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- The volume of procedures at ambulatory surgery centers is forecast to grow by 6% to 7% a year through 2021.
- Orthopedic, spine and cardio procedures will increase the fastest through the mid-2020s.
- Medtech companies' traditional commercial model is too costly and complex for ambulatory surgery centers.
- Surgeons at ambulatory surgery centers have a greater propensity than those in hospitals to switch to a competing device manufacturer if offered a discount.
Ambulatory surgery centers (ASCs) are transforming healthcare delivery as well as the market for medical devices and equipment. By focusing on routine, lower-risk procedures in a more convenient setting, ASCs can offer surgical procedures at rates 35% to 50% lower than hospitals. That's saving the US healthcare system an estimated $40 billion a year and fueling ASC growth. In 2018, 5,700 ASCs operating in the US performed 23 million procedures and generated $35 billion in revenue.
The steady growth of ASCs creates new challenges and opportunities for medtech companies. Most leadership teams have been focused on acute care hospitals as their primary customers given their historical dominance of most surgical procedures; as a result, they have not devoted much strategic energy and attention to ASCs as an important customer channel.
Now it's becoming urgent. ASCs performed more than half of all outpatient surgeries in 2017, up from 32% in 2005, and their influence is set to increase. Bain research shows procedures performed at ASCs will grow by an average 6% to 7% a year through 2021, up from 4% to 5% over the past three years (see Figure 1). Orthopedic, spine and cardio procedures will grow the fastest. That shift will increase price pressure on medical devices and products because ASCs have lower reimbursement rates and ASC-based physicians are more price sensitive than their hospital-based peers are. Selling to ASCs, which are smaller, lower volume and more geographically dispersed, drives up the costs of sales and distribution and adds complexity to medtech companies' business models.
Ambulatory surgery centers are handling a growing volume of procedures
A handful of medtech leadership teams are forging strategies to capture that new business. To compete effectively for a share of the outpatient surgery market, the leaders in this fast-growing sector are turning necessity into a virtue by developing lower-cost service models and simplifying their product offerings. They also are providing ASCs with a wider range of customized services and offering partnerships that address ASC needs. Such services include support for administration, scheduling, operating room utilization and staffing.
The growing volume of procedures handled by ASCs affects the broader healthcare industry as well. Hospitals and payers are rethinking their business models as highly profitable surgical procedures shift to outpatient centers. Many hospital networks are responding to this trend by acquiring ASCs to recapture a slice of the lost business—around 25% of ASCs now have hospitals as shareholders—while others are acquiring physician groups to control referral patterns. Payers continue to support the shift to lower-cost healthcare settings, and some are becoming ASC operators. In 2017, Optum acquired Surgical Care Affiliates, significantly expanding its own ambulatory surgery business.
Accelerated growth
Broad industry trends are fueling the growth of ASCs, the first of which was founded in 1970. A steady rise in healthcare spending has put fierce pressure on costs and margins throughout the industry, encouraging the shift to outpatient care. Payers are helping steer procedures to ASCs by lowering provider reimbursements for hospitals and reducing patient copayment for procedures performed at outpatient centers.
ASCs hold strong allure for physicians as well. A recent Bain survey showed that nearly 60% of physicians who are not affiliated with an ASC are interested in practicing at one. As advantages, they cite the potential to own equity in the center, the increased control over their own surgery schedules and the reduced bureaucracy when compared with traditional hospitals.
Over the next three years, growth in the volume of procedures performed in ASCs will accelerate, propelled by cost pressure, Medicare approval to reimburse a growing number of procedures for ASCs, the rise of results-based care models, and physician and patient preference for outpatient surgery centers.
Our analysis shows single-specialty centers focused on orthopedics, cardiology and spinal surgery will see the fastest growth in volume of procedures through the mid-2020s. These centers also are likely to have a higher average reimbursement per procedure. Let's take a closer look at the ASC growth dynamic in each of these specialties (see Figure 2).
Cardiology, spine and orthopedic procedures will fuel rapid growth of ambulatory surgery centers through the mid-2020s
Orthopedics. Commercial payers recently began reimbursing total joint replacements in ASCs, where they typically cost 30% to 35% less than the same procedure in a hospital. That shift has led to an eightfold increase in the number of ASCs offering total joint replacements over the past four years, to a total of 250 in 2018. Medicare is now following suit: In 2018, it removed total knee arthroplasty from the Medicare inpatient-only list, and many expect other orthopedic procedures to follow. The decision to reimburse knee and joint procedures at ASCs will have a significant effect on ASC volumes: Total joint replacements are one of Medicare's most common inpatient procedures, accounting for more than $7 billion in annual spending. Bain research indicates the share of hip replacements performed in ASCs will grow from slightly more than 9% today to nearly 25% by the mid-2020s, while knee replacements performed in ASCs will rise from 10% today to nearly 30%.
Spine. ASCs performed slightly more than 10% of all spinal surgeries in 2018, but based on our survey findings, we expect that figure to rise to around 30% by the mid-2020s. Physicians still perform the majority of outpatient spinal surgeries in hospital outpatient departments rather than ASCs. The number of ASCs specializing in spinal surgery rose in 2019, however, to 145, up from 35 in 2013, and physicians are increasingly willing to shift these procedures to ASCs. For instance, 86% of spine surgeons expect lumbar discectomies to move to ASCs at accelerating rates over the next three years, while 74% anticipate the same change for cervical-lumbar decompressions. Medicare approval for procedures performed in ASCs will contribute to the shift—the Centers for Medicare & Medicaid Services (CMS) approved two cervical spine procedures in 2018. In addition, spine procedures are among the most profitable for ASCs. That creates an incentive for spine surgeons to shift spinal surgeries to ASCs.
Cardiology. Cardio surgeries also are growing rapidly from a small base. ASCs handled an estimated 10% of all cardio procedures in 2018, but based on our survey findings, we expect ASCs will be performing between 30% and 35% by the mid-2020s, for an annual growth rate of approximately 20%. Diagnostic cardiology procedures began shifting to outpatient settings in 2005 with Medicare's approval of outpatient arterial endovascular interventions. That approval led to the rapid spread of office-based laboratories across the US, with the total recently surpassing 500. Today, cardiologists and regulators are becoming increasingly comfortable performing procedures such as angiograms and angioplasties in ASCs. Over the first half of 2019, CMS added 12 cardiac catheterization procedures to its ASC-covered list.
A different kind of customer
The business model at most medtech companies is designed for large hospitals and provider systems, which have high patient volumes, a broad range of procedural complexity and well-established buying behaviors. For ASCs, which are smaller, more nimble and have simpler needs, that commercial model is often too costly and overly complex.
Importantly, surgeons at ASCs have greater direct influence over purchasing decisions for medical devices and equipment compared with surgeons working in hospitals, where procurement departments have a role. At ASCs, 70% of physicians are the primary decision maker or have direct influence on the decision to purchase medical devices or equipment compared with slightly less than 45% at hospitals, Bain research shows (see Figure 3).
In ambulatory surgery centers, physicians are more likely to be the primary decision maker when purchasing medical equipment
Since payers reimburse ASCs less for the same procedure carried out in a hospital, ASCs are under constant pressure to reduce costs and improve efficiency. The risk to manufacturers is that ASCs will have a greater propensity than hospitals to switch to another manufacturer. Our research shows that ASC physicians are more price sensitive when purchasing medtech devices and expect lower prices than hospitals pay for the same equipment, especially in orthopedics. Sixty percent of ASC physicians said they would purchase a similar device from a different manufacturer if it were offered at a 15% discount (see Figure 4). Physicians in ASCs also are more likely to use innovative purchasing models and are willing to experiment with nontraditional services, such as 24-hour remote service instead of full-time onsite technicians, in exchange for a break on prices. Manufacturers will need to determine how to meet these price expectations without compromising their more comprehensive offerings in the acute care environment.
Physicians at ambulatory surgery centers are likely to switch device makers if offered a discount
Bain research shows that ASCs differ from hospitals in the services they value most from medtech companies. ASCs rank technical support first, while hospitals say operating room coverage is most important. ASCs also rank information on payer reimbursement as a top service, while hospital physicians include information on product upgrades in their top three choices. It is important to note that ASCs are less willing to compromise on the products themselves; they may be willing to switch to a different device manufacturer to reduce costs, but they are less inclined to use previous generation products or those with fewer features. Similarly, they expect the same high quality of technical and clinical support that medtech companies provide to hospitals, but tailored to their needs.
For medtech sales and distribution teams, serving ASCs efficiently is a challenge. Outpatient centers are more dispersed geographically than hospitals, and they perform a lower volume of procedures than hospitals. They have less space for stocking inventory and don't have sophisticated inventory management systems. As a result, ASCs have significantly different supply chain needs than hospitals, requiring medtech companies to be more flexible.
Winning in the ASC market
As outpatient surgery centers take an ever-larger slice of profitable business from hospitals, leading medtech companies are rethinking their sales and marketing models, particularly for ASCs specializing in orthopedic, spine and cardiology procedures. To succeed in this fast-growing market, medtech companies are taking four bold steps to target ASCs' needs.
Developing lower-cost service models. Medtech companies need to adjust their sales and service models to efficiently deliver the services that ASCs value most. One example: virtual operating room representatives. They also are training in-person operating room reps to cover multiple products instead of one, increasing their versatility. In addition, winning medtech companies are adjusting their logistics and distribution models, leaning more heavily on third-party logistics suppliers, for instance, to efficiently deliver and service products in ASCs.
Simplifying products. Medtech devices that reduce customer-holding costs by minimizing required inventory or increasing single-use offerings can help address ASC needs. Medtech companies can also create streamlined procedure-in-a-box kits that are designed for lower-acuity ASC procedures, are less expensive and are easier to manage logistically.
Addressing a broader spectrum of ASC needs. New products and services may help address a wider spectrum of ASC needs to offset pricing pressure. For example, some medtech companies are offering IT services and inventory management as well as innovative partnerships to help ASCs focus on their core business and maintain a streamlined business model.
Considering new business models. As healthcare delivery models change, with payers moving into the provider space and hospitals seeking to expand their networks, medical device companies may see new and innovative opportunities to collaborate with ASCs. For example, some may become equity owners of ASCs, providing cash or capital equipment to help bring the latest technologies to these centers. Others may provide perioperative consulting or marketing services to help ASCs grow faster and improve efficiency. These new models are still experimental, but we expect leading medtech companies to carve out new paths to create value by addressing ASCs' needs.
ASCs already are transforming the healthcare market. As they capture a growing volume of surgical procedures, outpatient centers will force down prices on medtech devices and trigger changes for payers and providers. Despite these challenges, medtech companies that pivot quickly can take advantage of ASC growth. For leadership teams keen to win their business, the market is wide open—no one has staked a major claim to this fast-moving sector. Those that lead in developing new business models for ASCs will help shape a changing market.
Tim van Biesen leads Bain & Company's Global Healthcare practice, and Todd Johnson is a partner with Bain's Healthcare practice. Both are based in the firm's New York office.


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subset: commoncrawl


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Sunday, March 01, 2009
Apollo 13: A Guilty Pleasure in the Age of Scarcity
But still I revel in the technical mastery and the astonishing ingenuity of the NASA scientists portrayed in the film who saved a crippled spacecraft and brought its crew safely home. Perhaps, I think to myself, just maybe perhaps, these technofix advocates have a point. Maybe when circumstances get really, really desperate, we will somehow pull off an energy transition while at the same time addressing climate change and a host of other issues in one transformative ingenuity-filled marathon. They did it in Apollo 13, didn't they?
Unfortunately, that is precisely what many people believe. I've been having an exchange with someone who works in the computer industry about the potential supply problems for two key but rare metals used widely in electronics: gallium and indium. He rightly points out that the information we have about the reserves of both are sketchy and that the decline in the production of gallium in the last few years could be due to decreasing demand. It could also be the case, he says, that new technology will make gallium easier to get in the future and the decline will be reversed. (He makes the same argument for oil.)
He insists that indium simply can't be that scarce because--get this--there is indium in billions of electronic devices including cellphones and computer screens, in fact, in nearly everything that has a flat-screen display associated with it.
This is curious logic. It says that because we are using a resource ubiquitously and at an exponentially increasing rate, it must be plentiful. Now, I would conclude that such a situation would, in fact, be likely to result in the very scarcity I fear. Of course, it is always possible that everything will turn out all right with regard to the supply of critical metals and energy. But given the risks and uncertainty, is it wise to bet the future of civilization on the most optimistic assumptions?
I realized later that what this computer professional actually meant was that the corporate and government planners charged with thinking about resource supply issues couldn't possibly have made a colossal blunder which would lead to a catastrophic shortage of key metals in the electronics industry. He presumed, I think, that such an outcome was simply out of the question given the competence and intelligence of the people in his industry.
I think this is really the hardest kind of denial to cut through. If one admits this kind of incompetence is possible, then it implies that we could be hitting limits all over the place which have not been foreseen by corporate and government planners. That would mean a complete readjustment of one's world view and a concentrated dose of fear and uncertainty to boot.
Now, I feel that fear and uncertainty on a regular basis. And, I think that's why I occasionally take refuge in the technofix triumphalism found in such movies as Apollo 13 and in quite a few science fiction ones as well. Wouldn't it be nice to be cruising the galaxy with everything one needs at the touch of a button, or better yet, via voice command? Wouldn't it be nice never to have to even think about how much energy one uses?
Yes, it would be nice...and it is nice for a couple of hours to imagine such a life. But then, that's why such interludes are really a guilty pleasure. None of us who understand the real risks we face can afford more time than that lost in a fantasy that has so thoroughly crippled the thinking of even very intelligent people on the planet and which threatens to condemn us all to an unpleasant future.
7 comments:
- Jerry said...
- This comment has been removed by the author.
- Jerry said...
Your computer friend's logic is exactly the sort by which fresh water consumption has been allowed to go off the chart and which will likely result in significant violence and death.
Or maybe we'll learn how to catch water and mineral filled asteroids just in the nick of time, perhaps even accompanied by an appropriate musical score. - 5:22 PM
- Henry Warwick said...
I deal with similar attitudes. They just can't seem to get it through their heads that "technology is not energy". It's a concept that eludes them.
Or the classic "we'll think of something". It's sad. I try to explain to them that it doesn't matter if "we think of something", and they look at me like I'm some kind of a doomer/crazy person.
We know where all the energy is (fossil fuel, solar, wind, nuclear, tides, hydro) Hydro and wind are (technically) aspects of solar power. Nuclear is a "kind" of fossil fuel, it's just a fossil from a supernova 5 billion years ago. Then there's the "breeder" reactor crowd, and yes, it has possibilities, but it requires massive computer support and the motherboards are made of what? Oh, that's right - oil... And the frames are made of what? Soem weird metal? Which is found in what? Some obscure sands in Florida or rock formations in Khazakhstan or Congo? And how exactly will this rock get dug up? And how will that rock get melted? And how will the metals be separated from the silicon, aluminum, salts, and other crap? That's right, using electrodes, and where will that electricity come from? In Congo?
It's frustrating when people don't see how it's all so tightly connected, and I have to talk to crown men like they're children because the obvious facts of the matter when stated in the language of fact leaves them so unimpressed.
Argh. - 8:26 PM
Yeah, I'v seen it about five times too! "Houston, we have a problem!" "With all due respect Sir, this will be our finest hour." And they were still using slide rules for crying out loud. Now, in 2015 we will glide the spacecraft New Horizons out to where no man has gone before, between Pluto and its satellite Charon for a photo op. Yet none of that magic could have happened then and will not happen in the future without prodigious quantities of plentiful, cheap, and easy energy, primarily oil. "Those were the days my friend, we'd sing and dance...."
- Hanley Tucks said...
Actually, I took a different lesson from Apollo 13. Not that with the right technology we can flourish in a push-button world, but that with the application of the work of many people, and the minds and creativity of many more, if there's a crisis we can just scrape through and survive.
After all, the "success" of the Apollo XII crew was not that they landed smoothly on the Moon after a comfortable journey, but that there was a crisis which nearly killed them, but they just managed to survive.
It cost a lot of money and effort to put them in a place where they almost died and managed to do no useful science at all. If that's a "technofix" it's not a very impressive one.
Looking at resource depletion and climate crises, then, we can expect that by extreme effort and creativity we can just manage to survive; not that we can cruise along easily without effort into a push-button world.
When we look at the past, I think it's important to draw the right lessons from it. - 7:14 PM
- John Weiser said...
MSNBC describes the situation with low oil prices and tankers serving as oil storage, as Kurt did in his Feb. 1 post.
Again, I think we need to draw the distinction between peak oil and climate change. One too plausible scenario is that oil peaking will ameliorate climate change and obviate the need for things like Kyoto treaties. Just look at Weisman's book, The World Without Us, and the History and NatGeo channel takeoffs.
My own peak oil blog,
thin by comparison to Kurt's, is:
http://thesparecan.blogspot.com/ - 3:45 PM
- Rice Farmer said...
Our leaders could not possibly commit such colossal blunders, could they? But in reality, such colossal blunders have been repeated ad nauseam throughout history. And our leaders haven't learned a thing. So, welcome to the latest installment.


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When details matter more than party
Charlie Arlinghaus
December 19, 2012
As originally published in the New Hampshire Union Leader
Much of the debate in the Legislature will devolve into predictable patterns reminiscent of the "infotainment" shows on what are generously called cable news channels: my party good, your party bad. This dynamic helps most of us tune out and ignore whatever silly thing they're up to in Concord or Washington this month.
Our boredom with the predictability (and superficiality) of the debate leaves the real discussion to a fairly small group of people. What we notice about most policy issues are only the fairly broad brush-strokes: in the budget, did we cut spending too much or raise it too much? Did taxes go up or down? There tends to be less discussion about the detail (which spending went up or down? How does that compare to four years ago or 10? Are those the right priorities, but the wrong amounts, or were the priorities reversed?)
This year, the Legislature will consider a few issues where details matter a great deal. The first of these is the establishment of the health care exchange that is the central mechanism under the federal health care law.
A health care "exchange" is the term used for the government-run structure anticipated to be set up to implement the rules, regulations, subsidies and penalties required by the federal health care law (Obamacare). The authors of the law envisioned the 50 states each running and, most importantly, paying for the exchange. The plan was envisioned as a partnership: the federal government would set all the rules and regulations and the states would pay for them (and add additional rules if they so chose).
States are naturally skittish, and only 16 have agreed to run an exchange. Many Legislatures, like New Hampshire's did last year, have actually prohibited the state from running a state exchange. To get around those prohibitions, some states are considering setting up partnership exchanges jointly with the federal government. The exact nature of the partnership isn't yet clear, but our governor-elect is said to be leaning in that direction.
State law still prohibits our running an exchange, and that would prohibit our running bits of an exchange too or paying for it with state-imposed taxes (which would have to pass the Legislature). Imposing some sort of hybrid exchange by executive fiat would seem to be prohibited, but this will be a big subject of debate in the coming months.
The governor will be asked not to say yes or no, but to explain operational and financial details in ways that don't lend themselves to 30-second blurbs.
Similar to exchanges, gambling will require longer explanations. Through much of the past, one either supported "gaming" or opposed "gambling." There was no middle ground. Even the word you used gave a superficial clue to your locked-in position. Today, with the first pro-gambling governor in modern history, details are starting to be considered.
Gambling used to be unlikely because of New Hampshire's natural tendency to avoid anything new. Today, an expansion of gambling (we have lotteries and charitable gaming now) is still an uphill climb because no one is quite sure about the details.
Some oppose any expansion, others support some options but oppose some others. Some who are open to gambling worry about the relative unpredictability of the revenue streams and are nervous about using it in the operating part of the budget (general fund) to support ongoing expenses. They would instead dedicate revenue to one-time expenses that are easily ratcheted up or down, such as paving roads and fixing old bridges, a fairly pressing but not very glamorous need of the state.
Others don't generally support gambling but would only if the money were dedicated to operating expenses that would receive no or little funding without that additional revenue. New Hampshire passed the first modern state sweepstakes in the 1963 by this method. Nervous lawmakers were told the money would be dedicated to education aid, which there was no money to support otherwise.
It is often said that the devil is in the details. In governing, too often we ignore the details. These are two issues that will pass or fail on the basis of careful negotiation over details. We should all pay attention.


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Tuesday, February 16, 2010
Independents and Moderates
Democrats are in trouble with independents right now. They are not, however, in trouble with moderates.
Independents as a group of voters are somewhat conservative leaning. Our last national poll found that 56% of independents were moderates but that among the rest 33% were conservatives to just 11% liberals. Overall independents were planning to vote Republican for Congress this year by a 40-27 margin. But break that out a little further and while conservative independents are tending toward the GOP by a 68-7 margin moderate independents are tied up at 33. And among all moderates- since moderates continue to identify more as Democrats than Republicans- Democrats lead 46-31 on the generic ballot.
It's a similar story when it comes to moderates and independents and Barack Obama's approval rating. Independents are split 48/48 on Obama. But moderates approve of him by a 62/34 margin.
Independents and moderates are not the same thing- get it right media!
10 comments:
A Moderate is nothing more than a liberal in disguise. The word "liberal" has become derogatory, thus whenever you see the word Moderate used in a poll, add it to the liberal polling section as well.
- February 16, 2010 at 2:04 PM
- Stephanie said...
The bad rep of the institutional GOP right now and since about 2006 should mean that former self-identified GOP'ers still vote GOP but call themselves independents-- which should mean that independents as a group since 2005-06 have been getting more and more conservative, even though no individual within that group became a self-identified conservative over that time. Tom, can you confirm?
- February 16, 2010 at 2:13 PM
- Christian Liberty said...
"Independents as a group of voters are somewhat conservative leaning."
Once again, this strongly supports the idea that if independents are the real swing voters, then the best thing Republicans can do electorally is to be more conservative. And the best thing Democrats can do electorally is to be more conservative. The best thing both parties can do to improve their electoral chances is to cleave more tightly to the Tea Party.
Conservatism wins elections. Tea Party principles will win in 2010. Any candidate in a district to the right of D+10 needs to vote as a conservative and run as a conservative. Because the conservative in the race will always be the heavy favorite. - February 16, 2010 at 2:21 PM
- Tom Jensen said...
Steve- I agree with that.
- February 16, 2010 at 2:27 PM
- Unknown said...
When surveyed people on the right overwhelmingly think they're conservative. Northeasters who are fiscally conservative but socially moderate or libertarian have been conservative for generations. They don't abandon that because others tell them they aren't conservative.Conservatives don't all like the GOP. So Republican numbers in surveys are low.
Anonymous is correct. While people on the right revel in being considered conservative or far right people on the left bristle at the idea of being on the left. Most Democrats think they're moderate. On Politico's arena the editor of The Dailykos responded to criticism that they were far left by saying they were moderate. Since Democrats tend to think they're moderate surveys show conservatives outnumbering liberals by a wide margin.
Thus, when you do a survey of "moderates" you'll tend to get more Democrats. - February 16, 2010 at 2:56 PM
- Matt said...
One thing I see as troublesome for this analysis is that it doesn't necessarily lead to policy recommendations. The reason is that it isn't at all clear to me that one's self-identification correlates all that well with one's actual views. There are quite a few people who self-identify as "conservative", but who hold left-wing views on a number of issues. Health care in particular is one of these. In the vague and abstract, universal health care, for example, picks up substantial "conservative" support.
Similarly, many of the folks who self-identify as liberal may very well hold conservative views on a number of issues. - February 16, 2010 at 9:14 PM
- Ben (The Tiger in Exile) said...
Republicans need to win a majority of independents, but only a minority of moderates.
Democrats need to win a majority of moderates, but only a minority of independents.
Easy as pie. - February 17, 2010 at 12:49 PM
- Ben (The Tiger in Exile) said...
Or, to put it another way, with "conservatives" outnumbering "liberals" in the general electorate 2-1, being even among "moderates" means that it's time for Democrats to... what's the phrase? Oh yes, "run for the hills". :p
No worries, though -- the pendulum swings both ways. - February 17, 2010 at 12:51 PM
I agree that, at this point, independents are more conservative leaning. But, in general, independents go with the wind -- and the trend. That is why they broke break with the democrats in 2008 and 2006. That is why they are planting their seeds with the republicans in 2010. 2012 is too far away and is very much up for grabs.
- February 17, 2010 at 2:37 PM
- Jed Carosaari said...
Please. Since when has "liberal" become derogatory? Only in the minds of conservatives, a self-fulfilling prophecy.
-Proud Liberal - February 18, 2010 at 5:47 AM


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In addition to the infinite design possibilities, Thermador's Freedom Collection offers an unrivalled assortment of exclusive features, including:
The unique Freedom® Hinge allows all the columns to be fully flush mounted to cabinetry – without sacrificing accessibility to the interior and the full extension drawers. In fact, the hinge opens the column doors up to an amazing 115 degrees. It can also accommodate a variety of custom panels up to 220 pounds in total door weight.
No longer will you have to unload a shelf to gain extra interior space. The fresh food column's motorized Liberty ShelfT™ conveniently moves a fully loaded shelf of up to 22 pounds with the simple touch of a button. Also available on bottom-freezer models.
The FreeFlowTM Air System (fresh food column) results in superior temperature regulation and air distribution that helps keep "market fresh" foods longer. Cool air continually travels the length of the column door, ensuring that these items are just as cold as those on the interior shelves. A carbon air filter also absorbs any unwanted odors for fresher and more hygienic food storage.
The freezer's FreeFlow™ Ice System regularly rotates the filtered ice in the icemaker to avoid clumping, while the UltraClarity™ Water Filter dispenses crystal fresh ice and water. The external dispenser also features an exclusive pull-down flip tray that accommodates pitcher-size containers to facilitate bulk amounts of ice or water. The Luminous Light System™ features bright halogen light towers and spotlights that fully illuminate foods, so everything can be clearly seen while creating a beautiful interior look.
Rounding out these industry exclusives are a number of additional performance features, including a convenient digital display that allows for precise temperature adjustments; multiple specially-insulated compartments that keep delicate and perishable foods fresher, longer; and an adjustable toe-kick that can range in height between 4-7 inches.
The entire Freedom Collection is ENERGY STAR® qualified and is among the quietest refrigeration units in the built-in category. Models are available with an MSRP of $2,899-$6,999; wine columns have an MSRP of $3,899-4,399.


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The ideological extremism of David Brooks
[Posted by Karl]
The latest column from David Brooks attempts to diagnose the fiscal crisis in Europe and the growing fiscal threats in America:
[M]any voters have come to regard their desires as entitlements. They become incensed when their leaders are not responsive to their needs. Like any normal set of human beings, they command their politicians to give them benefits without asking them to pay.
The consequences of this shift are now obvious. In Europe and America, governments have made promises they can't afford to fulfill. At the same time, the decision-making machinery is breaking down. American and European capitals still have the structures inherited from the past, but without the self-restraining ethos that made them function.
The American decentralized system of checks and balances has transmogrified into a fragmented system that scatters responsibility. Congress is capable of passing laws that give people benefits with borrowed money, but it gridlocks when it tries to impose self-restraint.
Of course, there are many Americans who still have an ethos of self-restraint. Those Americans have elected people to the House and Senate in an attempt to restrain and reform the entitlement state. And David Brooks has metaphorically compared them to Nazis, uninterested in governance.
How does Brooks square that circle? By assuming that the problem is gridlock, which he blames on the tougher position the right is now taking as the fiscal cliff draws ever closer. (I know; it's just craaaaazy of the right to do this, amirite?)
Mind you, the big-taxing, so-called "balanced approach" to addressing sovereign debt problems is failing where it is being tried in Europe. The wingnutty wingnuts at the OECD and the IMF already knew it would fail, and that solutions which rely overwhelmingly on controlling spending work. Yet Brooks bitterly clings to the center-left establishment mindset that has led America to the situation he now despairs.
Jonah Goldberg addresses this ideology in The Tyranny of Clichés:
If I say we need one hundred feet of bridge to cross a one-hundred-foot chasm that makes me an extremist. Somebody else says we don't need to build a bridge at all because we don't need to cross the chasm in the first place. That makes him an extremist. The third guy is the centrist because he insists that we compromise by building a fifty-foot bridge that ends in the middle of thin air? As an extremist I'll tell you that the other extremist has a much better grasp on reality than the centrist does. The extremists have a serious disagreement about what to do. The independent who splits the difference has no idea what to do and doesn't want to bother with figuring it out.
Goldberg does not identify centrism as an extreme ideology, but the quoted example (and others given in the book) graphically demonstrate it can be at least as impervious to logic or data as any other ideology. Anyone who finds those examples a straw man should consider the very real examples compiled by the NYT's Ross Douthat:
It wasn't the Tea Party that decided to create two new health care entitlements (Medicare Part D and Obamacare) just as America was about to go over a fiscal waterfall. It wasn't kooks and reactionaries who got the European Union into its current mess. It wasn't the radicals of the left and right who risked the global economy on a series of disastrous real estate bets, or locked our government into a permanently symbiotic relationship with the banking and financial sectors, or created a vast labyrinth of unaccountable bureaucracies in the hopeless quest for perfect security from terror attacks. And to bring things up the present day, it wasn't the more "extreme" members of the Senate — be they Jim DeMint and Tom Coburn on the right, or Bernie Sanders on the left — who just voted for more short-term spending and tax cuts without any plan to pay for it.
***[W]hat Jesse Walker has dubbed the "the paranoid style in center-left politics" *** seems like a rather odd response to a political moment in which nearly all of our overlapping crises are the result of disastrous misgovernment at the center ***. The Tea Party's politics are not my politics, but the movement has virtues as well as vices, and at the very least it represented a possible alternative force at a time when our politics desperately needs alternatives, whether right-wing or left-wing or something else entirely, to the policies that have led us to our present pass. Nothing good may come of it, but an awful lot more ill has come from politics-as-usual of late than from grassroots populism.
Brooks and his ilk are a particularly odious sort; they have urged and pursued a ruinous course of misgovernment, all the while deluding themselves that they are not extreme and demonizing the people who are not responsible for the West's current malaise.


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Ciabatta Bread
Ciabatta Bread
As much as it is true that one should not judge a book by its cover, you can safely go about life judging a good Ciabatta by the holes in its crumb! And this is one particular instance when size does matter: the bigger the holes, the better the loaf…The secret to a perfect Ciabatta is in the percentage of water in the dough, a dough that is sticky, wet and fun to manipulate. This is not your classic "knead for ten minutes" dough. In fact, you hardly have to knead it at all. So, where's the catch? No, catch. Ciabatta, it turns out, is a home-baker's new best friend.
INGREDIENTS , if using dry yeast
450 gr (3 3/4 cups) of flour
350 ml (1 1/4 cup) water at room temperature
a tablespoon of olive oil
1 scant tablespoon of dry yeast
2 teaspoons of salt
1. In a large bowl, mix together flour, water oil and yeast. When the yeast is well incorporated, add the salt.
2. Mix vigorously with a spatula or with a standing mixer fitter with a paddle attachment for 5-10 minutes or until the dough is shiny and slightly elastic. It will be sticky and wet. Put in an oiled bowl to prove for 30 minutes, then stretch it with wet hands and fold it onto itself and leave to rest. At this stage you have two options: place the covered bowl in the fridge to slow prove overnight , or for a minimum of 10 hours, or prove at room temperature, in a warm spot, for a further 1 1/2-2 hours or until doubled in size. Slow proving will add flavour and will ensure you a moist soft crumb, but you will still have a worthy ciabatta if you skip that stage. Up to you and your own time management, really! Once the dough has proven, you will notice that lovely air bubbles will have formed. Don't burst them, they hold the secret to the formation of those coveted holes. Tip the dough onto a baking tray lined with parchment paper, stretch it gently with floured hands and dimple the top lightly.
3. Place a metal bowl or a small skillet in the oven and bring the oven temperature to to 200 C (395 F)
4. Insert the bread tray into the hot oven, pour a glass of cold water into the skillet to create steam, close the oven door and bake for 30-35 minutes or until risen, golden and the bottom sounds hollow when tapped. You may need to flip the bread upside down to ensure even baking according to your oven. Cool at room temperature over a wire rack for at least 1 hour before slicing away to reveal that holey, moist crumb.
You can also make Ciabatta using an active sourdough starter. The flavour and longevity of your bread will be incomparably better.
Follow this link if you wish to make your sourdough starter
Sourdough ciabatta
In a large non-metal bowl mix 230 gr (1 cup) of sourdough, 380 (3 cups) gr of plain flour and 260 ml (1 cup) of filtered water at room temperature and a tablespoon of olive oil. When the ingredients are well amalgamated, add 2 teaspoonsof salt and mix well with a wooden spoon. Cover your bowl with either a lid or oiled cling wrap and let it rest overnight. Be mindful not to leave your dough to prove in a drafty spot. In the morning your dough will have more than doubled its volume. Using a spatula, scrape it onto an oven tray lined with grease-proof paper, dust the top with a little flour and let it prove for an hour or two. The proceed as step 4. You will find that your ciabatta will not puff up much in the oven, it will stay quite flat, like a slipper, hence its name (ciabatta means slipper in Italian)
As hard as it will be, allow to cool down before you attempt to slice it…
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The Performance Monitoring Toolset monitors all transactions on a ColdFusion server and captures the response times along with other basic details of a transaction.
The procedure requires recording metrics for all components of a transaction, and thus you have the Code Profiler.
To run the code profiler, click Code Profiler on the left panel.
The tags that are not captured in profiling are:
cfif cfelse cfelseif cftry cfcatch cfset
Choose the profile mode:
- Application: Specify the name of the application, that needs profiling. Profiling does not capture the data for other applications, which are not added.
- URL: Specify a URL that needs profiling. Add the URL and make sure that profile check-box is selected. Profiling does not capture the data for other URLs, which are not added.
- Server: Choose the server that needs profiling.
The Code Profiler only profiles the following built-in functions:
- ORMSearch
- ORMSearchOffline
- Encode*
- Decode*
- XMLFormat
- JSformat
- Encryption
- SecretKey
- GetSOAPRequest
- ObjectLoad
- ObjectSave
- Compare
- Wrap
- REFInd
- REFindNocase
- REMatch
- File operation functions
- PrinterInfo
- StructAppend
- RunAsync
- StructToSorted
- Sort
- Map
- Each
- Filter
- Find
- Reduce
- Evaluate
- PrecisionEvaluate
- DateDiff
- Xml functions
- Array functions
Basic info The section displays the following details:
- HTTP method
- Status code
- Response time
- Template path
- Cluster id
- ...and more
Code flow The section displays the cfm file's particular line number and the time taken by the code in that line to execute.CF server The section displays the following details:
- JVM: You can view, for example, memory usage of heap and non-heap, count of GC, and other JVM properties.
- Template cache size: You can view, for example, template cache count and hit ratio.
- Request queue size
- Throttle data
Database View the databases that are used in the cfm .External services View services, such as, cfhttp ,cfftp , orcffeed .Tags/Functions View the tags and functions that are used in the cfm and the number of times they are called.Error/Timeout View timeout errors, if any, when executing the cfm .Memory View the places that contain each variable used in the cfm along with the name of the function and function scopes.
Right-click on the project, click Performance Monitoring Toolset Profiler > Run Performance Monitoring Toolset Profiler.
You can see the results in the profiler tab, as shown below:
The code must be in sync with the project before running the code profiler. Otherwise, the line points to a wrong place in the code.


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I'll spare you the details of being a grad student wife. If you want to learn more about it, you'll get a kick out of Piled Higher and Deeper comics.
Now you know why I can't stop smiling :)
About the food...
After a whole week of healthy eating, I thought it was about time to satisfy my craving for potato vareniki (Russian and Ukrainian word for pierogies).The passion I feel for this dish is not unlike the passion Americans (myself included) feel for burgers. What can be simpler? The whole thing has just a handful of ingredients -- pasta type dough wrapped around creamy potato and sautéed onion filling. Yet, there are so many subtle nuances that can elevate such dishes to cult-like standing. With burgers, it's all about perfecting the balance between charring the outside while keeping the inside rare enough to explode with juices that leak to your elbows as you take a bite. With pierogies, it's all about making the dough that's elastic and supple enough to provide a bare hint of resistance as you take a bite. Both have to be seasoned to perfection -- under-salted ground beef or potatoes taste like "blah" and are the first give away of inexperienced cook.
You can serve pierogies 2 ways: just boiled or boiled and then sautéed in butter to crisp up (that's the one in the picture). Both ways you'll need plenty of sour cream, but if I just have them boiled, I also add a little butter.
I normally provide recipes for dishes that I appear on this blog. But this time, I decided to skip the recipe and talk about the process of recipe writing instead. A Jamie Oliver type recipe would be easy to put together, but it would probably do you no good. A Julia Child/Marcella Hazan type recipe would take me several hours of writing and days of testing, and that work would probably never pay off because I doubt anyone would care. Seriously -- raise your hand if you are willing to spend 3 hours making pierogies. Well, that's what it takes, and unless you have some pasta making experience, you'll probably need several tries to get it just right.
I find recipe writing to be a very interesting (although sometimes painful) process -- probably because I used to be a Usability engineer in my previous life. The most important questions a recipe writer needs to answer are:
- who will be using this recipe?
- what goal are they trying to accomplish?
- a home cook
- to make an amazing version of a particular dish
Since "a home cook" is a category too vast, I have the second bullet to narrow it down, but not by the level of experience, but by the goal of the cook. My primary audience are obsessive cooks who won't settle for "quite edible" or even "good." They are perfectionists, whose goal is not just to put some food on the table. They are eager to master the art of cooking and to make a truly fabulous dish. This means I have a very small audience -- cooks who are willing to carefully follow 5 pages of instructions. It's almost unheard of these days in the world of cookbook publishing, but that's the audience Julia Child and Marcella Hazan served so remarkably well.
Don't all recipe writers want their audience to end up with a great dish? On the surface, it seems that they all want you to have something wonderful for dinner. The real result depends on which trade offs they are making. The world of chef pop stars has an image to protect -- no one wants to be the boring-10-pages-of-instructions guy. They want to be your pal. They want to be cool. They want to make you think like they are luring you into the kitchen when they are really luring you to the couch for some pleasant food day dreaming with their books and TV shows. They make it sound so easy. Hey, the recipe is only 5 lines -- even I can do that. Who needs all that nonsense about how to knead the pasta dough? According to Jamie Oliver, you just "work the dough hard for about 3 minutes or until smooth, silky and elastic." And if you don't have a pasta machine, he doesn't hesitate to recommend that you roll it out with a pin. I tried it as my first attempt to make pasta several years ago. There is only one word to describe the result -- CRAP!
What was Jamie thinking when he wrote this recipe (assuming *he* actually wrote it because at the rate celebrity chefs publish their books and produce their shows, I doubt they write it all themselves). First of all -- how many people will actually attempt making their own pasta? Most will buy wonton wrappers. Second of all -- how many will be able to tell the difference between great pasta and mediocre one? Most of them just want to play with some dough and have fun. Jamie knows extremely well what most people want, and that's why he makes the big bucks. He is selling the image of food that's rustic and beautiful. And the good sales man that he is, he knows that if he makes it sound like it requires real cooking skills, it won't sell very well.
Sorry Jamie, I don't mean to pick on you. There are plenty of cookbook writers whose recipes are as bad as yours. It's just that you make a perfect counter example to Marcella Hazan. Her goal was not to make incompetent cooks feel better with "You can do it!" cheer leading. Her goal was to teach anyone, regardless of their experience, how to cook great Italian food. Not some sad parody of it, but the real thing. Her pasta and gnocchi recipes are flawless. It's as if she is there in the kitchen with me, helping me avoid all the pitfalls (like rolling pasta with a pin the first time you do it is bound to be a disaster). What to do if your dough is too wet or too dry, how to test when it's just right, how to knead, how long to knead, etc. If you think you can make a great pasta without knowing all this, you are kidding yourself.
I don't believe in evangelical cooking, the idea of "let's make it look easier so that more people can join the fun." If you don't think cooking is fun, and if kitchen is not your favorite room in the house, I ain't the person to convert you. But if you love it already and don't want to settle for less than perfect deliciousness, you've come to the right place.
P.S. If you try one of the recipes on this blog, I'd love your feedback. There is no way to write great recipes without usability testing :)


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Keflavik Airport (KEF): Bus Transfer to/from Reykjavik
Enjoy a safe and reliable airport transfer between Reykjavik Keflavik Airport (KEF) and your accommodation in Reykjavik or BSI Bus Terminal. Travel stress-free knowing that your seat on the bus is guaranteed and that you will not have to wait long for the service. Benefit from air-conditioned vehicles that are regularly maintained to high hygienic standards. Choose a one-way service to or from the airport and feel safe knowing that your service is reliable and secure. Save yourself the hassle of navigating the public transportation system before or after a long journey. Due to an environmental standpoint, the City of Reykjavik does not allow larger coaches on many of its streets. Therefore, during your transfer, you might have to change from a larger to a smaller bus at the BSI Bus terminal. The staff will make sure you feel confident and provide you all the information on the spot. Do not worry about waiting too long - the buses are scheduled to depart 30-45 minutes after each flight for your convenience. The only thing left to do will be to relax and enjoy the views from the comfort of your seat.


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No products
Prices are tax included
Replacement 5 cm adjustable grip made...
Replacement 5 cm adjustable grip made of ice blue rubber with longitudinal ribs. For use on sculls and Skinny sweeps that feature the Length Adjustment System. 33.5 mm diameter.
Not for use with Ultralight sweeps or fixed length oars. Important: You will need a T20 6-Lobe driver (available at hardware stores or from Concept2 (part number 2245)) to install and adjust these grips.
Sold individually.
Visit concept2.co.uk for more information: sweep grips | scull grips


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(REMSEN)–Remsen's annual Kids Day Kickoff and 5K Run/Walk is this (Sunday) afternoon.
The Remsen Chamber of Commerce Fun Day 5K Run/Walk starts at Sunrise Park at one this afternoon. Registration is at 12:30.
The first 150 participants will receive a free Run/Walk T-Shirt.
After the kickoff, there is a watermelon feed at Sunrise Park.
The Chamber-sponsored annual Kids Day is Monday and Tuesday. Food stands open both days at 11 a.m. and the carnival rides are in late afternoon.
(LE MARS)–Books were carried from class to class, kept in lockers and taken home to prepare assignments by students in the Gehlen Catholic High School Class of 1960.
Fifty years later, books are back in the hands of the Gehlen Catholic alumni. But these books aren't textbooks. They're the written history of their classmates gathered and edited by class president Joe Timmins of Melrose, Minnesota.
Timmins describes the reaction to the 59-page book as the highlight of the 50-year reunion for him.
Did Timmins, a retired teacher, notice a common thread among the graduates?
Timmins and the other alumni celebrated their 50th reunion with activities that included being an entry in the Ice Cream Days parade Saturday.
(ORANGE CITY)–Wellmark is recognizing the Orange City Area Health System Clinics for quality.
The Wellmark Blue Cross Blue Shield Primary Care program is designed to support primary care clinicians in their efforts to improve the quality and efficiency of health care for patients.
Information gathered through Wellmark health care claims is used to measure care. Clinics in Orange City, Hospers and Paullina met or exceeded measures for care for diabetes, hypertension, asthma, and childhood immunizations for Wellmark members. The rate of generic medication prescribed and the use of electronic medical records or e-prescribing tools was also measured.
C-E-O of the Orange City Health System, Marty Guthmiller, in a news release, says it is gratifying that organizations like Wellmark acknowledge the high level of quality by the clinics in the Orange City Health System.
(CALUMET)–Farmers with strip tillage experience will speak during the field day at Iowa State University's Northwest Iowa Research Farm June 30th near Calumet.
The field day begins at 9:30 with registration. The update on research projects at the farm will follow. Those attending will tour the farm and discuss topics including potassium and phosphorus replacement research, aphid management in corn and soybeans, agricultural land drainage and more.
The Iowa Learning Farm provides a lunch at noon. The afternoon focus is on strip tillage with a panel of farmers at 1 p-m. Strip tillage equipment from several manufacturers will be displayed and company representatives will answer questions.
The Iowa Learning Farm Conservation Station will be at the farm all day. Visitors will learn about soil, water, crop residue, prairies and wetlands. There is also a rainfall simulator.
(LOGAN)–The Iowa State Patrol is investigating a traffic accident that claimed a life near Logan Saturday afternoon. Several people who were injured were taken to Omaha area hospitals. The name of the person who died has not yet been released by the Patrol.
WEST DES MOINES, Iowa (AP) Police in West Des Moines are investigating a vehicle accident that left one motorcyclist dead.
Police were called around 1:30 p.m. Saturday to a crash on Interstate-80 in West Des Moines.
Authorities say a preliminary investigation shows four motorcyclists were headed westbound when one lost control, crossed a median and struck an eastbound vehicle.
The motorcyclist, an adult male, was pronounced dead on the scene. His name was not released.
Police say the eastbound vehicle, described as white SUV, did not stop and may have little or no damage.
Listen to the Sunday newscast
DUBUQUE, Iowa (AP) The National Mississippi River Museum and Aquarium will opening a new $40 million expansion on June 26, but with an altered Gulf of Mexico exhibit featuring an empty fish tank.
Officials at the Dubuque facility say the spill is one of the worst environmental disasters of its kind and they hope the empty exhibit will cause people to think, especially about the effects on wildlife.
In a statement, museum officials say they grappled with the appropriate course of action that would recognize the crisis.
They say the goal is to draw a connection between the Mississippi River and the ocean.
In addition to the empty fish tank, the exhibit will include information on how to get involved.
CEDAR RAPIDS, Iowa (AP) Fifty-six-year-old Clyde Davis of Cedar Rapids walks with the aid of a cane, and he says his current legal problems occurred because he walked into a federal courthouse with the wrong one.
A security guard found an 18-inch blade inside the bamboo cane Davis was carrying June 11; resulting in a misdemeanor weapons charge that could mean two years in prison.
Davis said Friday his actions were inadvertent. He doesn't know how he will plead.
Davis owns about a dozen canes. He said he was taking his nephew to an appointment at the federal courthouse and was running late, so he just grabbed a cane at random.
He said he and his nephew returned their cell phones to his car because were not allowed in the building, but he forgot that his cane had a blade in it.
NEWTON, Iowa (AP) Danica Patrick spent last weekend checking off one of the most important things on any maid of honor's to-do list.
The bachelorette party.
One of Patrick's best friends is getting married in September, so Patrick used the Indy Racing League's off week between Texas and Iowa to throw a bash.
Patrick had no choice but to throw the party last weekend, because it's her last one off for a while.
Patrick's ambitious IRL/NASCAR Nationwide summer schedule kicks off Sunday with the IRL's Iowa 250. Then it's off to the Nationwide race in New Hampshire next weekend, the open-wheel road course event at Watkins Glen on July 4 and the Nationwide race in Chicago on July 9.
(Copyright 2010 by The Associated Press. All Rights Reserved.)
Submit your news release, confidential news tip or news idea by email email@example.com, by calling 712.546.4121 or 712.546.9672 fax.


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Hello there young capitalists, are you ready to play the 2 players game that will double or triple your already enormous fortune? Well in that case, welcome to Monopoly Money Wars game! Grab your business briefcase, roll the dice and compete against professional businessman in coin collecting frenzy! Your opponent can be the skilled CPU player or your best friend, but either way you must find a way how to outsmart him or her and loot the most of the cash. In this 2 players funny game, victorious would be the businessman that would earn $100,000,000 first. Have fun!
Player 1: WASd to move, jump and enter bank. Player 2: Arrow keys to move, jump and enter bank.
Game Tags
1 Player, 2 Players, 2pg, collecting, flash, fun, Jumping, keyboard, kids, money, monopoly, platform, timing


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Your septic system is something that works day and night but is very seldom given any attention. What most of us don't realize is that our septic system requires regular maintenance that involves septic pumping services to pump out the sludge. You don't want to wait until something bad and stinky happens before you take action.
When it comes to your septic system, regular, scheduled septic pumping services are the key to keeping your septic system in good working order. Sludge build up cannot be avoided but regular septic pumping will help keep your system running smoothly. Regular septic pumping will also help to spot would-be problem areas that could be a disaster waiting to happen. SewerMan trained technicians will be able to recognize the warning signs that most homeowners don't see.
At SewerMan of Sharon, PA we can evaluate your household septic system and put together a plan for your regular septic pumping and septic system maintenance. Call us today for an appointment.
For Residential Septic Pumping in Sharon, PA Call (866) 533-4007
Sewer-Man was fast and dependable to clear my sewer line!
Steps in Residential Septic Pumping Service
A septic pumping service involves the following steps:
- Locating the septic tank
- Inspecting the area around the septic tank before opening the tank or removing its cover
- Inspection of the tank before actual pumping
- Pumping out the tank while continually inspecting the tank
- Washing the septic tank after pumping
- Closing down the tank
- Recording the location of the tank
- Informing the homeowner that the job is done
How Often Should a Septic Tank be Pumped?
Every home has a unique septic system. What works for your neighbor may not necessarily work for you. Determining how often your tank needs pumping service will be determined by several factors. These factors include the age of the septic system, the size and shape of the tank, the number of household occupants, the quantity of laundry done at the home and whether or not you have a garbage disposal. It is best to discuss these factors with your septic tank technician when determining the optimum frequency of septic pumping service for your septic system.
At SewerMan of Sharon, PA we can create a septic pumping frequency table based on your specific needs, or if you prefer we can use an electronic device called a grease trap or septic tank monitor that can track down the level of scum, grease or sludge in a septic tank to determine the best schedule for septic pumping.
The pumping out of septic waste is an essential step in the maintenance of your septic system to extend the life of your septic field. You need not worry about how it is done but knowing when it should be done is critical.
Call SewerMan of Sharon, PA today to schedule your residential septic pumping and overall septic system maintenance.
Some services are only offered at participating locations.


text: Mungo Morrison is a young mole who is due to begin work at his proud father's side in their hometown's legendary gold mine. While his best friends are excited to be in the mine, Mungo secretly dreams of becoming a professional footballer. However, desperate not to upset his father, as well as being a small mole and unable to play football in bright light, Mungo sadly resigns himself to life as a miner. When the mine is forced to shut down after a mysterious accident, an evil and gold-obsessed supervillain known only as 'The Boss', attempts to bully the townsfolk into selling him the mine. Against all odds and with a little help from his whacky friends, Mungo begins an epic adventure of thrills, laughs, action and peril, as he hurtles towards the Wild Cup football finals in Russia and a final, breathtaking showdown with 'The Boss.'


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This article originally appeared on beautifulbetween.com.
I was in California on a business trip, just yards from the beach, eating ice cream and laughing as the conversation drifted away from business. Eventually, somebody mentioned a friend-of-a-friend who had died by suicide.
The familiar ache and nausea filled my chest. My insides rattled when my coworker said he didn't understand what would make someone feel like taking their life was the only option.
I swallowed hard and let out the breath I'd been holding. "I do." For the first time in my life, I spoke up. "I completely get that. I've been there."
My coworkers stared, jaws dangling in breathless shock. Finally, someone asked what it's like to want to die. So I told them about the physical pain, the exhaustion, the heaviness. I told them it's like dying of a terrible disease and wishing I could hurry it up, knowing things would only get worse.
The last two weeks have brought news of too many people wanting to die. Anthony Bourdain and Kate Spade ended their lives last week. Several of our friends' kids have attempted suicide, shocking their church communities. Our hearts are breaking with those in such pain.
I remember my colleagues' faces as my words sunk in. They had never heard what it's like to be suicidal and they started to understand, at least a little. And I'm reminded how little the church knows about depression and suicide.
We are called to be the light of the world, a refuge for the broken and weary. But if we don't understand the darkness people endure, it's much less likely we'll reach them in it. So here are some things every Christian should know about suicide and depression:
It's not just mental and emotional.
The phrase "mental illness" makes it seem like it just exists in our thoughts. But it doesn't. WebMD lists at least 12 physical symptoms of serious depression. Chronic pain develops or worsens. Chest pain, migraines, stomach problems, and a weakened immune system are some common symptoms.
There's a bone-deep weariness that becomes a constant companion; no amount sleep or coffee can shake it off. When people say they can't get out of bed because of depression, this is what they're talking about.
That day at the beach, I told my coworkers about depression's physicality. Every part of me ached from resisting gravity, as though my cells wanted to collapse in a puddle on the ground. My skin stung like lotion on a fresh sunburn and my throat hurt from the lump that lived in it. At one point, I was seriously underweight because I couldn't force food down.
Suicide is not a selfish choice.
Sometimes people say suicide is the most selfish act you can commit. But for many battling the darkness, dying seems like the most selfless thing to do. Depression often carries an intense, shameful sense of self-hatred. In those pits, I believed I was toxic and harmful to those close to me. I was certain taking my own life would be a blessing to others.
It's a familiar refrain. This mom thought her husband would find a beautiful new wife and mother for their baby. She knew he wouldn't be burdened by her illness and her child would have a better mom. My good friend, Steve Austin, nearly died because he believed ending his life was best for his wife and infant son. Thankfully, he didn't die. He spent some time in a psych ward, got on meds, and found support he'd never found in the church.
We might not be sad.
Depression isn't sadness, as this article explains. It's much more complex: emptiness, flatness, irritation, or a strange numbness. Many people who seek help for depression only report physical symptoms because they don't feel sad.
For me, I first notice it as brain fog. The world seems to move in slow motion, but I still can't keep up. All I want is sleep, not just because depression is exhausting, but because sleep is an escape.
It's not because we don't pray or read our Bibles.
In 2013, a Lifeway Research study found that nearly 50% of evangelicals believe that prayer and Bible study alone can conquer serious mental illness. Unfortunately, this mistaken belief prevents people from seeking the help they need.
I know this firsthand. No matter how many times I recited verses, asked for healing, and did all the other things I was supposed to do, I still had an illness. I wasn't miraculously healed.
Of course, our God is powerful and able to heal in an instant. And sometimes, mild depression naturally goes into remission, like cancer, which may reinforce the dangerous idea that seeking medical help signifies lack of faith. Christians need to know prayer and reading hope-filled verses are important parts of a holistic self-care plan.
But they aren't enough. It wasn't until I started taking medication and seeing a licensed therapist (pastors don't receive adequate training to counsel people with depression or suicidal thoughts) weekly that the darkness lifted and my chest stopped aching.
And I'm just as grateful God chooses to work through little pills and skilled professionals as if he waved a magic wand and healed me instantly. He is still the ultimate source of healing and still glorified by working through people.
People serving God wholeheartedly struggle, too.
The lie that those walking closely with God don't ever have suicidal thoughts or other mental health issues is dangerous because it wrongly casts these issues as sin.
If we believe depression and dark thoughts are sinful, we're more likely to feel ashamed and expect God to deal sternly with us. But the truth is he's good and gracious, not waiting to punish us for our struggles.
Depression and suicidal thoughts don't care about how spiritual we are. I'm sure plenty of devout believers and faithful leaders wish it did. I do.
I was in ministry — serving, preaching, leading worship, going on mission trips, leading Bible studies — but still wanting to die. Still hurting. Still hopeless.
I mentioned Steve earlier. He was a youth pastor when he tried to die. He knew what the Bible said and how to pray. He was well aware of all the "right" answers and appropriate spiritual statements. They just left him more ashamed because the stigma of being a pastor with these issues was too great.
Depression and suicide are on the rise nationwide. We can't assume that those we love and look up to aren't fighting the darkness.
We can't "choose joy" or "stop thinking about it."
Sometimes Christians tell us to "choose joy" or focus on somebody other than ourselves. There is some truth to this: caring for others and learning to cultivate joy are important parts of a healthy life.
But when death seems like the only way out of an internal torture chamber, those things don't work. What's worse, they become a way to mask pain. That's how I could be involved in several ministries and wear a big smile while I wished for death.
Saying things like, "I'm so sorry you're hurting," and spending time with people struggling is much more effective than telling them to choose joy. It allows them to be honest, which might wind up saving a life.
Not sure what to say to someone struggling with depression and suicidal thoughts? Or are you dealing with depression and wish someone knew how to help? Click here for a free, 2-page guide to talking to struggling loved ones.
Suicidal thoughts are intrusive.
They show up, whether we want them or not, like a horror movie playing constantly in our heads. We watch our demise over and over. Sometimes, it's terrifying. Other times, it seems like sweet relief.
Several years ago, I was part of an incredible church in Atlanta. I co-directed a non-profit and served in the youth ministry; students looked up to me and came to me for wisdom. Nobody knew how much I struggled. They never knew about the horror movie in my mind.
One tough Sunday, I stood alongside my students in worship, doing everything I could to turn my eyes upon Jesus. I told him I love him and would praise him anyway, even if I always felt like that. But when I closed my eyes, all I could see was an image of my body, swinging from the rafters.
I didn't tell anyone.
We know we're not supposed to have these thoughts, so we don't tell.
We know they are not healthy and normal thoughts. We are well aware that they are uncomfortable and frightening for people to talk about. So we fight to suppress them, telling ourselves not to think such hideous thoughts. If we've been in treatment for a while, we might be able to recognize that those thoughts belong to the disease. We might be able to recognize them as lies.
But we might not.
We might believe God has forsaken us because we're so bad.
The disease lies. When healing doesn't come, it's easy to believe that God has left. And if we've been taught that depression and suicidal thoughts are sinful, selfish, or displeasing to God, we may believe he's right in abandoning us.
This is why we need to treat depression and suicide with the same compassion we treat other serious health issues. Kindness and encouragement from other believers are rich and powerful; they prove the presence of God and demonstrate his unshakeable love.
You can wholeheartedly love Jesus and be depressed.
If you're struggling, you need to know your life can be set apart to his purpose and filled with opportunities to serve and bless others. You may still struggle. Sometimes, you might want to die, but you are no less beloved, worthy, or faithful because of the dark thoughts. And, though you may not believe it, it's still possible to live a full, joyful life in the midst of depression.
It will require hard work and lots of support from trained professionals. It will probably require therapy, digging into painful stuff, and maybe medication. But you can still have abundant life; I know because I do.
I have to take my meds every day, spend time with Jesus in the morning, and go to therapy faithfully. I tell those closest to me when I have hard days and dark thoughts because I am determined they will not win. And a few years into my journey, I still struggle. But my life is beautiful and I'm happy.
You can be, too. But please, invest in yourself. Take care of yourself. Here are a few steps to take:
- Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text with someone at the Crisis Text Line by texting HOME to 741741. Program these numbers into your phone so you have support 24/7.
- Make an appointment with your doctor. If you don't have insurance or can't afford the appointment, most cities have free or reduced-cost clinics that offer mental health services.
- Find somebody to talk to. You are not a burden to them. You are precious and important and this world is better because you're drawing breath in it.
It's easier to save a life than you think.
Earlier, I mentioned believing my death would be a blessing to others. But I'm still here because one friend noticed something was wrong and did something about it.
Angela invited me to dinner, took me along to pick blackberries with her kids, and constantly reminded me how important I was to her family. She told me she loved me, it wasn't my fault I was broken, and God didn't like that I was hurting. She was simply present in my pain.
On a hot July night, when I was tired of fighting to stay alive, I showed up on her doorstep because I knew it was safe. And her family walked with me through the dark.
When I needed Immanuel, God With Us, she carried him into my life. She helped me believe I was loved and my life mattered.
So often, all it takes to save a life is being Jesus to us — being present, being loving, and being light. Christ is "in you, the hope of glory" (Col. 1:27). You don't need answers or to be able to fix it. You just need to be present, perhaps help set the doctor's appointment or just listen. Just be aware of those hurting. Just be kind.
Depressed and suicidal people just need you to enter the dark and sit there with us, your love unchanged. You could be his arms to hold us, his hands to feed us, his voice to tell us we're not alone. Your love and kindness are more powerful than you know.
Depression and suicide are serious issues, and my heart breaks with those of you facing them.
If you need to talk or you know somebody struggling, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text with someone at the Crisis Text Line by texting HOME to 741741.


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Radeon HD 7800 series belongs to the so called sweet spot segment of graphics cards. The card is aimed at more budget conscious gamers playing at 1680x1050 and 1950x1080. Our today's test sample was one of the fastest HD 7850 cards – XFX's Black Edition DD Radeon 7850 975M.
XFX did a great job when it comes to designing the cooler and factory overclocking. The card's GPU runs 115MHz faster while the memory is 50MHz faster (200MHz effectively). This results in 7 to 11 percent performance increase when compared to reference clocks. The included 2GB of GDDR5 memory and 256-bit memory interface also come in handy when gaming at 1920x1080.
Bear in mind that the XFX Black Edition's PCB was borrowed from XFX's HD 7870 and is 24cm long, meaning it's longer than most other Radeon 7850 cards. Good thing is that XFX also borrowed the same cards Double Dissipation cooler that boasts two silent fans. For starters, this means that the card will never overheat as the cooler is more than enough for the needs of Pitcairn Pro chips used on Radeon HD 7850 cards.
The Black Edition R7850 is silent in idle mode whereas during gaming, we had to turn down all other fans in our case only to hear it run. The DD cooler works great both at factory clocks and after our further overclocking.
One of the flagship features of AMD's graphics cards made in 28nm is low consumption, something that our today's sample already proved. Although overclocked, the Black Edition Radeon 7850 provides performance better or similar to Radeon HD 6950 while maintaining lower consumption.
Perhaps the only downside to this XFX's Black DD Radeon 7850 975M 2GB graphics card is the price. It currently goes for €258, making it the priciest HD 7850 around. On the other side of the fence, Nvidia offers GTX 560 Ti 448 cores that can stand up to the HD 7850 and is prices similarly. However, if you're not willing to compromise and are looking for silence as well as a high factory overclock with headroom for further overclocking, then there's no excuse why XFX's Black Edition R7850 shouldn't make your shopping list. XFX has once again shown that it's capable of making quality HD 7850 cards so the only thing left is to hope the price will be slashed once Nvidia rolls out its sweet spot cards.


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The latest project of Nobili Design, architecture and interior design services provider, is so awesome, that you should hurry to catch a flight to see it yourself!The latest finishes and textures, shapes and colors are blending to create a unique concept for a clothes shop interior design project. It couldn't be less than a remarkable show for the exquisite tastes of the very important people that could hit this shop. The clothes shop interior design concept has been developed to create sensational feelings from the moment when you are reaching it and opening the door until you leave with your new purchase.
You will see that also the looks on the exterior are just as amazing as on the inside. Our team did so fine to match the latest pieces of furniture, in the contemporary style at a luxurious level and created this lovely scenery. Is clear like daylight that our team put much passion in the concept and also the knowledge gathered in no less than 10 years.
The fine materials and fabrics, the sleek design of the furniture and finishes, the luxurious lights and touches, all are playing a luxury show in front of our eyes. Every inch of the clothes shop is well structured and organized being practical for the staff and comfortable for the customers. It's the kind of shop that is hard to exit from and is looking like a "fashion week show" location.
Nobili Design has a wide portfolio of customers and projects, from residential to commercial, from classic style interior design concept to contemporary interior design. No job is too little so if you think of redecorating your home or your office, just give us a call and reach out for us. We have created concepts for customers all across Europe but also over the oceans. We are there where you need us and we can also recommend to you the right furniture and fixtures. We can provide for you the full interior design concept as well as the best choice of furniture, appliances, and home accessories.
Interior design concept for a clothes shop
Concept for a clothes shop


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This post courtesy BBC Earth. For more wildlife news, find BBC Earth on Facebook and Posterous.
After laboring for weeks on end, pushing themselves to their physical limits, the time has now come for the beavers to reap the rewards of their hard work. Not only can signs of the beaver species hard work be seen in the successful colonisation of vast areas including that of the Taiga and Tundra in far North America, but also in their genetic make-up. Beavers teeth have evolved to endure the tough grind needed to prepare for this time of year. For instance, beaver teeth have such sharp edges they were once used as knife blades by Native Americans. In fact, beaver's front teeth do not stop growing. Which is especially useful as being particularly prolific builders means their most important wood-cutting tool never degenerates or goes blunt!
We return to the beaver family in the thick of winter. The lush vegetation, mud and stone are now frozen solid and we see exactly how the beavers hydro-engineering and science of preparation have paid off.


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Nevada Concealed Firearms Permit Course
Event created by Eric Loden
Event details
Enroll Now! Space is limited
Nevada Concealed Firearms Permit Course
Location: Clark County Shooting Complex Education Center. Drive in video.
- Classroom 0800-1100
- Lunch 1100-1200
- Range 1200-1700 (Renewal course only enroll here)
This class meets and exceeds all requirements set forth by the Nevada Sheriff and Chiefs Association to obtain a Nevada Concealed Firearms Permit. (Additionally qualifies you for your Florida permit at no additional cost.) Contact us about obtaining a Utah State Permit
Do you need to renew your expiring CFP? Click here.
Time: Review the Course Calendar for date specific times
Classroom time: 3 hours
Lunch break: 1 hour (lunch is not provided) Map of food vendors in the area.
Range time: 5 hours $20 Range Fee for initial applicants
Location: Clark County Shooting Complex: Education Center
11357 N. Decatur Blvd. Las Vegas, Nevada 89131
Requirements: Minimum age for attendance is 12 with guardian present. Must be 21 years or older to obtain applications for *Nevada*, and Florida permits. *Active or honorably discharged Military may be 18-20 to apply for Nevada permit.*
Prerequisite: None
Required Equipment:
- 1 Handgun Semi-automatic, or Revolver (We strongly encourage you to come study with the weapon you plan on carrying for self-defense.) Rental Weapons Packages
- 2 Magazines or 2 speed-loaders for the weapon
- 100 rounds of ammunition for qualifying weapon
- A hat with brim
- Wrap-around eye protection
- Hearing protection (Electronic is advised) Rental Gear Packages
Recommended Equipment:
- 1 Holster View our Approved and Recommended Holster page
- 1 Magazine Pouch
- 1 Sturdy Belt
- Firearms safe handling and storage
- Federal, State, and Local laws
- Prohibited areas (Quick reference page, FAQ)
- Criminal and Civil liability and the aftermath of a shooting incident
- Basic tactics
- Situational awareness, De-escalation, and threat avoidance
- Loading/Unloading, Grip, Stance, Marksmanship, and Diagnostic techniques
- Concealed carry options and presentation methods
- Rules of Engagement (Legal and appropriate use of force in response to a violent threat)
- Defensive marksmanship (The balance between speed and accuracy)
- Survival Sequence (Surviving the initial encounter, and beyond)
- Malfunction clearances
Useful Information:
Useful Information:
To take the practice QUIZ and test your skills click here. (Updated for 2021)
Your signed application received upon the completion of the course is valid for 1 year from the date of attendance.
Following your course, there are two ways to apply, either online or in person following the instructions provided on the forms.
- LVMPD CFP Online Application Form LVMPD CFP Online Application Information page.
- LVMPD CFP PDF Application Download (New revision with updated fees 08/2019)
The 120 day permit processing time starts once you have completed the fingerprint and photograph at the LVMPD office, not submission of the online application.
The fees paid to LVMPD are as follows: (updated fee list can be found here) *Fees to LVMPD may be paid by credit/debit cards, cash, money order or cashier's check.
1. New Application -- $100.25
2. Renewal Application -- $65.25
3. Late Renewal Application -- $80.25
4. Name Change -- $25.00
5. Duplicate Permit/Late Fee/Address Change -- $15.00
6. Additional Fingerprint Cards For Out Of State Applications $15.00 For The First Card, $2.00 For Each Additional Card
Reciprocity: - State Reciprocity laws change often, please follow the links below to find out where your Nevada permit will be honored.
Updated: 01/01/2021
All courses are subject to cancellation due to unforeseen circumstances. Email and phone call notifications will be sent out immediately and students will be asked to choose a future course date.
To view our Course reservation procedure, Cancellation and Refund Policy please click here.


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Columbia Journalism Review, April 19, 2016
Original article: Did Obama Change Cuba?
When President Obama made his historic visit to Cuba last month, the US media followed. At a joint press conference on March 21 with Cuban president Raúl Castro, Obama called on CNN's Jim Acosta, who asked the Cuban leader if he would be willing to release political prisoners. A flustered Castro sputtered and demanded a list of those imprisoned. Obama directed aknowing wink at the assembled journalists.
Obama's implication was that by maneuvering to force Castro to respond live in front of the Cuban people and the world, he had bolstered the power of the press. Indeed, one of the key goals of Obama's Havana trip was to create more space for critical expression in a country that until recently was one of world's most censored. Among the 13 dissidents Obama invited to meet with him at the US Embassy in Havana on March 22 were several independent journalists. He insisted that his joint news conference with Castro be broadcast live.
While it's too early to assess the overall impact of Obama's visit, it seems the right moment to ask a more basic question: Has anything changed for journalists on the island in the month since Obama departed?
Miriam Leiva, an independent journalists and blogger who met with Obama, sees the presidential visit as accelerating trends already under way. "The Cuban government is losing credibility day after day," Leiva noted by phone from Miami, where she was visiting relatives. "President Castro made many promises and has not been able to fulfill those promises."
Leiva has been a leading voice of independent journalism in Cuba since 2003, when her husband, economist turned journalist Oscar Espinosa Chepe, was arrested as part of a sweeping crackdown known as the Black Spring. Espinosa Chepe was released after two years due to poor health (he died of a liver ailment in 2013). But many of those detained along with him were not freed until 2010, in a deal brokered by the Spanish government and the Cuban Catholic Church.
By far the favored strategy employed by the Cuban government against dissident journalists has been organized stigmatization and isolation. Independent journalists have been confronted by screaming mobs, denounced in the state media, and relentlessly tracked by state security.
That is why Leiva is so heartened by the fact that her neighbors now greet her in the street and even occasionally read her stories, which are distributed by email. "People are now more open, they feel less fear," she says. "We ourselves have gained spaces."
Indeed, Cuba's media landscape is no longer static. While the stale state media predominates, there are over 3,000 blogs. Some espouse dissidence and resistance; others express support for the government and the Communist Party while highlighting shortcomings by local officials. "I wanted something small that wouldn't be seen as a threat by the state media," said blogger Elaine Díaz Rodríguez in arecent CPJ report. Díaz was the first Cuban journalists to receive a Nieman Fellowship from Harvard University.
For Yoani Sánchez—another leader in the independent media—Obama's visit had tremendous symbolic value. When Obama arrived in Havana in the middle of a rainstorm, he carried his own umbrella. Cuban functionaries had aides hold theirs. Obama is youthful; Cuba's leadership is decrepit. Obama is black; Cuba's leadership is white (despite the fact that Cuba is a majority black country); Obama shows off his family; Cuban leaders hide theirs.
Speaking this weekend at the International Symposium of Online Journalism, an annual media confab in Austin, Sánchez said the primary impetus for change in Cuba has been technology. Only 5 percent of the Cuban population has access to the internet (according to Sánchez; other sources say it's higher). Cubans must use creative means to access information, including emailed PDFs and flash drives, which are easy to hide and distribute. More recently, Cubans have been flocking to a handful of expensive WiFi hotspots set up around Havana.
"We thought the Cuban people would take to the streets to topple the government, but instead they have done so to get online," Sánchez quipped.
Sánchez, who started out posting an irreverent personal blog, is now essentially a publisher. She employs a regular staff that puts out a online newspaper, 14YMedio, that provides comprehensive coverage of daily events. "I'm worried less about who will be our next president, and more about who will our next citizens," Sánchez explained. "As citizens become empowered, they need more information to make decisions. We want to be the newspaper of the Cuban transition."
While the changing environment for news and information in Cuba is exciting, it is important to keep in mind that is still for the most part taking place within limits set by the Cuban Communist Party, which while no longer monolithic, is still firmly in control. Its reasons for opening Cuba are complex, but they are largely dictated by pragmatic concerns and a desire for self-preservation.
Even as it ceded the limelight briefly to Obama during his trip, the government made a point of consistently affirming the limits of dissent. Dissidents were roughed up and detained prior to and following Obama's visit; the state media, which operates in accordance with Communist Party dictates, published identical headlines; Fidel Castro lashed out at Obama as soon as he departed the island; the Communist Party Congress, which ends today and will set the stage for transition from nearly six decades of rule by the Castro brothers, has been a particularly opaque affair, even by Cuban standards. Raúl Castro emphatically rejected new reforms during his opening speech, which only state media were invited to cover.
In visiting Havana, the gambit for Obama was that his mere presence could accelerate the opening in Cuba; the gambit for Raúl Castro was that he could gain international credibility and legitimacy without making political concessions. With his press conference wink, Obama implied that he had gotten the upper hand, but that is far from clear. While the press conference showed that Raúl Castro doesn't like answering tough questions, there is no real evidence that he will be forced to do so again anytime soon.
After all, as 14YMedio photojournalist Luz Escobar pointed out, no independent Cuban reporters were present. "Cuba continues to be hostile for journalists" she says. "What gives me hope is the changing attitudes of the Cuban people."
Joel Simon is a CJR columnist and the executive director of the Committee to Protect Journalists. His second book, The New Censorship: Inside the Global Battle for Media Freedom, was published by Columbia University Press in November 2014.