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Clinical scores for risk stratification of chest pain patients in the emergency department: an updated systematic review
Chest pain is a common presenting symptom in the emergency department (ED). Many chest pain patients are admitted to the hospital due to the possibility of life threatening conditions, such as acute myocardial infarction (AMI) (1). It is however, not feasible to admit all chest pain patients due to limited healthcare resources (2). Therefore, distinguishing acute coronary syndrome (ACS) from other cardiac and non-cardiac diseases is crucial (3). It is essential to quickly and accurately identify patients who are at high and low risk of developing major adverse cardiac events (MACE) in order to optimally allocate ED and hospital resources.
Risk stratification of ED chest pain patients has been extensively studied in recent years (3). However, there is currently no widely accepted risk stratification method for ED chest pain patients (4). Initial ED risk scores were adopted from those created for post-ACS risk stratification such as the Thrombolysis in Myocardial Infarction (TIMI) score (5) and the Global Registry of Acute Coronary Events (GRACE) score (6), among others (7,8). However, because these risk scoring tools were not specifically designed for ED chest pain patients, their performance in the ED has been marginal (9-13).
The History, Electrocardiogram (ECG), Age, Risk factors, and initial Troponin (HEART) score was specifically created for risk stratifying ED patients with undifferentiated chest pain (14,15). Since its inception, there have been numerous validation studies to evaluate its effectiveness in diagnosing non-ST-elevation (NSTE) ACS (16,17). In many comparison studies, the HEART score was found to be superior to most existing risk stratification tools such as the TIMI and GRACE scores (4,18-21).
Because of growing patient censuses in many EDs, it is becoming increasingly important to quickly and accurately identify high risk chest pain patients to promote efficient and effective care. The purpose of this systematic review is to present an updated investigation on various risk stratification tools that are used in the ED to categorize chest pain patients according to their risk of developing MACE.
We searched PubMed and Embase, using keywords "(score OR scoring) AND (emergency department OR emergency room) AND (chest pain OR acute coronary syndrome)". Our search was limited to English-language articles published between 01 January 2012 and 25 September 2017. Studies were eligible for inclusion if the reported clinical scores were used for risk stratifying ED chest pain patients, where one or more scoring methods were investigated. Systematic reviews, meta-analyses, case reports, letters to the editor, and articles without full text were excluded from this review. Studies with non-MACE outcomes were also excluded.
Initial literature search was conducted by N Liu. Two reviewers (N Liu and JC Ng) independently screened the titles, abstracts, and full articles for the inclusion of studies. Discrepancies were resolved through discussions among all authors to reach consensus. After screening for inclusion and exclusion criteria, data from the selected studies were extracted by N Liu. The extracted information included publication year, country of study, clinical scores investigated, sample size, study outcomes, summarized key information, and predictive performances including the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Since the aim of this systematic review was to present an updated summary of currently used risk stratification scores for ED chest pain patients, a meta-analysis was not conducted to rigorously compare the performances of various clinical scores.
Our literature search identified a total of 514 articles, with 249 from PubMed database and 265 from Embase database. After removing 210 duplicated entries, we included 304 articles for abstract screening. We further excluded 243 articles due to reasons such as absence of risk stratification, non-MACE outcomes, etc. We reviewed the full-texts for the remaining 61 articles and further excluded 32 articles from the list; a final total of 29 articles were included in this systematic review (Figure 1).
Characteristics of the 29 selected studies are summarized in Table 1. Predictive performances of the clinical scores in the selected studies are presented in Table 2. These studies were conducted in the Asia-Pacific (n=16) and Europe (n=11) and in more than 20 countries. Majority of the studies were conducted in Singapore (n=9), the Netherlands (n=5), the United States (n=5), and Australia (n=5). Four studies involved more than one country. Outcomes in all studies were MACE within a period after discharge from the ED, ranging from 72 hours to 1 year. Thirty-day MACE was the most commonly used outcome.
Full table
Full table
Seven out of 29 studies recruited more than 2,000 patients, with Sun et al.'s study (19) having the largest cohort of 8,255 patients obtained from the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS) (45). More than 20 different risk scores or scoring methods were reported in these studies, which can be categorized into several main groups including the HEART score and its variants and the TIMI score and its variants. Among all scores, the HEART and the TIMI scores were the most widely validated; both scores appeared in 19 studies. The GRACE score and heart rate variability (HRV) based scores were also well studied.
TIMI score
The TIMI score was introduced in 2000 (5) and has since been widely adopted to assess the risk of MACE for patients with chest pain in the ED (46). There are seven elements in the TIMI score, namely age more than 65 years, more than three coronary artery disease (CAD) risk factors (hypertension, hyperlipidemia, diabetes, family history, and smoking), significant coronary artery stenosis, severe angina symptoms, ST-deviation, elevated cardiac enzymes, and use of aspirin in the last 7 days. Each element is assigned a score of 0 or 1. Therefore, the TIMI score is between 0 and 7.
Although not specifically designed for risk stratifying ED chest pain patients, the TIMI score and its variants have been widely applied and validated on the ED cohorts (46). In this systematic review, 19 out of 29 selected studies investigated TIMI based risk scores. The standard TIMI score has been implemented in most of the studies, and the modified TIMI score was also investigated in (26) and (28). In a study conducted in Australia, Macdonald et al. (28) validated a modified TIMI (mTIMI) score (range 0–10) (47) and found out that mTIMI outperformed standard TIMI score but was not sufficiently sensitive to allow safe discharge of low risk patients without further investigations.
Among the comparisons with various risk scores, the TIMI score achieved moderate performance in discriminating between chest pain patients with and without MACE (18-20). Furthermore, the TIMI score and its variants were reported as unreliable in identifying low risk chest pain patients (28,31).
GRACE score
Introduced in 2001, the GRACE score is a risk stratification tool developed based on the GRACE (6,48), studying an inpatient cohort rather than an ED cohort and initially designed to look at MACE outcomes at 6 months after hospital discharge (49). There are eight elements in the GRACE score, including age, heart rate, systolic blood pressure, creatinine, Killip class, cardiac arrest on admission, ST-deviation, and elevated cardiac enzymes.
External validations of the GRACE score showed moderate to poor performance in stratifying ED chest pain patients in distinguishing either the MACE group or the non-MACE group (17,18,31). However, the results are mixed. In the study by Cullen et al. (9), the GRACE score was found to be able to identify a sizable low risk cohort with high sensitivity and NPV. Yet, a study by Singer et al. (50) evaluating the frequency of missed AMIs in low-risk cohorts that were identified by established risk scores demonstrated that the GRACE score had the highest percentage of missed AMI, compared to the TIMI and HEART.
HEART score
Different from the TIMI and the GRACE scores, the HEART score was specifically developed for chest pain patients in the ED (14,20). It has been widely reported to outperform the TIMI and the GRACE scores (4,18,19). The HEART score has five prognostic factors, namely history, ECG, age, risk factors, and troponin. Each risk factor has a score of 0, 1, or 2, and the final score has a range of 0–10. The HEART score stratifies patients into three risk categories, that is, low risk [0–3], intermediate risk [4–6], and high risk [7–10]. It is noted that the HEART score was developed according to expert opinion (3), but not based on traditional multivariable regression analysis that is commonly used in clinical score derivation (51,52).
Due to its excellent performance in discriminating both high risk and low risk patients in terms of MACE development, the HEART score is the most validated score among all studied scores in this systematic review, where 19 out of 29 studies selected the HEART score as a main comparator. Comparing HEART with TIMI score in predicting 30-day MACE and 5-year all-cause mortality, Jain and colleagues (36) found that the HEART score was valuable in predicting not only short-term but also long-term outcomes for ED chest pain patients.
Other than the validations on general chest pain cohorts in the ED, the HEART score has been evaluated when several factors such as ethnicity and sex are taken into considerations. de Hoog et al. (41) conducted a study on a mixture of ethnic groups consisting of Caucasian, Chinese, Indian and Malay, and concluded that the overall performance of the HEART score was similar among Caucasians and Asians. Furthermore, Bank et al. (44) reported that male sex remained a significant factor for 6-week MACE when the HEART score was implemented for the prediction.
Based on the standard HEART score, many of its variants have been proposed and validated. Fesmire et al. proposed the HEARTS3 score by adding three additional variables, sex, serial 2-hour ECG, and serial 2-hour delta troponin (23). The HEARTS3 score reliably risk stratified patients with chest pain for MACE. Modified versions (37,40,42) of the HEART score were proposed where high-sensitivity troponin T was adopted to replace the traditional troponin element in the standard HEART score. These modifications suggested that the identified low-risk population might be directly discharged from the ED (40,42).
HRV score
HRV reflects the change in time intervals between heartbeats and has been shown to be a good predictor of MACE (53). Out of 29 studies selected in this review, Ong et al. (24), Liu et al. (29), and Sakamoto et al. (39) proposed several HRV-based risk scores to stratify ED chest pain patients with the purpose of making fast triage by predicting 72-hour MACE outcomes. Heldeweg et al. (35) developed a 30-day MACE prediction score SEDRSM by incorporating HRV, age, gender, and vitals through multivariable regression analysis. To calculate the score, all variables are discretized by proper thresholding and converted into individual scores. The range of SEDRSM is 0–37.
Liu et al. (29) and Liu et al. (27) used machine learning methods for variable selection and model derivation. In this review, most HRV-based scores were reported to outperform the TIMI score in predicting either 72-hour or 30-day MACE. Sakamoto et al. (39) made comparisons among the HRV score, the HEART score, the TIMI score and the GRACE score, and showed that the HRV score was superior to TIMI and GRACE scores, while achieving comparable performance with the HEART score. One advantage that the HRV-based scores have demonstrated over other clinical scores is their capability of computing the risk scores within a few minutes as only five-minute ECG records are needed for HRV parameter calculation (29).
Other scores
In addition to the above mentioned scores, several other clinical scores have been studied and evaluated, for example, the Vancouver chest pain rule (32), the Goldman risk score (30), the Heart Foundation of Australia (HFA)/Cardiac Society of Australia and New Zealand (CSANZ) guidelines (9), the Banach score (38), and the Manchester triage system (33). Cullen et al. (9) compared three risk scores (HFA/CSANZ, TIMI, and GRACE) and pointed out that all three scores had similar performance in predicting the risk of MACE for ED patients with chest pain. In Chen et al. (38), the Banach score had the largest AUC for predicting safety outcome while the HEART score had the largest AUC for predicting MACE.
This systematic review provides an updated summary of studies on clinical scores for risk stratification of chest pain patients in the ED. The review was limited to articles published between 01 January 2012 and 25 September 2017. The initial literature search gave 514 published articles in the past 5 years that are related to risk stratification of ED chest pain patients. After screening and detailed verification according to inclusion and exclusion criteria, 29 articles were eventually selected for further review. More than 20 risk scores or scoring methods were found in these 29 studies and among them the HEART score and the TIMI score were the most investigated risk stratification tools. The selected studies have been well distributed among more than 20 countries, covering a mixture of diverse patient cohorts. Thirty-day and 6-week MACE were the most commonly used outcomes, and long-term outcomes followed up at 6-month (38,42) were also investigated.
As one of the most common reasons for emergency hospital admission, chest pain receives much attention as it is sometimes difficult to discern the etiology quickly and accurately (3). For efficient and accurate patient care, it is essential to develop strategies for rapid rule-out or rule-in of MACE. Most chest pain scores use troponin or other laboratory tests which require time. The pathway using high sensitivity cardiac troponin may be done in a hour, but still requires two blood tests (16). Although point-of-care (POC) cardiac biomarker testing have been gaining interest in recent years and have been developed to overcome the long turnaround time of laboratory testing, POC testing is still largely unavailable in most countries (54). Therefore, there seems to still be needs for faster tools to accurately risk stratify chest pain patients presenting to the ED. Over the years, many reviews have been published, ranging from general topics related to diagnosis of ACS (8,55,56) to systematic reviews on specific risk scores (16,46). Long and Koyfman have particularly studied current controversies in evaluating low risk chest pain patients with the aids of risk scores (1). Our systematic review aimed to provide a summary of the latest studies on risk scores for ED chest pain patient, therefore the focus was not on rigorous meta-analysis of predictive performance. Instead, we targeted at listing out widely used clinical scores and scoring methods in recent years, and summarizing their key characteristics.
The HEART, TIMI, and GRACE scores are three established stratification tools to assess the risk of MACE for chest pain patients. As a score that was specifically developed for chest pain patients in the ED, the HEART score is generally considered to outperform most other risk scores in discriminating high and low risk chest pain patients. This discovery has been consistent in most of the selected studies in this review, although some studies reported that there was no significant difference in terms of diagnostic accuracy between the HEART score and the TIMI score (38) or clinical gestalt (34). The HEART score was found particularly useful for identifying ED chest pain patients who had low probability of developing MACE (16,18). Marcoon et al. (57) proposed using the HEART score to further risk stratify patients with low TIMI scores and they suggested that a combined use of the HEART score and the TIMI score could identify a subgroup of patients with very low risk of developing MACE.
Other than conventional clinical scores, HRV-based scores and scoring methods were widely discussed (24,29,39) with the added value of faster risk stratification of chest pain patients. HRV techniques have been applied to develop a triage tool in the ED (39) where short-term outcome (i.e., 72-hour MACE) was adopted. With this tool, quicker response to high or low risk patients is possible as laboratory tests are not required. This may potentially shorten the process of risk prediction to a few minutes (29,35,39), compared to hours of waiting time in traditional chest pain pathways (58). However, the main disadvantage of HRV is its low interpretability. Ong et al. (24) and Heldeweg et al. (35) proposed risk scores by categorizing the HRV parameters through simple thresholding. Alternatively, Sakamoto et al. (39) and Liu et al. (29) used continuous HRV parameters for predictive modelling by either traditional logistic regression or advanced machine learning methods. Although the HRV-based scores are reported to achieve good performance compared to scores such as the TIMI and GRACE scores, they need extensive external validations. Future work may combine the strengths of the HRV technique and the clinical scores to create robust, fast, and accurate scores for stratifying chest pain patients in the ED. Machine learning (59) may also play important roles in selecting significant variables (27) and improving predictive performance (60).
This systematic review has limitations. First, this review only included studies that were published in the past 5 years. Second, the focus of the review was on studies that reported score derivations and validations. It is noted that studies on clinical pathways using the risk scores were excluded. Lastly, meta-analysis was not conducted due to the heterogeneity of the study cohorts and the outcomes in the selected articles.
Chest pain, as a common yet potentially life threatening condition, deserves much attention in risk stratification and management, particularly in the ED where quick decisions are required for efficient patient care. This systematic review presents the latest studies on clinical scores that are used to categorize ED chest pain patients according to their risk of MACE. Traditional HEART, TIMI, and GRACE scores including their variants have been widely implemented and externally validated. Emerging techniques such as the HRV and machine learning were also adopted for developing risk scores where their flexibility and fast risk stratification were attractive, though low interpretability was a concern. In this review, risk score based clinical pathways were not discussed. Further investigations of existing risk scores including clinical outcomes and health economic measures are needed.
Conflicts of Interests: N Liu and ME Ong have a patent filing related to heart rate variability (system and method of determining a risk score for triage, application number: US 13/791,764); ME Ong has a similar patent filing unrelated to this study (method of predicting acute cardiopulmonary events and survivability of a patient, application number: US 13/047,348) and he also has a licensing agreement with ZOLL Medical Corporation for the above patented technology. The other authors have no conflicts of interest to declare.
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Cite this article as: Liu N, Ng JC, Ting CE, Sakamoto JT, Ho AF, Koh ZX, Pek PP, Lim SH, Ong ME. Clinical scores for risk stratification of chest pain patients in the emergency department: an updated systematic review. J Emerg Crit Care Med 2018;2:16.


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Yoga Nut will reschedule any session cancelled 48 hours before the start of the session at no charge. If a session is cancelled less than 48 hours in advance, a late cancellation fee of $35 will be charged. In order to reschedule the session, Yoga Nut must first receive the late fee. For classes scheduled outside, Yoga Nut reserves the right to reschedule or cancel at any time due to unsafe weather conditions.


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Gambler (PUA) Is He The Real Deal?
Pick-up artists are each advocates of their own different styles of game.
Some people support canned routines, groups of men saying the same lines to women every night they go out in the bar. Some people advocate a mix of natural game with canned material. Other PUAs are advocates of being yourself – being purely natural, and the man that started that movement was Gambler.
Who is Gambler?
Gambler, born Richard La Ruina was bullied so badly during primary and high school that he had to switch schools to cope with that problem. He showed a financial flair, though, and invested his life savings into the stock market and managed to turn a sizable profit.
How he got into pick up
By the age of 21, he had never kissed a woman. Frustrated with the lack of advice out in the market and accessible to the public about structured approaches you could do with women while maintaining your natural state, he created PUA Training in 2007, and their trainers were instantly catapulted to the forefront of the seduction community when featured on a BBC documentary.
Since then, PUA Training has morphed into one of the giants of the industry, with arms all across the world and a legion of products. He's released a book called The Natural Art of Seduction, Ultimate Natural Game DVD's, and various other pick-up artist products such as The Social Domination Blueprint, Secrets of 9's and 10's, Approaching Confidence and many more. The current hit is Stealth Attraction.
To this day, PUA Training is one of the only seduction companies that advocates using natural game and adapting to situations (calibrating) to pick-up women instead of using canned routines. But does that work? Is it more effective? After teaching thousands of men how to imitate the same success that he's had, it seems that the answer is a resounding yes.
PUA Training also offers live training bootcamps, live-in weeklong residential's, and happen to employ the current number one ranked pick-up artist in the world, Adam Lyons.
Products by Gambler
Stealth Attraction – His latest teachings, showing you exactly how to create unstoppable attraction with any woman within minutes. This is truly a ground breaking training product, with heaps of practical advice you can use right away.
Natural art of seduction – His very first book, which has proven that he not only knows how to attract women, but that his teachings are extremely popular.
Live Events – With events being held all over the world throughout any given year, it's no wonder PUA Training are one of the leading dating companies in the world. You will be taken out in the field, shown by the instructors how it's done and then coached fully for the entire day/evening until it clicks for you.
Famous techniques/routines
Gambler is well known for his seductive charisma and doesn't use any routines, only natural game.
Stealth Seduction – Subtle but very sexual body language that turns a woman on almost instantly and sub-consciously makes them want to take you home. These are advanced techniques that can be used by any guy.
All-in-all, it's been an impressive journey from a zero to hero – and it looks like Gambler is, in fact, the real deal.


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Catarina & Tiago
Moody, raw, real!
We met these two beautiful guys in the area of Sintra. We were so excited to take pictures of this beautiful couple on the cliffs of the Portuguese coast line. With a breathtaking sunset ... But not this time. We found ourselves in the middle of clouds. No sun, just grey.
But it's not about a beautiful sunset ... It's about people!
Lasst uns Eure Geschichte schreiben!


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Updated on June 11, 2019
Best Air Purifier for Smoke
It's a host's worst nightmare – You enter the room after the guest has departed and smell the pungent odor of cigarette smoke in the room. Now what? Turn on the ceiling fan and open all the windows, but the smell still lingers. It lingers and lingers.
Your next guest is arriving any minute now and that stubborn smell of smoke has not moved on. Those air fresheners and scented candles aren't making things any better. The air truly needs to be cleansed and the best air purifier for smoke can help you get the job done fast!
Having an air purifier on hand is an essential cleaning item for Airbnb hosts. Even if you do not allow smoking in the home, some guests will disregard your rule and light up in your home. Even if they smoke outside, that smell will come back inside with them and make itself at home too. The disgusting odor of smoke will not go away for a very long time unless you take action.
Best Air Purifier for Smoke
Winix 5300-2 Air Purifier
The Winix 5300-2 Air Purifier is atop the list of best air purifier for smoke. This air purifier is built to eliminate the strongest odors with a 3 stage purifying system. The true HEPA filter and odor-eliminating carbon filter are complemented by PlasmaWave technology that attacks air pollutants at a molecular level. On top of that, this air purifier is able to combat odors in very large rooms making it an ideal choice to combat smoke, pollen, pet odors, and much more!
- 3 Stage Purification – True HEPA filter, PlasmaWave, and carbon filter
- Removes 99.97% of airborne pollutants
- Eliminates smoke, cooking odors, and pet smells
- 4 fan speeds
- Automatically adjusts fan depending on air quality
- CADR rated for up to 360 square feet
- LEDs automatically dim when the room is dark
Superhost Tip: When cleaning up a room that smells of smoke, get all of the washable items out of the room right away so the air purifier can eliminate the smoke smell even faster!
GermGuardian AC4825 Air Purifier
Second on our list is the GermGuardian 3-in-1 Air Purifier. This air purifier is smaller than the Winix air purifier and an excellent budget-friendly option that still packs a punch. If the smoke smell is isolated to one or two rooms, the GermGuardian is the perfect size to rid the air of that pesky smoke odor in no time at all! As a bonus, the UV sanitizer kills germs and viruses such as staph and influenza.
- 3 in 1 Purifier – True HEPA filter, UV-C Sanitizer, and charcoal filter
- Removes 99.97% of airborne particles
- Eliminates smoke, cooking odors, germs, viruses, and pet smells
- Lightweight for easy movement between rooms
- Tall profile minimizes floor space usage
- 3 fan speeds
Superhost Tip: Use your air purifier regularly to ensure the air in your home is fresh for every guest!
Levoit LV-H132 Air Purifier
Rounding out our top 3, and another budget-friendly air purifier is the Levoit LV-H132 air purifier. The sleek and modern design of this air purifier makes it an aesthetically appealing way to dominate the pungent smoke odors you may encounter. Quietly operating and ozone-free, you can be confident that you won't disturb anybody while making the inside air free from harmful particles and pollutants.
- 3 in 1 Purifier – pre-filter, True HEPA filter, and carbon filter
- Removes 99.97% of airborne particles
- Eliminates smoke, cooking odors, germs, viruses, and pet smells
- Lightweight for easy movement between rooms
- Compact design can be used almost anywhere
- 3 fan speeds
- 2 year warranty and lifetime support
Superhost Tip: Make sure to change filters as needed to your air purifier is working efficiently!


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Fake IAS Cons MLAs & MPs
A fake IAS officer Ravinder Reddy who deceived MLAs and MPs has been caught in Alwal of Hyderabad. He belongs to Peddapuram of East Godavari distict. The man introduced himself to MLAs and MPs as an IAS officer. Later, when Ravinder got much closer to the ministers, he used their names to earn money illegally. Providing jobs for the unemployed, houses for the poor were the promises that he made and took large sum of money from them. Later, he absconded from the places. People who realized that they had been betrayed complained to police. The policemen who filed case against Ravinder arrested him today and seized Rs. 90 thousand cash from him. It is observed that many MLAs also fell in his trap.
Tags : fake ias caught in hyderabadfake ias cheats mla mpfake ias officer caught in alwalfake ias ravinder reddytelangana fake ias


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Nations of Immigrants
Australia and the USA Compared
Edited by John Higley, John Nieuwenhuysen and Stine Neerup
Chapter 6: Immigration and the Labour Market in Australia
Santina Bertone
Santina Bertone* In Australia the recruitment of skilled migrants has been a central feature of the migration programme since at least the late 1980s. A detailed points test, modelled broadly on the Canadian version in the 1970s, gives priority to applicants who are young, well educated, English literate and qualified for high-demand jobs in which local skills are in short supply. The points test was considerably tightened in 1997 after the election of the conservative Coalition government (Hawthorne 2005). Not only principal applicants, but also concessional family applicants (distant relatives) were required to meet the test. In the ensuing decade the implementation of mandatory English language testing and rigorous overseas qualifications screening effectively 'closed the gate' on applicants who were thought to be 'at risk' of unemployment or poor integration within the Australian labour market. The figures for permanent settlers bear out this increased focus on skilled migration. By 2002 the majority (or 58 per cent) of permanent migrants entering the country were skilled, with this figure rising to 70 per cent (out of a total intake of 190 000) in 2008 (Kelly 2008). Skilled migration has also been the dominant feature of Australia's relatively recent temporary migration programme. Introduced in 1996, a 457 (long stay) subclass temporary visa, similar to the U H1B in the US, has allowed increasing numbers of skilled migrants (defined as ranging from trades qualified up to tertiary educated) to enter and work for a sponsoring employer for up to four years. The visa is...
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The Foreigner
My oldest son is starting high school today. Occasionally, a movie crops up about a character transported back to high school where he or she lives as a teenager but with the life experience of an adult. I understand the temptation of this fantasy, but it is actually a very strange thing to wish for. You would be unbelievably bored if this every actually happened to you because you have already learned everything high school had to teach you.
Life is never so interesting as when we are learning something. Writers above all should understand this. What is the blank page after all? It doesn't matter how many stories you've already written, it doesn't matter how much you outline, or how many classes you've taken, or books on writing you've read, the blank page is the start of a new journey into a foreign country.
It is tempting as a traveler to view the unknown country as unfriendly. To hear writers talk about their works in progress sometimes is like listening to a soldier radio from behind enemy lines. Whose idea was it to send them here, and how will they ever get out? The way out, of course, is always the same as the way in, namely your own curiosity.
You will stay in that foreign country until you have discovered all you wish to discover. You are never lost; you are only trying to understand the way out before you have found it, and this is confusing. All roads do in fact lead to Rome. You may not be able to see Rome, but it is always there. If you are feeling lost, return to where you are at this very moment. This is where all the clues exist. You need only pick the path that interests you most and it will inevitably lead where you need to go.


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Would recommend to anyone with similar discomfort
"I have now been using my Bacrac for several months and, after some years of using the previous wooden version, I find it much more comfortable and more effective.
My lower back problems of many years have given me no trouble since using the new model and I would recommend it to anyone with similar discomfort.
I can only thank you for your ingenuity and patience in finally getting Bacrac into production"


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MASON CITY - NIACC freshman forward Wendell Matthews was selected as the NJCAA Division II men's basketball national player of the week for the week of Nov. 26-Dec. 2 on Wednesday.
On Tuesday, the St. Paul, Minn. native was selected as the ICCAC player of the week for the week of Nov. 26-Dec. 2.
Matthews scored 19 points with 12 rebounds in the Trojans' 101-65 victory over No. 16 DCTC. He also scored a career-high 30 points with nine rebounds against Northeast CC at the Great Western Shootout in Fort Dodge.
Matthews is averaging 17.3 points and 8.3 rebounds (2nd in ICCAC) per contest.
Matthews is the first NIACC men's basketball player to earn the NJCAA Division II national player of the week award since Al Davis was honored in February of the 2014-15 season.
NIACC (8-2 overall) begins ICCAC play Saturday at No. 2 Southwestern. Game time is slated for 3 p.m. in Creston.


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Published at Wednesday, 20 December 2017. Kitchen. By Alita Guerin.
Pendant lightings are typically used as task lighting above a kitchen island or peninsula. They serve as a perfect design element that accentuates the tone of your kitchen. Under mount lighting is a nice way to add luminosity to areas otherwise void in your kitchen. They're a great way to accent your kitchen's features such as a special tile backsplash or glassware.
A second kitchen sink can be included on the kitchen island. Use a sink that is deep enough for washing large pots and pans, and consider equipping the kitchen island with a trash compactor, garbage disposal, recycle bin and even a dishwasher. Cleanup will be much easier when these appliances are close by the sink.
Maple A very hard wood with a mild grain pattern. This material can take a natural stain, dark stain, or hold paint with a high level of durability. Cost is higher than poplar as a paint grade alternative and alder as a stain grade alternative but the maple will hold up better over the long run.
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BUFORD, Ga. (CBS.MW) -- Theragenics said data from a nine-year study show that prostate cancer patients who were given its TheraSeed implants, or internal radiation therapy treatments, had a success rate equal to or better than traditional treatments..
The study's findings, published in the March issue of the International Journal of Radiation Oncology, Biology and Physics, show that 83.5 percent of patients treated with TheraSeed were cancer-free at nine years, the company TGX, +2.35% said.
The study is significant because it shows the results of long-term follow-up and demonstrates that the treatment is at least as effective as traditional therapies, said Juan Noble, an analyst at Fahnestock & Co. Noble rates the stock a "hold."
The treatment, called brachytherapy, or internal radiation therapy, involves implanting short-lived radiation into cancerous tissue. Theragenics said the procedure minimizes the effects of radiation on surrounding healthy tissue. It doesn't require hospitalization and patients usually resume normal activities within 24 to 48 hours, the company said.
Noble said the treatment, which works only in men with early-stage prostate cancer that hasn't spread, is an alternative to surgery. "It's less invasive and less traumatic," Noble said. It's also significantly less expensive than surgery, and doesn't cause comparable side effects such as urinary incontinence or impotence, he said.
The analyst said that while the acceptance of brachytherapy is widening, there have been expectations that treatment would catch on more rapidly than it has.
Shares of Theragenics rose 3/8 to 14 1/4 in recent trading.
The study was conducted by Dr. John Blasko and colleagues at the Seattle Prostate Institute."The nine-year results using TheraSeed in this series add to the growing body of knowledge that brachytherapy can achieve a high rate of success for patients with organ-confined disease," Blasko said in a statement.
Theragenics said nearly 200,000 men in the U.S. are expected to be diagnosed with prostate cancer this year, the most common form of cancer in men. According to the National Prostate Cancer Coalition, one in six American men are at a lifetime risk of the disease, which represents 29 percent of all new cancer cases for men.


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Wimbledon Posters
The state Poster the Championships 2015 brings together the practices of Wimbledon in an attractive tennis-ball formed design which includes this new begin day, one week later from 2015 onwards, at its heart.
Developed by Russian report musician Yulia Brodskaya, the poster brings your nearly all Wimbledon's most well-known icons, from grass on strawberries, the trophies and umbrellas, the blossoms and fruit.
The initial artwork while the poster it self are both on screen in Wimbledon lawn-tennis Museum's existing convention, Powerful Posters: Tennis and Advertising, 1893-2015.
Brodskaya's style is to produce 'paper graphics', by rolling, cutting and folding paper, and took great enjoyment in bringing to life the heritage of Wimbledon, the woman very first endeavor into activities.
"I'm very excited to exert effort about this year's Wimbledon poster, " Brodskaya commented.
"it absolutely was a lot of enjoyment, and time and effort as well, trying to include all the iconic event elements into one three-dimensional composition which in fact checks out as a giant tennis ball."
"I understood some, I do watch it almost all of the many years, but you can find items that i discovered that was rather new for me personally, so I performed a bit of research to see what elements I could use for my design and I also tried to include almost all of the iconic things of Wimbledon."
"My favourite is maybe the umbrella...it's hard to see to start with but once you've spotted it you will not forget it!"
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Baku, Azerbaijan, April 17
As part of his official visit to Poland, Azerbaijani Foreign Minister Elmar Mammadyarov met with Minister of Foreign Affairs of Poland Jacek Czaputowicz, Trend reports on April 17 with reference to Azerbaijan's Foreign Ministry.
After tête-à-tête discussions between Minister Elmar Mammadyarov and Minister Jacek Czaputowicz, the talks continued with the participation of the national delegations.
At the beginning, speaking about the negotiation process on the settlement of the Armenia-Azerbaijan Nagorno-Karabakh conflict, Minister Elmar Mammadyarov noted the importance of resolving the conflict based on the principles of international law and the UN Security Council resolutions. Having stressed the necessity of withdrawal of the Armenian armed forces from the occupied territories of Azerbaijan, Minister Elmar Mammadyarov extended his gratitude to Polish government for the support of the territorial integrity and sovereignty of Azerbaijan.
Furthermore, giving a brief information about large-scale energy and infrastructure projects implemented upon an initiative and with participation of Azerbaijan, Minister Elmar Mammadyarov underlined the importance of the South Gas Corridor.
Speaking about the Trans-Caspian and South-West transport corridors, Minister Elmar Mammadyarov emphasized that Azerbaijan, which cooperates with Poland in this field, is interested in enhancing the existing relations.
Minister Jacek Czaputowicz highly appreciated relations between the two countries. He underlined that Poland supports the cooperation of the European Union with the Eastern Partnership countries and emphasized that his country is interested in developing cooperation with Azerbaijan in the energy sector.
The ministers discussed the issues related to exchanging mutual visits, increasing trade turnover and expanding the legal framework between the two countries. At the meeting, the sides also exchanged views on other issues of mutual interest.
Furthermore, the joint press conference of the ministers was held.
Follow Trend on Telegram. Only most interesting and important news


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Tag Archives: engineered wood flooring cape town
Pioneers in Green Building Products
Alco Exotic Green Building Products, one of the largest suppliers of green flooring solutions in South Africa, specialises in high-quality flooring products, ranging from bamboo, oak to flooring accessories. For superior warehousing standards, alongside an attention to details, the company has earned an excellent reputation, importing premium quality materials to clients belonging to various industries. All materials have been carefully sourced from authorised sources to match all requirements of clients. Also, the company collaborates with specialist installers, retailers and applicators, ensuring the products in question deliver optimum performance as per the specifications. The company's strict adherence to the SADC standard, coupled with the procurement of premium quality products from accredited sources, has successfully placed it among the leading green building service providers.
Alco Exotic Green Building Products: The Leading Supplier of Flooring Products
Alco Exotic Green Building Products, the supplier of exotic woods for flooring and its accessories is based in Cape Town. The company possesses warehousing and stockholding facilities.
Alco Exotic Green Building Products has an extensive range of flooring options like Natural Bamboo Flooring, Superior Bamboo Flooring, Rustic Engineered Oak Flooring, Par- ky Engineered Oak Flooring, and oak panels like Shinnoki Prefinished Wood Panels and Querkus Finest Oak Collection.


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Sojitz Corporation (Sojitz") has acquired the franchise rights and property of Mill Valley Imports, Inc. Mark, who we had to cope with, for the reason that seller we had been doing business with (Ford) was not there, Mark was pretty mellow at first; After our test drive I informed him to examine to see if the remembers had been achieved on the Ford Escape, all he had to do is inform me, if you happen to go to the ford dealership they may care for it free of charge.
Subsequently, after going to supplier college and passing through the chairs, Jimmy's dad took over as General Manager; the store thrived; and Jimmy not solely purchased the dealership land and facility, however purchased the Ford retailer within the subsequent town, and is at the moment building a brand new Toyota store in order that his Chevrolet and Toyota franchises can have separate amenities.
Salesman stated let me ask my boss hold comes again on the cellphone and said an appointment with to the dealership for the appointment.First factor we found a car to purchase.After that it went stated my car did not qualify but that I could get the zero {34cef82ab9de95f88c4f6bb1386b642f85abe4fae66813eed527c2ffb4a19c8d} interest.Pissed me off waisted all that time once they could have told me on cellphone.Tried the old bait and swap with me.These knuckleheads are the Chuckee Cheese of car dealers.
This processes helped one dealership that I worked with do an additional 8 units one month. Our Ford dealership has a large choice of new and previously owned vehicles sure to meet your wants and price range. Sidebar: New car dealership revenues reached nearly One Trillion Dollars in 2004. Unfortunately, when I went to go purchase another Jetta a number of years later, I had a horrible experience at Stevens Creek VW. After approach an excessive amount of drama, I purchased my Jetta in Milpitas. When you handle the financing upfront, you narrow your dealership time down drastically.
Recommendations from fellow shoppers resonate far more with potential consumers researching a dealership than a seller or salesman's advice. I consider that should a smaller dealership have your automotive the experience shall be better. Reviews online are highly effective tool that customers use when contemplating a dealership they want to make a purchase from. A theft may be almost definitely to occur during the nighttime hours and a bit of prevention is usually a great tool that each automotive dealership ought to posses.


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Medixsoft always follow the latest trends, technologies and design patterns that emerge in software industry. That is why we are proud to announce the creation of a technology platform called ekōhī. Relying on best of breed technologies, our solutions have gained important benefits such as security, reliability, flexibility, scalability, fast time to market, efficient integration and interoperability. Careful design and a technology independent architecture are other important factors that lead towards the above benefits, while avoiding the well-known risks of early adoption of new technologies. This N-Tier architecture has given us the ability to implement solutions that exploit the benefits of various technologies such as:
1. HTTP based solutions providing interoperability and flexibility
2. TCP based solutions with WPF smart clients providing scalability performance and great user experience
.NET is a framework that covers all the layers of software development. It provides the richest level of integration among presentation technologies, component technologies, security technologies, and data technologies. Our business solutions are designed and implemented on .NET platform using Visual Studio .NET.
Active Server Pages (ASP) allow for forceful page generation on the Microsoft Internet Information Server (IIS). ASP's are the presentation layer that allows the creation of sophisticated user interfaces on a browser.
Using the Windows Communication Foundation (WCF) framework we provide secure solutions using various methodologies and technologies.
Transport Based Security and Message Based Security are the primary methodologies supported by our solutions, digitally signed with certificates.
ASP.NET's Memebership, Authorization and Role providers are the frameworks we also use to achieve our security goals.
We have developed our custom audit trail mechanism to fit the demanding need of our customers.
Extensible Markup Language, or XML, is a technology which has gained in popularity due to its flexibility and ease of integration. It provides a format for describing structured data and facilitates more flexible means of communication in the current generation of web-based applications.
1. Microsoft SQL Server is a complete set of enterprise-ready technologies and tools that help people derive the most value from information at the lowest total-cost-of-ownership. Enjoy high levels of performance, availability, and security; employ more productive management and development tools; and deliver pervasive insight with self-service business intelligence (BI).
2. High levels of performance, scalability, availability, and security for mission-critical applications delivered at lower total-cost-of-ownership by Windows Server and Microsoft SQL Server.
3. A comprehensive, interoperable platform that empowers IT to be more productive and agile.
With Microsoft Visual Studio, the Microsoft .NET Framework, and SQL Server, integrated development tools help developers quickly build rich, intuitive, and connected applications.
4. A complete BI platform that connects users to the right information at the right time to improve business decisions through familiar tools such as Microsoft Excel and SharePoint Server.
SQL Server Reporting Services is a report generation environment for data gathered from SQL Server databases. Reporting services features a web services interface to support the development of custom reporting applications. Users can create reports and explore data with Report Builder, a familiar report-authoring environment with rich visualizations. Rely on a semantic report model, users build reports without understanding data structures.
SQL Server Integration Services is used to integrate data from different data sources. It is used for the ETL capabilities for SQL Server for data warehousing needs. Integration Services includes GUI tools to build data extraction workflows integration various functionality such as extracting data from various sources, querying data, transforming data including aggregating, duplication and merging data, and then loading the transformed data onto other sources, or sending e-mails detailing the status of the operation as defined by the user.
Our solutions integrate with SSIS combining a unified user experience and powerful capabilities such as:
1. Speed, SSIS is one of the fastest ETL tool on the market.
2. Security, Packages are digitally signed for deployment.
3. Reliability, SSIS supports transactions, enabling resilient processes for execution.
4. Quick data access from multiple sources by using high-speed connectors. Supports Oralce, SAP, Teradata, OLE DB, text files, the Microsoft Entity Framework, and other common sources.
We integrate Content Management based solutions of your choice providing flexibility to edit and publish data changes on your website. Through flexible reporting structure and implementation of workflows we hand you tools that are as unique as your business. Your data changes pretty fast and yet it doesn't require tremendous development efforts to make those changes publicly visible. It can be as easy and as simple as sipping your morning coffee.
Open source tools are the lifeblood of big data. You can't have one without the other (and, really, why would you want to?).
1) Data Analysis and Platforms
a) Hadoop
The granddaddy of them all. With the help of simple programming models, Apache Hadoop is a framework that allows for the distributed processing of huge data sets across clusters of computers.
To do this, Hadoop uses the parallel-processing system MapReduce. The large computational tasks of dealing with big data are divvied up into small jobs which are then shared out among as many nodes as needed, in any available cluster, to be executed or re-executed.
b) Storm
Storm's claim to fame is its ability to process unbounded streams of data in real-time, "doing for real-time processing what Hadoop did for batch processing." It will integrate with any queuing system and any database system.
Storm's real-time processing capabilities come in handy when analysts are dealing with highly dynamic sources. Twitter, for example, uses it to help generate its trending topics. Other applications include online machine learning, continuous computation, distributed RPC, ETL and the list goes on.
c) Drill
Hadoop is outstanding at handling massive batches of data, but exploring ideas with it can make the clock drag.Taking its inspiration from Google's Dremel system, Apache Drill is designed to permit super-fast ad-hoc querying and interactive analysis of giant data sets.
Drill can tap into multiple sources of data – HBase, Cassandra, MongoDB, etc. in addition to traditional databases. When you need a tool to scan petabytes of data and trillions of records in seconds, Drill is an excellent choice.
2) Statistical Languages
a) R
Where once there was S, there now is R. This freely available statistical programming language and environment is rapidly becoming the popular standard for statistics software and data analysis. It combines the fundamentals of the S programming language (created by John Chambers at Bell Labs) with lexical scoping semantics derived from Scheme.
Developers like it because it's cheap, powerful and plays well with Hadoop.
3) Data Mining
a) Mahout
This Apache project aims to teach machines some of what humans do: to recognize patterns in data. The stated goal of Mahout, a machine learning and data mining library, is to build freely distributed and scalable machine learning algorithms. The current algorithms focus on grouping related documents together (clustering), learning to match documents to categories (classification), matching users to probable favorites (collaborative filtering), and identifying items that typically fall into groups together (frequent pattern mining).
Though many of Mahout's offerings are implemented on top of Hadoop using the map/reduce paradigm, it's still pretty democratic. Contributors are welcome to introduce algorithms that run on a single node or a non-Hadoop cluster.
b) RapidMiner
Once known as YALE (Yet Another Learning Environment), RapidMiner has been around since the beginning of the millennium. Its data mining system is available as a stand-alone application for data analysis or as an engine for integration into other products.
RapidMiner pulls its learning schemes and attribute evaluators from Weka, and for statistical modeling, offers either the native Rapid-I scripting environment or the R language. Machine learning, data mining, text mining, predictive analytics – it's equipped to handle them all. Written in Java, it runs on every major platform and operating system.
4) Databases / Data Warehousing
a) Cassandra
Apache's popular key-value oriented database management system is built to juggle large amounts of data across multiple commodity servers. It prides itself on availability, scalability and fault-tolerance, and avoids bottlenecks and single points of failure.
Because data is automatically replicated to multiple nodes, failed nodes can be replaced with no downtime. That's good news for data-critical applications.
Cassandra started its life at Facebook, when Avinash Lakshman and Prashant Malik created it to power the Inbox Search feature. Today it's working for Netflix, eBay, Twitter, Reddit, Ooyala and more. The largest known Cassandra cluster boasts over 300 terabytes of data in over 400 computers.
b) Hive
Apache's data warehouse infrastructure is designed to facilitate querying and management of large data sets in distributed storage. Built on top of Hadoop, it allows you to overlay structure on a variety of data formats and provides tools for data querying and analysis.
Hive's versions as far back as 0.8.x are compatible with Hadoop 2.0. As of late 2013, Hortonworks is looking to boost Hive's power with the Stinger Initiative. Among other improvements, Hive will use YARN to query Hadoop directly and add a new runtime framework, Tez, for greater efficiency.
c) OrientDB
OrientDB, a NoSQL DBMS written in Java, provides the schema-less flexibility of document databases, the complexity of the graph model with direct relationships among document records, and object orientation for added power and flexibility.
In addition to schema-less mode, OrientDB also functions in schema-full or hybrid mode. It ensures reliability with ACID transactions and multi-master replication, and it's fast – storing 150,000 records per second on ordinary hardware.
d) HBase
For random, realtime read/write access to big data, many data miners turn to Apache's HBase, the Hadoop database. Written in Java, this scalable, distributed database is modeled after Google's BigTable.
Running on top of Hadoop and HDFS (Hadoop Distributed Filesystem), HBase is particularly good at fault-tolerant storing of sparse data (i.e., small bits of information caught within a larger collection of empty or unimportant data that must be waded through efficiently).
5) NoSQL
a) MongoDB
MongoDB is a cross-platform, document-oriented database system and currently the most popular NoSQL database.It ditches the rigid schemas of RDBMS in favor of a binary form of JSON documents – with dynamic schemas, giving data miners a lot of power.
You'll find MongoDB at work in Shutterfly's photo platform, eBay's search suggestion, Forbes's storage system and MetLife's "The Wall."
Even better, it's recently been updated. 2013 features include:
1) A faster JavaScript engine (V8)
2) Text search (beta) and geospatial capabilities
3) Concurrent index builds and many more
b) CouchDB
Apache's NoSQL database uses a trio of components making it extremely Web-friendly:
1) JSON for documents
2) JavaScript for MapReduce queries
3) HTTP for an API
In his comparison of NoSQL databases, Kristof Kovacs points out that CouchDB works well with data that accumulates, changes occasionally, answers to pre-defined queries, and needs versioning as a priority (e.g., CRM, CMS systems).


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By Stephen Lemons
The Rep finally reports on the Russell Pearce domestic violence story, long after New Times and the bloggers. Gordon and Arpaio do the man dance in print. An El Mirage chick confesses to slaying boyfriend on Tom Leykis, of all places (allegedly). The Cardinals play New Orleans tonight. Bad news nativists: Arizona Hispanics are on the rise. Suns will start season with Spurs.(Groan.) PHX bankruptcies double. And a famous Frog restaurant in Cave Creek is shuttered.
Gordon and Arpaio slug it out.
The Rep covers Pearce abuse allegations.
Boy brings gun to school, Arpaio deports family.
Number of AZ Hispanics skyrockets.
El Mirage chick confesses murder on Tom Leykis?
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Goodyear minister arrested for alleged child molest.


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This. Is. Awesome.
Image: Warner Bros
Here's Kevin Conroy (who voiced the Caped Crusader in Batman: The Animated Series, and the terrific Arkham Knight video game trilogy) acting out Bats' final scene from The Dark Knight:
Pretty freakin' awesome, right?
The above clip was taken from The Nerdist's Talkin' Toons podcast, and the chap sat next to Conroy (who does a decidedly decent Jim Gordon) is host and voice actor, Rob Paulsen.
Life is truly better for the exchange above. Oh, and on a totally unrelated side note, wasn't Rob Paulsen the name of Meatloaf's character in Fight Club?


text: WBGO Journal Saturday 6:30am - 7am Hosted by Doug Doyle The WBGO Journal is an award-winning half-hour news magazine that airs Saturdays at 6 am. Reports and analysis, informative interviews and features. The Modern Side of Shakespeare's Merry Wives of Windsor By Doug Doyle & Ken Downey Jr. • Mar 13, 2017 Two River Theater Featuring only three actors—Nicole Lewis, Jason O'Connell, and Zuzanna Szadkowski—this production of The Merry Wives of Windsor explores the darker undercurrent of one of Shakespeare's silliest comedies. In the play, the lecherous buffoon John Falstaff decides to seduce both Mistress Page and Mistress Ford, respectable married women of Windsor. When the two women immediately see through Falstaff's plot, they decide to turn the tables on him and devise a plot of their own. Berkeley College in NYC: Champions in Life and Hoops By Doug Doyle • Mar 13, 2017 Berkeley College Athletics for WBGO The Berkeley College Men's Basketball team in New York City won 53 games in a row to claim it's third consecutive USCAA Division 2 Championship. Berkeley defeated Penn State-York 80-76 in overtime to grab the title. Coach Chris Christensen sat down on the bench when it appeared their opponents only had to make a free throw to win the championship game. It was the first time the coach had taken a seat the entire contest. He says divine intervention may have led to another victory: Solar Industry In NJ May Be On Way To Bust Part Of Cycle By Phil Gregory • Mar 13, 2017 Phil Gregory Nationwide employment in the solar industry increased 25 percent last year, but solar employment in New Jersey fell 15 percent. There are still plenty of projects underway in the Garden State, but a slowdown may be on the way. You can see solar panels on many rooftops, utility poles, and in fields in New Jersey. There are 66,000 solar installations in the state that generate 2 gigawatts of electricity. And more are being put up. Theater Critic Michael Bourne Loves the Twists of David Mamet's The Penitent By Michael Bourne • Mar 12, 2017 Michael Bourne for WBGO WBGO's Theater Critic Michael Bourne reviews David Mamet's The Pentinent, which is running off-Broadway at the Atlantic Theater. Laying Down the Law with NYC's Corporation Counsel Zachary Carter By Bob Hennelly • Mar 12, 2017 NYC Law Department for WBGO Recently when Mayor Bill de Blasio was asked by reporters how he planned to defend the city's law abiding undocumented immigrants from President Trump he turned to his top lawyer Zachary Carter, the city's Corporation Counsel to explain the city's legal strategy. WBGO's Bob Hennelly has this one on one with Carter who also has the distinction of being the first African-American to serve as the US Attorney for New York's Eastern District, where he prosecuted the NYPD officers who were involved with the brutal assualt of Abner Louima. NYC Venue 'The Stone ' Finds New Home By Ang Santos • Mar 3, 2017 Ang Santos / WBGO An influential music venue set to close in New York City is moving to a revamped performance space at the New School's College of Performing Arts. The Stone was founded by multi-instrumentalist composer John Zorn, an experimental music extraordinaire who's saxophone stylings have graced the stage alongside thousands of musicians over the last twelve years. He opened the East Village hub so musicians wouldn't need to depend on venue income to get booked. Broadway's Revival of Sunday in the Park with George By Doug Doyle • Mar 2, 2017 Michael Bourne for WBGO Listen Listening... / 2:41 Theater critic Michael Bourne reviews the Broadway revival of Sunday in the Park with George, now playing at the Hudson Theatre Theater critic Michael Bourne enjoys the Broadway revival of Sunday in the Park with George now playing at the revamped Hudson Theatre. Rep. Lance Hosts 'Boisterous' Town Hall Meeting By Ang Santos • Feb 24, 2017 Ang Santos / WBGO There wasn't much love for President Donald Trump from the hundreds of people who came to Republican Congressman Leonard Lance's town hall meeting at Raritan Valley Community College. A little ironic considering Trump's Bedminster golf course sits only a few miles away. "We actually have gone to his office his office to demand a town hall meeting, and it was kind of nice because a couple of days later there's a town hall meeting. I like to feel that we had something to do with it but I don't think so," said Michelle de Mico, a constituent of Lance's. President Trump's Immigration Crackdown Prompts Unrest in NYC By Bob Hennelly • Feb 24, 2017 William Alatriste/NYC CIty Council In the first several weeks of Donald Trump's presidency one of the hottest controversies has been sparked by the President's use of executive orders to make good on his campaign promises to crack down on illegal immigration here in the United States. How is New York City, a sanctuary city that has historically welcomed immigrant , responding? Harlan Jacobson's Take on the 89th Academy Awards By Harlan Jacobson • Feb 24, 2017 oscarwinners2017.com A recent Hollywood Reporter poll, however, shows that 66% of Trump voters turn off the show when it goes political, but 43% of Clinton voters want speechifyers to slam Trump. And 60% of the country can't name one best picture nominee. Well I can, and that's Barry Jenkin's Moonlight, and it's the film of the year. Superbly made, with pitch perfect performances, in a script that began as a play and continually plays with our notions of black life and character. The Future of NYC's Homeless Hotels By Topher Forhecz • Feb 24, 2017 Topher Forhecz for WBGO New York City and its mayor Bill de Blasio are sending mixed signals over plans to end the controversial practice of renting out hotel rooms to house its homeless population. This comes as the number of people sleeping in city shelters reached record numbers last year. De Blasio says he wants to end the practice, which critics call disruptive and expensive. Documents show the city may continue the practice for up to nine years. Glenn Close Shines Again in Revival of Sunset Boulevard By Michael Bourne • Feb 24, 2017 Michael Bourne for WBGO WBGO Theater Critic Michael Bourne reviews the revival of Andrew Lloyd Webber's revival "Sunset Boulevard." Glenn Close returns to Broadway to star in the role she wowed audiences 23 years ago. SportsJam with Doug Doyle: Lamoureux Twins Share Same Olympic Goals By Doug Doyle • Feb 21, 2017 USA Hockey for WBGO Many refer to two-time Olympic silver medalists Jocelyne and Monique Lamoureux as just "The Twins." They seem to be okay with that even though they are both married now. They realize people will group the Team USA hockey players together for obvious reasons, especially since they've been teammates all their lives. The twins from Grand Forks, North Dakota joined Hilary Knight and Meghan Duggan on a recent promotional tour of New York City. Is This the Year Newark Regains Control of Its Schools? By Ang Santos • Feb 17, 2017 Ang Santos / WBGO It's been over twenty years since the state took control of Newark Public School's because of low graduation rates and overall poor student performance. It's been a rocky road for the city's education system since, and many residents believe not much has changed over the course of time. At First Avenue School in Newark's North Ward, about 100 city residents gathered to hear Mayor Ras Baraka's latest updates on regaining local control of schools. They had their own concerns. The World Premiere of "Indian Head" Fires Up Audiences at Luna Stage By Doug Doyle • Feb 17, 2017 Luna Stage for WBGO Indian Head is a provocative play by Obie Award-Winner Nikkole Salter. Indian Head was commissioned in partnership with the NJPAC Stage Exchange, a program of the New Jersey Performing Arts Center. It is currently wowing audiences at Luna Stage in West Orange, New Jersey. UNCF Addresses Crisis In Black Education By Alexandra Hill • Feb 17, 2017 UNCF's Vaughn McKoy chats with WBGO's Alexandra Hill about the organization's efforts to address the current crisis in black education, and their ongoing mission to provide college scholarships and opportunities to African-American students. Team USA's Hilary Knight Is Focused On Gold By Doug Doyle • Feb 12, 2017 Fox Sports The USA Women's National Hockey team is now less than a year away from the Winter Olympics in Pyeonchang, South Korea. The team's goal is clear, WIN THE GOLD MEDAL. Two-time Olympic silver medalists Hilary Knight and twins Monique and Jocelyne Lamoureux sat down with me during their media tour of NYC last week…Meghan Duggan was also on the trip. Newark Welcomes 'Grammy Museum Experience' By Ang Santos • Feb 10, 2017 Ang Santos / WBGO When the city of Newark announced the Mulberry Commons Project last month, transforming lot and warehouse space on Prudential Centers Mulberry St. side into a 22-acre park, was it possible for something to outshine the ambitious project. I guess that depends on if you like music more than shops and recreational activity. The Grammy Museum Experience will use 8,000 square feet of Prudential Center space to bring its history to New Jersey. Daniel Cherry is the Chief Marketing Innovation Officer for the New Jersey Devils. He says they're a perfect match. The 37th Annual MTW Lecture Series Focuses on The Uprising of '67 By Doug Doyle • Feb 10, 2017 Doug Doyle for WBGO The 37th annual Marion Thompson Wright Lecture Series is February 18th at the Paul Robeson Campus Center at Rutgers University-Newark. The series was founded by the late Dr. Clement A. Price and Giles Wright. This year's MTW is once again being put together by Mark Krasovic, an assistant professor of history and American Studies at Rutgers University-Newark. Krasovic is also the interim director of the Clement A. Price Institute on Ethnicity, Culture and the Modern Experience. The theme of this year's one-day event is City Moves: Black Urban History Since 1967. Emotions Run High in George Street Playhouse's "American Son" By Doug Doyle • Feb 10, 2017 Doug Doyle for WBGO Stage and screen stars Suzzanne Douglas and John Bolger return to George Street Playhouse in New Brunswick, NJ for the award-winning play American Son, which runs through February 26th. Douglas is returning to GSP for the sixth time. She plays Kendra Ellis-Connor. Bolger plays her estranged husband, Scott Connor. Their son Jamal's car has been pulled over in the middle of the night and the Connors can't get any answers about his whereabouts. Douglas says her character fights like a tiger to save her son: Chapter & Verse By Jon Kalish • Feb 3, 2017 Chapter and Verse Partners, LLC The film is directed by 64 year-old Jamal Joseph, a former Black Panther who is now a professor at Columbia University. Joseph spent several years behind bars himself after being convicted of a variety of crimes including the sheltering of members of the Black Liberation Army and Weather Underground involved in the infamous Brinks robbery and murders in 1981. During a prison stint in Kansas he became a playwright and has been active in film and theater since he was freed. His focus has very much been on the plight of black men in America. NJ, NY Lawmakers To Challenge Trump Travel Ban By Ang Santos • Feb 3, 2017 Ang Santos / WBGO With the tolling of flag poles all around, and a backdrop of the Statue of Liberty and Ellis Island, top lawmakers from New York and New Jersey huddled together in opposition to President Trump's travel ban. "My name is Senator Michael Gianaris. I'm from New York, not New Jersey but we're happy to be here on the New Jersey side today." Gianaris is the deputy democratic leader of the New York State Senate and author of legislation that would prevent the Port Authority from using its resources to support Trump's Executive Order. Bloomfield College Bears Dominate the Court By Doug Doyle • Feb 2, 2017 Bloomfield College Athletics The Bloomfield College men's and women's basketball teams are rolling, both on top of the Central Atlantic Collegiate Conference. The captains of the Bears men's team got here via different paths. 6-foot-6 junior forward Nick Davidson had a brilliant senior season at Rancocas Valley High School and has emerged as this year's leading scorer on the Bears. Rakwan Kelly, a 6-4 junior forward, transferred to Bloomfield after playing at Division 1 Mississippi Valley State. Davidson, Kelly and women's 6-1 sophomore forward Bobbi Floyd are all pursuing degrees in the communications field. Former Devils Great Martin Brodeur Makes NHL's Top 100 By Doug Doyle • Jan 30, 2017 Doug Doyle for WBGO Former New Jersey Devils goalie Martin Brodeur was no surprise to make the NHL's 100 Greatest Players List released this past Friday night. Brodeur is a certain hall of famer and is the assistant general manager of the St. Louis Blues. In his 21-season tenure with the New Jersey Devils, he won three Stanley Cup championships and five Eastern Conference titles in 17 postseason campaigns. He finished up his career in St. Louis. Brodeur also won two Olympic gold medals with Team Canada in the 2002 and 2010 Winter Olympic Games. The Crypto Party Phenomenon Hits Brooklyn By Jon Kalish • Jan 27, 2017 crypto_party.org We're going to take you now to a crypto party. It's really more of a teach-in than a party. Privacy advocates and political activists have been organizing crypto parties to foil efforts by corporations and governments to collect data. The phenomenon started in Australia in 2012 and has since spread around the world. Reporter Jon Kalish recently went to a couple of crypto parties in Brooklyn. Click above to hear the story. The Liar Completes Its Comedic Mission By Michael Bourne • Jan 27, 2017 Classic Stage Company Theater critic Michael Bourne reviews the Classic Stage Company's The Liar, a new David Ives translation of a French comedy. Experts Torn On Cat Declaw Ban By Ang Santos • Jan 27, 2017 Ang Santos / WBGO New Jersey could become the first state to ban veterinarians from declawing cats. Feline advocates are split over whether the legislation is a good idea. A bill passed by the Assembly and awaiting action in the state Senate would fine veterinarians as much as $2000 for declawing a cat unless it's considered medically necessary. Kathleen Schatzmann, the state director of the Humane Society, supports the proposed ban. Harlan Jacobson's Finest From Sundance By Harlan Jacobson • Jan 27, 2017 Susan Jacobson for WBGO What a work of man Sundance is, namely Robert Redford. It's his legacy, after all, far more than the Way We Were or All the President's Men or that near-silent film he starred in, ALL IS LOST, as a sailor adrift at sea. The 33rd Sundance Film Festival wraps up this weekend. If you stop thinking of film as art—the 7th art, in fact—which the majority of Americans don't anyway—and think of it for a second as a product, Sundance didn't invent the independent film. But it did find a way to make it a business. Hurricane Diane Blows People Away At Two River Theater By Doug Doyle & Ishmael Martinez & Ken Downey Jr. • Jan 27, 2017 Cassie Galisetti for WBGO Becca Blackwell is making audiences laugh as "Diane" in Two River Theater's latest production Hurricane Diane. In this wild comedy, the Greek god Dionysus takes form as "Diane", a lesbian permaculture gardener from Vermont. She's on a mission to gather followers and restore the Earth to its natural state. Where better to begin than a Monmouth County cul-de-sac and the women who live there? Blackwell is enjoying working with Two River's playwright-in-residence, Madeleine George: Donald Trump becomes the 45th president of the United States By Doug Doyle • Jan 20, 2017 Alex Wong/Getty Images The nation's new president is continuing to sound the themes of economic populism and nationalism that fueled his campaign. In his inaugural speech in Washington, DC, President Donald Trump painted a dark picture of a country he vowed to take in a new direction. Click above to hear more of the President's remarks and the oath of office. Pages« first ‹ previous … 16 17 18 19 next › last »


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I called up one of my closest friends one night and as soon as she picked up the phone, I told her, "It's time. Come chop my hair off."
That was the moment I decided to go full-on natural. I was tired of what I was doing to my hair. My hair was tired of what I was doing to my hair. After using chemical and heat straightening methods it had some serious damage to it.
I was in denial for a while. I, like so many other people in this world, valued my hair too much and wanted to keep it. But what I didn't realize is that keeping those frazzled ends weren't helping me, it was hurting me. So after three weeks of bad hair days and friends grilling me about cutting it, I finally did.
For African American women the big chop is huge. It's the step you take when you want to go natural and get rid of the straightened portions of your hair. To me it felt like a rite of passage.
Now that I am natural, it's so much fun to play with my hair. I love the curls and the coily shape my strands take. I'm learning how to use the right conditioners and other products that will help keep my 'fro moisturized and soft. I'm thoroughly embracing the fact that my hair is not like other people's, and I can't wait to see what I can do with it.
As a person just starting the journey of finding my inner happiness and mastering the art of letting go of fears, I am so glad I made this decision for myself. On the inside, I have found this girl who is daring and bold. She is unafraid to love herself for who she is. She is also unafraid to share her true self with others and love them just as much. She is me.
Do not be afraid to explore to find your true self. Let me tell you, it's exhilarating.


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This past spring, a nude performance artist made a minor media stir by publicly pushing paint-and-ink-filled eggs out of her vagina onto a canvas to make a profound statement – okay, perhaps not so much profound as profoundly messy. Around the same time, Lady Gaga, the music industry's most self-consciously artsy star, incorporated a vomit performance artist into her show (it's even more repulsive than it sounds). "That performance," says Lady Gaga, "was art in its purest form."
I'm not sure what "art in its purest form" means, but was it even art at all? Have we so degraded the definition of art that it includes whatever we decide to spew publicly from bodily orifices? As a critic for The Guardian correctly notes, much of the modern tradition of performance art "is an embarrassing revelation of the art world's distance from real aesthetic values or real human life."
And that's the problem. Such acts of disgusting fetishism, desperate self-promotion, and calculated shock value taint the endeavor of art itself as it has been understood around the world for many centuries. They make it difficult for the average person-on-the-street to understand, respect, and value art. They make it hard to remember that there was a time when creating art involved serious training, skill, and vision, and that it isn't just about attention-seekers acting on their most idiotic or disturbed impulses.
In the past, creating art was the domain of a trained few, employed and appreciated by the moneyed elite. But with the rise of capitalism, gradual breakdown of the class structure, and the proliferation of museums, cheap reproductions, and art education, pretty much anyone could enjoy art. Eventually, access to affordable materials meant that anyone could also attempt to produce art. In time, this democratization downgraded our culture's definition of art to mere personal expression, as if anything anyone does to express himself or herself rises to the level of art as long as a pretentious enough justification can be fashioned for it.
For example, last week Business Insider reported on photographer Jedediah Johnson, whose art consists of slathering on lipstick, making out with people, and taking pictures of the smeared results. His "Makeout Project" supposedly "attempts to change our preconceived notions about kissing," which sounds like just the sort of postmodern bull that artists say to get girls – although in this case, he occasionally makes out with men too, and in at least one ultra-disturbing instance, with a baby (as an aside, what kind of parents allow this frankly twisted creep to smear lipstick on their child with his lips?).
It doesn't help that such postmodern silliness earns insane valuations at art auctions and sales. In an article bluntly titled, "The Overpriced World of Bad Art," the New York Post reports that collectors are increasingly "spending millions on artists still alive who are producing art that is less and less accessible... It's a cynical attempt to be cool by consumption, and increasingly, the artists they collect create work for them that verges on contemptuous."
Examples include "art" like light bulbs on a blank wall ($506,503), a dead tree ($468,000), and a dead shark in a tank ($12 million). "My Bed," an installation consisting of cigarette butts, used condoms, and stained underwear piled adjacent to artist Tracey Emin's unmade bed, sold at Christie's last month for $4.25 million. In museums a hundred years from now, will frauds like this be representative of the best art of our time?
The dead shark went for spare change compared to a Francis Bacon triptych that sold for an auction record of $142 million at Sotheby's last year. Also in 2013, a collector picked up a Picasso for $155 million in a private sale. Several years before that, a Jackson Pollack splatter-fest fetched $140 million. Now, unlike Tracey Emin's rumpled sheets, those were exceptional works by recognized modern masters, but the point is that when a piece of art sells for such an astronomical sum, the money becomes the focal point. It distracts from the work itself and makes people view the art world as nothing a scam on obscenely wealthy collectors.
(This article originally appeared here on Acculturated, 8/4/14)


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Can I organise an appointment online?
Yes, we take bookings through Health Engine. Please book here. If you are seeking an urgent appointment please call the clinic directly on (08) 9271 9422.
Is parking available?
Yes, limited free parking is available on Thirlmere Road, along Ellesmere Road and to the rear of the Mercy Medical Centre. Please download this Hospital Map to view other parking options. Grid reference for Mercy Physio is E-4.
Can I contact my Practitioner via email?
Patient care will not be discussed via email. This is not only a legal requirement, but ensures patients receive the appropriate time and care from their practitioner.
Do I need a referral?
A Doctors referral is required if you are under Veterans affairs, Motor Vehicle or Workers compensation insurance. If claiming under a Medicare Enhanced Primary Care (EPC) Plan you must bring all relevant documentation (or organise for your GP to send it through to us ahead of your appointment). All other patients do not require a referral to see a Physiotherapist.
Do I need to bring anything or wear anything in particular?
Please bring any x-rays, scans or other medical tests that are relevant to your injury to your appointment with a Physiotherapist.
For ease of examination, please wear comfortable clothing or a change of clothes that allows our practitioners and physiotherapists to adequately view and assess the injured area, this is particularly pertinent for injuries to the shoulder/thoracic region and the hip/knee region. We respectfully ask all female patients with shoulder-related injuries to consider wearing or bringing along a singlet.
Our Physiotherapists regularly incorporate exercise therapy and rehabilitation into their consultations, therefore access to clothing and footwear that allows you to move freely and comfortably while performing functional tasks or exercises may be required.
For Orthotic Assessment, please bring your sports shoes and/or work shoes. Ladies may benefit from bringing a small selection of your usual footwear.
For Compartment Pressure Testing, you will need to bring clothes and footwear suitable for exercise.
Do I need to pay for the visit at the time?
Yes, payment is required on the same day of service for all services offered at Mercy Physio. For your convenience we provide EFTPOS facilities. We also accept Visa and Mastercard.
For Physiotherapy services, we provide Hicaps so that you can claim your private health insurance rebates at the time of billing. Remember to bring your private healthcare membership card. Rebates may apply for Physiotherapy services including Hydrotherapy, Ante-natal and Post-natal classes, and Clinical Pilates sessions.
For those attending under an EPC plan you must bring your Medicare card.
Do you treat Workcover and MVIT Patients?
Yes, but please be aware you will be required to bring your claim number, date of accident and employer's full details including name, address and insurance company. Please note that all accounts are the responsibility of the patient and that Workcover and MVIT may only partially cover the cost of services at this clinic.
Is there a cancellation policy?
Yes. Please phone the clinic 24 hours prior to your appointment if you wish to cancel or change your appointment. Full charges apply unless 24 hours notice is given.