text:
Are private physiotherapy clinics only useful for MSK problems?
- 1 Neurological Physiotherapy
- 2 Prevalence of Neurological Conditions
- 3 Public perceptions of Neurological Conditions
- 4 Waiting times for NHS Neurological Services
- 5 NHS patient involvement in decision making
- 6 Stroke
- 6.1 What is a stroke?
- 6.2 How is a stroke diagnosed?
- 6.3 Stroke prevalence in the UK
- 6.4 NHS Stroke services
- 6.5 Deficits of neurological physiotherapy in the NHS
- 6.6 Benefits of using private practice for stroke care
- 7 Parkinson's
- 8 Overall benefits of private physiotherapy for Neurological Conditions.
- 9 References
Neurological Physiotherapy
You have navigated yourself to this portion of the Wiki by recognising an interest you have in Neurological physiotherapy within the private setting. This section is designed to give an introduction into neurological physiotherapy, highlight the prevalence of neurological conditions within the UK, briefly discuss neurological physiotherapy services offered by the NHS with emphasis placed on two common conditions, stroke and Parkinson's, and conclude by outlining the benefits of private neurological physiotherapy. This will hopefully trigger questions for thought and reflection on whether neurological physiotherapy in the NHS or private practice is suitable for the career pathway you have in mind.
Firstly, we will aim to answer the basic question of "What is Neurological physiotherapy?"
Neurological Physiotherapy is a specialist area of physiotherapy focused on the treatment of individuals with neurological conditions. Neurological disorders affect the functioning of the brain, spinal cord, and nerves. Stroke, multiple sclerosis, spinal cord injury and Parkinson's disease are common neurological conditions [1]. It also includes conditions of the peripheral nervous system such as Guillain Barre Syndrome. Neurological conditions can have a devastating impact on the lives of the sufferers, along with family and friends. Disturbances in the travelling of messages between the brain and the body can result in the loss of movement, sensation, co-ordination, and balance. Other aspects of bodily function, such as perception, speech, memory, cognition, and behaviour may also be effected. Therefore, it is important that neurological physiotherapists work in close partnership with other members of the multidisciplinary team including speech and language therapists, occupational therapist, dieticians, nurses, and doctors. Effective communication between patient, family members, and the multidisciplinary team is critical to positive healthcare outcomes following a neurological disorder [2].
The role of a Neurological Physiotherapist
Neurological physiotherapists are expeirenced and trained to treat neurological conditions with the aim to provide interventions which assist an individual to regain or maintain their maximum movement and functional independence. This is achieved by aiding in the development of new pathways through repetition and exercise.
Treatment interventions
A number of treatment approaches are used, often incorporating a selection of the following as appropriate [2]
- Stretching
- Strengthening
- Balance re-education
- Gait re-education
- Joint mobilization
- Electrical stimulation
- Postural exercise
- Spasticity management
- Advice/Education on lifestyle, fatigue management, and exercise
Reflection Questions:
1. Does the role of a neurological physiotherapist still interest me?
2. Do I want to further investigate if working in the private sector would interest me?
If you have answered "yes" to the above questions, continue reading below. If not return to the career pathway in the introduction section and select another specialty that may be of interest.
Prevalence of Neurological Conditions
The Neurological Alliance [3] reported the total number of neurological cases in England to be 12.5 million or 59,000 cases per CCG in 2013-14, with a further 1 million cases in Scotland reported in the NHS QIS Clinical Standards on Neurological Health Services [4].
This table[5]represents the most common neurological conditions in England.
The image[3] below illustrates the number of neurological conditions and the distribution of cases between progressive, intermittent, stable with changing needs, and sudden onset.
Within NHS Lothian, it is estimated 53,480 people are living with a neurological condition. The number of people disabled by the condition is 5,348 and an estimated 1,872 people will need assistance carrying out activities of daily living. Each year, a further 8,489 people in Lothian will be diagnosed with a neurological condition [6]. The illustration below represents the number of people affected by neurological conditions in Lothian [6].
Public perceptions of Neurological Conditions
A study conducted by Sue Ryder revealed that 45% of the UK population feared being impacted by a neurological condition the most which is compared to 36% who feared getting cancer. The study highlighted the beliefs of the public with regards to neurological conditions, showing that 26% of the public felt that "nothing much can be done" for people with neurological conditions [7]. It is understandable why the general public fear being effected by a neurological condition when one takes into consideration patients poor experience with neurological healthcare. The Neurological Alliance conducted a neurological patient experience survey in 2014 [5].
Figure 2 indicates the neurological conditions represented in the survey.
The survey stated that 58.1% (n=3402) of NHS England respondents (n=6916) have experienced difficulty accessing the service/treatment they require, 39.8% (n= 2357) of respondents had a 12-month waiting period from the time of observation of the first symptom to seeing a neurologist specialist, 31.5% of respondents (n=2140) had 5 or more GP visits related to the health problems experienced due to their condition prior to being referred to a neurological specialist, and 71.5% (n=4603) of respondents were not provided with a care plan to help manage their condition [5]
Waiting times for NHS Neurological Services
The 2005 National Service Framework for Long-term Conditions [8] identified the need for prioritising an accurate and rapid diagnosis of neurological conditions, highlighting the importance of early diagnosis within this clinical population to reduce neurological damage, delay disease progression, elevate survival numbers, and enhance patient's quality of life. However, it appears in 2014 that this call to action had not been achieved with 3,402 respondents to the neurological patient experience survey [5] voicing concerns regarding challenges experienced trying to access the treatment and services they needed.
Respondents opinions emphasized the concern of long waiting times especially transitioning from general practice to specialist care settings.
In December 2011, a survey of NHS Physiotherapy waiting times[9] in the UK was published, showing that in neurology departments, the longest wait reported was 2-4 weeks and 83% of neurological patients were seen in 8 weeks or less. The shortest wait was less than a week and the longest wait was 18-20 weeks.
NHS patient involvement in decision making
Only 34.1% of Clinical commissioning groups which responded to the quality of commissioning audit, utilise mechanisms to involve patients in decision-making processes and only 33% obtain important feedback on the services they provide. Taking into consideration the NHS principle of "no decision about me without me" [10], the NHS must actively incorporate patient views in the design and provision of services. The chart below [5] highlights the high number of neurological patients receiving no information from healthcare professionals on various aspects of patient care. Without crucial information, how is it possible for patients to make educated, informed decisions about their healthcare?
What is a stroke?
A stroke is a type of cerebrovascular disease. A stroke occurs when the blood supply to part of the brain is disrupted, depriving brain cells of oxygen and nutrients.
The two types of stroke are [11]:
1. Ischemic stroke: A blood clot interrupts the blood supply to the brain. Blockages may be due to atherosclerosis, small vessel disease, arterial dissection, or a heart condition. A blood clot may be treated with thrombolysis, which is a clot busting medication. Thrombolysis needs to be given within 4.5 hours of the onset of the first stroke symptom in order to have the optimum effect. This medication can break down and disperse a clot, helping to regain the blood supply to the brain.
Below the left scan shows an infarct represented by the black areas and the right scan shows a haemorrhage indicated by the white areas [12]
2. Haemorrhagic stroke: This type of stroke occurs when a blood vessel ruptures causing bleeding in the brain. The bleeding may occur within the brain, known as an intracerebral haemorrhage or blood can leak into the subarachnoid space, known as a subarachnoid haemorrhage. Symptoms of an intracerebral haemorrhage may include loss of consciousness, nausea, muscle weakness on one side of the body, or severe headache, a subarachnoid haemorrhage causes a sudden onset of symptoms, including a severe headache, loss of consciousness, vomiting, or neck stiffness. A ruptured blood vessel may be caused by high blood pressure, cerebral amyloid angiopathy, an aneurysm, anticoagulant medication, or drugs such as cocaine. A haemorrhagic stroke may need surgery to stop the bleeding, relieve pressure, or remove blood around the brain. This operation is known as a craniotomy.
A transient ischemic attack is similar to a stroke but the symptoms last less than 24 hours. It acts as a warning sign for being at risk of a full stroke.
How is a stroke diagnosed?
A stroke is usually diagnosed using a brain scan, either a magnetic resonance imaging scan or a computed tomography scan. If the patient has had a subarachnoid haemorrhage, a lumbar puncture may be carried out in addition to a brain scan to remove fluid around the spinal cord to determine if any blood has leaked into it [13].
Stroke prevalence in the UK
A stroke occurs every 3 minutes and 27 seconds in the UK, totalling approximately 152,000 strokes a year [14] . There is a high prevalence of stroke in Scotland due to the risk factors linked with the condition, including hypertension, smoking, inadequate exercise, high levels of alcohol consumption, and a poor diet. The Scottish Health survey 2014 revealed a shocking figure of 3.3% of males and 3.1% of females reported to have suffered from a stroke. In 2014/2015, 10,306 females and 10,310 males were discharged from hospital with stroke in Scotland. The percentage of stroke patients surviving 30 days or more after first emergency admission has improved very slightly from 81.6% in 2005/2006 to 84.9% in 2014/2015.[15] Scotland has the highest percentage of stroke survivors, meaning a large population of people requiring support and therapy post-stroke. This places addtitional stress on resources within NHS Scotland [14] .
Within Lothian, it is estimated that there are 1,698 first or recurrent strokes per year, along with a further 340 people experiencing a transient ischemic attack, and 6,112 people living with stroke [6].
NHS Stroke services
The NHS Physiotherapy waiting times, workforce and caseloads survey in the UK in 2010-2011 asked the question "Do you provide a stroke service?". Sixty-seven respondents answered the question to show overall that 42% provided an inpatient stroke service, 34% did not provide any physiotherapy for stroke, 16% provided both community and inpatient stroke services, and 8% only provided a community stroke service.
The Scottish Stroke Care Audit 2015 [16] identified clear standards for stroke services in Scottish hospitals to achieve. Standard one states that at least 90% of stroke patients should be admitted to the stroke unit on the day they arrive or the day after. The table below shows the Scottish hospitals that did not meet standard one in 2014.
Deficits of neurological physiotherapy in the NHS
There are a number of key issues within neurological physiotherapy in Lothian that have been identified within the NHS Lothian Neurological Care Improvement Plan 2014-2017 [6].
• Improvements need to be made with regards to accessibility, including inequality of access, problems of physical access and transport for people with more complex disabilities, lack of clear, identifiable pathways and possible duplication.
• There are currently only eight qualified neurological physiotherapists within Lothian. This service capacity needs to be increased.
• The quality of care needs to be more consistent, improving on the current situation of irregular bouts of excellent practice and expertise.
• Further encouragement needs to be provided to consider a single point of referral for neurological physiotherapy, which would supply information on demand.
A study conducted by Verpillat et al 2015 [18] examined the management of ischemic stroke in West Scotland. This study showed that out of 101 patients, 45.5% sought further physical therapy during the 1-year follow-up period. Often, within the NHS, the provision of physiotherapy is based on achieving goals within an expected timeframe. Unfortunately, if progress is limited, the continuation of physiotherapy may be questioned and focus may shift towards self management of the condition with less frequent physiotherapy sessions [19].
Do patients get enough therapy in hospital?
Rehabilitation is evidence based medicine utilised "to reach and maintain optimal functioning in physical, intellectual, psychological and/or social domains, according to the World Health Organisation [20].
It has been recognised that many patients in stroke units feel they do not receive enough therapy during their hospital stay. The SSNAP [21] reported that physiotherapy is required by 85% of stroke patients. Despite this, patients who need physiotherapy only receive 32 minutes on average on just over 50% of their days in hospital. This is one of the NHS's downfalls as patients should be obtaining the equivalent of 45 minutes of physiotherapy per day for 5 days a week. These are the opinions of stroke survivors regarding the care they received in the UK by the NHS in 2013-2014, highlighting some key areas of concern.[21].
The NHS does not have sufficient resources to provide long-term physiotherapy treatment for stroke survivors. Instead, the focus is placed on the initial period following a stroke. Pressure can be felt by patients within the hospital setting to reach targets fast in order to reach their recovery potential within a specified timeframe and some patients are led to believe that after 6 months, recovery stops. It is essential to know that stroke can potentially be a deteriorating condition as patients who do not continue treatment may become stiffer and less mobile. Also due to pressures on hospital beds, patients may get an early supported discharge with continuation of treatment at home [15], as shown in the illustration below. However, treatment at home may be delayed, reduced in intensity, and hence hinder recovery.
What happens when I transfer home?
Early supported discharge can lead to better outcomes for patients, but The Second SSNAP Annual Report[12], 2015 highlights certain areas in the UK where this service is unavailable, leaving patients isolated with limited therapy at home.
Benefits of using private practice for stroke care
For the reasons highlighted above, having the option to go for physiotherapy for stroke care at a private practice can be of benefit to numerous people to eliminate pressures related to timescales and improve accessibility to therapy. Patients can receive a higher volume and frequency of therapy which is criticial, especially in the early stages post stroke. Evidence shows that spontaneous recovery tends to occur mostly within the first 3 months [22]. Motor impairment is the focus for stroke rehabilitation of physiotherapists [23]. In the first 30 days following a stroke, the largest improvement in motor recovery occurs. However, significant progress is still seen up to 90 days' post stroke in patients with more severe deficits [24] [25] [26]
Private neurological physiotherapy services in the UK have experienced significant improvements in the functioning levels of patients with a stroke beyond the first 6 months. Neurological physiotherapists re-educate the brain and body through movement that allow further progression in rehabilitation to be achieved [27]
Parkinson's disease is a chronic, progressive movement disorder affecting an estimated 127,000 people in the UK [28]. Parkinson's disease sufferers have inadequate levels of dopamine, which is the chemical needed to send messages to an area of the brain that controls coordination and movement. The primary motor signs of Parkinson's disease are a tremor, bradykinesia, rigidity, and impaired balance and coordination [29]
Youtube video [30]
NHS Parkinson's care
Parkinson's disease is the second most common neurological condition in the UK. The NHS Lothian Neurological Care Improvement Plan 2014-2017 states that medical care alone is insufficient for this disease. In spite of this, patients with Parkinson's disease frequently have no access to allied health professionals. The Edinburgh Parkinson's Assessment Clinic (EPAC) is led by therapists to provide people diagnosed with Parkinson's access to advice from a physiotherapist. However, the EPAC offers all newly diagnosed patients of parkinsonism a once-off assessment by a physiotherapist to provide education on self management. Following the initial assessment, there is no standardised pathway of care to therapeutic services. It has been highlighted that the NHS Lothian physiotherapist service needs specific Parkinson's staff training, an intranet page dedicated to Parkinson's physiotherapy to improve communication between professionals, a system to review staff competencies in Parkinson's regularly, a system to review patient education throughout their journey frequently, and an evaluation of Parkinson's community exercise programmes [6]. Based on this information, the Lothian physiotherapist service for patients with Parkinson's is inadequate and requires improvements.
Physiotherapy aimed at rehabilitating patients with Parkinson's focuses on posture, upper limb function, transfers, balance, physical capacity, and gait. Supporting evidence in recent years for the inclusion of physiotherapy in the care of Parkinson's disease has increased [31]. Management guidelines such as the National Collaborating Centre for Chronic Conditions: National clinical guidelines for diagnosis and management in primary and secondary care of Parkinson's [32] and the Royal Dutch Society of Physical Therapy's practice recommendations [33] have supported physiotherapy, leading to an increase in the number of referrals to physiotherapy. A systemic review and meta-analysis completed by Tomlinson et al. 2012 [34] showed that physiotherapy resulted in significant outcomes for gait speed, balance, and the unified Parkinson's disease rating scale.
However, the 2015 UK Parkinson's Audit [35] showed that only 50% of patients with Parkinson's are referred to a physiotherapist within two years of diagnosis, as shown in the table below.[35]. The APPG launched an inquiry to examine the availability and quality of health and social care for patients with Parkinson's and their carers. This inquiry revealed evidence emphasising the benefits of early and ongoing access to therapy services including physiotherapy, which is less likely considering the two year wait to be referred to physiotherapy following diagnosis. A preventative approach to Parkinson's care is cost effective by reducing admissions to hospital and supporting patients in the community for an extended period of time. Unfortunately, evidence showed these interventions in many areas are unavailable until a later stage in the illness, which is too late or not at the frequency needed to be beneficial. For the limited amount of patients who received access to therapy services, some patients highlighted that they were only receiving short periods of therapy before being "signed off", despite the long term requirement for support associated with the nature of the condition [36] .
Physiotherapist's role in Parkinson's care
Physiotherapists play a key role in the care of patients with PD. Physiotherapy is the most common non-drug treatment recommended for Parkinson's [37] [38] and physiotherapy is recommended by national guidelines as a mainstay of management. Some of the physiotherapists objectives are to improve the patient's quality of life by increasing or maintaining the patients level of independence, wellbeing, and safety. These aims may be achieved by preventing falls and inactivity, reducing the patient's activity limitation, and enhancing functional activity.
Parkinson's disease can be divided into three phases, with the patient requiring physiotherapy in each phase. The early phase is characterised by little or no patient limitations. The physiotherapists goals are to prevent inactivity, prevent the fear to move or fall, and improving exercise capacity by providing information, advice, and exercise. The mid phase is recognised by balance issues, restrictions in performance of activities, and an increase fall risk. The therapeutic intervention is focused on body posture, gait, balance, reaching and grasping, and transfers. The late phase is identifiable by the patient's confinement to a wheelchair or bed. The physiotherapist treating a patient in this phase is focused on preservation of vital functions and prevention of pressure sores and contractures.The figure below is the International Classification of Functioning, Disability, and Health[20] associated with PD [39]
The impairments linked with Parkinson's that fall within the scope of physiotherapy are [40]
The ParkinsonNet model
Bloem and Munneke [41] recognised that Parkinson's is a condition where patients require long term support to manage, hence described the benefits of a model of integrated care incorporating a network of specialists. ParkinsonNet is a scheme established in the Netherlands to tackle problems such as inadequate interdisciplinary collaboration and communication, lack of specific training and expertise in PD, treatment focus on suppression of symptoms via drugs, and that referrals to allied health professionals such as physiotherapy being arbitrary. This model developed regional networks of inspiring, motivated, specialist health professionals to whom patients are referred for treatment long term [41]. Parkinson's UK and the Parkinson's service have been advocating the ParkinsonNet model, however as highlighted by the NHS Lothian Neurological Care Improvement Plan 2014-2017 [6], this model has yet to be established in Scotland. In 2014, the Chair of the Lothian Parkinson's Service Advisory Group, Dr Conor Maguire sought approval for the appointment of a Specialist Parkinson's Physiotherapist to lead the development of a multidisciplinary model such as ParkinsonNet to help decrease geographical inequalities and standardise the provision of multidisciplinary care within Lothian. This process is ongoing currently [6], meaning the patients with Parkinson's in Scotland are not receiving the benefits of this model.
How private physiotherapy can aid in the treatment of PD
Due to the long waiting period between diagnosis and referral to physiotherapy as highlighted in table 12 above, private physiotherapy can aid in reducing shortfalls in early therapeutic and preventative interventions.
Bhanu Ramaswamy, a consultant physiotherapist in Derbyshire, shared the significance of early referral to physiotherapy in the treatment of Parkinson's to help avoid complications such as falls. She reiterated the importance of early intervention stating: [36]
Private physiotherapy can provide early intervention to delay the decline in a patient's conditions and help maintain or improve a patient's quality of life, confidence, and mobility. A person with Parkinson's responded to the APPG's inquiry by saying [36]:
This patients experience with poor NHS accessibility highlights significant unmet needs. Private neurological physiotherapy can meet these needs providing early intervention following diagnosis, allowing patients to benefit from a preventative approach to care[36] .
Overall benefits of private physiotherapy for Neurological Conditions.
Private UK neurological physiotherapy clinics such as Neurolink [42] in London provide specialist physiotherapy for neurological conditions such as Stroke, Parkinson's Disease, Traumatic Brain Injury, Multiple Sclerosis, and Spinal Cord Injury.
At Neurolink, the majority of clients attend x3 sessions a week, addressing issues proactively to prevent long term complications from developing. For progressive neurological conditions such as PD, the clinic aims to provide treatment and advice at each stage of the condition. A major benefit to private physiotherapy is on achievement of a client's short term goals, focus shifts immediately to longer term maintenance and progression through a combination of neurophysiotherapy and the use of FES machines, neuro pilates, personal training, and massage therapy.
Many private clinics purchase state-of-the-art equipment. Neurolink uses a number of large Functional electrical stimulation machines including the RT-600 aimed at increasing the percentage weight bearing capacity of a client's body through their legs, the RT-300 allowing for leg and/or arm cycling whilst seated, and the RT-200 providing arm and leg therapy and offering high cardiovascular demands. These machines are typically used with the aim of building up to daily 1 hour sessions. Neurolink also houses a five piece Integra wheelchair accessible gym, a five piece pilates equipment system, and a Medimotion leg bike [42]. With longer and more frequent treatment sessions privately, patients can really experience benefits using advanced, up-to-date technology.
Following an interview with a physiotheraist treating neurological conditions in Edinburgh, it is clear that private physiotherapy for neurological conditions plays a pivotal role in helping clients achieve a threshold level of mobility and gain confidence and competence with exercise in order to support the transition to a local leisure club or community-based activity groups. The physiotherapist describes the role of a private physiotherapist, in addition to providing an incredible opportunity for improvement, is to help a client reflect on important outcomes from functional perspective to quality of life using careful documentation and involving family members. He believes this offers the client time to make a decision independently as to whether a change in functional status is possible and help shape their ideas about future management of their long term condition.
To quote an experienced physiotherapist in the field of neurological conditions:
This statement highlights the need for private physiotherapy to help neurological patients reach personal aspirations and higher goals, which take more time and effort to achieve.
Receiving regular physiotherapy not only improves patients physically, but also psychologically, building patient and family members confidence, positivity, hope, and belief. A private neurological physiotherapy clinic in California known as the Challenge Center, [43]provides long term physiotherapy for neurological conditions for people who are no longer eligible to receive physiotherapy from the health system as they have reached their insurance coverage limit. For people who had run out of hope, this private physiotherapy clinic raises money through fundraisers to provide scholarships to clients needing continuous therapy. This scholarship is in addition to patients financing therapy independently. The video[44] below describes the physical and psychological benefits private physiotherapy brings to the lives of people with a neurological condition and their family members.
- ↑ NEUROLOGICAL ALLIANCE OF SCOTLAND.,2016. Neurological conditions factsheet [online]. [viewed 31 October 2016]. Available from: http://www.scottishneurological.org.uk/content/res/Neurological_Conditions_Factsheet.pdf
- ↑ 2.0 2.1 NEUROLOGICAL PHYSIOTHERAPY., 2016. Neurological physiotherapy [online]. [viewed 31 October 2016]. Available from: http://neurologicalphysiotherapy.com
- ↑ 3.0 3.1 THE NEUROLOGICAL ALLIANCE., 2014. Neurological alliance neuro numbers [online]. London: The Neurological Alliance. [viewed 31 October 2016]. Available from: http://www.neural.org.uk/store/assets/files/381/original/Final_-_Neuro_Numbers_30_April_2014_.pdf
- ↑ NATIONAL HEALTH SERVICE QUALITY IMPROVEMENT SCOTLAND., 2009. Neurological health services: Clinical standards.
- ↑ 5.0 5.1 5.2 5.3 5.4 THE NEUROLOGICAL ALLIANCE., 2015.The invisible patients: revealing the state of neurology services [online]. London: The Neurological Alliance. pp. 1-69.[viewed 31 October 2016]. Available from: http://www.neural.org.uk/store/assets/files/495/original/Invisible_patients_-_revealing_the_state_of_neurology_services_final_14_January_2015_.pdf
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 NATIONAL HEALTH SERVICE LOTHIAN., 2015. Lothian neurological care improvement plan 2014 to 2017 [online]. [viewed 31 October 2016]. Available from: http://www.nhslothian.scot.nhs.uk/OurOrganisation/Strategies/Documents/NHS%20Lothian%20Neurological%20Care%20Improvement%20Plan%202014-2017%20-%20Final.pdf
- ↑ SUE RYDER., 2016. Public fear getting a neurological condition [online].[viewed 31 October 2016]. Available from: http://www.sueryder.org/media-centre/news/2016/june/public%20fear%20getting%20a%20neurological%20disorder
- ↑ DEPARTMENT OF HEALTH., 2005. The national service framework for longterm conditions. Leeds: NSF.
- ↑ JJ CONSULTING., 2011. A survey of NHS Physiotherapy waiting times, workforce and caseloads in the UK 2010-2011. London: CSP.
- ↑ DEPARTMENT OF HEALTH., 2012. Liberating the NHS:No decision about me, without me. London:NHS
- ↑ STROKE ASSOCIATION, 2015. What is a stroke? [online].[viewed 1 November 2016]. Available from: https://www.stroke.org.uk/what-stroke/what-stroke
- ↑ 12.0 12.1 ROYAL COLLEGE OF PHYSICIANS., 2015. The second SSNAP annual report: Is stroke care improving?[online]. London: SSNAP.pp. 1-30. [viewed 2 November 2016]. Available from: https://www.strokeaudit.org/Documents/Results/National/Apr2014Mar2015/Apr2014Mar2015-AnnualReport.aspx
- ↑ NEUROSCIENCE., 2010. Subarachnoid haemorrhage [online]. Bristol: NHS Trust. pp. 1-10. [viewed 1 November 2016]. Available from: https://www.nbt.nhs.uk/sites/default/files/attachments/Subarachnoid%20Haemorrhage_NBT002126.pdf
- ↑ 14.0 14.1 STROKE ASSOCIATION., 2016. State of the nation: stroke statistics [online]. [viewed 1 November 2016]. Available from: https://www.stroke.org.uk/sites/default/files/stroke_statistics_2015.pdf
- ↑ 15.0 15.1 NATIONAL HEALTH SERVICE SCOTLAND., 2016. Scottish stroke statistics [online]. [viewed 1 November 2016]. Available from: https://www.isdscotland.org/Health-Topics/Stroke/Publications/2016-01-26/2016-01-26-Stroke-Report.pdf
- ↑ NATIONAL HEALTH SERVICE SCOTLAND, 2015. Scottish stroke care audit: public summary of 2015 national report [online]. Edinburgh: ISD Scotland Publications. pp. 1-37. [viewed 1 November 2016]. Available from: http://www.strokeaudit.scot.nhs.uk/Downloads/2015_report/SSCA-summary-2015-web.pdf
- ↑ SCOTTISH INTERCOLLEGIATE GUIDELINES NETWORK., 2010. Management of patients with stroke: Rehabilitation, prevention and management of complications, and discharge planning. Edinburgh:SIGN.
- ↑ VERPILLAT, P., DOREY, J., GUILHAUME-GOULANT, C., DABBOUS, F. and ABALLEA, S., 2015. Ischemic stroke management in West Scotland: a chart review.Journal of market access and health policy [online] September, vol. 3. [viewed 1 November 2016]. Available from: http://europepmc.org/articles/PMC4802692
- ↑ ASHFORD AND ST PETER'S HOSPITALS NHS FOUNDATION TRUST., 2014. Physiotherapy for stroke patients [online]. viewed 2 November 2016. Available from: http://www.ashfordstpeters.nhs.uk/physiotherapy-for-stroke-patients.
- ↑ 20.0 20.1 World Health Organization, 2001. International Classification of Functioning, Disability and Health: ICF. World Health Organization.
- ↑ 21.0 21.1 21.2 ROYAL COLLEGE OF PHYSICIANS., 2014. How good is stroke care?:first SSNAP annual report [online]. London: SSNAP. pp. 1-39. [viewed 2 November 2016]. Available from: https://www.strokeaudit.org/Documents/Newspress/SSNAP-Annual-Report-(April-2013-March-2014).pdf
- ↑ KRAKAUER, JW.,CARMICHAEL, ST., CORBETT,D. and WITTENBERG, GF., 2012. Getting neurorehabilitation right: what can be learned from animal models? Neurorehabilitation and Neural Repair. vol. 26, pp. 923–931.
- ↑ LANGHORNE, P., COUPAR, F. and POLLOCK, A., 2009. Motor recovery after stroke: a systematic review. The Lancet Neurology. vol. 8, pp. 741–754.
- ↑ DUNCAN, PW., GOLDSTEIN, LB., MATCHAR, D., DIVINE, GW. and FEUSSNER, J., 1992. Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke [online]. August, vol. 23, no. 8, pp. 1084–1089. [viewed 3 November 2016]. Available from: http://stroke.ahajournals.org/content/23/8/1084.long
- ↑ DUNCAN, PW., GOLDSTEIN, LB., HORNER, RD., LANDSMAN, PB., SAMSA, GP. and MATCHAR, D., 1994. Similar motor recovery of upper and lower extremities after stroke. Stroke [online]. June, vol. 25, no. 6, pp. 1181–1188. [viewed 3 November 2016]. Available from: http://stroke.ahajournals.org/content/25/6/1181
- ↑ DUNCAN, PW., ZOROWITZ, R., BATES, B., CHOI, JY., GLASBERG, JJ., GRAHAM, GD., KATZ, RC., LAMBERTY, K. and REKER, D., 2005. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke [online]. September, vol. 36, no. 9, pp. 100-143. [viewed 3 November 2016] Available from: http://stroke.ahajournals.org/content/36/9/e100.full
- ↑ HEADS UP NEURO REHAB LTD., 2016. Neurological physiotherapy for long term strokes [online].[viewed 2 November 2016] Available from: http://headsup.co.uk/neurological-physiotherapy-for-long-term-strokes/
- ↑ NHS CHOICES., 2016. Parkinson's [online]. [viewed 2 November 2016]. Available from: https://www.parkinsons.org.uk/sites/default/files/appg_report_please_mind_the_gap.pdf
- ↑ PARKINSON'S DISEASE FOUNDATION., 2016. What is Parkinson's? [online]. [viewed 2 November 2016]. Available from: http://www.pdf.org/en/about_pd
- ↑ PARKINSON'S UK., 2016. What is Parkinson's? [online video]. [viewed 2 November 2016]. Available from: https://www.youtube.com/watch?v=ODX2-C2uEAs
- ↑ KEUS, SH., MUNNEKE, M., NIJKRAKE, MJ., KWAKKEL, G.and BLOEM, BR., 2009. Physical therapy in Parkinson's: evolution and future challenges. Movement Disorders. vol. 24, no. 1, pp. 1-14.
- ↑ THE NATIONAL COLLABORATING CENTRE FOR CHRONIC CONDITIONS., 2006. Parkinson's disease: national clinical guideline for diagnosis and management in primary and secondary care [online]. London: Royal College of Physicians. pp. 1-534. [viewed 2 November 2016]. Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0008867/pdf/PubMedHealth_PMH0008867.pdf
- ↑ KEUS, SH., BLOEM, BR., HENDRIKS, EJ., BREDERO-COHEN, AB. and MUNNEKE, M., 2007. Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Movement Disorders [online]. November, vol. 22, no. 4, pp. 451-460. [viewed 2 November 2016]. Available from: http://onlinelibrary.wiley.com/store/10.1002/mds.21244/asset/21244_ftp.pdf?v=1&t=iv143vsw&s=93baac2479c4103cb2114bcf8151168c0f24ca54
- ↑ TOMLINSON, C., PATEL, S., MEEK, C., HERD, C., CLARKE, C., STOWE, R., SHAH, L., SACKLEY, C., O DEANE, K., WHEATLEY, K. and IVES, N., 2012. Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis. BMJ [online]. August, vol. 345, pp. 1-14. [viewed 2 November 2016]. Available from: http://www.bmj.com/content/bmj/345/bmj.e5004.full.pdf
- ↑ 35.0 35.1 UK PARKINSON'S EXCELLENCE NETWORK., 2015. 2015 UK Parkinson's Audit Summary Report [online]. London:UK Parkinson's. pp. 1-43. [viewed 2 November 2016]. Available from: https://www.parkinsons.org.uk/sites/default/files/audit2015_summaryreport.pdf
- ↑ 36.0 36.1 36.2 36.3 ALL PARTY PARLIAMENTARY GROUP FOR PARKINSON'S DISEASE., 2009. Please mind the gap:Parkinson's disease services today [online]. pp. 1-40. [viewed 2 November 2016]. Available from: https://www.parkinsons.org.uk/sites/default/files/appg_report_please_mind_the_gap.pdf
- ↑ KEUS, SH., BLOEM, BR., VERBAAN, D., DE JONGE, PA., HOFMAN, M., VAN HILTEN, BJ. and MUNNEKE, M., 2004. Physiotherapy in Parkinson's disease: utilisation and patient satisfaction. Journal of Neurology [online]. June, vol. 251, no. 6, pp. 680-687.
- ↑ STOCCHI, F. and BLOEM, BR., 2013. Move for change part II: a European survey evaluating the impact of the EPDA Charter for people with Parkinson's disease. European Journal of Neurology [online]. March, vol. 20, no. 3, pp. 461-472 [viewed 29 October 2016]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2012.03876.x/epdf
- ↑ KAMSMA, YPT., 2002, Functional reorganisation of basic motor actions in Parkinson's: problem analysis, development and evaluation of a compensatory strategy training. Groningen.
- ↑ KNGF., 2004. Guidelines for physical therapy in patients with Parkinson's disease [online]. Netherlands: Royal Dutch Society for Physiotherapy. pp. 1-86. [viewed 29 October 2016]. Available from: http://www.appde.eu/pdfs/Dutch%20Parkinson's%20Physiotherapy%20Guidelines.pdf
- ↑ 41.0 41.1 BLOEM, B. and MUNNEKE, M., 2014. Revolutionising management of chronic disease: the ParkinsonNet approach. BMJ [online]. vol. 348, pp. 1-8 [viewed 29 October 2016]. Available from: http://www.west-info.eu/files/Revolutionising-management-of-chronic-disease_-the-ParkinsonNet-approach-_-BMJ.pdf
- ↑ 42.0 42.1 NEUROLINK PHYSIOTHERAPY LTD., 2016. Specialist neurological physiotherapy clinic: enable enhance empower-unlock your potential [online]. [viewed 3 November 2016]. Available from: http://neurolinkphysio.co.uk/index.html
- ↑ CHALLENGE CENTER., 2011. About us [online]. [viewed 3 November 2016]. Available from: http://challengecenter.org/about-us
- ↑ CHALLENGE CENTER., 2015. Challenge center video 2014 [online video]. California: Challenge Center. [viewed 3 November 2016]. Available from: https://www.youtube.com/watch?v=TDGETLa4Bm8


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read the dialogue for students and ask them to look at the paper and start the conversation with their classmates, then they can color the worksheet. have fun ;)
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School location and facilities
Temple University, Japan Campus is located within two buildings in the Minami Azabu and Mita districts in central Tokyo and is surrounded by several embassies, international companies, and two major universities. Occupying several floors of each building, TUJ provides a comfortable yet lively atmosphere, where you can expect to see the familiar faces of faculty, staff and fellow students on a regular basis.
A new campus for TUJ coming in Fall 2019
Temple University, Japan Campus has partnered with Showa Women's University to create a brand new campus for TUJ students, scheduled to open for the Fall 2019 semester. The new building will provide excellent resources for TUJ students, including study abroad students. Plans include a 9,000 square-meter academic building, enhanced common areas, a modern library, expanded and improved studio spaces, and a dedicated art gallery. Students will also have access to athletic facilities and the more traditional university setting at Showa. Showa's campus is just a 10-minute train ride from Shibuya, a popular district in Tokyo.
Read the full article on TUJ's website
Why Tokyo?
Tokyo is:
- A city at the forefront of innovation, a cosmopolitan capital rich with ancient customs that still continue to shape daily Japanese life
- A city with an incredible level of energy and vitality
- A city made up of many centers, each with its own special character
- An ideal city in which to study abroad
You could spend a lifetime exploring Tokyo and never see it all.


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Derma-Mode is the preeminent provider of permanent cosmetics and medical pigmentation in Denver.
Susan Maruyama
4700 Hale Parkway, Suite # 520
Denver, CO 80220
E. email@example.com
Time is a valuable commodity. Derma-Mode requires a non-refundable $50.00 consultation fee for all new clients at the time of reservation. This fee will be applied to the final cost of service. Should you have interest in more than one procedure, Derma-Mode will not require an additional consultation expense.
Derma-Mode is conveniently located in Central Denver at Rose Medical Center. Should you need assistance with directions, convenient parking options including free valet parking, please call or email us.


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Special Sunday and Friday
Does your daily routine oppress you? We have the right solution!
Access to our small private spa, with Jacuzzi and sauna.
The Package Included:
And if you want to make your day even more special ... lots of treatments and massages at your disposal!
DAY SPA offer in Rome
05/11/2018 - 31/12/2019
מיקום: רומא


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Who is paying lobbyists in SC and how much?
From staff reports
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Note the "updated" column in results to determine how new the data is.
This database is a list of companies and organizations that employee lobbyists at the S.C. State House, and the amounts they spend.
This data is reported twice yearly to the S.C. Ethics Commission. These figures come from year-to-date filings through July 2017.
Why do we publish this data? Lobbyists work to influence the legislative process in South Carolina, and are required to disclose lobbying activity and their principals to the state Ethics Commission.
Search tips: You can view all the lobbying principals by clicking on Search with All in the the search box. This will list all principals from highest to lowest based on the amount they paid lobbyists. To see how much a particular principal spent, click on the down arrow at the far right of the search box and scroll down until you find the desired principal and then click Search. The results for just that principal will be displayed.


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Welcome Junior Campers! A very exciting week has begun here at Tall Timber. We are hosting 3 camps: YILT, Caravan Rafting trip, and Junior camp! With a welcome dinner, skit night, mixers and campfire, junior camp is off to a great start! New friendships have already started to bloom and campers are settling in.
-Sarah (Media Specialist)


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In his role as a Child Nutrition Initiatives Specialist, Tim works with schools, community organizations, and state partners to grow access to healthy, delicious, and affordable food for all of Vermont's children. In this role, he provides individualized support to schools and communities to strengthen their use of federal child nutrition programs, including leading organizational efforts to grow breakfast and after school meal programs across the state. He is also using his experience managing and collecting data to create new data utilization tools for the organization.
Before joining Hunger Free VT, Tim worked in food service for most of the preceding 10 years. His background working with food, nutrition, and meal planning has fueled a passion for food and food systems. Always actively politically engaged, Tim is thrilled to be focusing his activist energy towards ending hunger. He is excited to be working as a part of the energetic, inspiring, and value-driven team at Hunger Free.
Tim received his Bachelor of the Arts in Politics from Oberlin College in 2011. His work at Oberlin focused on political theory and comparative political economy with a focus on class and labor politics. He enjoys engaging in lively debates, cooking, gardening, learning, and being outside. Tim lives in Williston with his partner, Barbara.


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At West Annapolis Family Dentistry, we understand that missing teeth can cause an on slot of problems. Your missing teeth may have affected your confidence and may have even hindered you from enjoying some of your favorite foods. Fortunately, our Annapolis dental office offers a wide range of tooth replacement options just for you. During your visit, family dentists Dr. Maria Colucciello and Dr. Jerry Berkow will examine your teeth to determine which replacement option is best for you. We believe that each patient should receive personalized, comprehensive dental care during each visit. During your consultation, we welcome questions and any concerns you may have about your missing teeth.
Teeth Replacement Options
Each patient is different and therefore has different needs.Dr. Colucciello and Dr. Berkow take the time to address your specific dental issues and provide the best treatment to restore your smile. Depending on your overall oral health, budget, and dental goals, we may suggest the use of dental implants, dental bridge, or dentures as your tooth replacement option.
Dentures: Dentures are used to replace the top and/or bottom arch of teeth. We can provide either a full or partial denture depending on your needs. Dentures are a removable appliance that may be removed for proper cleaning and maintenance. Under the care of an experienced dentist, dentures can function and look like natural teeth. However, for a more stable solution, dentures can be secured with the use of strategically placed dental implants. Dr. Berkow or Dr. Colucciello will need to examine your teeth to determine if implant secured dental implants are right for you.
Dental Bridge: A dental bridge can be used to replace several consecutive missing teeth. Dental bridges rely on neighboring teeth for support. The dental bridge bridges the gap between missing teeth with the use of pontics, which are held in place by dental crowns, or abutments. For a more secure solution, a dental bridge can be fixed into place using dental implants. Dental implants do not rely on neighboring teeth for support.
Dental Implants: Dental implants have one of the highest patient success rates due to its durability and comfort. Dental implants mimic the structure of your natural tooth. Dental implants act as a tooth root, which can support a dental crown, dental bridge, or denture as the final restoration. Dr. Colecciello and Dr.Berkow will perform a thorough examination of your mouth, teeth, gums, and bone structure to determine if dental implants are right for you.
Schedule an Appointment
Finding the right tooth replacement options can be time-consuming and frustrating. At West Annapolis Family Dentistry, we work with you to find the right solution to help restore your missing teeth. Dr. Colucciello and Dr. Berkow are highly trained dentists who provide advanced general, restorative, and cosmetic dentistry services to each of their patients. If you are looking for dentists you can trust, visit West Annapolis Family Dentistry. Patients can call (410) 216-4199 or schedule an appointment online.


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Dan Barnard-2009 President of home builders association of St. Louis & Eastern Missouri Wrote a column in the St.louis Post-Dispatch The week of April 5,2009.
New home buyers have something to look forward to, with some credit due to the american recovery and reinvestment act of2009 recently being signed into law, as part of the economic stimulus measures, the legislation created a homebuyers tax credit that is bigger and better than the previous credit that was implemented in July, 2008. The website www.federalhousingtaxcredit.com explains in detail the provisions of the new tax credit. We are seeing significant activity in both the resale and new-home market as first-time buyers take advantage of the credit coupled with record-low mortgage interest rates. In a nutshell, it.
Provides a tax credit equal to 10 percent of the sale price of the home,up to an $8,000 maximum and is a true tax credit. It does not need to be rpaid unless the homeowner sells the home within three years of the purchase. and in Missouri, the Missouri housing development commission has developed a plan to make $6,750 of the tax credit available immediately for down payment! Learn more at www.mhdc.com under Homeownership.
Can only be used with the purchase of a home that will be the buyers principal residence. It cannot be claimed for the purchase of a vaction home or property to be used as a rental.
Is available to first-time homebuyers only with a modified adjusted gross income less than$95,000 for a single tax payers or $170,000 for married filers. A first time home Buyer is defined as someone who has not owned a principal residence for three years or more.
Applies to homes purchased by qualified buyers between Jan 1 and Nov30,2009. The purchase date is the date when closing occurs and the title transfers.
Allows unmarried joint purchasers to allocate the credit amount to amy Buyer who qualifies as a first-time buyer. Also, a parent who jointly purchases a home with a child can allocate the credit to the child. The same goes for two unmarried people one who owns a home and the other who does not, who purchase a home together befor getting married can allocate the credit to the taxpayer who qualifies as a first-time Homebuyer.This new tax credit provides an uprecedented opportunity for people looking to Buy their first home. Not only will they riceive an $8,000 tax credit, they also will be taking advantage of record-low interest rates, a large selection of homes to choose from and competitive home prices.
House hunters will also find that many builders have inventory that is move-in ready, and may offer upgrades or other incentives to seal the deal. Also, owners of existing homes who are looking to trade-up or relocate are ready to bargain.


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Friday, May 10, 2013
The Cinema File #175: "The Frankenstein Theory" Review
This is the first of a loose and most likely out of sequence trilogy of movie reviews focusing on recent films based on or inspired by classic Universal horror monsters, something I decided to do after recently being so disappointed by the vampire comedy Vamp U. To kick off this mini-series, I figured I might as well start with the one featuring my personal favorite movie monster, Frankenstein, which is to say the monster named Frankenstein, not the doctor named Dr. Frankenstein. Yeah, I still hate that nerdy debate. Anyway, the movie is called The Frankenstein Theory, a unique twist on the found footage format that might be the first mostly traditional example of the genre that I have actually enjoyed.
The story follows a historian who has come to believe that Mary Shelly's original novel Frankenstein is actually secretly a work of non-fiction, and sets out into the Canadian wilderness to prove his theory and find first hand evidence of the still living creature. The premise would have been an interesting one even independent of the found footage gimmick, but as it is its the first time I've ever actually been excited to watch a found footage movie after reading what it was about, and for the most part, it didn't disappoint. It indulges in all the cliches of the genre but presents them in an original context and with rich characters that I could invest in, making the experience much more watchable than it probably has any right to be.
As I was watching, I found myself marveling at both how far we've come with these movies, and how much we're still stuck in the same rut with this genre. With all due respect to the five or six Last Broadcast fans out there, The Blair Witch Project was what really started this trend, and even as we've moved on to the suburbs with the Paranormal Activity movies, it still seems like the vast majority of found footage movies I see are the same group of douche bags traipsing through the woods until they die. I watched not one but two Bigfoot found footage movies just last year with that formula. But even as we go through the same motions, the mysterious poorly shot something out there has gotten more and more esoteric as we've run out of the basics. Frankenstein might be the weirdest one so far, but probably not the weirdest yet to come.
And yet it works a lot better than I expected it would. I'm not saying its plausible, as if any found footage monster is, but I was surprised by how quickly I was able to accept the world of this movie and go along for the ride. Much like the last decent found footage movie I watched, The Lost Coast Tapes, the writing and acting here is clearly more geared towards witty hyper-realistic characters rather than authentically boring ones, but again I think it helps the film immensely, especially considering its not like I was going to suspend my disbelief and pretend these were real people anyway. Much of the dialogue is funny or at least charming when its supposed to be, enough that I feel for the characters by the time the carnage is unleashed and they start getting picked off one by one.
Overall, as strange as it is for me to say it given my own personal biases against this type of movie, I would definitely recommend giving The Frankenstein Theory a shot. Its available on Netflix Streaming as of this writing, and while it follows the standard formula that you've seen again and again, it does it better than I've ever seen it at least in long form, not counting the surprisingly good anthology film VHS. It maintains a level of intrigue and tension throughout, and if you can resist what I guess would be the knee jerk reaction to dismiss the film based on its particularly silly premise, there's more here than I was certainly expecting to find, and enough to justify the effort of watching.
Labels: Movies, The Cinema File
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Chris Powell: Cowardice of press, miners, financial industry sustains gold market riggingSubmitted by cpowell on Thu, 2016-04-14 10:09. Section: Documentation
Remarks by Chris Powell, Secretary/Treasurer
Gold Anti-Trust Action Committee Inc.
Mining Investment Asia Conference
Marina Bay Sands, Singapore
Thursday, April 14, 2016
I'm here again this year to update you on the surreptitious manipulation of the gold market by central banks and to explain how this surreptitious manipulation now extends to all major markets around the world.
All central banks swap gold, Venezuelan central banker says, but who asks why?Submitted by cpowell on Tue, 2016-03-22 23:29. Section: Documentation
7:32a ChST Wednesday, March 23, 2016
Dear Friend of GATA and Gold:
In the report excerpted below Reuters reminds us today that in February the president of Venezuela's central bank, Nelson Merentes, discussing gold swaps such as those the bank had begun, told the news agency: "It's normal. All central banks do this."
NATO overthrew Libyan dictator to prevent gold-backed African currencySubmitted by cpowell on Sun, 2016-01-10 00:41. Section: Documentation
Hillary Emails Reveal True Motive for Libya Intervention
Newly disclosed emails show that Libya's plan to create a gold-backed currency to compete with the euro and dollar was a motive for NATO's intervention
By Brad Hoff
Foreign Policy Journal, Cross Village, Michigan
Wednesday, January 6, 2016
Central banks, LBMA are one and the same; and gold price suppression's Asian angleSubmitted by cpowell on Thu, 2015-10-29 20:15. Section: Documentation
3:29p CT Thursday, October 29, 2015
Dear Friend of GATA and Gold:
Freelance financial journalist Lars Schall today reports another brief exchange with the press officer of Austria's central bank, Christian Gutlederer, that is illuminating though it wasn't meant to be.
Austrian central bank won't answer questions about its exec's remark on gold interventionSubmitted by cpowell on Wed, 2015-10-28 22:40. Section: Documentation
5:37p CT Wednesday, October 28, 2015
Dear Friend of GATA and Gold:
Chris Powell: Gold market manipulation updateSubmitted by cpowell on Wed, 2015-10-28 21:55. Section: Documentation
By Chris Powell, Secretary/Treasurer
Gold Anti-Trust Action Committee Inc.
New Orleans Investment Conference
Hilton New Orleans Riverside Hotel
Wednesday, October 28, 2015
Everything about the financial markets today must begin with two documents.
Austrian central bank refuses questions about executive's assertion of gold interventionsSubmitted by cpowell on Tue, 2015-10-27 12:25. Section: Documentation
7:24a CT Tuesday, October 27, 2015
Dear Friend of GATA and Gold:
The German freelance financial journalist Lars Schall has done again what no mainstream financial journalist in the world dares to do: put critical questions about gold to a central bank.
Did Austrian central banker just acknowledge gold market intervention?Submitted by cpowell on Wed, 2015-10-21 03:39. Section: Documentation
11:43p ET Tuesday, October 20, 2015
Dear Friend of GATA and Gold:
Did Peter Mooslechner, an executive director of Austria's central bank, interviewed this week by Daniela Cambone of Kitco News on the sidelines of the London Bullion Market Association conference in Vienna, say that Asian central banks are using their gold reserves for market intervention?
Ronan Manly: Central banks' secrecy and silence on gold storage arrangementsSubmitted by cpowell on Wed, 2015-09-30 01:01. Section: Documentation
9:13p ET Tuesday, September 29, 2015
Dear Friend of GATA and Gold:
Koos Jansen: Monetary gold escapes international trade reportsSubmitted by cpowell on Mon, 2015-09-21 12:30. Section: Documentation
8:33a ET Monday, September 21, 2015
Dear Friend of GATA and Gold:


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Women's Leadership Conference
Wednesday, April 3, 2019
**Registration is Full.**
To be placed on the waitlist, contact Kristy Mayer at email@example.com.
The conference will explore the theme: Finding Your Power: Cultivating Authentic Leadership. This year's theme speaks to the importance of culture change through individual and shared empowerment, cultivating leadership through positive, open and honest relationships; and building a diverse and innovative community to create dynamic, respectful and inclusive work environments. The conference will be held at the University Inn Best Western in Moscow.
About the Conference
A partnership between the University of Idaho and Washington State University, the Women's Leadership Conference invites all women in higher education — students, staff, faculty and administrators — to come together for a day of learning, networking and sharing. Join us to celebrate our differences, build common ground and create an empowered community of professional colleagues.
Women's Center
A campus advocate for equality, racial and gender equity, women's reproductive health, and ending violence against women and LGBTQA/gender discrimination. Located in Memorial Gym Room 109.
WSU Women*s Center
Cosponsors and Co-organizers of the Women's Leadership Conference
Athena is an association of U of I staff and faculty committed to promoting an inclusive and equitable climate for women.


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Can you believe that this is the first muffin recipe to make it to the blog?! There are a lot of muffin recipes out there that are a bit too dense or too sugary, so making a perfectly fluffy muffin with tons of flavor was so easy task. However, these muffins do not disappoint! You can even top your muffins with candied oranges and fresh raspberries to make these muffins extra fun. I seriously cannot wait for you all to try these absolutely delicious Vegan Orange & Raspberry Jam Muffins!
Jammy Muffins?! I'm sold! Jump to Recipe
Why Jam Works Best!
So you might be wondering- why jam-filled muffins? Well, honestly, I originally tried this recipe with fresh berries and was not a fan! They actually had a really good texture and were perfectly moist, but the berries themselves shrunk and therefore the muffins were left with huge holes in them. Maybe it's just my baking skills not being up to par, but switching to jam completely eliminated this problem. However, once I brought a more sugary jam into the picture, I needed a to add a little tang to the mix. Adding in some fresh squeezed orange juice and zest was the perfect touch!
Some Key Tips & Tricks
One really important step you don't want to miss when making these muffins is to VERY gently fold in the jam. Seriously, you really want thick swirls and don't want the jam to be perfectly mixed into the batter. Whenever I fold in any ingredient, I always use a rubber spatula. I imagine if you don't have that on hand a large wooden spoon might do the trick, but please no whisks or forks or you will ruin the swirly jammy goodness of these muffins!
Also, definitely only stick to baking powder when making these muffins or you might end up with green muffins! Fun fact, but the pigments in raspberries are very sensitive to pH and, when mixed with baking soda or another alkaline, they will turn your batter green. Also, you'll want to make sure to avoid baking powder with any aluminum in it or you'll have the same problem. I did call out aluminum free baking powder in the recipe but just wanted to explain the "why" a bit more for you all as well.
In other news, I just got back from a week-long trip to London where I was totally inspired by all the food I was eating, so I can't wait to start baking and cooking more for Fall! I was actually blown away by all the vegan food options I was able to find in London- especially all the perfect sourdough bread and avocado toast I ate. I have to say, I left totally in love with the city and am already scheming on how I can get back there sometime very soon. I guess I'll have to make do with the large container of tea I brought back in the meantime. Dare I say the perfect compliment to these jam-filled muffins?!
Hope you all have a great week, and I'll see you back here September 12th when weekly recipes will resume (yayyyy!)!
In case you are looking for some of the tools & ingredients used in this recipe, I've put a few of my favorites for you here:
- Per usual, I baked these goodies with my favorite brand of flour, Bob's Red Mill Organic All Purpose Flour. I promise, not sponsored, just seriously their biggest fan!
- You really don't need a fancy muffin pan to make great muffins, but having one that is non-stick is definitely helpful. I use the Wilton 12-cup regular muffin pan and love it! Also, I prefer to use muffin liners because it makes for super easy cleanup and easy transport of muffins. Silicone cups are a great reusable option, but I personally used Alere Unbleached Muffin Baking Cups for a non-toxic liner.
- 1.5 cups almond milk (or other milk alternative)
- 1/4 cup melted coconut oil
- 1/2 Tbsp apple cider vinegar
- 1 Tbsp fresh orange juice (juice from about 1/2 navel orange)
- 1 tsp orange zest
- 1/2 cup sugar
- 1 tsp vanilla bean paste/extract
- 2 cups all purpose flour
- 2 tsp baking powder *make sure aluminum-free
- 1 tsp salt
- 3/4 cup raspberry jam
- Preheat your oven to 350F.
- In a large mixing bowl add in your nut milk, apple cider vinegar, orange juice, and orange zest and let sit 5-10 minutes until curdled.
- Next, add in your vanilla bean paste/extract and coconut oil and mix until combined.
- In a separate mixing bowl sift together your flour, baking powder, and salt. Slowly add this dry mixture to the wet mixture and whisk to combine into a thick batter.
- Take your raspberry jam and very gently fold it into the muffin batter using a spatula or wooden spoon. Do not over-mix as large swirls of jam are desired!
- Spray muffin liners and fill until they are about 3/4 of the way filled with batter. Top your muffins with additional sugar (optional) and bake for 28-32 minutes until the tops are beginning to brown and center is cooked through but still moist. Remove from the oven and let cool. Enjoy!


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I like it but it's too calm for me, it starts off almost silent and suddenly bass kicks in a little, then silence again, it brings suspense and then it starts calmly, I like this but could have done more on this because its the same thing over and over from this point.
Please contact me if you would like to use this in a project. We can discuss the details.


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We want to help spread the word about your benefit or wedding!
Please fill out the applicable form and include as much detail as you'd like in the comment section. The editors at Currents welcome your submission and reserve the right to edit as needed.
Currents is a lifestyle & society publication that delivers editorial excellence aimed at local people, about local people. Simply call (440) 247-5335 if you should have any questions.


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Receive money instantly into your Co-op bank account via PesaLink.
The PesaLink service allows you to transfer money into a Co-op Bank account instantly from another bank.
You can transfer as little as Ksh 10 up to Ksh 200,000 at an extremely low cost between Ksh 0 to Ksh 152, depending on the amount you transfer.
In addition, you can make payments directly from your Co-op Bank account to any local bank account instantly from as little as Ksh 10 up to Ksh 200,000.
Simply access MCo-op Cash via *667# or open the MCo-op Cash app, select PESALINK, and link your Co-op Bank accounts to your mobile number. Linking your accounts is free of charge.
Once you link your Co-op Bank accounts to PesaLink, you will be able to access PesaLink services via:
- Co-op Kwa Jirani Agents
- Co-op Bank ATMs
- Co-op Bank Mobile Banking (MCo-op Cash)
- Our branches
PesaLink services are available to customers 24/7. You can receive money into your Co-op Bank account at any time of the day.
Linking your Co-op Bank Account to PesaLink from a Co-op Bank ATM
- Insert your Co-op Bank Visa Card and input PIN.
- Select 'Other Transactions'.
- Select 'PESALINK'.
- Select 'Link Phone'.
- Input the phone number to be linked.
- Confirm to make the account the primary account.
- You will receive a confirmation message.
- Select the option of doing another transaction.
- Select 'Primary Account Option' on the upper right hand side of the screen.
- Input the phone number to be linked to the account.
- Confirm that you wish to make that account the 'Primary Account' by clicking the 'Okay' button.
- You will then get a confirmation message on the screen that the linking was successful.
How to link your Co-op Bank Account to PesaLink via MCo-op Cash
- Go to the MCo-op Cash app or dial *667# to access the MCo-op Cash USSD.
- Select 'PesaLink' menu.
- Select 'Link your Phone'.
- Select the account number you want linked.
- Select 'yes' to make the account the primary account.
- A confirmation with details will be displayed on the phone.
- You will then receive an SMS confirmation of the linking
PesaLink Charges
|PesaLink Limits(Co-op Bank)
|Amount (KES)
|Maximum amount you can send per transaction
|Maximum amount you can send per day
|Maximum amount you can receiver per transaction /per day
|Fees (KES)
|0 - 500
|501 - 10,000
|10,001 – 50,000
|50,001 – 70,000
|70,001 – 100,000
|100,001 – 200,000


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[ Ref. 10558 ]
Retail friendly detailing kit
Contains: Slick Mist, Interior Detailer and Tire & Trim
Includes micro fibre cloth and tyre sponge
Ideal for use on cars, trucks, motorcycles, ATVs, boats, planes & RVs
Use on wet or dry surfaces
[ Ref. 10160B ]
Premium Paint Gloss Intensifier
Great for Cars, Trucks, Boats, and Airplanes
Shines and Protects in One Easy Application
Excellent Results on Chrome, Glass and Vinyl Decals
Use on Wet or Dry Surfaces
If necessary, wash and rinse vehicle
Shake well before using to activate ingredients
Apply a fine mist to wet or dry surface
Wipe dry with a soft towel
Between washes, simply mist on and wipe off to keep that showroom shine.
ATTENTION: Do not use any Slick Mist products on floors, vehicle controls (Pedals, grips, steering wheels), Motorcycle seats or tyres, bicycle seats or tyres, brake drums any any other surfaces where slipperiness may be hazardous.
Suitable for use with 6V & 12V lead-acid and 12V AGM batteries of 1.2Ah to 120Ah
Not recommended for use with GEL batteries
Input: 230V AC 50Hz 0.6A
Outputs: 6V: 4A DC 12V:4A DC
Automatic detection of battery voltage & condition


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It is possible to construct an inexpensive homemade trellis using twigs collected from your backyard and local field. This not only helps recycle old twigs, but your new, low-budget gardening structure will lift climbing vines off the ground and free up yard space. A twig trellis looks natural and rustic, perfect for the garden. Construct a diamond-patterned trellis using twigs and inexpensive materials to add charm to your yard or garden spot.
Separate the twigs into bundles according to their length. Also, cut 6-inch lengths of twine (to form a bundle), which you will use to assemble the trellis. Cut a 5-inch-long spacing twig, and a 3-foot-long twig that you will use as a height guide.
Insert a 5-foot-tall support twig in the ground to demarcate a corner of your trellis. Push it 8 to 10 inches deep. Insert an identical support twig on the other corner. Measure the distance between both the corner support twigs and push a third identical support twig in the center.
Place the spacing twig horizontally in front of the support twig in the center. Push a twig diagonally at each corner of this spacing guide at an angle of 60 degrees, ensuring each goes 3 inches deep in the ground. Keep both diagonal twigs parallel. Insert two diagonal sticks at the base of the first ones but in the opposite direction, ensuring they cross the support stick from the front.
Push three to four more diagonal twigs in the ground, in the direction of the first twigs, and space them 5 inches apart. Push the same number of diagonal twigs in the ground, but in the other direction. Weave intersecting twigs over one another. Bind intersecting twigs near the top, bottom and center by knotting them with the lengths of cut wire.
Continue inserting diagonal twigs in the ground until you reach the ends of the trellis. Secure the end twigs and corner supports with twine. Stand the 3-foot height reference twig on the ground next to the trellis. Use handheld pruners to trim the tops of the trellis twigs so they are equally tall.
Things You Will Need
- 1/2-inch-wide, 4-foot-tall twigs
- Lightweight wire
- Scissors
- 3 support twigs, 5 feet tall
- Hand pruners
- Use 60 4-foot long twigs to construct a 3-foot tall trellis that is 10 feet long.
More Articles
- Build a Garden Arbor Out of Branches and Limbs
- Secure a Trellis
- Install a Trellis
- Use a Rose Trellis
- Build an Angled Pergola
- Make Vine & Branch Fencing
- Make Bamboo Crafts
- Train a Zucchini Plant to Grow Up a Trellis
- Build an Overhead Grape Vine Trellis
- Make Your Own Garden Bench
- Make Your Own Wooden Landscape Edging
- Build a Vineyard Trellis


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Looking for the best makeup remover?
Killer Cleanser lifts off makeup and dirt while soothing and nourishing the skin. Helps soften mascara and removes waterproof makeup quickly and efficiently. Skin looks refreshed and smooth.
This formula contains Aloe Vera, Jojoba Oil, and Vitamin E. Blends and melts into skin effortlessly and can also be used as an all over body creme to moisturize dry skin!
Product Ingredients: Aloe Barbadensis Leaf, Petrolatum, Purified Water, Mineral Oil, Laureth-4, Simmondsia Chinensis (Jojoba) Seed Oil, Prunus Avium (Sweet Cherry) Seed Oil, Paraffin, Cetyl Alcohol, Diazolidinyl Urea, Methylparaben, Fragrance, Propyparaben, Tocopherol, Yellow 5.


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HOT TOPIC! Deepika Padukone Talks About Ranveer Singh's Insecurity As A Boyfriend!
Lovebirds Deepika Padukone and Ranveer Singh, are on top of the world after winning the Filmfare Awards 2016 for the 'Best Actor' & 'Best Actress' for Sanjay Leela Bhansali's Bajirao Mastani and Shoojit Sircar's Piku.
While Deepika and Ranveer are enjoying every moment of their love life, Katrina Kaif and Ranbir Kapoor are left heartbroken after ending their relationship with each other again.
Deepika Padukone, says only her boyfriend Ranveer Singh can answer the question if he would he feel comfortable, if she's working with Ranbir Kapoor once again.
Lovebirds Ranveer Singh and Deepika Padukone, always praise each other and showcase their feelings at every opportunity.
Deepika Padukone
Deepika Padukone, has dodged the question very carefully and now kept the onus on Ranveer Singh to answer, if he would feel comfortable seeing Deepika working with Ranbir Kapoor or not.
Wait & Watch
We will now have to wait and watch the reply of Ranveer Singh, whether he wants his girlfriend Deepika Padukone to work with Ranbir Kapoor in the future.
Awesome Threesome!
It would be really awesome to see Deepika Padukone, Ranveer Singh and Ranbir Kapoor on-screen together someday, of course.
The award winning actress, Deepika Padukone spoke exclusively to Filmfare, about the idea of her working with her ex-boyfriend Ranbir Kapoor. Would Ranveer feel secure if that ever happens?
Deepika Padukone was quoted as saying,
"Is he secure? You have to ask him. How secure or insecure is my boyfriend? I can't answer that question on his behalf. It would be unfair. But what I will definitely say is that I'm going to take a bit of credit for that. I also make it easier by being honest about my feelings for all the people in my life, good, bad, past and present. I'm very, very clear and honest that this is how it is. I make the relationship easier if at all."
Yes, for the first time ever, Deepika Padukone has said the words 'Ranveer Singh & my boyfriend' in a single quote. That's just amazing coming out from a private person like, Deepika Padukone.
Also Read: Revealed! Raees Heroine Mahira Khan's Role In The Movie
Both Deepika Padukone and Ranveer Singh, can't stop talking about each other, and at every given opportunity, the couple end up praising each other and showcase their true feelings.
So Deepika Padukone, has cleverly backed out of the question by saying only her boyfriend Ranveer Singh, can answer the question whether he feels comfortable, when she works with Ranbir Kapoor or not.
Also Read: Was Sunny Leone's Interview With Bhupendra Chaubey A Publicity Gimmick For Mastizaade?


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Why Mothering Permits Me To Be Only a Pseudo Intellectual
When I have time to read a book, I read a shitty one. One that doesn't utilize any of my (former?) intellectual prowess. In my down time my brain turns into a big stinking pile of mush.
I have two kids and it is wonderful and mind-numbing and inspiring and brutal.
I miss my life. I miss by brain. I miss my husband. I miss my work. Yes. I still get to all of those things. But, god, remember when you could stay up all night and work on something? I can't. If I do (and I have) my next day(s) are brutal. It is just not worth it and OH man I am sad about that. I covet you - you stay-up-all-night-and-create-amazing-works-of-art people.
There. There I am. That complaining mom. Who only has lots of little slivers and no BIG chunk. I am spread thin. And I am complaining and YET. AND YET. I chose this. And, you know what? I choose it again, day after day. I am not willing to give up anything that I love, even if it means I am spread thin.
I know you've heard this before, but we only live once. Motherfucker, even this moment is close to over. So if there is something you want, TAKE IT. Maybe you can drown in it and roll around in it and languish in it. But stick your toe in. Half-ass it if you must. Keep trying.


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Are you shy? Do you feel uncomfortable or embarrassed when speaking English? Are you envious when your classmates, coworkers, or friends seem so comfortable speaking English to each other or in front of groups? In this video, I will give you advice to overcome your shyness. If you are shy, don't be discouraged, because you can learn English just as well as talkative, social people, but you need to use different strategies. Today, I will share my tips and tricks with you to help you break out of your shell!
Did you understand the video? Take the quiz to find out: http://www.engvid.com/how-to-learn-english-if-you-are-shy/
Hi there. My name is Emma, and in today's video I am going to help you become a better speaker, especially if you are shy. Okay? So, a lot of people when they learn new languages, they're very embarrassed and they're too shy to speak. This video will help you with good tips and strategies on how to become more confident in your speaking. So let's get started.
Okay, so the first thing I like to tell shy people, so people who are afraid to speak, is: You need to find your strengths. You need to ask yourself: "What am I good at?" Because a lot of the times, shy people, they think: "Oh my goodness, I'm not good at speaking, I'm terrible at English, I'll never learn this language", and they feel really sad. But that's not usually true. Usually shy people are good at many different things, they just don't realize it. So remember: English is not only speaking. Speaking is part of it, but there are other skills, too. Maybe you're a great listener. Okay? Maybe you're good at grammar. Maybe you're not good at all grammar, but you're amazing at the present perfect or the simple past. You know, maybe you're good at reading or writing. So it's good to recognize what you're good at so you don't feel so sad when you're learning English, because you might be good at a lot of different things. So, you can always write down on a piece of paper: "I am able to", you know, listen very well, or: "I am able to do well on my grammar test." Okay? So think about: What are your strengths?
My next tip is probably one of the most important tips. When you're trying to learn a language, especially when you're shy, it's good to make goals and to write them down. Okay? So what do I mean by goals? Well, for example, I have three goals here and I'm going to talk about each of them. Somebody's goal might be: "I will be a better speaker." Or they might say: "I will say two things in class today." Or: "I will ask two people: 'How is your day going?'" So these are all goals, but these goals are not all great goals. What do I mean by that? Well, this first goal: "I will be a better speaker", you will not know if you've become a better speaker or not. This goal, it's too big so I would not use this goal. Okay?
When you make a goal it's good to make something where you have a number in it, and you can tell very easily: Did you do it or didn't you do it? So, for example: "I will say two things in class today", this is a great goal because you know: "Okay, I said two things in class, I met my goal for the day." This will really help you with speaking, especially if you're shy. Maybe you're too shy even to say two things in class, so maybe you can say one thing in class or maybe for the first class you can just listen and try for the next class to say one thing. Okay? Another example of a great goal is: "I will ask two", and again, this can be any number. "I will ask two people: 'How is your day going today?'" So just by making goals, it can really encourage you to speak and practice your English, and you will improve this way because it is important to speak as much as you can. This way, you know, it's not too difficult, it's something you can do. The other key point here is: Write down your goals. I think it's great to have a journal or a diary where you write down your daily goal, and then at the end of the week you can check it off and see: Did I meet this goal? Hopefully you did, and that way you can actually monitor your English progress. So now let's look at some more tips.
Okay, so my next tip is very important, too: Don't compare yourself to extroverts. So, what is an extrovert? It's the opposite of a shy person. So, an extrovert is somebody who everybody pays attention to because they love to talk, they're great in social situations, they're usually with friends or out with people. So, an extrovert is somebody who's not really shy. So, what a lot of shy people do is they compare themselves. They see the extrovert, and they think: "Wow, I wish I was just like that person. That person's speaking is so good. Why can't I speak like that?" It's very common to compare yourself, but it's not a good idea, because number one, it's possible that person is making a lot of mistakes.


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Kickass music
micheinnz turned me on to this, David Byrne and Brian Eno's latest collaboration. Good stuff, and I do NOT like Byrne in general.
http://www.everythingthathappens.com/ and if you have the latest Flash player, you can listen to the entire album online for free. They also offer a free MP3 download of one of the songs.
And if you want to know just how good I think this album is?
I paid for it.
Yes, really.


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Influencer Marketing Channels
Obviously supports all of the major influencer marketing channels:
Instagram, YouTube, Pinterest, Twitter, Snapchat, Blogs & more
Optimize your campaign by leveraging the ideal social channel for your brand
Every social media platform has different strengths, and selecting the ideal channel for your campaign can be challenging. Fortunately, the experts at Obviously have an in-depth understanding of the social media landscape. We'll guide you towards the perfect channel for your brand, and make sure you get the most of your influencer campaign.
Instagram is the most popular channel for social media marketing, and with good reason. High engagement, dedicated audiences, and professional-quality ad content make this the ideal channel for visual and product-based campaigns.
YouTube is great for authentic product reviews and tutorials. This platform is perfect for brands who are hoping for a more in-depth look at their product.
Blogs are the original influencer marketing platform, and provide a great alternative for brands looking for long-form reviews. Obviously can also provide custom trackable links to your brand's landing page.
Other Platforms
For brands with particular goals, Obviously can leverage alternative influencer channels, such as Twitter, Pinterest, and Snapchat. Speak to our experts to find out will work best for you!


text: Search Results We have found 1 classified ads matching your search query. Close Sort By: TitleDatePopularityFeaturedRatingPrice List Grid Mr. Locksmith Vancouver Posted 08 months 29 days 14 hours 32 minutes ago. Services 123 Address: 555 West Hastings Street, Vancouver BC V6B 4N4 001 We're a family owned and operated business that provides Professional Locksmithing & Security Services on a 24-hour basis. If you need $NA Unknown 1 Page 1 of 1


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International Lifestyle PR, Branding and Marketing Agency
International Lifestyle PR, Branding and Marketing Agency
Case Study 1
The Client: International Lifestyle PR, Branding and Marketing Agency, New York City.
The Brief: Individual coaching for senior executives alongside a program of team development workshops to help integrate new team members, developing 'soft' skills and creating inspiration.
The Company: 150 + staff in London, New York and LA. After a 2018 merger with a similarly sized, West Coast-based agency - the company asked me to give individual executive coaching to newly hired senior managers and to run a program of training/development workshops to enhance team integration.
To date I've run 3 workshops - Communication, Public-Speaking & Pitching and Confidence.
The company directors and Head of HR asked for my help to coach two senior team members who were struggling with increased demands and expectations due to the merger.
Coaching clients:
Client 1: Senior Executive leading a team of 5.
Task: improving prioritization and learning to give critical feedback to team.
My client struggled with prioritizing due to increasing work expectations as well as finding it hard to give appropriate (including critical feedback) to her co-workers and his team of 5.
We worked together over 8 weekly 50 minute sessions. I taught my client meaningful communication skills - being able to acknowledge and express his feelings, how to listen and show empathy and being able to put himself in someone else's shoes when giving feedback.
I set tasks each week with for interactions with his team and for de-briefing and reflection/learning in follow-up sessions. I used role-play, empathic interactions with his difficulties and assertiveness skills training using a combination of body work, journal keeping, CBT (cognitive behavioral therapy) and mindfulness.
From the Head of HR his team felt they were being heard and responded to in new and more work-appropriate ways.
My client told me he felt more confidence in being able to express himself, being able to give clearer instructions and better able to relate to his team.
We had a one-off session three months after our work ended to ensure these improvements were 'bedded in' and on going. Happily, they were.
Client 2
Head of Finance. Presenting issue: assertiveness, learning to say 'No' and setting boundaries with stressed co-workers.
My client and I worked with over two intensive (1.5 hour) sessions offering role-play, CBT (cognitive behavioral therapy) techniques and a program of 'real life' tasks between each session to practice new skills and strategies.
As the support and insights required were specific, I felt two longer sessions would work best for her. These longer, intensive sessions appealed to my client and were better able to work around her busy schedule.
My client felt 'listened to for the first time' since joining the company in 2015. She enjoyed our sessions which she said were 'engaging, informative and fun'. She found the role-play and the between sessions tasks she described as 'really helpful'. She had been struggling to say 'No' both at work and in her personal life.
It was 'hugely helpful', she said and that she could risk changing her communication style knowing she had the support of the follow-up session with me.
Team Development
The company directors and myself felt my workshops on the Communication, Public-Speaking & Pitching and Confidence would be the most useful for the company to roll out now.
Because of the ever-urgent need to present and pitch to clients and internally, improving public speaking was added too.
Both two hour workshops were attended by over 60 people in the New York office. My workshops integrate latest research in business psychology, neuroscience, philosophy and coaching as well as paired work, group discussion and role-play. Sessions usually run for 2 hours.
Feedback was positive and enthusiastic. Comments such as 'can we have more of this, please!', 'I didn't realize communication was a skill I can get better at' and, 'it was good to work with people I don't normally come across in my day-to-day role'.
I have an ongoing relationship with this company to provide individual coaching and team development sessions when required. The company lets me know about staff changes and structural changes that may need my support and help with coaching or workshops.
An anticipated office move in the next 6 months and taking on new staff in the coming months will mean my support will needed again soon.
Feedback from the directors - my personal background in media, journalism, publishing and creative, this company feels by working with me they have an expert on hand who is sensitive to the pressures and expectations specific to their industry.


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For months I've been hiking Table Mountain and Cape Town's outlying nature reserves. The Western Cape has so many beautiful reserves it will take a long time to visit them all! Last weekend the hike was at Jonkershoek Nature Reserve near Stellenbosch.
"Jonkershoek is one of four nature reserves that are part of the greater Cape Winelands Biosphere – a World Heritage Site registered by UNESCO in late 2007. The Biosphere reserve is gorgeous – beautiful is an understatement."
Jonkershoek Reserve is surrounded by the Jonkershoek Mountains, a part of the larger Boland Mountain Range, which in turn is part of the Hottentots Holland Nature Reserve. The area is strikingly beautiful with hiking trails embraced by magnificent blue jagged peaks. Thick fynbos vegetation is heaven for sunbirds and sugarbirds.
There are two major waterfalls in the Jonkershoek Reserve. The hike to Tweede Waterval (second waterfall in Afrikaans) flows along the fertile hills of Guardian Peak (Blaauwklippen Valley in Afrikaans). Guardian Peak, also called the "Hidden Valley", is well-known for its popular restaurants and wine estates, including those in Stellenbosch, Franschhoek, and Paarl.
The ascent to the waterfall was steep, windy, and rocky. Bordered by bud-laden protea forests, the scenic trail is rich in mountain fynbos, and rock pools ending in a wooded cove near the base of Tweede Waterfall. I'm fascinated by exotic Cape Proteas! Hundreds of different protea types flourish in South Africa's rich fynbos vegetation.
If you wanted to get closer to the waterfall, you were sure to get wet. Some in our hiking group removed their boots and climbed to the base of the waterfall barefooted. Others stayed behind in the cove and enjoyed more distant views. After climbing in the cool spray over a few slippery boulder-sized rocks, I decided it was too risky, wimped out, and returned to the cove.
Taking a leisurely pace, we returned via Jonkershoek's first waterfall – also impressive. The brisk clear winter weather was perfect for hiking. After a peaceful, inspiring day enjoying nature we stopped at an outdoor café for well-deserved cappuccino.
Now that I've been in Cape Town for almost six months I'm considering moving to a less-populated outlying suburb for contrast. Stellenbosch and Somerset West near the Helderberg Mountains, Hout Bay, Gordons Bay, Fish Hoek, and Hermanus are interesting possibilities.


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Creating the Screencast
Unable to display content. Adobe Flash is required. Although it only took me about a half hour, I enjoyed my time creating the screencast. I initially had a difficult time thinking of a website that I could use for the assignment, as it felt like a such a broad task to take … More Creating the Screencast


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Mirchaiya residents protest against tax hikeResidents of Mirchaiya, Siraha, took out a rally to protest against the municipality's decision to hike tax rates on Wednesday.
Bharat Jarghamagar
Residents of Mirchaiya, Siraha, took out a rally to protest against the municipality's decision to hike tax rates on Wednesday.
Vice-chairman of Siraha Chamber of Commerce and Industry Ashok Kumar Sah said they were compelled to take out the rally as the municipality did not address their demands despite the 15-day ultimatum they had issued to the municipality to revise the tax rates. According to the protesters, the mayor of the municipality had agreed to address their demand within August 31.
They had demanded the municipality to register personal records of the citizens free of cost and make the municipality's income details transparent. As the municipality haphazardly hiked taxes and fees, both public
and private sectors have taken to the streets to protest the hike.
The agitating Mirchaiya residents said the municipality has imposed huge taxes even on poultry. As per the municipality's decision, people will have to pay a tax of Rs 20 for selling a pair of ducks and Rs 50 for a chicken. Previously, no taxes were levied on poultry.
Besides, the municipality has also raised the annual tax on highway-side home owners to Rs 60,000. Sah said they will not accept random taxation imposed by the local government.
Pradip Mahaseth, a leader of the Nepal Communist Party, said they will continue to protest until the municipality revises the tax rates.