulation of the mental body, and bringing to awareness of negative thoughtforms stored in the aura.
I feel this may have to do with hyperactivity of fungi in the skin of the scalp, and the intermixing of their emotional thoughtforms with our own. That makes it hard to get to sleep, and it also makes the interlude before sleep less than pleasant.
Thus I suggest ingesting no sugars or honey after nightfall.
pH of Body and Blood Is Essential to Maintaining Optimum Microbe Balance and Physical Health
It's not really microbes that cause illness in the body; it's the pH of the body that allows or prevents their proliferation. Apparently, acidic blood and acidic body cells are breeding grounds for viruses and bacteria.
Here are lists of foods, showing foods that are acidic, neutral, and alkaline in pH:
Link: Foods sorted by category and pH, https://i.pinimg.com/originals/5f/2d/e8/5f2de8db40b0ad14a50552363ed3f2a3.gif ..
Link: Foods sorted in horizontal rows, with each row showing foods at a certain pH: https://i.pinimg.com/736x/be/86/f0/be86f0972264ba21b75ead5da5b6824c–acidic-foods-acidic-food-chart.jpg ..
Link: Food Impact on Body pH Chart … a list with vertical rows, each row showing foods with a certain pH: https://trans4mind.com/nutrition/AirWaterLife-FoodImpactOnBody-pH-Chart.png ..
I notice the above lists contradict some of the AARP literature I've read; one would have to approach the topic of what to eat experimentally, and item by item, I feel. For instance, is coffee life-extending, or is it bad for us because it's acidic? That is one example.
In love, light and joy,
I Am of the Stars
(1) Opposing Effects of Fasting Metabolism on Tissue Tolerance in Bacterial and Viral Inflammation. Wang A, Huen SC, Luan HH, Yu S, Zhang C, Gallezot JD, Booth CJ, Medzhitov R. Cell. 2016 Sep 8;166(6):1512-1525.e12. doi: 10.1016/j.cell.2016.07.026. https://www.ncbi.nlm.nih.gov/pubmed/27610573 ..
(2) "Green or yellow phlegm likely to be bacterial," by Kerry Grens, 10 November 2011, https://www.reuters.com/article/us-phlegm/green-or-yellow-phlegm-likely-to-be-bacterial-idUSTRE7AA04M20111111 ..


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Chiang Mai is the largest city of Northern Thailand. Chiang mai is 700 km north of Bangkok. Some of the highest mountains in Thailand are in Bangkok.
Thousands of foreigners visit Chiang Mai each year for its many attractions. One of most interesting events is Chiang Mai Lantern Festival. It was also known as, "Yi Peng Loi Krathong Festival. "Yi Peng" can translate to the full moon night of twelve lunar month. Chaing Mai municipality of Thailand organize the festival in November of every years.
Chiang Mai locals usually launch hot air lantern balloons to celebrate Chiang Mai Loi Krathong festival in Thailand. The hot air balloons suppose to drift away the troubles and bad luck away.
Banana leaf boat or "Krathong" are also used to celebrate the festival. Chiang Mai will make boats out of banana leaves and drift it away in the river. While tradition Kratong were made exclusively from banana leaves, modern Kratong come in all shapes and sizes.
The final night of the festival is the most spectacular. People invent giant Kratong for display through the streets of Chiang Mai. The giant Kratong usually tell the story of lord Buddha, history, and beautiful culture of Thailand.
There are many other interesting activities during the festival such as fireworks, Kratong contests, and folk show. If you would have a chance to visit Chiang Mai in November, you definitely don't' want to miss out.
For more information :
The Tourism Authority of Thailand
1600 New Phetburi Road,
Makkasan, Rajatevee,
Bangkok 10400 - Thailand
Email: email@example.com
Lampang Province - Thailand Tourist Attractions :
Lampang Province is one of the oldest and most exciting tourist
destinations of Thailand. It is rich in archaeological evidences reflecting More.


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It's another lovely day, and loads of yard work is getting done. Our deck is nearing the finish line and that makes me extremely happy! The kitties are full of life also and wanting to jump on feet as they go by and follow
us everywhere we go. I plan to work on my novel for awhile and finish making a new necklace that I started the other day. Every day is another day in which to excel! Happy day to you.
Love the blog Grandma. Miss you
Bill, So sorry to hear about MelvaI Know it's hard for you. My son lost his wife three weeks ago from ovarian cancer. This has been a tough year. Love, Carolee
I did not read your book, but I am extremely happy to see you are doing so well . I am a full time care giver for Melva ,who has sever dementia.Cousin Bill.
Thank you, Gloria. It was good talking to you the other day. I'm sorry that I did not see your January (!) message earlier. Love


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Most have three wheels and do not tilt An exception is in Cambodia, where two various sorts of cars are referred to as tuk-tuks, one of which (also known as a remorque) has 4 wheels and is composed of a motorcycle (which leans) and trailer (which does not). Auto wallahs who doesn't have meters for their autos will demand a hell lot of amount(which is at least Rs.50+ genuine meter fare) and our skill of bargaining helps to some extent. Years of experience and expert mechanics are only two significant factors you ought to trust your vehicle encounter in the skilled hands at GP Autos. With many years of invaluable experience in the car service enterprise, GP Autos provides a wide variety of professional functions for vehicles, motorbikes, trikes and three wheelers that are expertly carried out. Causes and effects of any of these problems are easy for the group right here at GP Autos to diagnose.
At times, i feel taxis are far better when compared to autos except for the reality that they are not quite economical. The odd-searching line in this graph is the one particular for domestic consumption of autos and parts as a fraction of GDP the line starts to drop soon after 2002, only reversing in 2010. Autos to support me making this transaction on the web and why I cannot make a phone conversation appropriate now.
Some family members members of the victims alleged Mexican authorities confiscated their autos and arrested people attempting to cross autos when the cars VIN numbers didn't match the VIN in the documents. Autos to secure the transaction and begin the shipping of the item The motorhome is at the shipping center in Oakland, CA but f you want to see the motorhome at the shipping center, I will have to come there to meet you and right now I am not in a position to do this. Autos areas you below no obligation to purchase the motorhome if you are not satisfied with it The payment only enables Yahoo!
Apple Autos pioneered no-hassle, a single-cost promoting in the Minneapolis, St. Paul market. GP Autos are the number 1 option for vehicle servicing , becoming authorized by VOSA as effectively as the members of the Great Garage Scheme and are proud to have highly experienced staff at garages throughout the UK. We are always striving to take client service to the subsequent level. Inventories of autos rose two.3 {4846215268656ba8be241872e33815d562ff1575ccce86b06c9e68ca6e7fcc7a} as wholesalers try to preserve up with what is very sturdy retail demand for autos.
Just before October 31, only 1999 year model of autos could be legalized to be imported to Mexico, and after that date only 2000 year model autos could be legalized for import into Mexico, according to Mexican government officials. Why servicing your vehicle is so critical, and why selecting GP Autos is the proper option. Your automobile is one of your dearest possession and we at GP Autos really recognize that.


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For a long time I've been noticing an abundance of personality-type quizzes that tend to be based on this topic—What country should I live in? What European city do I belong in? etc. etc. And it seems to be a curious thing to me. How does the country you live in define you as a person? If you go to a country that is more in line with your personality, will you be happier?
The thought of this is exciting and scary at the same time. Imagine arriving in a new country and understanding and knowing immediately that this was the place for you. You belong here. You will find happiness because these are your people. On the other side of things, what if you don't find your country? What if you go your whole existence living in Chile when you really were meant to be in Iceland? Does it really make a difference to your happiness?
Of course, I can relate to the concept that different countries (and areas within countries) have different moods. My experience with Korean culture is quite different from in Cambodia or Thailand. Even countries that are close to one another, like Australia and New Zealand, have very different moods. The mood is a reflection of the people, the lifestyle. Korea is more put together, where Thailand is more relaxed. This is not true of everyone, but I think there are certain things that can be generalized to some extent.
If you come from a big country, like I do, you'll find yourself explaining from time to time about how the culture on one side of your country varies greatly from the other side. I am from the east coast, the North Atlantic, much closer to Europe than to the west coast of my own country. But I'm not talking necessarily about geography, or culture, but about mindset.
So, then begs the question: does it really make a difference? Maybe I would fit in better in Venezuela. Maybe I'd find my soul in Romania. But, should I really pack up and leave for that hope alone? How can you say that fitting in brings happiness? Aren't we taught to be proud of our individual personalities? To parade our differences, don't be afraid to be yourself. Maybe it's not as easy as to fit in, but it's much easier than trying to find where you might fit in slightly better, at least a little bit.
After all the rambling is said and done, who can deny the fun in this kind of quiz. The pride you get in saying you'd fit in much better in a cultural European capital, or in an adrenaline junky dreamland like New Zealand.
By the way, I did take this Buzzfeed quiz just as "research," and found I'd actually fit in much better in Switzerland. And, actually the description is pretty true to my personality. I'm a bit disappointed that I won't get to live out my life in a tropical climate, but I think I'll be quite happy in Switzerland.
(Disclaimer: I'm not sure how scientific this quiz is, based on the fact that one of the deciding criteria is "Pick an animal in a sweater.")


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Posts Tagged 'award winning caregiving book'
OMG! Come See Me at the Farmers Market.September 29, 2016
Anything can happen at an Open Mic . . .August 16, 2016
Caregiver Support finds The Blue GuitarApril 3, 2015
Every caregiver needs a support group. You may think you don't, but you do.
See page 79 of the Arizona Consortium For the Arts magazine The Blue Guitar for details.


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Green Chile Ranch Dressing is a southwest spin on your favorite all-American salad dressing. Add it coleslaw, smear it on your favorite sandwich or even dollop it on a big bowl of chili.
Green Chile Ranch Dressing
When your husband brings home 3+ pounds of fresh Hatch chiles straight from New Mexico you know it's true love! [bctt tweet="Green Chile Ranch Dressing #southwest #salad #Hatchchiles" username="thyme4cocktails"] Every year Paul's employer has 3 huge bags of Hatch chiles shipped to the local warehouse for the employees to enjoy. We love to get fresh roasted chiles from the farmers market so he knew I could put them to good use. We eat green chiles in everything from sausage gravy for breakfast to cocktail mixes. I was just telling a friend there isn't much that wouldn't be just a little better with a healthy dose of smokey chiles. And don't worry if you don't have access to fresh chiles. I have made this recipe with canned chiles and it just as delicious. You could even make homemade ranch if you are feeling ambitious! I made a simple coleslaw with this dressing that we piled on these Easy Southwest Buffalo Chicken Tacos Monday night for football! Needless to say I will be making a lot more tailgate goodies with this yummy Green Chile Ranch Dressing! What is your favorite recipe with green chiles? Enjoy~ Loriann
Green Chile Ranch Dressing
- 2 cups ranch dressing
- 1/4 cup green chiles
- 1/4 cup whole milk
- 1 tablespoon red wine vinegar
- 2 teaspoons dried oregano
- 1 teaspoon cumin
- Place all ingredients to a food processor or blender. Pulse until throughly combined.
- Store in an airtight container in the refrigerator for up to 2 weeks.


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Starting MSRP from * $37,600
Test-drive a 2019 Chevrolet Silverado 2500HD in Tulsa at Route 66 Chevrolet. Why it is such a great truck for Tulsa and Broken Arrow drivers? The Chevrolet Silverado 2500HD is a classic, heavy-duty American truck. It's a highly rated truck with a comfortable ride and quiet cabin, and it can tow your heavier loads. It features several trims and engines and helps you get any job done. There are plenty of different sizes, meaning you can choose a truck made for your needs. Search our inventory of new Chevrolet Silverado 2500HD vehicles in Tulsa. For more specs, contact us at 9188946114 about buying or leasing your vehicle of choice. Get a quick quote today!
- Requires Silverado 2500HD Double Cab Long Box 2WD and Vortec 6.0L V8 engine. Before you buy a vehicle or use it for trailering, carefully review the Trailering section of the Owner's Manual. The weight of passengers, cargo and options or accessories may reduce the amount you can tow.
- Requires Silverado 2500HD Crew Cab 2WD with fifth-wheel hitch and available Duramax 6.6L Turbo-Diesel V8 engine. Before you buy a vehicle or use it for trailering, carefully review the Trailering section of the Owner's Manual. The weight of passengers, cargo and options or accessories may reduce the amount you can tow.
- Chevrolet Infotainment System functionality varies by model. Full functionality requires compatible Bluetooth and smartphone, and USB connectivity for some devices.
- Vehicle user interface is a product of Apple and its terms and privacy statements apply. Requires compatible iPhone and data plan rates apply. Apple CarPlay, Siri, iPhone and iTunes are trademarks for Apple Inc, registered in the U.S. and other countries.
- Service varies with conditions and location. Requires active service plan and paid AT&T Data plan. See onstar.com for details and limitations.
- Requires compatible Apple or Android device and data connection. Remote Services require paid plan. Visit Onstar.com for details.
- Based on the 2006-2017 Vincentric Fleet Awards analyses of the full-size ½-ton, ¾-ton, and 1-ton pickup segments.
2019 Chevrolet Silverado 2500HD in Tulsa at Route 66 Chevrolet
Route 66 Chevrolet has a large selection of 2019 Chevrolet Silverado 2500HD for our Tulsa, OK drivers. With miles of rigorous testing, the Chevrolet Silverado 2500HD is one of the strongest, most intelligent and capable vehicles ever. The impressive engine provides power while making this one of the most fuel-efficient vehicles on the market. We encourage you to come test drive this vehicle to see for yourself.
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Our vehicle financing department is here to committed to making the auto financing process easy and seamless for each car shopper. We specialize in finding the most affordable financial options that best suits your financial needs. Use our online tools to value your trade in, get pre-approved for auto financing or compare auto loan and auto lease options.
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Chevy vehicles are known for their remarkable performance, dependability, and all around good value. You can't go wrong with any of our new vehicles in Tulsa, and we think you're sure to enjoy the Chevrolet Silverado 2500HD.
Please contact us anytime at 9188946114 to schedule a test drive or come visit our Tulsa dealership near Broken Arrow. If you're also looking for auto lease options, our friendly auto financing department is here to help get you the automobile you're looking for.


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Sony reports the issue has been fixed.
Posted By Ravi Sinha | On 28th, Dec. 2015 Under News
Sony's PlayStation Network was facing some issues several days ago, mainly regarding account creation. Essentially there were delays with account validation and password reset emails, most likely due to the number of people logging on for Christmas.
Thankfully, Sony has identified the issue and revealed in an update on Twitter that, "The issue with email verification delays has been resolved. Thanks again for your patience! For password reset help: http://bit.ly/1Ix9In8"
It's a good thing Sony fixed the issue reasonably quickly – without your PSN account, you can't access multiplayer or your collection of free PlayStation Plus games or even access the online Store. Of course, there's also the problem with managing your account if the service is down if your account is compromised, it would be difficult to even reset your information.
Are you still facing issues with PlayStation Network? Let us know in the comments below and stay tuned or more information.
Contact Us About Us Staff Advertise With Us Privacy Policy Terms of Use Reviews Policy Hooked Gamers Community Policy


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Canadian Federal Election: October 14, 2008
Please consider a donation should you wish to use my materials. ©Copyright Jennifer Jilks, 2007.
Here we are in another election! It seems like yesterday that we had the previous Federal election. It is a grand time to be an educator. Teachers are wise to take this opportunity to explore this important facet of Canadian Politics. Students can collect articles, campaign pamphlets, view debates, and generally exploit this phenomenon that lends itself to literacy and integrated unit opportunities. You need not have a great deal of experience or be a political animal, the older students (Gr. 4 and above) can have a grand time. My Gr. 8's, back in 2006, found a lot of excitement in following what proved to be a minority government.
I am concerned with the news coverage. I would like to read information and news – not the blog of everyman. It is hard to weed out facts from those who pontificate with little knowledge or expertise behind them. I read every article with a critical eye. I know that reporters have editors and are accountable. When I see the trend towards anyone being allowed to post offensive, biased, racist and sexist comments, I shudder.
We debated platforms, talked about issues, spoke of local candidates and party leaders. There was a buzz. We learned not to believe everything we read. In the time since, however, there are much more information out there than before. The wise educator needs to educate her students. In 2005, 2006 and spoke of candidates. In my classrooms we compared and contrasted what we read, saw on TV and heard on radio. My classroom walls were filled with articles that students would rush in to show me.
It was interesting comparing the difference between Municipal ( and Regional), Provincial and Federal mandates and issues. It is the Municipal elections that have a profound effect on citizens in terms of your region and local taxes, but a Federal election is a prime opportunity for separating out the various levels of government and determining their mandate and effect upon Canadians as a whole. ONce the election was over we were not finished. Then we compared the candidates between 2004 - 2006. Wikipedia was a great source, as long as we were not looking for much more than data.
Another aspect of this current election is the effect that applications like Twitter and Facebook have on election fever. Entrepreneurs http://www.nodice.ca/elections/canada/ have taken advantage of the money they can glean from ads on web site. I have chosen not to. This, in and of itself reflects a bias. One web site provides much information by a political science grad and student teacher. It is possible to have interesting discussions about potential bias (or lack thereof) in this Web site.
1. To begin: a) Create a title page and a table of contents. Create a KWL chart.
b) View this Powerpoint introduction to voting in Canada, an overview - based on the book:Canada Votes.
2. a) Visit the Political party names and logos page on Election Canada's website to find the registered political parties.
b) What is the platform of the various parties?
3. VOCABULARY: Spelling activity sheet | My Wordsearch Puzzle | My Crossword Puzzle | Glossary of special terms.
c) Here are some vocabulary words you should know:
d) What do you think should be done to resolve these issues. If you were a candidate what would your platform be like?
e) What do you think about the various slogans candidates are using?
f) Which of the issues concern you?
4. a) How many women vs. men sat in Parliament in 2006?
5. a) What was the voting results (by party) in the last Federal Election in your riding, by province or in Canada? Visit the map of election 2006 results.
b) This is the Parliamentary seating chart National Results in 2004, from Wikipedia. They also offer a graph/map of the results. Students can label this seating chart and colour code it by party affiliation. Then can compare and contrast the 2006 results.
6. a) Look at the graphs that examine polls, created by CBC news. Another great site has been created at WLU (2008) looks at various polls. Very thoughful site. It looks at the inconsistency of polls. Dr. Kay questions the lack of systematic approach by pollsters.
b) Compare the Globe & Mail interactive graph results dating from 2000 to 1867. Originally the two parties in Canada were the Tories and the Liberals. Which results indicated that other parties were involved and winning seats and in which years?
c)Write 250 words about the expenses in the 2000 election.
d) Wikipedia also has polling data. At this site you can compare graphs from various polling agencies.
i) Write 5 questions a peer should be able to answer based on these graphs.
e) Facts and Figures about Canada and voters. This page includes historical facts and a timeline.
f) Election 2004 Results in Nepean-Carleton by the 611 individual polling stations, by Southern Ontario,
g) percentage of votes by party for 2000 & 2004, (all in .pdf format) from the larger document on the Elections Canada web site.
7. a) Many newspapers, and other media, have been printing polling information.
You should be aware of the candidates in your riding. Go to Elections Canada and put in your postal code. (If you do not remember your postal code put in the school's postal code: K2E 6M7.)
A) Elector information:
B) The voting process:
Visit the on-line, user-friendly guide (for Jr./Intermediates) on
voting in Canada hosted by NALD called: "I
Can Vote!."
CTV shows where the party leaders are travelling.
What has been happening during the election campaign? Create a timeline of the process.
h) In which ridings were there VERY CLOSE class? e. g. Parry Sound-Muskoka (2006).
D) Research a history of democracy (from Wikipedia).
D) Write a 5-paragraph essay on one topic or aspect of the election. It could be a biography, it could be about the slogans, corruption, comparing the platforms of the different candidates, compare voting practices in other countries.
11. a) Collect some editorial cartoons (CBC has some on-line) for the past month, available on-line. Check for the targets of various cartoons. Is there an evidence of bias for or against particular parties? Here is an analysis sheet to compare them.
b) Check out the editorial cartoons, the editorials, letters to the editor and look for bias on the
part of reporters and individual newspapers.
12. a) On-line quizzes:
i) CBC Election Quiz ii) Can you answer any of the Poll FAQs?
b) Check out Wikipedia information. Write a report based on this information.
c) What is the difference between municipal, provincial and federal politics? Write a 4-paragraph essay explaining the differences. Here is a gr. 7 Rubric and a gr. 8 rubric in .pdf file.
d) Read about by-elections.
i) There was one in Ottawa Center in 2004. Answer the "W" questions about this by-election. Who was running? Who was elected. Where was it held? Why was it held? and "So What?"
14. Local information: Ottawa Candidates in Election 2006.
15. out what the bloggers are saying about the election!
a) What do you really think about the reporters who are out following candidates?
16)a) Craig Marlatt offers a fair number of geography information at the high school level, with some phenomenal free maps and other geography resources.
b) Atlas.gc.ca has election 2004 results by map. Great site for maps, aside from the fact that the government will no longer be printing maps. Lesson plans are included here.
17. In 1971 22% of 15 - 19 year olds had jobs (Macleans, 2006). People aged 23 to 29 who won't vote: 14%. According to Elections Canada, percentage of 18-24 year olds who actually voted in 2000: 25%. In 2001 it was 13% of teens who worked full-time. What do you think about having 16 - 18 year olds vote? Is it the right thing to do? Do you think they will vote thoughtfully? Will they vote properly? Will they vote at all? Here is the percentage of voters by province and territory in 2004.
Quick Here is web page. This includes a PDF Teacher's Guide.
[ CBC Canada archives | bloggers | Canada Info | Elections Canada | Editorial cartoons | Election Quiz | Globe &Mail Platform Spreadsheet | House of Commons | Learning Resources | "I Can Vote!" | Canada Votes | Political party names and logos | Ottawa Candidates | Young Voters | Learning Resources | Nodice Elections | Wikipedia Polls | Final unit test (in .pdf)
Back to my portfolio page. Last update: September 10, 2008. Images
All learning activities contained within my site are ©Copyright Jennifer Jilks, 2008. All Rights Reserved. Please respect intellectual property.


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Hear what people and partners think of our work and how we are improving the lives of all residents.
Hear what people and partners think of our work and how we are improving the lives of all residents.
" We have been working with Mancunian Way since almost the day they started, they are our main youth and community engagement partner in the North West. They do what they say, achieve results, keep me informed and always bring in extra funding and support. "
01/11/2018 - Kevin McCloskey, Clarion Housing
" As a health organisation we have been very impressed at the commitment of Change4Good project in supporting people to access and engage with healthcare services and to ensure that health remains a priority throughout their engagement with clients. "
04/10/2017 - Rachel Brennan, Nurse, NHS
" The Booth Centre values the partnership with Change4Good project and would be keen to support them to roll out the best practice that they have developed in delivering street based support to homeless people and people begging in the city centre. "
03/04/2017 - Amanda Croome, CEO, Booth Centre
" It was great to work with Mancunian Way at The Big Weekend event in 2016. Having experts in youth engagement on the ground advising young people on how to stay safe and also liaising directly with our security team had a real, measurable impact. The project displayed a great example of partnership working. "
12/01/2017 - Mark Fletcher, CEO, Manchester Pride
" I can't thank you and your team enough for the impact you are having on the community here in Gorton. I have been able to share these figures with the local Council and Councillors at the last two meetings I have been at for Gorton North and South and they too are really encouraged by the work which is being undertaken. "
05/12/2016 - Seargent Tracey Mortimer, Greater Manchester Police
" The work Mancunian Way are doing is vital in deprived areas like Gorton, where disillusionment with the system among young people is high. It is great to see youths being engaged with on their own level, by people who show a genuine concern for their well-being. Working with Mancunian Way has allowed me as a PCSO to interact informally with local young people and help them to see me as someone who cares too, rather than just another figure of authority. "
05/12/2016 - PCSO Oliver Thompson, Greater Manchester Police
" NCA fully support the work that Mancunian Way undertake and support any application for funding to continue and expand their vital intervention and prevention work in communities. "
24/10/2015 - Melinda McCready, National Crime Agency
" I think the value of the project (Stay Safe) is youth workers going to where the young people are and where they may be vulnerable and at risk. We should all be committed to prevention. "
14/01/2015 - Ann Coffey, Member of Parliament
" I attended the official launch of this project (Stay Safe) at the Virgin Money Lounge in the city centre and was impressed with how the project targets young people in locations of concern to prevent further victims of this horrendous crime through education and working in partnership with the police and other agencies. "
11/01/2015 - Tony Lloyd, Police & Crime Commissioner


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PESHAWAR: The Muttahida Majlis-e-Amal (MMA) and Pakistan Tehreek-e-Insaf (PTI) are the main contenders in three out of the five National Assembly constituencies in the Peshawar district.
The position of the Awami National Party (ANP) and Pakistan Muslim League-Nawaz (PML-N) is considered stronger than the MMA in the remaining two constituencies out of the National Assembly seats in Peshawar.
Political observers in their separate chats with The News opined that neck and neck competition was expected among the candidates of major political parties, but the PTI would be the main rival against MMA, ANP and PML-N in all the five constituencies.
Among the 10 candidates running for NA-27, PTI's Noor Alam Khan and MMA's Ghulam Ali are the main contestants. Asma Alamgir of Pakistan People's Party (PPP) and Arbab Tahir Nadim of ANP are also contesting from this rural constituency.
Six candidates running for NA-28, including PTI's Arbab Aamir Ayub and MMA's Sabir Hussain Awan are stated to be ahead of other contestants, including Mohammad Intikhab Chamkani of PML-N who recently joined the party.
Earlier, he quit Pakistan Muslim League-Quaid (PML-Q) and joined Jamaat-e-Islami (JI). Shafi Akbar of the ANP and Ikramullah of Tehreek-e-Labbaik Pakistan and an independent candidate, Mohammad Daud Burki are also in the run from NA-28.
Among the five candidates for NA-29, the main contestants are expected to be the PTI's Nasir Khan Musazai and PML-N's Amir Muqam. Their position is considered stronger than Naeem Jan of MMA, Arbab Kamal Ahmad of ANP and Mohammad Shafiq of Tehreek-e-Labbaik. PTI's Arbab Sher Ali and MMA's Arbab Najeebullah and PPP's former federal minister Arbab Alamgir are strong candidates in NA-30.
The other candidates are Mohammad Alamgir Khalil of ANP, Mohammad Junaid of PML-N , Noor Wali Khan of Justice and Democratic Party and independent candidate Mohammad Khurshid.
Out of 13 candidates in NA-31 comprising Peshawar city, tough competition is expected between PTI's Shaukat Ali and ANP's Ghulam Ahmad Bilour. The latter's nephew Haroon Bilour, who was running for PK-78, was martyred along with 20 people in a suicide attack during a corner meeting at Yakatoot locality on July 10.
Ghulam Bilour is expected to get the sympathy vote. Though political parties have restricted their election activities, the candidates are now holding corner meetings in the face of looming threats.
Gulab Khan, who is a daily wager, said this wasn't the usual election as the candidates could not hold large public gatherings to woo the voters. He said the candidates made promises to seek votes from the electorate, but they were nowhere to be seen after winning the polls.
He said the candidates made pledges that ranged from curbing corruption to serving the poor, but they seldom honoured their commitment. "We meet all the candidates, but I have told my family that we will vote for those who can deliver," he maintained. APP


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The makers of Kaabil have shared a poster which gives a comic type feel for Hrithik Roshan's character. It is dark and looking highly interesting. It is captioned as: The fires of vengeance consume him. Will he find the light? #MindSeesAll
It is evident that Hrithik's character will be powerful as he will be looking for vengeance. The trailer of the film is releasing on 26th October.
Check out the poster here:
Kaabil also stars Yami Gautam and is directed by Sanjay Gupta. It is slated to release on 26th January, 2017. How did you like the picture?


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Prospects who want to run Microsoft 365 Enterprise in their group must be operating Home windows 7, eight.1, or 10 Pro on their present desktops and do not depend on a domain controller for his or her group. Prospects who use on-premises Energetic Directory should change to cloud id and administration as a part of their deployment. Current Windows 10 Professional PCs should be operating Creators Update if they haven't already done so.
With a full vary of customized companies – including In a single day, Two-Day Service, Floor Supply, Worldwide, Freight, and Subsequent Flight Out – and the perfect customer support in the business, Mercury eliminates the hassles, helps you manage costs, and allows you to concentrate on what issues the most – your online business.… Read More..Read More »


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GRANBURY, TEXAS — Early in 1963, Betty Smallin found herself in California, a young mother and housewife who didn't know anyone in the area. Fortunately, the family next door moved in about the same time. The two young mothers shared a common malady — neither had local friends. The neighbor told Betty about a new game she learned to play. The two women decided Mah Jongg gave them a perfect vehicle to meet other women. Betty headed to the store and purchased her first set, spending $28. They played that evening. "It was so exciting we just couldn't wait for the next Monday," Betty said. As they played hands to make the right combinations with the tiles, Betty didn't want to lose her place on the directional card. She put her index finger on the line and kept it there. Intent on the game, she didn't realize until they finished how hard she had pressed down.
She trudged home happy, but with a numb finger. "It still felt weird late into the evening," she said. She played with the neighbors for years, members changing as some moved away or life forced others to stop playing. Later, Betty became part of a group that included two sisters from New York. Their mother had taught them to play at 7 and 8 years old, so if her group couldn't get together for any reason she could still play.
Far away in Ohio, in the late '60s lived a young housewife named Marion Yeagler. Some of her neighbors invited her to play the exciting game of Mah Jongg, willingly teaching her the rules and moves. She quickly grew to love playing, which she did until moving from Ohio. When she came to Texas, her Mah Jongg tile set took a place on the closet shelf, remaining there for 20 years. After her husband passed away, Marion decided she should get the set out.
In the same way she had learned, Marion invited some friends to come over and she taught them the art of her beloved game. The small group grew, eventually becoming an activity for the Senior Circle. Dots, bams and cracks form the suits of the tiles, much like card suits. With many rules and annually changing hand requirements, avid fans stay interested, often playing for decades, while teaching friends and family members the game as well. Why do these women still play the same game after more than 50 years? "We love it. It's challenging," Betty said. "The more I play, the more I want to play the challenging hands," Marion remarked. ?
The game provides a fun way to socialize, but also keeps minds active. "Most people only play Mah Jongg on days that end in Y," said Doris Moore, chair of The Tiles That Bind Committee. Although she moved to Fort Worth and found groups of players there, she returns to Granbury and maintains friendships forged over small tiles with interesting symbols.
The game includes benefits far greater than a mere social outlet. Because the game requires a great deal of thought, focus and attention, it can increase cognitive abilities. In some cases, people with traumatic brain injuries who have played the game on a regular basis saw improvement. The constant thinking involved in the game also helps stave off Alzheimer's. Because of its complex nature, new players don't learn to play in a single sitting. According to Betty, Marion and Doris, new players should anticipate about a month of playing once or twice each week before fully understanding the game.
The exact beginnings of Mah Jongg aren't known. However, most believe it originated in China — perhaps around the time of Confucius. Joseph P. Babcock, an American resident of Shanghai, brought the game to America in 1920. He coined and copyrighted the term mah-jongg and produced a simplified set of rules. Using English translations for the tiles and adding index letters and numbers familiar to card players, Joseph successfully promoted the game. The popularity grew exponentially while he imported the first sets. Within a decade, demand for new sets dwindled, but the Great Depression prompted a renewed interest. Over the years, players continued to teach others.
In the '50s and '60s, the game became popular with housewives looking for social outlets and ways to make new friends. Today, Mah Jongg is again gaining new fans. Players seek out local groups and clubs, but also participate in tournaments, Mah Jongg Madness days and even special Mah Jongg cruises.
In Granbury, the last Tuesday in February marks the date of a local Mah Jongg Madness event celebrating the Chinese New Year. Doris Moore, Wanda Strain, Carolyn Neill and Donna Thorstenson form The Tiles That Bind Committee. They join forces to plan and implement the one-day event. Starting at 9:00 a.m., Mah Jongg players will descend on the clubhouse at Pecan Plantation. At 10:00 a.m., they will begin the first of two rounds, each lasting one hour. After a break for lunch and the drawing of door prizes, two more rounds of play will ensue, continuing until the day ends around 4:00 p.m.
The Granbury Mah Jongg Madness event provides players a fun day and an opportunity to win some great door prizes. Surprisingly, the players get most excited over winning the return of their $25 entry fee. In addition to many local players, people from Fort Worth, the mid-cities, Weatherford, Tolar and other locales come for the annual event. While the players take the games seriously, they approach it with less solemnity than tournament attendees do.
The event in Granbury launched in 2011. Having 44 people the first year thrilled the organizers. In 2014, the committee allowed 100 spots, which filled and left others on a waiting list, hoping for a spot to open. The committee keeps attendance at 100 maximum.
Although not required, oriental attire dots the tables. From kimonos and silk tops to hats or chopsticks as hair accessories, players get in the mood for a festive day. Each year, the committee tries to match the symbol of the Chinese New Year. This year, the committee will creatively incorporate sheep as part of the decor.
Meanwhile, Betty and Marion continue playing and teaching others. "If you want to play, you have to teach someone to play," Marion said. "That's the situation I found myself in. When you move, you lose contact with fellow players." Groups change as members move or quit playing for different reasons. Both ladies are more than willing to teach anyone interested in learning.
The groups at Pecan Plantation and the Senior Circle are two of many groups playing in Granbury. In some cases, fans of the game carry on the tradition of inviting neighbors to learn. As faithful players teach about dots, bams, cracks and all that goes with them, Mah Jongg lives on.
Written by Lisa Bell.


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The Honda OpenTheCheer contest, which has been held over the month of December on Twitter, has awarded a prize to a different Twitter user every day of the month, with the grand prize being a 2016 Honda Accord Touring. Honda is the first automaker to give a car away over social media.
Honda is utilizing Twitter's Instant Win feature for the contest. Users retweet the daily tweet on Honda's Twitter account, and then they receive a short video letting them know whether or not they've won. Honda will donate a dollar to the Pediatric Brain Tumor Foundation for every retweet up to $100,000.
Aside from the daily retweets for smaller prizes, all retweets from the month will be put into a pool to choose the winner of the new Accord Touring. Some of the daily prizes include Apple Watches and Amazon gift cards.
PBTF officials expressed excitement at the partnership with Honda, saying the OpenTheCheer campaign will shed light on the devastation of this disease and "make the 'power of dreams' come true for kids battling brain tumors."


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Injuries, Luck and Chipper Jones
Is it better to be lucky or good? Annual injuries aside, Chipper Jones was both of these things in 2008 as he batted over .400 for the first two-and-a-half months of the season. How was he lucky? He was second in the majors with a .388 BABIP, which was 65 points higher than his career average. How was he good? His 17.0 percent BB% was the highest mark of his career since 1999 while his 13.9 percent K% was his lowest since 2000.
Ahh, but those injuries. Last year he missed time due to the following ailments: back spasms, quadriceps, eye, left hamstring, stomach virus, allergies, knee, back and shoulder. It was the fourth time in five years that Jones failed to reach 500 at-bats in a season.
Injuries and age have robbed him of his speed and some of his power. No longer is Jones a threat to steal 20 bases or hit 35 home runs. But three of his top five seasons for AVG have come since 2006, including last year's monster .364 season. This combination makes Jones one of the tougher players to properly value in a fantasy draft.
In 2006, Jones was the 43rd-best fantasy hitter, according to the RotoTimes Player Rater. In 2007 he was the 15th best. Yet due to injury concerns, Jones had an ADP in the mid-60s last year, meaning he was a sixth-round pick in a standard 12-team mixed league.
Both the Bill James and the Marcel projection for Jones show similar results. They both expect him to match last year's production in HR, RBI and R but suffer a 45-50 point drop in AVG. Those two forecast systems are projecting Jones to be roughly the fantasy player he was in 2006.
So, if Jones was a sixth-round pick one year after delivering second-round production, where will he fall after a season in which he delivered fourth-round value? It's hard to imagine Jones being drafted earlier in 2009 than he was in 2008 in competitive leagues. If it is the eighth round and Jones is still available, you have to consider pulling the trigger. Just make sure to draft a competent backup on the late rounds because you know you will be playing him more than most reserves.


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Deadlines, Dates and Times
Commencement Ceremony Date and Time
April 28, 2019 2:00pm EDT
Van Andel Arena
130 Fulton Street West
Grand Rapids, MI 49503
Important Dates
February 1, 2019
Graduation Application must be on file in order to receive the mailing regarding purchasing cap and gown items and signing up for participating in commencement.
February 25 – March 24, 2019
Caps and Gowns available for purchase at regular price online at www.duspirit.com.
March 22, 2019
Last day to sign-up in order for your name appear in the Commencement program. Graduation Application must be on file. Last day to order any part of the cap and gown package at the lower price. Cap and gown availability cannot be guaranteed after this date. Higher shipping and handling charges may apply after this date.
April 19, 2019
After April 20, 2018 students will no longer be able to sign up to participate in the Commencement Ceremony or purchase any part of the cap and gown package.
April 28, 2019
Commencement Day
Doors open at 12:30pm on April 28, 2019
Graduates should arrive by 1:00 p.m. EDT to check-in and find line-up location
Graduates must be in line by 1:45 p.m. EDT. Late arrivals may not be able to participate in the ceremony.


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- by Super User /
- Published: 13 April 2014 /
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General Civil Law, Tax Law, Commercial Law, Companies and individuals, Bankruptcy, Leasings.
Born in Gottmadingen (Germany).
Bachelor of law awarded by University of Oviedo.
Member of the Bar association of lawyers, Oviedo.
Practising law since 6 November 1990.
Formed as Mediator since 1995. Expert in family conflicts mediation by the University of Oviedo.
Languages: Spanish and English. Nationality: Spanish.


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Australian cricket team in England in 2005The Australian cricket team landed in England on 6 June 2005. Over the course of the summer, they played one Twenty20 International, a one-day triangular tournament with both Bangladesh and England, a one-day tournament with England, and five Test matches, the outcome of which would decide The Ashes. With Australia the top-ranked team in the World Test table, and England the second-ranked, this was the most eagerly anticipated Ashes series since the 1980s. One-day International series
The first international matches scheduled were as part of the Natwest Series against England and Bangladesh. In their first match, Australia lost to Bangladesh by five wickets in the last over, perhaps the biggest upset in recent memory. Just before that game Andrew Symonds was dropped for disciplinary reasons. The following day, Australia lost their second match in a row to England, due mainly to Kevin Pietersen's late batting onslaught. However, Australia remained undefeated throughout the rest of the series to tie a thrilling final against England at Lord's.
Australia's next tournament was a three match Natwest Challenge One-day International tournament against England. Despite losing the first match, they bounced back to take the series 2-1. After a drawn 3-day match against Leicestershire, the main part of the tour - the Tests against England for The Ashes - were about to start.
Australian cricket team in England in 2005
Australian cricket team in England in 2005 ResultsThe Ashes Tests
With all the hype preceding Australia's arrival in England, especially Glenn McGrath's assertion that Australia would win 5-0, many people expected a good, tight contest, although Australia's fans predicted a clear overall victory. English fans were quietly confident that their strong run - winning 15 and drawing 2 of their last 18 Test matches - would continue and they could at least stand up to Australia, having lost the last eight Ashes series.
First Test
What followed surprised everyone - England's hostile pace bowling ripped through Australia in the first Test, reducing them to 190 all out. However, Australia replied in style by skittling England out for 155, with only Pietersen - playing in his Test debut - able to resist. During this innings, McGrath took his 500th Test wicket. Australia then fared considerably better in their second innings to win the first Test by 239 runs.
Second Test
The third Test match was held at Old Trafford, and again England took a large first innings lead, the England innings notable for Shane Warne taking his 600th Test wicket and Michael Vaughan scoring the first century of the series. Glenn McGrath had also returned from injury, returning the Australian side to full strength. Due to rain delays, the Australian first innings did not finish until the fourth day. England then set about scoring quickly in their second innings (with the aim of declaring and bowling Australia out to win), setting Australia 423 to win with only a day and 10 overs remaining. Ricky Ponting batted for seven hours on the final day to score the first Australian century of the series, but was dismissed with only four overs left and Australia's last two batsmen facing them. Brett Lee and Glenn McGrath managed to hang on for those four overs to salvage a draw for Australia, with England unable to take the last wicket.
Australia then played a two-day match against Northants, a drawn match in which Australia opted for batting practice instead of trying to force the win. Fourth Test
For the second time in less than a month, Glenn McGrath was ruled out of a test due to injury - this time with elbow problems. Australia also dropped Jason Gillespie from their side after taking just three wickets so far in the series. In contrast, England remained with their original starting XI from the first Test. They carried on their first innings form with their best of the series (477 all out), before England's bowlers managed to swing the ball prodigiously to leave Australia at 99/5 and 175/9. Despite the best efforts of Brett Lee, Australia finished 259 runs behind England and were asked to follow-on - for the first time in 17 years. However, with the need to bowl for two innings in a row, Simon Jones, England's best swing bowler, started showing signs of injury and was taken to hospital for a scan on his ankle. Australia were then able to post a target for England to chase, but on a wearing pitch with Shane Warne getting large amounts of turn, England struggled in their pursuit of 129, winning by three wickets in the end.
Australia then played a two-day match against Essex, in which Essex reached 500 in the first day before declaring, while Australia reached 500 on the second day. The match finished in a high-scoring draw, as no team was able to dismiss the other twice.
Fifth Test
For the first time in the series, England made a change to their side - Simon Jones' ankle injury meant that England needed to replace him. With England 2-1 up with one to play, Australia needed a victory to level the series (and thus retain the Ashes). With this in mind, England decided to call up Paul Collingwood, an all-rounder and England's best fielder, rather than a like-for-like bowler.
England won the toss and elected to bat, reaching 373 in their first innings. Matthew Hayden and Justin Langer then batted through to the end of the second day, coming off for bad light before the scheduled close of play. With Australia needing to force the victory, many were surprised at this move. The third day was also affected by rain and bad light, with only half of the scheduled overs being bowled. Australia again came off early for bad light, but as they were only 96 runs behind England and still had eight wickets in hand, they were possibly hoping to establish a significant lead and bowl England out cheaply. An Australian collapse after lunch on the fourth day meant England were actually leading by six runs after the first innings. With Australia needing to dismiss England and score more runs than them, England merely had to bat for as long as possible, denying Australia the time needed to force victory. Thanks to Kevin Pietersen's maiden Test century on the fifth day, and Paul Collingwood batting patiently for 10 runs in 51 minutes in the second innings, Australia were left with a target of 342 runs with only 19 overs remaining in the day. With Steve Harmison opening the bowling for England, Australia were offered the light in the first over of their second innings and accepted, leaving Rudi Koertzen and Billy Bowden to remove the bails at 18:17 BST to signal a drawn match and the series victory for England.
During the presentations, Pietersen was voted Man of the match for his innings of 158, while Andrew Flintoff and Shane Warne received the Man of the Series awards, nominated by the opposing team coaches (Duncan Fletcher for England and John Buchanan for Australia). In addition, Flintoff was awarded the inaugural Compton-Miller medal for the overall "Man of the Series", nominated by the two chairmen of selectors, David Graveney and Trevor Hohns.


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Dr. Hess' 1893 All-Purpose Skin Ointment was formulated over 10 years ago to nourish and moistureize dry, rough skin of all types. Today, we trust it to do the same. For dry skin, rashed, bumps, cracked heels, chafing, and other skin irritations, count on Dr. Hess Original Oinment to get the job done.Net wt 1.4 oz
Key Ingredients
Water, Lanolin, Mineral Oil, Beeswax, Paraffin Wax, Borax, Methyl Salicylate, Phoenoxyethanol, Vitamin E, Eucalyptus Oil, NA2, Camphor Oil
Apply as needed to dry skin areas. Avoid use around the eyes.
For dry, chapped skin, cracked heels, chafing, eczema, minor abrasions, burns & more
With natural ingredients that help relieve muscle and joint pain
All Natural with Lanolin, Vitamin E & Olive Oil to form a barrier of hydration for dry, sensitive skin
Available in a variety of flavors including Vanilla, Pomegranate, Lemonade and Peppermint!


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(My Original Blog Post: http://ping.fm/9hSYJ)
I'm blogging today over at thebookbinge.com about how my hero in His Intimate Submission isn't the 'sterotypical' male submissive. Please come over and chat with me about how you feel about female domination and male submission.
Wednesday, December 16, 2009
Chatting today at Bookbinge
(My Original Blog Post: http://ping.fm/9hSYJ)
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For the serious noodle aficionado, Flying Monk is the clear choice. The Broughton Street foodie scene truly made it into world class status with the addition of this on-point fusion spot.
Runner-up: Saigon Bistro
The Flying Monk Noodle Bar
May 24, 2016
5 West Broughton Street (Savannah-Downtown)
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