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1. USING SILENCE...utilizing absence of verbal communication.
Silence in itself often encourages the patient to verbalize if it is an interested, expectant silence. This kind of silence indicated to the patient that the nurse expects him to speak, to take the initiative, to communicate that which is most pressing. It gives the patient the opportunity to collect and organize his thoughts, to think through a point, or to consider introducing a topic of greater concern to him than the one being discussed. A positive and accepting silence can be a valuable therapeutic tool. (1) It encourages the patient to talk; (2) directs his thoughts to the task at hand--the consideration of his problem; (3) reduces the pace of the interview when either the nurse or the patient is pressing or pushing too hard; (4) gives the patient time to consider alternative courses of action, delve deeply into his feelings, or weigh a decision; (5) and allows the patient to discover that he can be accepted even though he is silent, that even though he is shy and quiet, he has worth and is respected by another person.
Much nonverbal communication occurs during these interludes. The nurse needs to be alert to what she is communicating as well as perceiving. Even momentary loss of interest can be interpreted as indifference. Schwartz and Schockley state that the utilization of silence is often difficult for nursing personnel, since they think that nothing is happening and that they are wasting their time. In long periods of silence, they may become bored and their attention wanders from the patient. If the nurse could observe the patient and herself carefully, she might discover that a great deal happens between then at these times.
2. ACCEPTING...giving indication of reception.
"Uh hmm."
"I follow what you said."
An accepting response, such as "I'm with you" or "I follow what you're saying," indicates that the nurse has heard and has followed the trend of thought. Such responses signify that the nurse is attuned to the patient, that communication is occurring, and that she is a participant rather than a passive observer. Accepting does not indicate agreement but is nonjudgemental in character. "It is simply a verbalization of the attitudes of permissiveness and acceptance of the counselor which say in effect: "Go on, it's safe, you needn't be ashamed of expressing how you really feel."
It should not need to be added that the nurse does not imply that she understands when she does not.Roger adds that accepting does not mean much until it involves understanding. It is only as I understand the feelings and thoughts which seem so horrible to you, or so weak, or so sentimental or so bizarre--it is only as I see them as you see them, and accept them and you, that you can feel really free to explore all the hidden nooks and frightening crannies of your inner and often times buried experiences.
Not only the words are important, but also the facial expression, the tone of voice and inflection, and the posture of the nurse. All must convey the same feeling of acceptance. If they do not, the words will be meaningless.
3. GIVING RECOGNITION...acknowledging, indicating awareness.
"Good morning, Mr. S."
"You've tooled a leather wallet."
"I notice that you've combed your hair."
To greet the patient by name, to indicate awareness of change, to note the efforts the patient has made--these and other similar indications by the nurse show that she recognizes the patient as a person, as an individual. Such recognition carries with it none of the burden for him that praise or approval imposes. It does not imply that one thing is "good" and its opposite "bad." Nor does it cause the patient to strive for more and more approval for its own sake. Peplau comments quite simply, "When a patient accomplishes something that is a fact, a nurse can say so."
4. OFFERING SELF...making one's self available.
"I'll sit with you awhile."
"I'll stay here with you."
"I'm interested in your comfort."
The patient may not be ready to communicate verbally with another person. Or the patient may not be able to make himself understood. Often the nurse can offer only her presence, her interest, and her desire to understand. To be therapeutic this offer must be made unconditionally, i.e., without the patient's feeling that he must give in order to receive or that the nurse will stay only if he does or does not do this or that. (However, those conditions that do apply should be stated, e.g., all the nurse's time is not available to the patient.) On this point Peplau says, "The patient must deny her own feelings and needs in order to be accepted and liked by a nurse who is conditional in her relations with the patient."
5. GIVING BROAD OPENINGS...allowing the patient to take the initiative in introducing the topic.
"Is there something you'd like to talk about?"
"What are you thinking about?"
"Where would you like to begin?"
Broad opening comments merely make explicit the idea that the lead is to be taken by the patient. For the patient who is hesitant or uncertain as to what role his is to play in the interaction, these openings, such as "Is there anything you'd like to discuss with me?" stimulate him to take the initiative and to feel that this is what is expected of him. The nurse should avoid the conventional pleasantries when greeting the patient and refrain from making "small talk." If the nurse does start the discussion, she can try to alter this situation by asking, "Would you like to talk about yourself now?" and then waiting silently until the patient takes over.
6. OFFERING GENERAL LEADS. . . . giving encouragement to continue.
"Go on."
"And then?"
"Tell me about it."
General leads, such as "And after that?" or "Go on" leave the direction of
the discussion almost entirely to the patient. They indicate that the
nurse is following what has been said and is interested in what is to come next.
Brown and Fowler comment:
...the verbal activity of the nurse is at a minimum with the patient doing most of the talking. The nurse encourages the patient to talk by her nonverbal activity such as nodding or various gestures. If verbal activity becomes necessary, sometimes just a word as "well" or "really" will enable the patient to continue.
Schwartz and Shockley state that the nurse "waits for" the patient's communication, "goes along with it" or follows his leads, and takes the cue from him rather than directing the discussion herself.
7. PLACING THE EVENT IN TIME OR IN SEQUENCE. . . clarifying the relationship of events in time.
"What seemed to lead up to...?"
"Was this before or after...?"
"When did this happen?"
Putting events in their proper sequence helps both the nurse and the patient to see them in perspective. The extent to which one event may have led to another can be viewed more objectively once a certain amount of chronologic ordering has occurred. And at times it will become obvious to the patient that previously accepted cause-and-effect relationships could not exist. The nurse may find that she is then able to identify a recurring pattern of interpersonal difficulties, giving her clues to the kind of satisfying experiences with others that the patient needs.
8. MAKING OBSERVATIONS. . . verbalizing what is perceived.
"You appear tense."
"Are you uncomfortable when you...?"
"I notice that you're biting your lips."
"It makes me uncomfortable when you..."
The nurse often makes observations that can be called to the patient's attention. The patient may be showing signs of anxiety--trembling, clenching his fists, biting his nails or lips, smoking endlessly, or other restless mannerisms--of which he is unaware. Or he may have begun to hallucinate actively. He may seem perplexed, fearful, far off in thought, angry or sad. On the other hand, the nurse herself may have become uncomfortable as the result of certain behavior on the part of the patient. In any of these or similar instances, the nurse can bring her observations to the awareness of the patient and encourage their mutual understanding of the behavior or feeling through discussion. This technique is especially useful in relating to mute patients. By voicing her perceptions, such as, "You seem deep in thought," "Your expression conveys bewilderment to me," or "You appear more comfortable with me today," she offers the patient something to which he may respond when ready. Thus she avoids pressing questions on him, yet does not enter into a mutual state of muteness.
By calling the patient's attention to what is happening to him, the nurse seeks to encourage the patient's noticing for himself so that he can do the describing. Then the nurse and the patient can compare their observations.
9. ENCOURAGING DESCRIPTION OF PERCEPTIONS. . . asking the patient to verbalize what he perceives.
"Tell me when you feel anxious."
"What is happening?"
"What does the voice seem to be saying?"
If the nurse is to understand the patient, she must come to see things as they seem to him. The patient should feel free to describe his perceptions to the nurse. In addition to describing his past experiences, he should be alerted to becoming aware of signs of anxiety, thoughts that interrupt and normally would be pushed aside, hallucinatory phenomena, and other disturbing events, feelings, sensations, or ideas. When possible, these should be described to the nurse as they are occurring. Both the patient and the nurse need such descriptions if they are to come to understand the reasons for the patient's behavior. These descriptions are the raw material from which the understandings will be drawn.
Roger states:
It is natural to expect that with increasing security in clinical experience there will be an increasing variety of attempts to communicate the fact that the therapist is endeavoring to achieve the internal frame of reference of the client, and is trying to see with him as deeply as the client sees, or even more deeply than the latter is able at the moment to perceive.
He adds:
.... it would appear that for me, as counselor, to focus my whole attention and effort upon understanding and perceiving as the client perceives and understands, is a striking operational demonstration of the belief I have in the worth and significance of this individual client.
Nurses sometimes feel that encouraging the patient to describe his ideas tend to fix more firmly in his mind the irrational and delusional thoughts he may have. Suicidal and aggressive thoughts and feelings are especially anxiety-provoking for the nurse. However, Schwartz and Shockley point out that the patient may not have to act out if he feels free to talk about his difficulties. Talking may make it unnecessary for the patient to behave in a manner harmful to himself and others.
10. ENCOURAGING COMPARISON. . . asking that similarities and differences be noted.
"Was this something like...?"
"Have you had similar experiences?"
Comparing ideas or experiences or interpersonal relationships brings out many recurring themes. Seeing the similarities helps the patient become aware of the continuity in his life, and noting differences helps him to evaluate the influence of each event or person individually. Peplau emphasizes the nurse's "being herself" as another means of assisting the patient to become aware of likenesses and differences among people. Again, it is obvious that relationships are based on more than words alone. The whole person who is the nurse is relating to the patient. Her feelings and behavior communicate more than her words.
While comparisons are to be encouraged, it is rarely helpful for the nurse to introduce experiences from her own life for his purpose. Too frequently the result is a discussion focused on the needs and problems of the nurse.
11. RESTATING. . . repeating the main idea expressed.
Patient. "I can't sleep. I stay awake all night."
Nurse. "You have difficulty sleeping."
Patient. "The fellow that is my mate died at war and is pending me yet
to marry."
Nurse. "You were going to marry him, but he died during the war."
What the patient has said is repeated in approximately or nearly the same words that he has used. This restatement gives evidence to the patient that an idea has been communicated effectively. He is encouraged to continue. Or, if his thoughts have been misunderstood, he can reword and restate them until he makes himself clear.
An additional benefit, Wolberg feels, is that, "Recasting certain statements into different words brings out related aspects of the material that may have escaped the patient's attention.
12. REFLECTING. . . directing back to the patient questions, feelings, and ideas.
Patient: "Do you think I should tell the doctor...?"
Nurse: "Do you think you should?"
Patient: "My brother spends all my money and then has the nerve to ask for
Nurse: "This causes you to feel angry."
Reflection encourages the patient to bring forth and accept as part of himself his own ideas and feelings. When the patient asks what he should think, or do or feel, the nurse can ask, "What do you think?" or "What are your feelings?" The nurse thereby indicates that it is the patient's point of view that has value. Thus she acknowledges his right to have opinions, to make decisions, and to think for himself. As the nurse shows that she expects him to be able to do these things, he too comes to think of himself as a capable person--as a relatively integrated whole rather than the incorporated parts of others. When the patient expresses feelings and ideas, the nurse can recognize and accept them, acknowledge their existence and reflect them back by noting, "You think..." and "You feel..." This helps the patient to accept them as belonging to him. Karnosh and Mereness suggest that the nurse's skillful reflection of the patient's comments makes obvious her interest in hearing as much as the patient needs to tell.
Reflection, Brammer and Shostrom state:
....focuses on the subjective element of what the client says. Reflection emphasizes the pronoun "you" in the phrases, "you feel" and "you think."
Reflection serves a useful purpose in that it leads the client to think of the feelings and ideas he is expressing as part of his own personality and not outside himself.
The patient is encouraged to separate himself from the personalities of others and to become a person in his own right.
13. FOCUSING. . .concentrating on a single point.
"This point seems worth looking at more closely."
Focusing on a single idea or even a single word can often be very valuable. In effect the nurse says, "This seems important. It is worth spending some time in understanding it now." It is an especially useful technique when the patient jumps rapidly from one thought to another. If severe anxiety is present, however, and the patient is thereby prevented from focusing, the nurse should not persist. As anxiety lessens, the nurse may again utilize this technique.
14. EXPLORING. . .delving further into a subject or idea.
"Tell me more about that."
"Would you describe it more fully?"
"What kind of work?"
Exploring more fully certain ideas, experiences, or relationships is frequently indicated. Many patients deal only superficially with each topic they bring up, as if testing to see whether the nurse is really interested enough to look further or as if to say that nothing of importance has ever happened in their lives. Wolberg suggests that once a theme or trend is identified, it should be explored in as elaborate detail as possible. While the nurse should recognize when to delve further, she should refrain from probing or prying. If the patient chooses not to elaborate, the nurse should respect the patient's wishes.
15. GIVING INFORMATION. . .making available the facts the patient needs.
"My name is..."
"Visiting hours are..."
"My purpose in being here is..."
"I'm taking you to the..."
Informing the patient of the facts when he asks questions--or in other ways indicates the need for information--builds up trust as well as gives the patient a greater body of knowledge from which to make decisions or come to realistic conclusions. Peplau states that a nurse, functioning in the role of resource person, may give specific, needed information that will assist the patient to understand his problem and the situation. If the nurse is not acquainted with the body of knowledge in question, she can truthfully state that she does not know. Then she can endeavor to find out or to refer the patient to someone who has the answers. Areas of information not to be neglected are the role of the nurse and the purpose of the nurse-patient relationship. The nurse should inform the patient of the amount of time she will spend with him, how frequently she will talk with him, and the length or duration of the relationship if this has been predetermined. If she will be recording the interaction, the patient should be told the purpose of the notes. A distinction should be made between this therapeutic relationship and other social relationships the patient may be establishing. In all these things the nurse will usually find that she can be quite direct, avoiding vague and misleading statements.
16. SEEKING CLARIFICATION. . . seeking to make clear that which is not meaningful or that which is vague.
"I'm not sure that I follow."
"What would you say is the main point of what you said?"
Clarification should be sought at each step of the way. The patient is
usually quite aware when he is not being understood. Eventually he may
cease trying to communicate. Peplau states that it
is always possible to ask: What did you have in mind? Have I heard you correctly? Have I understood what you mean, let me repeat what you said? Perhaps you can help me to get clear on what you mean. Perhaps both of us are looking at this issue or problem from a different standpoint; maybe we'd better talk about its meaning to each.
Fromm-Reichmann notes that it is not necessary to understand everything the patient says as long as the nurse is frank about it and does not make pretenses. Not only is the nurse benefitted by clarification Sullivan points out, but attempts to discover what the patient is
talking about can lead to his becoming more clear himself on what he means. The patient's grasp on life is thus to some extent enhanced.
17. PRESENTING REALITY... offering for consideration that which is real.
"I see no one else in the room."
"That sound was a car backfiring."
"Your mother is not here; I'm a nurse."
When it is obvious that the patient is misinterpreting reality, the nurse can indicate that which is real. She does this not by way of arguing with the patient or belittling his own experiences, but rather by calmly and quietly expressing her own perceptions or the facts in the situation. The intent here is merely to indicate an alternate line of thought for the patient to consider, not to "convince" the patient that he is in error.
18. VOICING DOUBT... expressing uncertainty as to the reality of the patient's perceptions.
"Isn't that unusual?"
"That's hard to believe."
Another means of responding to distortions of reality is to express doubt. Such expression permits the patient to become aware that others do not necessarily perceive events in the same way or draw the same conclusions that he does. This does not mean that he will alter his point of view, but at least he will be encouraged to reconsider and to re-evaluate what has occurred. And the nurse has neither agreed or disagreed, yet, at the same time, she has not let misinterpretations and distortions of reality pass uncommented upon. Sullivan expresses this quite well when he states that you should first confirm, by asking the most natural questions that would follow, that the patient intended to say what he did...Having made sure that the patient's statement was as bad as it sounded--that he is entertaining an idea which is not only wrong, but also, in a sense, does violence to the possibility of his living in a social situation among others--you do not the say, "Oh, yes, yes. How interesting." You rather say, "I can scarcely believe it. What on earth gives you that impression:" You note a marked exception,...at least you note your exception and do not agree tacitly.
19. SEEKING CONSENSUAL VALIDATION... searching for mutual understanding, for accord in the meaning of words.
"Tell me whether my understanding of it agrees with yours."
"Are you using this word to convey the idea...?"
For verbal communication to be meaningful, it is imperative that the words conveying the ideas and concepts being discussed have essentially the same meaning for all participants. The nurse may have to suggest "Are you using this phrase to convey the idea...?" or "Perhaps my understanding of this word differs from yours." Otherwise, nurse and patient may find that each is using the same words differently and that no communication is taking place.
Sullivan suggests that the therapist listen with critical interest, asking himself whether what he hears could have any other meaning than that which first occurs to him, asking questions when indicated to be sure that he knows what he is being told. As the patient makes himself clearer to the listener, he becomes more clear in his own mind as to what he means. Peplau adds that both the nurse and patient have preconceptions about the meanings of words, but that a common reference for the word can usually be arrived at though observation and discussion. To facilitate such consensual validation, the nurse should make every effort to avoid expressions that can easily be misinterpreted or misunderstood.
20. VERBALIZING THE IMPLIED...voicing what the patient has hinted at or suggested.
Patient. I can't talk to you or to anyone. It's a waste of time.
Nurse. Is it your feeling that no one understands?
Patient. My wife pushed me around just like my mother and sister did.
Nurse. Is it your impression that women are domineering?
To put into words what has been implied or said only indirectly tends to make the discussion less obscure. The nurse should be as direct as she can be, without being obtuse, or unfeelingly blunt. The patient himself may find it difficult to be direct--to find the appropriate words or the courage to say them--or he may be testing the nurse to see whether she is really striving to grasp what he says. The nurse should take care to express only what is fairly obvious; otherwise she gets into the realm of offering interpretations. In Sullivan's words,"...putting the obvious into words often markedly improves things." Verbalizing the implied goes one step beyond restatement in that it clarifies that which is implicit, rather that explicit, in that which has just been said. It reflects relationships or meanings for the patient that have been suggested or implied in the thoughts or feelings brought out by the patient's responses.
21. ENCOURAGING EVALUATION...asking the patient to appraise the quality of his experiences.
"What are your feelings in regard to...?"
"Does this contribute to your discomfort?"
The patient is asked to consider people and events in the light of his own set of values and to evaluate the way in which they affect him personally. He is thereby discouraged from adopting without appraisal the opinions and values of others, including those of the nurse. Rogers notes that some patients make great efforts to have the therapist's task to consistently keep "the locus of evaluation" with the patient.
22. ATTEMPTING TO TRANSLATE INTO FEELINGS...seeking to verbalize the feelings that are being expressed only indirectly.
Patient. "I'm dead."
Nurse. "Are you suggesting that you feel lifeless?" or "Is it that life seems without meaning?"
Patient. "I'm way out in the ocean."
Nurse. "It must be lonely." or "You seem to feel deserted."
Often what the patient says, when taken literally, seems meaningless or far removed from reality. To understand, the nurse must concentrate on what the patient might be feeling in order to express himself as he does. Peplau suggests that the nurse ask herself what the patient is saying that he cannot say in any other way. She then must desymbolize what is actually said to find clues to the underlying meaning. Wolberg aptly speaks of this process as "reaching" for feelings that lie behind verbalization. Only then can the nurse attempt to verbalize the feelings that the patient has difficulty putting into words. For example, the patient who sees the personnel as "giants" is likely to feel insignificant and powerless by comparison. For the nurse to introduce these feelings into the discussion is likely to have more value than for her to discuss the "giants" as such. It is the latent meaning of the expression rather than the actual content that demands the nurse's attention. Rogers points out that responding primarily in terms of the feelings expressed--rather that the content--gives the patient the satisfaction of feeling deeply understood and enables him to express further feelings.
23. SUGGESTING COLLABORATION...offering to share, to strive, to work together with the patient for his benefit.
"Perhaps you and I can discuss and discover what produces your anxiety."
The nurse seeks to offer the patient a relationship in which he can identify his problems in living with others, grow emotionally, and improve his ability to form satisfying relationships with others. She offers to do things not for him or to him, but with him. Peplau speaks of a cooperative relationship in which both the nurse and the patient can become aware of the nature of the problems or tasks and how they can be met. "To encourage the patient to participate in identifying and assessing his problem is to engage him as an active partner in an enterprise of great concern to him." Sullivan states that he always tries to outline for the patient what he sees as a major difficulty in his living with others with the implication that if the "work together," he has hopes that they will get somewhere with the problem.
24. SUMMARIZING...organizing and summing up that which has gone before.
"Have I got this straight?"
"You've said that..."
"During the past hour you and I have discussed..."
Summarization seeks to bring together the important points of the discussion and to give each participant an awareness of the progress made toward greater understanding. It omits the irrelevant and organizes the pertinent aspects of the interaction. It allows both nurse and patient to depart with the same ideas in mind and provides a sense of closure at the completion of each discussion. This summing up can be done periodically throughout the discussion or only at its close. But no matter who does it or how frequently it occurs, summarization is a valuable part of each exchange. For it is during periods of summarization that the nurse and the patient strive to grasp the significance of what has been said, to formulate the meaning of the data, and to achieve new understandings. Wolberg mentions that for the patient who rambles and becomes too engrossed in detail that he loses sight of the inter-relationship of the topics he's presenting, summarization is helpful. It pulls together what seems to be disorganized material.
Brammer and Shostron suggest three alternatives. The therapist himself can review the content and essential feelings expressed during the interview. The patient can be asked to relate what he feels he has accomplished or what the situation appears to be now. Or the therapist and the patient can look together at what has been achieved. Perhaps in the nursing relationship the summary can be less formal, but this does not mean that it should be omitted. A simple, "Have you and I learned anything from today's conversation?" may be quite sufficient.
25. ENCOURAGING FORMULATION OF A PLAN OF ACTION...asking the patient to consider kinds of behavior likely to be appropriate in further situations.
It may be helpful for the patient to plan for the future what he might do to
handle various interpersonal situations that he finds disturbing, such as those
in which he is provoked to anger or in which he is hesitant or shy or
anxious. Talking over each situation in an attempt to better understand it
will, of course, precede this "plan of action." And whatever plans are
made should be the patient's, not the nurse's. While it should be
recognized that preplanning in itself will not solve the problem, there is the
likelihood that later behavior will be guided by such thinking rather than by
impulse alone. In addition, the nurse may encourage the patient to
role-play or act out with her such situations in advance, as another means of
preparation. In a broad sense, the entire nurse-patient relationship is an
experience of this sort--a preview of future relationships of a more reciprocal
nature in which the patient may find--and give--acceptance, respect, and
1. REASSURING...indicating that there is no cause for anxiety.
"I wouldn't worry about..."
"Everything will be all right."
"You're coming along fine."
To attempt to dispel the patient's anxiety by implying that there is not sufficient reason for it to exist is to completely devaluate the patient's own feelings. Hence, no value is placed on the patient's judgment. The nurse communicates only her lack of understanding and empathy. If it is the patient's progress she wants to comment upon, she can offer concrete examples of changes that have occurred rather than state, "You're doing fine" or other equally vague reassurances that have little or no meaning. Burton tells us that giving reassurance is a common error. It makes the person giving it feel better for a short time but it is meaningless to the patient. She adds,
In the first place, the person giving the reassurance is not sure that someone will feel better, or will live, or will have a satisfactory outcome from an operation. It is hoped that he will, but that is all. Furthermore, the reassurance is belittling to the person who has the problem or worry...An immediate effort of this response is to block the person from expressing further feeling. If the person who is blocked by someone's reassurance there is a negative feeling stirred up which says, "There's no point in trying to tell her anything because she won't understand; she will ridicule my fear, making me feel foolish."
Sullivan concurs by stating that such verbalisms--the attempt to do magic with language--reassures the therapist rather than the patient. Magic, he says, cannot be done with reassuring words. The real magic is done by the patient, not the therapist, and occurs in the interpersonal relationship. There is absolutely no justification for trying to reassure, unless you are able to document what you say. "All in all, when you can't reassure a person except by magic, the sensible thing is not to try."
2. GIVING APPROVAL...sanctioning the patient's ideas or behavior.
"That's good."
"I'm glad that you.."
To state what the patient is doing, feeling, or saying is "good" is to imply that its opposite is "bad." Approval, then tends to limit the patient's freedom to think, speak, or act in a way that displeases the nurse. It also leads the patient to strive for praise rather than progress. Peplau states that praise arouses undue ambition, competitiveness, and a sense of superiority. The possibilities for learning are closed off, as the patient speaks and acts in terms of what brings approval. Eventually, the patient comes to focus almost exclusively on what will bring approval. She adds, "Praise and blame, good and bad, right and wrong, leave nurses only a two-sided coin with which to operate in their relations with patients. Focusing on the steps in learning allows infinite variety in relations with patients.."
While approval and disapproval are likely to alter undesirable behavior, Burton notes that such changes, though they come about quickly, are not usually lasting. For as soon as the motivating force is removed, the original behavior returns. Hence, no learning has occurred.
"Let's not discuss..."
"I don't want to hear about..."
When any topic is rejected, it is closed off from exploration. When the patient himself is rejected, therapeutic interaction ceases. Fromm-Reichmann points out that the insecure therapist is likely to be afraid of the patient's anxiety-producing experiences. He thwarts the patient's expressions by giving premature reassurances that he needs himself. Consequently, certain areas of the patient's experience are not submitted to investigation.
According to Burton, the patient tends to feel rejected by the nurse when she is fearful of permitting him to express his feelings and to reveal his problems. He then may avoid help rather that risk further rejection. It is important for the nurse to know herself--to identify kinds of behavior of ideas that make her anxious-and to seed help for her problems. Otherwise, she is likely to add new problems to those with which the patient is already struggling.
4. DISAPPROVING...denouncing the patient's behavior or ideas.
"That's bad."
"I'd rather you wouldn't..."
Disapproval implies that the nurse has the right to pass judgment on the patient's thoughts and actions. It further implies that the patient is expected to please the nurse. Schwartz and Shockley suggest that the nurse accept the patient for what he is, being neither moralistic nor conditional in this acceptance. They add,
It is important for a number of reasons to find an alternative to the moralistic attitude in relating with patients. The patient may have been criticized, condemned and rejected in the past, and these attitudes have contributed to his illness. A blaming and punishing attitude may reinforce his loneliness and hopelessness by confirming his feeling that people cannot or will not understand him. These moralistic attitudes might take the nurse's attention away from the patient's needs and from her relations with him and direct it toward her own feelings.
It is important for the nurse to acknowledge that the patient has a right to
behave as he does, for a patient's sick behavior is no more right or wrong, good
or bad, than is the pain of a somatic illness. Brammer and Shostrom add
that approval and disapproval tend to "have unfortunate effect of rigidifying
the client's thinking." At times the patient's behavior may be so extreme
as to cause harm or discomfort to others. Rather that insist, "You're
behaving badly" or "That's wrong," she might say, "You are hurting Mr. S., we
cannot allow you to do this," or "We will have to move you from the dayroom for
now, you're making Mr. S. very uncomfortable by speaking to him this way."
Thus the nurse informs the patient of the effects of his actions instead of
value judgments.
5. AGREEING...indicating accord with the patient.
"That's right."
"I agree."
While approval indicates that the patient is "good" rather that "bad," agreeing indicates that he is "right" rather than "wrong." Furthermore, agreement gives the patient the impression the he is "right" because his opinion is the same as that of the nurse. Opinions and conclusions should be exclusively the patient's, not of the nurse. When the nurse agrees with the patient, she leaves him with little opportunity to modify his point of view subsequently. Actual agreement tends to make the patient feel that he cannot later change his position without admitting error. Rather than take sides for or against the patient, the nurse can better use her time to help the patient gather the data needed to form his own opinions and draw conclusions. If she is aware of information the patient needs, she can make this available to him. But to evaluate the data is a task for the patient. This does not mean that she cannot say, "That's right," when the patient asks, "This is Thursday, isn't it?" This the acknowledgment of a fact. At no time, however, should the nurse agree with delusional ideas.
Since accord is involved in both, it is important to distinguish between agreement and consensual validation. To agree is to indicate accord with the patient's system of values--with his opinions, conclusions, or point of view. Consensual validation refers to shared understanding of the meaning of words. No value judgment is involved. It is not a question of whether a word or an expression is right or wrong but whether it conveys similar meaning to both nurse and patient. Without consensual validation no communication can occur. Shared opinions and judgments are not necessary to effective communication.
6. DISAGREEING...opposing the patient's ideas.
"That's wrong."
"I definitely disagree with..."
"I don't believe that."
Conversely, to disagree is to imply that a patient is "wrong." Disagreement places the nurse in opposition to the patient. Consequently, he feels called on to defend himself. To defend one's ideas tends to strengthen them. If these are delusional ideas, the nurse may be building up what she had intended to tear down. Rogers feels that when the therapist thinks in evaluative terms, i.e., becomes judgmental, he is seeing the patient as an object rather than as a person, and to that extent respects the patient less.
Acceptance of the patient as he is frees him to perceive new meanings and new
goals. Roger states:
...only as the therapist is completely willing that any outcome, and direction, may be chosen--only then does he realize the vital strength of the capacity and potentiality of the individual for constructive action. It is as he is willing for death to be the choice, that life is chosen; for neuroticism to be the choice that a healthy normality is chosen.
These are strong words--anxiety-provoking perhaps. But while disagreement confines the patient, acceptance frees him to grow emotionally. The nurse cannot grow for the patient. She can only provide a relationship in which growth is possible--not mandatory.
7. ADVISING...telling the patient what to do.
"I think you should..."
"Why don't you...?"
When the nurse tells the patient what he should think or how he should behave, she implies that she knows what is best for him and that he is incapable of any self-direction. Peplau states that advice acts to prevent the patient from struggling with and thinking through his problems. Moreover, it is most likely that the patient has already received innumerable suggestions and advice from his family and friends. "If the matter were simply one of telling patients what is wrong with their feelings...most--if not all--of the psychiatric patients in psychiatric institutions would probably be well..." There is a difference between giving advice and giving information. By giving advice, the nurse takes away from the patient the responsibility that is rightly his. To give advice is to keep patients in a state "of immature dependence upon the judgment and guidance of others..." To give information, on the other hand, is to supply the patient with additional data from which he can later formulate his own course of action.
8. PROBING...persistent questioning of the patient.
"Now tell me about..."
"Tell me your life history."
Probing tends to make the patient feel used. He feels valued only for what he can give. It places him on the defensive. He may respond with anger, with distortions or evasions, or cease to respond entirely. As Burton aptly notes, "Probing belongs in surgery, not in counseling." Arieti states,
Each question is experienced by the schizophrenic as an imposition, or an intrusion into his private life, and will increase his anxiety, his hostility, and his desire to desocialize. The request for information is not seldom interpreted by the patient as "an attempt to take away something from him."
While the response of the schizophrenic patient may be extreme, it is not unusual for any person to resent this technique, particularly the patient under the stress of illness. Often the nurse is not aware that she has been persistently questioning the patient until she looks over the notes she has taken during the interaction. Especially when the patient is quiet or withdrawn and answers only briefly or not at all, the nurse tends to become increasingly anxious and increasingly persistent in her questioning, without being aware of what is happening. If the nurse can focus on the patient and his discomfort and can "put herself in his place" during the discussion, she is likely to find herself less anxious and more likely to be "in tune with" the patient.
9. CHALLENGING...demanding proof from the patient.
"But how can you be President of the United States?"
"If you're dead, why is your heart beating?"
Often the nurse feels that if she can challenge the patient to prove his unrealistic ideas and/or perceptions, he will realize that he has no "proof" and will be forced to acknowledge what is "true." She forgets that delusional ideas serve a purpose for the patient and are not given up so readily. Moreover, these ideas conceal feelings and meet needs that are real. When challenged, the patient tends only to strengthen and expand his misinterpretations of reality, as he seeks support for his point of view. Only as the nurse is able to discover the unmet needs and help the patient meet them in reality is there likely to be less need for the unrealistic ideas and perceptions.
10. TESTING...appraising the patient's degree of insight.
"What day is this?"
"Do you know what kind of a hospital this is?"
"Do you still have the idea that...?"
It is not uncommon for the nurse to feel that she must convince the patient of the extent of his incapacity and have him agree that this is so. Actually the nurse is saying, "Admit that you are sick and need help." Paradoxically, she demands that the patient have insight into his very lack of insight. For him to agree that this is so--at her insistence--meets only the nurse's needs, not those of the patient. It is preferable to assume the best about the patient, e.g., the nurse saying, "Tell me about what took place," rather than asking, "Can you remember what happened?" The latter implies that the patient is probably not capable of recall. As Sullivan has noted, "There is not reason to pronounce the patient insane as a preliminary to helping him to regain his sanity."
11. DEFENDING...attempting to protect someone or something from verbal attack.
"This hospital has a fine reputation."
"No one here would lie to you."
"But Dr. B. is a very able psychiatrist."
"I'm sure that he has your welfare in mind when he..."
To defend what the patient has criticized is to imply that he has no right to express his impressions, opinions, or feelings. Telling the patient that his criticism is unjust or unfounded does not change his feelings. The feelings still exist and are in need of expression. But when the nurse becomes defensive, she causes the patient to feel that he should discontinue such expression. As a result the patient often feels only more strongly that his impressions are valid--that he has uncovered a weakness that others are trying to conceal. Burton states that the nurse accepts the patient's right to feel as he does, without necessarily agreeing with him...When we fly to the defense of someone we are implying that the other person needs to be defended. Whereas if we really have faith in the person or profession criticized we should not feel that defense is necessary. Furthermore, when we defend someone we are usually lining ourselves up with the person against the person making the criticism.
12. REQUESTING AN EXPLANATION...asking the patient to provide the reasons for thoughts, feelings, behavior, and events.
"Why do you think that?"
"Why do you feel this way?"
"Why did you do that?"
There is a difference between asking the patient to describe what is occurring or has taken place and asking him to explain why. The former is to be encouraged. When an explanation is sought, however, it is often necessary for the patient to make up for his lack of sufficient understanding by inventing a reason, giving partial answers, or expanding his delusional system to provide the requested explanations. It is only after much learning has taken place that the patient is ready to attempt to explain what has happened. Peplau notes that the nurse often automatically asks, "Why?" or "Why not?" she adds,
More often than not a "why" question has an intimidation effect. It has a ring of familiarity and is frequently reminiscent of earlier experiences when mother or teacher reiterated "Why don't you do this" or "Why can't you tell me" or some similarly coercing "why" question. Moreover, if the patient knew why he wasn't sleeping or hungry or comfortable, he would most probably deal with the situation. A "why" question asks for reasons which the patient is not likely to know immediately. He can discover them with help. But, in order to discover them, the patient requires some raw data--he must recall, for example what actually went on... The reasons can be generalized from these data; then the "why" question can be answered.
13. INDICATING THE EXISTENCE OF AN EXTERNAL SOURCE...attributing the source of thoughts, feelings, and behavior to others or to outside influences.
"What makes you say that?"
"Who told you that you were Jesus?"
"What made you do that?"
The nurse can ask, "What happened?" or "What events led you to draw such a conclusion?" But to question "What made you think that?" seems to imply that the patient was made or compelled to think in a certain way--that someone or something was the cause for the patient's ideas, feelings, or actions. Usually the nurse does not intend to suggest that the source is external. She really thinks that she is asking the patient to describe the way in which something came about. But its probably meaning to the patient is what must be considered. As Sullivan comments, "...you don't know what people mean, or what your words mean to them, until you find out!" Hence, the nurse should always strive to word her comments so as to avoid, insofar as possible, ambiguity. To actually suggest the reality of an external source is to encourage the patient to greater utilization of projection as a means of alleviation anxiety. Moreover, it relieves the patient of responsibility for his own thoughts and actions.
14. BELITTLING FEELINGS EXPRESSED...misjudging the degree of the patient's discomfort.
Patient. "I have nothing to live for...I wish I were dead."
Nurse. "Everybody gets down in the dumps." or "I've felt that way sometimes."
When the nurse tries to equate the intense and overwhelming feelings expressed by the patient with those of "everybody" or herself, she implies that the discomfort is temporary, mild, and self-limiting. She then often tells the patient to smile "buck up" or think of something else. In this way she indicates her lack of empathy and understanding and can offer no constructive assistance. Sullivan warns that anything that causes a patient to feel "small" or insignificant is apt to leave a long-lasting wound. Therefore, the therapist should try very carefully not to belittle or humiliate. As Burton states,
When you are worried about your own problem whether big or little, it does not comfort you to know that others are, or have been, in the same boat...when you are concerned with and focusing on your own misery you are not capable of concern about the misery of others.
Of greater value would be comments such as, "You must be very uncomfortable" or "Would you like to talk about it?" Again, it is important for the nurse to perceive what is taking place from the patient's point of view, nor her own.
15. MAKING STEREOTYPED COMMENTS...offering meaningless cliches, trite expressions.
"Nice weather we're having."
"I'm fine, and how are you?"
"It's for your own good."
"Keep your chin up."
"Just listed to your doctor and take part in activities--you'll be home in no time."
It is not unusual for conversations to contain a large proportion of trite expressions, empty words, meaningless cliches, and patterned replies. Such comments lack value in the nurse-patient relationship, just as they do elsewhere. Sullivan asks the therapist to avoid "all impractical meaningless comment..." For the nurse to make empty conversation is to encourage a like response from the patient. And as Sullivan notes, "The more conventional a person's statements are, of course, the more doubtful it is you have any idea of what he really means." Consequently, many words of meaninglessness are exchanged, but nothing is really communicated. If the nurse has nothing meaningful to say, she should say nothing.
Schwartz and Shockley state that the nurse tends to become accustomed to the patient's behavior and adjusts to it by developing a few automatic approaches to him. These responses are of little value. They add,
Stereotyped responses are also indicated by the way a nurse talks to a patient. When a patient asks the nurse why he should do something which she asks of him the nurse may reply: "It's good for you." "The doctor ordered it." "It will get you well." "Because I want you to do it..."
None of these responses is necessarily stereotyped, but if her answer is given in a mechanical way as a substitute for a more reasonable and considered explanation, the response may easily become stereotyped attitudes.
16. GIVING LITERAL RESPONSES...responding to a figurative comment as though it were a statement of fact.
Patient. I'm an Easter egg.
Nurse. What shade? or You don't look like one.
Patient. They're looking in my head with television.
Nurse. Try not to watch television. or With what channel?
Often the patient is at a loss to describe his feelings. When, for example, it seems as though his every thought is known to others, he may say, "They're looking in my head all the time with television." To say that he is an Easter egg may mean that he feels closed away in a shell or conspicuous or less than human. (He says these things because at this time it is the best way he has of putting into words the way it seems or feels to him. The feelings he is having are so strange--so foreign to him--that conventional expressions seem highly unsuitable.) For the nurse to respond in kind is to indicate her inability to understand when anxiety-producing feelings are being described. Sullivan makes an apt remark:... "the patient may get the idea that the psychiatrist is a fool, poorly trained, or part of a plot--no one of which ideas is particularly helpful to therapeutic progress." This is not to imply that all delusional ideas are wholly without literal meaning to the patient. Perhaps originally this may have been so, but now he undoubtedly takes them literally too. Even so, there is no reason for the nurse to acquire a similar manner of thinking.
17. USING DENIAL...refusing to admit that a problem exists.
Patient. I'm nothing.
Nurse. Of course you're something. Everybody is something.
Patient. I'm dead.
Nurse. Don't be silly.
We are familiar with the patient who denies that he is sick or has problems of any kind. The nurse, by her comment, tone of voice, or facial expression, often unwittingly uses the same defense to avoid discussion of a problem that she thinks should not exist or an idea that she considers meaningless or perhaps even frightening. In effect, she has closed both her eyes and her mind to the patient's problem. When the nurse uses denial, she shuts off an avenue of discussion and avoids helping the patient to identify and explore his difficulties. Peplau points out that when the nurse "denies the validity of the patient's feelings...in order to feel safe the patient may have to give up attending to what he feels and indicate verbal acceptance of what the nurse has indicated he should feel.
18. INTERPRETING...seeking to make conscious that which is unconscious, telling the patient the meaning of his experiences.
"What you really mean is..."
"Unconsciously you're saying..."
Fromm-Reichmann states that to interpret is to "translate the manifestations of that which is barred from awareness into the language of consciousness." The nurse, Peplau tells us, respects the patient's right to have his own feelings and to express them to those who may understand them, but she will not necessarily confront him with the intention of these feelings. While the psychiatrist may interpret directly to the patient, the nurse endangers her usefulness in her other roles--of resource person, mother surrogate--by doing so. She notes that only the psycho-therapist is prepared to try to aid in the "release and formulation into awareness of dissociated perceptions, i.e., with unconscious materials." Rogers points out that interpretation seems to indicate a limited confidence in the patient's capacity to cope with his problems. Matheney and Topalis feel that the goal of therapy is helping the patient to develop sufficient emotional maturity so that he can develop and utilize an understanding of his behavior, but they note that such understanding does not come from without. Rogers concurs: "...insight is an experience which is achieved, not an experience which can be imposed." Brammer and Shostrom sum up this point of view by noting that a cardinal goal of all therapists for patients is "assisting them toward self-interpretation," since it is the patient who must get the insight, not the therapist. Several drawbacks seem obvious: (1) the interpretation may be incorrect, (2) the patient may not be ready for it, (3) the patient is prevented from having the opportunity to achieve the insight on his own. And as Sullivan notes, "The supply of interpretations, like that of advice, greatly exceeds the need for them."
19. INTRODUCING AN UNRELATED TOPIC...changing the subject.
Patient. I'd like to die.
Nurse. Did you have visitors this weekend?
When the nurse changes the subject or introduces one, she takes over the
direction of the discussion. The initiative is taken from the
patient. The nurse often does this in order to get to something that she
wants to discuss or to get away from a topic that she would prefer not to
discuss. Sometimes she just feels the need to say something.
* From Hays, Joyce and Kenneth Larson. (1963)
Interacting With Patients. MacMillan: New York.


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Prescription drugs and household chemicals are found in many Minnesota rivers and lakes. Education initiatives around the state will encourage residents to properly dispose of old or unused prescription drugs to keep them from contaminating water. (MPR Photo/Dan Gunderson)
Read the article: Stopping water contamination, in Minnesota, requires new message
Read the article: Grand Forks Park Board backs river recreation idea

subset: commoncrawl


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You will find below information about Cordova Mudhole Smith airport. Use the links below to read detailed information about Cordova Mudhole Smith airport: location, route maps, live departures and arrivals etc.
Skyscanner allows you to find the cheapest flights to Cordova Mudhole Smith airport without having to enter specific dates or even destinations, making it the best place to find cheap flights for your trip to Cordova Mudhole Smith airport. Use the links at the side of the page to browse for flight information or use the flight search controls above to start a new search.
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- Valdez airport (82km)
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- See all airports in United States.


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Learn more about Helizone Combat Fighter 3 Channel Gyro Missile Shooting RC Helicopter - Helizone RC - HZ-Combat:
Manufacturer: Helizone RC
Mfg Part#: HZ-Combat
Sku: 226276213
Package Weight: 2 lbs
Batteries: Not Applicable
See more in Remote Control Vehicles
|"Helizone RC introduces the newest 3 Channel Gyro Helicopter. This isn't your ordinary radio control helicopter that is limited to just flying, up/down, left/right, forward and backward. The combat fighter adds missile launching shooting abilities as well as speed acceleration for action pack fun. Along with precise gyro flight stability, the Helizone Combat Fighter has 2 missile launching buttons on top of the controller. Left button for Left missile and right button for right missile. Comes equipped with launch target and extra missiles."


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With reference to Ian Stewart's interesting article on how to make two spheres out of one ("Paradox of the spheres", 14 January), readers may be interested to know of a simpler method which, while perhaps lacking something of the elegance of the Banach-Tarski procedure, is quite satisfactory for home use.
Take a sphere composed of an infinite number of points and place it in a jug or other suitable container. Stir briskly to reduce it to a topologically fluid state, with no points left sticking together. Pour into a spherical wooden or plastic mould; tap the mould to ensure that no voids are left. The mould may now be carefully disassembled, leaving a sphere made up of an infinite number of points.
You have not emptied the jug, however, since the number of points it contained was infinite. You can now therefore pour another sphere, or a different shape if ...
To continue reading this article, subscribe to receive access to all of newscientist.com, including 20 years of archive content.


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Jersey Shore
Vinny Guadagnino 'All Blotchy' From Lil Wayne, Ke$ha's Visit?
Vinny Guadagnino's spin-off The Show With Vinny premiered last night on MTV, and though you may have seen the guido welcome Lil Wayne and Jenna Marbles into his home no problem, you may not have seen just how nervous the Jersey Shore alum can get.
The show, a hybrid reality/talk show, features a slew of A-listers as they join Vinny and his very Italian family around the dinner table.
"Basically it's a show that shows the real side of people. It shows the human side of celebrities you don't always get to see."
And what exactly might you get to see? Nerves, according to the Staten Island native and his mom.
"I'm a fan of all these people, so when they come in the house I get really nervous," he said. "I'm like a fan ..."
"He does," his mom Paola said. "He gets all blotchy." Aw, isn't that sweet?
"I'm nervous like you would be nervous if Ciara walked into your house, or if Jenny McCarthy climbed into your bed that you grew up in," Vinny defends. "But what makes it a little bit easier for me is that my mom and uncle don't know who any of these people are, so it kind of, like, makes me feel comfortable because I'm always like, 'Alright, you don't care,' because I don't want everyone pampering the person because it makes me more nervous."
And with a guest list featuring the likes of Mark Wahlberg, Ke$ha, Jenny McCarthy, and Brittany Snow, wouldn't you be nervous too?
I know I would! Stay tuned this season to see just how nervous Vinny gets!
Source: MTV News


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West Monroe, LA (PRWEB) July 24, 2013
Coast Professional, Inc., a leading provider of collection services to the higher education marketplace, is pleased to announce that Brian Davis, CEO of Coast Professional, was recently awarded the International Fellowship of Certified Collection Executives (IFCCE) designation by the Association of Credit and Collection Professionals (ACA International).
The IFCCE designation, one of ACA International's most prestigious awards, recognizes experienced individuals who have made significant contributions to the improvement of the collection industry, emphasizing their achievements in five areas: collection and other business experience; education and training; association achievements and leadership; personal contributions to improvements of collection service operations; and accomplishments in public relations, community involvement and business ethics. The designation was first awarded in 1966, and since that time, only 377 individuals nationwide have been granted the IFCCE credential.
"I am deeply honored to be recognized by the ACA International in this fashion," Mr. Davis said. "My success is a testament to the phenomenal team we have built here at Coast. It is a confluence of leadership at all levels, teamwork, and unsurpassed customer service that has enabled our firm to flourish."
Everett Stagg, President of Coast Professional, expressed his support of Mr. Davis. "Brian has been an exceptional leader in the collections industry, and this award is an indication of the hard work and dedication that has characterized his entire career."


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If you've been anywhere near the Internet this week, you have heard talk of Beyoncé being on our February 2013 cover.
Well, the rumor is true, and here is your first official peek at her GQ debut.
And now, you can see ALL of our photos of Beyoncé, the first of our 100 Sexiest Women of the 21st Century. (You're welcome.)
To be guaranteed you get your copy, click here.
Update: See All of Beyoncé's GQ Cover Shoot Here


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IOWA CITY, Iowa – The Iowa City school board has set aside plans to redraw some school boundaries, a process that had been debated the past couple of months.
The board Tuesday night voted 7-0 to follow Superintendent Stephen Murley's recommendation that there be no changes in elementary school and junior high attendance zones in the 2013-14 school year.
One exception may be sending children from the Lake Ridge neighborhood in southern Iowa City to Hills Elementary School instead of Twain Elementary, where they go now.
Redistricting, as the process is known, was proposed by Murley's administration in early March to ease overcrowding at Wood Elementary in Iowa City and North Central Junior High in North Liberty. To do that, several other schools would have had their boundaries changed.
But the superintendent said Tuesday that reaction from the public caused him to recommend the board pull back.
Murley said several themes arose at forums and through other feedback:
Parents are concerned about how the school district determines enrollment projections. Murley said the district is looking at how it can do this differently.
There is too much uncertainty over Iowa's request for a waiver from the federal No Child Left Behind Law and how, if it is granted, that would affect transfers. Several Iowa City school district schools that have run afoul of the law must allow students to transfer, and 20 percent of the district's students don't attend their home schools.
There is a need to address overcrowding at Penn Elementary immediately.
The district has identified a need for a North Liberty-area elementary school and another on the east side of Iowa City. Changing junior high school and elementary school boundaries are predicated on those decisions.
There needs to be a clearly delineated feeder system.
A long-range plan needs to be developed to address the above concerns.
Murley said the planning process will require the school board to either reaffirm the 2010 vote to eventually build a third comprehensive high school or take the steps to allow West High and City High to handle increasing enrollment.
A district committee studying a new high school is expected to submit its report soon, with the school board likely discussing it in June.
Murley said the district has identified five available temporary facilities to help ease overcrowding now at Wood, Penn and Lemme elementary schools.
In the Lake Ridge mobile home park neighborhood, Murley said many parents have expressed an interest in being in the Hills Elementary attendance zone. Administrators want more time to talk with parents before making a recommendation, he said.
Cedar Rapids, Iowa News, Sports, and Weather
Iowa City School District Backs Off Redistricting Plans
By Gregg Hennigan, Reporter
Most Popular


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Eran Shemer, DVM — Chief of Staff
Dr. Shemer, Chief of Staff, has been with North Windham Animal Hospital since 2011. He graduated Magna Cum Laude from St. George's University after completing clinical training at Cornell University. Dr. Shemer is passionate about veterinary medicine and has a genuine love for animals, big and small; he sees dogs, cats and exotics.
While providing personal and compassionate care, Dr. Shemer continuously strives to keep the hospital on the cutting edge of medical advances. He has a special interest in surgery, internal medicine, and ultrasound. With unflagging enthusiasm, he values the chance to help animals and make positive changes in the lives of pet owners.
Dr. Shemer resides in Storrs with his wife, two young children, and dog companion of the last 15 years, Shirly. In his free time, he enjoys cycling, hiking, and spending time with his family.
Dianne Beal, DVM
Dr. Beal originally hails from upstate New York and earned her undergraduate degree from the College of St. Rose in Albany. She received her DVM degree from Iowa State University and completed a portion of her training in the UK. Following graduation, Dr. Beal completed a small animal internship at Regional Veterinary Referral Center in Springfield, Virginia and has worked locally in small animal practice since returning to her home in Connecticut. While she enjoys many aspects of veterinary medicine, she has a soft spot for the older patients and has an interest in dermatology.
Dr. Beal now resides in North Stonington with her husband Clayton, her beloved hound Dobby, and her black and white cat Holstein. In her spare time, she enjoys the outdoors, belly dance, ballroom dance, good books and movies, and making and selling jewelry. Dr. Beal is thrilled to join the team at North Windham Animal Hospital and looks forward to meeting and being of service to our clients and their beloved pets.
Jill Dennis, DVM
Dr. Dennis is a veterinarian at North Windham Animal Hospital, joining our team in August 2014. Originally from Rhode Island, she received her Bachelor of Science degree in Biology from Bates College in Maine (1982), graduating summa cum laude. She then earned her DVM degree from Cornell University in New York (1986). There, she was elected to Phi Zeta, the National Veterinary Honor Society.
Dr. Dennis has been working in the veterinary field since she was nineteen years old and has owned two businesses during that time. She started Acoaxet Veterinary Clinic in Westport, Massachusetts, in 1987. Later, Dr. Dennis sold the business to spend more time with her children who were very young at the time. Her three children, Natalie, Ethan and Gordon, are now ages 26, 23 and 18 respectively.
While the children were growing up, Dr. Dennis had a house call practice for 16 years. She has also performed relief work at several hospitals in Rhode Island over the years. Now that the last of her children has gone off to college, she is ready to focus even more of her time on veterinary practice.


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|free trial vps hosting java
cbeginner.com is a tutorial blog where we introduce the c language in a different angle. C is a language which besically a high level language but we can done many low level job through the c language that's why many people called c language is a moddle level language. This is blog where the reader can get the actual procedure to learn a language. The only key to learn a language is codding, if you do codding then you can able to understand about the technique and the feature of the particular language. In our tutorial we try to produce a technique which is more useful for the learner.


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Live Video: Live video will be available for the Boise State-Arizona State match at http://www.foxsportsarizona.com/pages/sundevils_stream.
Live video will also be available for the Oklahoma State match for premium members at broncosports.com.
Starting Lineups - The weekend lineup for the Broncos will consist of Isaac Romero (125), Shawn Jones (133), Josh Strait (141), Steven Hernandez (149), George Ivanov (157), Michael Cuthbertson (165), Scott Bacon (174), Jake Swartz (184), Cody Dixon (197) and J.T. Felix (285).
Among the Elite - Among the Elite - In the latest Intermat rankings, Jake Swartz was picked as the 12th-best wrestler in the nation at the 184-pound division. The redshirt sophomore was an at-large selection to the NCAA tournament last year.
Fellow sophomore J.T. Felix holds the No. 19 position at the 285-pound weight class. Felix finished second at the Pac-10 Championships last year and was an automatic qualifier to the NCAA tournament where he went 1-2.
Redshirt junior Josh Strait has also found his way into the latest rankings, clinching the No. 16 spot at 141 pounds.
Junior-transfer George Ivanov made his way back into the rankings last week and now sits 15th at 157 pounds.
What Happened Last Time - The Broncos last competed in the Reno Tournament of Champions, Dec. 18. George Ivanov led the squad with a first-place finish at 154 pounds, taking down three wrestlers with top-20 rankings. Redshirt junior Josh Strait finished fourth in the 141-pound bracket to help Boise State to a 10th-place team finish.
Scouting the Competition - Nebraska Cornhuskers - Nebraska enters the weekend ranked No. 21 in the nation with six wrestlers holding top-20 positions. Freshman Robert Kokesh leads the team with a No. 5 ranking at 165 pounds.
Arizona State Sun Devils - The Sun Devils have one wrestler ranked in the top 20 of the latest Intermat polls - Levi Cooper at the heavyweight division. Arizona State is 4-2 in dual matches so far this season.
Oklahoma State Cowboys - Oklahoma State has ranked competitors in nine of the 10 weight categories, boasting them to a second-place team ranking behind Iowa. Jordan Oliver (133) is currently ranked first in his class.
The "Biggest Little" Upset - George Ivanov, a junior-transfer from the University of Nebraska-Omaha, recently fell out of the Intermat rankings, but redeemed himself Sunday by taking down three wrestlers with top-20 rankings at the 157-pound weight class. After winning in the first two rounds, Ivanov knocked off No. 12 Albert White in the quarterfinals. In the semifinal matchup, he faced Oregon State's R.J. Pena who entered the match ranked 16th in the nation. Ivanov pinned the Pac-12 foe in 4:42. The magical run concluded with a matchup against the No. 1 seed and fifth-ranked Justin Lister of Binghamton. Ivanov pulled off the upset in a 5-3 decision, completing the five-bout win streak to stand atop the podium.


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Bolingbrook, IL (PRWEB) May 31, 2012
Today WaterPumpsDirect.com released its recommendations for the best deep well pumps.
"Well pumps are necessary for people who live outside of urban areas and need to pump their own water," said Jose Castellanos, resident product expert at Water Pumps Direct. "While shallow well pumps can pump water above 25 feet, these deep well pumps will reach as far down as 200-500 feet."
Top Deep Well Pumps
Good: Red Lion RL12G05-2W1V - 1/2 HP Deep Well Submersible Pump (2-Wire 115V)
Better: Red Lion RL12G05-3W2V- 1/2 HP Deep Well Submersible Pump (3-Wire 230V) w/ Control Box
Best: Red Lion RL22G10-3W2V - 1 HP Deep Well Submersible Pump (3-Wire 230V) w/ Control Box
Most retailers are loyal to whatever is on their shelves. Water Pumps Direct, however, isn't your ordinary retailer. The online superstore specializes exclusively in water pumps and carries more than 225 models of water pumps from the leading national brands.
The online retailer combined recent sales history, customer reviews and personal insight to generate its final recommendations.
Once the dust settled, only three deep well pumps sold by WaterPumpsDirect.com were given its prestigious "Recommended" status.
In addition, the expert staff personally wrote online reviews for each deep well pump, explaining why the company recommended it.
By providing these recommendations and reviews, WaterPumpsDirect.com hopes to arm shoppers with enough ammunition to pick the perfect deep well pump for their needs.
Power Equipment Direct operates 11 niche online superstores. In addition to WaterPumpsDirect.com, the Bolingbrook, IL-based company operates AirCompressorsDirect.com, ChainSawsDirect.com, ElectricGeneratorsDirect.com, LeafBlowersDirect.com, LogSplittersDirect.com, MowersDirect.com, PressureWashersDirect.com, SnowBlowersDirect.com, SumpPumpsDirect.com and TillersDirect.com.


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High Performance Centre Workout sets
The athletes at the High Performance Centre in Aldershot can train anywhere up to six hours a day, six days a week. Their training is structured using workout sets.
Here you can view a selection of some of the previous training the athletes have undertaken.
2013 Training Sets
2010 Training
November (Uploaded 4.11.10)


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General Info | Sponsors | Faculty | Program | Schedule | Travel | Accommodations | Registration | Gift Form | Youth Workshop | Post-Conference Workshop | Area Activities | Manuscript Reviews | Contact Us | Reviews from 2013 |
Back to Faculty
Debby Dahl Edwardson
Debby Dahl Edwardson's books include Whale Snow, Blessing's Bead, and My Name is Not Easy. My Name is Not Easy was named a finalist for the National Book Award, was chosen to represent Alaska at the Library of Congress and was named Best of 2011 by the Washington Post. Her books have earned starred reviews in Booklist, Publisher's Weekly and School Library Journal, been named to many lists and have generally received more recognition than she ever expected, watching their journeys from her northern perch.
Kachemak Bay Campus - Kenai Peninsula College/UAA


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Replacing the console pocket shelf, our panels use either 2" or 2 1/16" (52mm) gauges. The panels are computer-matched in color, texture and gloss with the Volkswagen console so your gauges will look like a factory installation. Made from a custom textured ABS, the Mk4 panels require no adhesives and lock solidly in place.
We make it simple to design your own your Mk4 1.8T gauge bundles from our Indigo gauge family. Our gauges come with everything you need for installation - gauges, senders, wiring, and even zipties.
For other engines - VR6, TDI and 2.0L please contact us for custom configuration.
NOTE: When ordering both oil temperature and oil pressure gauges, choose oil temp gauge with FilterPort. If ordering just oil temperature gauge and spare oil filter port is unused, choose oil temperature gauge with 10mm sender.
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tag:blogger.com,1999:blog-8810099708146569685.post2679800709625270909..comments2015-06-26T12:19:22.441-07:00Comments on Change Your Life. Ride A Bike!: Fad Or Fab?Adrienne Johnsonhttp://firstname.lastname@example.com:blogger.com,1999:blog-8810099708146569685.post-51781544860007620472011-04-08T06:17:44.538-07:002011-04-08T06:17:44.538-07:00THe first picture is in Santiago de Chile, not Mex...THe first picture is in Santiago de Chile, not Mexico City ;)

Thanks for publishing!

All the bestClaudio Olivareshttp://email@example.com:blogger.com,1999:blog-8810099708146569685.post-74376483923059320422011-03-29T23:14:18.044-07:002011-03-29T23:14:18.044-07:00Krista- I was actually shopping at Costco with jus...Krista- I was actually shopping at Costco with just my Batavus for the last several years. It worked just fine and kept me from over shopping. My primary need when we chose cargo bicycles, first an Xtracycle and now the Metrofiets, is that we needed a way to carry our youngest child that would grow with him as well as the shopping. It has made life a great deal easier, that is for sure.

Ben- you should see my panniers sometimes. They look like circus clown cars : )

Maria- Well. Chile it is! : )Adrienne Johnsonhttp://firstname.lastname@example.com:blogger.com,1999:blog-8810099708146569685.post-42085321337147194802011-03-25T20:48:18.320-07:002011-03-25T20:48:18.320-07:00Hi!! Is a very interesting post about cargo bikes...Hi!!
Is a very interesting post about cargo bikes, but I have to say, the first photo is from Chile,not Mexico, is a bike store called Nación Pedal, and here is the page! http://www.nacionpedal.com/
Regards! =)María Franciscahttp://firstname.lastname@example.com:blogger.com,1999:blog-8810099708146569685.post-69876122044615361492011-03-23T15:18:32.287-07:002011-03-23T15:18:32.287-07:00Yes riding will change your life... It maintain yo...Yes riding will change your life... It maintain you fit....change your lifehttp://firstname.lastname@example.com:blogger.com,1999:blog-8810099708146569685.post-16150847236437868862011-03-23T13:34:39.231-07:002011-03-23T13:34:39.231-07:00I needed a cargo bike yesterday, when I overstuffe...I needed a cargo bike yesterday, when I overstuffed my panniers!Benhttp://email@example.com:blogger.com,1999:blog-8810099708146569685.post-10239388231903102812011-03-22T01:19:36.030-07:002011-03-22T01:19:36.030-07:00I think for some it could be a fad but for most ot...I think for some it could be a fad but for most others is it simply a way of life. Like cars...some resort to the cars that suite their lifestyle needs while others just want what are considered classic or cool.

My father-in-law built his own cargo attatchment so it's not that he wanted one because it was in the store window. He built it to fit his personal need for the cargo he planned to carry with him places.

At first when i thought of getting one it was because they seemed cool and were becoming the new 'in' thing for bikes. I still have yet to get one but now I want one because it would make shopping trips easier :) It gets me giddy thinking I can do a full out grocery trip without the car!!Kristahttp://email@example.com:blogger.com,1999:blog-8810099708146569685.post-69927923800149262632011-03-21T22:53:27.858-07:002011-03-21T22:53:27.858-07:00Unity- OnyaUnity- OnyaAdrienne Johnsonhttp://firstname.lastname@example.com:blogger.com,1999:blog-8810099708146569685.post-2449599487163119672011-03-21T22:31:16.400-07:002011-03-21T22:31:16.400-07:00What type of trike is the one with the kid in an o...What type of trike is the one with the kid in an orange jersey and a brown helmet? I've never seen one like that and it looks just the thing for me! UnityUnity Finesmithhttp://email@example.com:blogger.com,1999:blog-8810099708146569685.post-61376149715195132802011-03-21T17:06:53.824-07:002011-03-21T17:06:53.824-07:00cubbie- that Targa is something else! I would lov...cubbie- that Targa is something else! I would love to know how to rides!

Ian- When you buy a cargo bicycle, your initial worry is that you will not use it enough to justify the cost. Then you get it and the next thing you know you have found a million things to use it for you never thought of : )

Anon L- i am not surprised by the question at all. These kind of bicycles have not quite achieved the ubiquitous status they have in other countries. As regular cycling has not yet become commonplace in most places in North America, I can totally see where cargo bicycles would seem very exotic and strange.Adrienne Johnsonhttp://email@example.com:blogger.com,1999:blog-8810099708146569685.post-35165385587590734602011-03-21T06:04:51.159-07:002011-03-21T06:04:51.159-07:00I'm surprised that a reporter should ask that ...I'm surprised that a reporter should ask that question!
People acquire cargo-bikes for their utilitarian attributes - Not fashion.
Their number is going to increase in societies/communities where their (intrinsic) value(s) has(have) not been (widely and fully)realised or appreciated yet .
My prediction is that cargo-bikes in all their forms are going to be ubiquitous  ...  NOT transient ... in the west of Europe & Asia.
firstname.lastname@example.com:blogger.com,1999:blog-8810099708146569685.post-63764807176030116212011-03-21T03:51:58.387-07:002011-03-21T03:51:58.387-07:00Thanks from me,also. You could have knocked me dow...Thanks from me,also. You could have knocked me down with a feather when I saw our picture in your blog. Since purchasing the Bullitt, we have taken stuff to the tip,(and brought some home),made numerous school drop offs,trips to Costco plus transported myself and baggage to and from the ship,where I work for half of the year.

Along with 'fad' you generally hear the word'passing', and you only have to look to Europe to see that cargo bikes are not a passing fad.Petrol isn't getting any cheaper and I suspect we will be seeing a lot more of these treadlies around the streets in future.

cheers,

Ian

PS:good for you,Cubbie. If you see us and/or hear us around the streets of StKilda, give a little ting,ting!slow rpmhttp://email@example.com:blogger.com,1999:blog-8810099708146569685.post-34245568724299686522011-03-21T01:58:10.642-07:002011-03-21T01:58:10.642-07:00Thank you for the lovely post about Cargo Bikes! I...Thank you for the lovely post about Cargo Bikes! I am encouraged by Melbourne (currently no. 2 mostly livable city) in Australia to get on a bike, with all the bike lanes they've made and bicycle rules in the city and in neighboring suburbs. And since i don't have a car (i don't drive & our family can only afford 1 car) I recently bought a Taga prambike (www.taga.com.au) to get me to nearby shops, my baby's medical appointments & got back into shape after having 2 kids (keep postnatal depression & diabetes type 2 away!)

Just as long there are bike lanes, new families w/ babies/children, cargobikes / prambikes are here to stay!cubbiehttp://firstname.lastname@example.com


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This item is brand new and ships directly from the supplier. Please note the image above is for reference only. This item has a standard lead time of 5 days (Please call for more information)
Item:APW Champion 24" Countertop Thermostatic Griddle Natural Gas
Model Number:GGTi-24
Description: This unit is ideal for breakfast diners, hotel dining kitchens, and cafeteria kitchens. Perfectly suited for cooking bacon, sausages, scrambled eggs, and bologna.
This item comes with a field conversion kit to change unit from natural gas to liquid propane
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Tuesday, July 7, 2015
Set on the last day of 1999, Generation takes place during a family reunion. Richard Beymer plays an inventor who has created high-tech prosthetic devices in order to help his younger brother Drake Hogestyn. Once a star athlete in the brutal (and sometimes fatal) game of combat hockey, Hogestyn wants to maintain his status as a public hero, and to that end has no qualms about turning bionic. On a less fantastic note, the boys' social activist sister Cristina Raines rejects the reconciliation efforts extended by her macho-man father Bert Remsen. The pilot for a never-produced TV series, Generation was originally telecast May 24, 1985. ~ Hal Erickson, Rovi


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Park Tool has been manufacturing bicycle specific tools since 1963. Based out of St. Paul Minnesota, they are the world's largest bicycle tool manufacturer. A long-term dedication to quality, innovation, and customer service has made Park Tool the first choice of professional and home bicycle mechanics around the world.
The use of Star-shaped fittings on disc brakes, pedals and chainring bolts are becoming increasingly popular. The TWS-2 is the perfect tool to use on all the various sized parts.
Key Features:
Please remember to add postal time (2-3 working days) to obtain a complete estimate of delivery to your door.
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You can also check the status of your order and individual items by accessing your account details and following the prompts.
Please allow 10 working days from dispatch of your order before notifying us of any late deliveries.
It may be advisable to check with your neighbours to see if a parcel has been left with them, check any outhouses you might have where it may be left if it cannot fit through your letterbox and contact your local sorting office to see if the item has been returned to the depot as undelivered and awaiting collection.
Please see our returns policy.
Park Tool AWS-10 Fold Up Hex Wrench Set
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In This Article:
Vitamin D is the one essential nutrient that's linked to getting routine sun exposure. But before you skimp on sunscreen and head outdoors to bask in the sun (as you might have read you should do), you need to know the pros and cons of getting this important vitamin from the sun compared to being sun smart and taking a vitamin D supplement.
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The issue: If exposure to sunlight is the best way to get vitamin D, then what about the damage sun exposure causes? Unprotected sun exposure causes premature aging of the skin, a heightened risk of skin cancer, macular degeneration, DNA abnormalities, and gets in the way of the body's ability to heal. Swapping one health concern and creating another is not good medicine for anyone.
This dilemma has made the issue of unprotected sun exposure (seeking shade and using sunscreen) controversial and complicated.
The question is: can our bodies create vitamin D if we regularly use sunscreen and seek shade? According to many researchers, the answer is that most likely sunscreen and seeking shade does not block vitamin D production in the body. Despite news stories to the contrary, several large, controlled studies have shown that vitamin D deficiency does not result from ongoing, regular sunscreen use. But there are studies that counter that point of view.
It is also important to understand that people wearing sunscreen and seeking shade doesn't explain the entire problem of vitamin D deficiency. Considering that most people don't use sunscreen on a regular basis and they almost never apply enough of it or reapply it as they should to get the SPF benefit on the label. That means during the day, if you are outside, plenty of sunlight is getting to your skin, enabling your body to make vitamin D.
You may have read that 15 or 30 minutes of unprotected sun exposure a day will create all the vitamin D you need. Yet there is limited evidence showing that to be the case, especially considering the amount of sunlight present in different parts of the world at different times of the year.
For example, thirty minutes of sun exposure at noon during the winter months in London, Paris, Moscow, Seattle, or Toronto, won't do you much good. Just counting the minutes you are in the sun without protection is ill advised.
There is also the issue of how much vitamin D do you need which remains a complete unknown. If you are sick, elderly, athletic, or don't live in a sunny environment 30 minutes of sun exposure is most likely not enough to gain the health benefits vitamin D provides.
Most importantly, please do not give up sunscreen and do not give up being sun smart! That means seeking shade and wearing sunglasses and hats. You can have the best of both worlds: adequate levels of vitamin D, without having your skin suffer the aging consequences of unprotected sun exposure.
Fear of getting enough vitamin D is causing a frightening increase in the use of tanning beds. Many tanning salons are advertising that they provide the added benefit of increasing vitamin D levels in the body. Aside from the terrible risks associated with using tanning beds they cannot produce vitamin D in the body. Shocking, right? As it turns out, UVB rays are responsible for stimulating vitamin D in the body and tanning beds emit almost entirely UVA rays! This is one more sneaky way the indoor tanning industry is trying to capture business, even though the purported benefit is practically non-existent.
Psoriasis is a very specific skin disorder that can be controlled but not prevented by sun exposure. However, it takes far more than 30 minutes in the sun to achieve sun- induced reduction of psoriatic lesions. Studies in patients with psoriasis require hours of sun exposure in tropic or Mediterranean climates. You can learn more about psoriasis and treatment optionshere.
Learn more about what the sun is doing to your skin and how you can prevent it. See our sunscreen infographic.
(Sources for the information above: The British Journal of Dermatology, August 2010, Epublication, and October 2005, pages 706–714; Osteoporosis International, August 2010, Epublication; Mayo Clinic Proceedings, August 2010, pages 752–757; Current Rheumatology Reports, October 2005, pages 356-364; The Journal of Steroid Biochemistry and Molecular Biology, Epublication, July 19, 2005; Photochemistry and Photobiology, Epublication, February 1, 2005; Experimental Dermatology, December 2004, page 11; The Journal of the American Osteopathic Association, August 2003, pages 3-4; American Journal of Clinical Dermatology, March 2002, pages 185-191; Dermatology, January 2001, pages 27-30; British Medical Journal, October 1999, page 1066; and www.naturaldatabase.com.)
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THE TAXI strike this week mobilised many drivers who feel their interests are not represented by the Namibia Bus and Taxi Association (Nabta).
Yesterday, members of the ad-hoc committee, which was born out of the strike this week, met with union leader Evilastus Kaaronda, who was accused in some quarters of interfering in the strike that had nothing to do with his union.
Kaaronda, secretary general of the National Union of Namibian Workers (NUNW), has consistently been at hand, advising the striking drivers on organising themselves and talking on their behalf to various authorities this week.
Kaaronda said yesterday the goal of the meeting was to "assist them to map the way forward".
The committee members present at the meeting with Kaaronda were Jerobeam Shipepe, Josef Kalimbo, Joseph Salomo and Martin Kondjeni. They were elected on the ground in Katutura during the strike, in order to present a unified and organised front.
According to the committee, it is time that taxi divers, not just taxi owners, are represented by an organisation.
The members confirmed that part of the meeting with Kaaronda was aimed at gauging the general feeling among taxi drivers about forming their own association, which would take up their concerns.
"We plan to have either a union or an association to represent us," one of the members said.
They emphasised that their positions on the committee are unofficial and temporary.
The committee members said there is "no division between us and Nabta" but added that Nabta leaders are embroiled in internal conflicts. Communication lacks in Nabta ranks and this draws the focus away from the day-to-day concerns of taxi drivers, they said.
They said whether it is Nabta or a new organisation or union, the primary goal is to create a body that will "stand by us".
The committee members say Nabta does little, if anything, to inform taxi drivers of the association's functions.
"How can you join Nabta if you don't know anything about the organisation?" they asked.
For now, the strike is over, they confirmed.
But, "we won't stop to try and achieve our goal". They say they will wait until Tuesday, and resume the strike if their demands have not been met.
Their demands they say, rest on three points.
The first two points concern the high fines issued for obstructing traffic and for operating without the so-called "blue paper" - a permit from the City of Windhoek allowing the transport of passengers for a fee.
They claim that a critical lack of taxi ranks in Windhoek and surrounding areas make it impossible for taxis to stop at legal points to pick up passengers. For this reason, the City of Windhoek has to either lower the fines or provide sufficient taxi ranks.
Taxi drivers are often fined for operating without the "blue paper". The "blue paper", and the professional authorisation (PA) required on taxi drivers' driving licences, are interlinked in that the one cannot be obtained without the other.
But the drivers claim that it can take longer than six months to obtain both endorsements.
A committee member said the process should be simplified and applications processed faster.
"We are not against seat-belt fines, red-light fines or speeding fines, but we are against the things we specify. We want the municipality to supply more taxi ranks, and the municipality must begin to educate customers on the cost of hiring a taxi," they concluded yesterday.


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Designing and creating a card game from the ground up has proven to be an incredibly challenging and highly rewarding experience for me. Not only do I have a lot of creative impact with a game like this, I also am able to push the game making industry forward towards new ideas. Producing unique and unusual concept like Sneaky Cards we can expand our thoughts of what games are and how we interact with them.
"I want to show people that the world is a game, and you are a player."
Life is meant to be fun and enjoyable. But at the same time that takes a lot of work, it takes time and effort to better your self. There are so many ways of improving your own outlook and perspective on life through gaming. Board games and card games in the past have been centered around the table, playing with people you know. I love that there are games like that, I think that should be and always will be the core of gaming, but there is a place for games like Sneaky Cards too. A place where you are seeking that self betterment and giving yourself personal challenges to cultivate growth in your life.
To me this project pushes the edges of the box, it is something I am incredibly proud of. That is why I have personally invested so much into it. I know I haven't been able to keep everyone up to date on what we're doing, and there's a good reason for that. I can't say a lot, but soon… I promise.
As for my side of production I have been working hard on a huge revamp of the game, there are tons of cards that just don't work right now. In my update I have removed nearly 15 cards and added even more. I have also been rewriting a lot of the old cards so they flow better, the next update you see will be very big in terms of the differences you see.
There's a ton I have learned through making this game. Having patients is a big one, also just the design process is a lot different than most projects I have been a part of. Moving forward after this is done(and we are far from finished) – I can't wait to start making more games, I have so many new ideas. I would like to try a traditional board game at some point too, but knowing me it will have some crazy idea with it.
P.S. I am looking for a new web host with a VPS – my current one is very slow and people are having trouble with it… It needs to be done for sure.


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Experience EAA AirVenture 2009 as You Have Never Seen Before
Each July, Oshkosh Wisconsin becomes home to hundreds of thousands of aviation enthusiasts from all corners of the world as visitors flock to EAA AirVenture. Started in September of 1953, the gathering has grown into the world's foremost aviation event. During the week, roughly 10,000 attending aircraft transform Wittman Field from a quiet country airport to the world's busiest air traffic control center.
Catch a Sneak Peek of Aero-TV's Exclusive Interview with Matt Younkin
Aero-TV is premiering a new aspect to our video coverage, offering viewers the opportunity to preview one of our upcoming exclusive features. This aero-minute offers a sneak peek of our time with Matt Younkin at EAA AirVenture 2009.
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Aero-TV: ForeFlight Web - Web-Based Flight Planning From ForeFlight
Airborne 06.30.15: Defending Santa Monica, Aspen ADS-B TXCVR, NBAA v Privatization
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Learn to Ski and Snowboard Month in PA 01/06/2011 01:52 PM 01/06/2011 02:01 PM Learn to Ski and Snowboard Month in PA 01/06/2011 02:01 PM This is an odd tip that is actually geared to those who haven't given the winter sports a try but have been wondering if it is for them. A lot of people really want to give it a go but fear they won't succeed or won't be able to do it. While skiing or snowboarding is not for 100% of the people the percentage of those who can enjoy is not too far away. Let me address the two biggest concerns.

I will end up hurting myself

I will tell you that in most (but not all) cases you will not get hurt unless you are doing something that you shouldn't do. Yes, for some that includes putting the skis on your feet, but again that is a minority. If you can walk and perform many things with some coordination, then you can do it. Just have a positive attitude and learn from a qualified instructor who will teach you the proper start by learning to turn to control your skiing, you should be able to go.

It is very expensive for trying something new

Many resorts offer learn to ski or board programs at a very reasonable rate. One reasonable fee gets you a lesson, rental and lift ticket to beginner areas (where you should stay at first). And given the month, Blue Knob, Seven Springs and Hidden Valley all are offering extra discounts on these packages.
 Copyright 2013 Nexstar Broadcasting, Inc. All rights reserved. Page: [[$index + 1]] life skiing tips/tutorials


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Magura HS33 uni edition WHITE
Just got our Magura-uni-edition back in stock. As last time (the silver one), hose-lengths are specially adapted to unicycle use (main hose and also hose connecting both sides) - ready for tyres up to 3", and now.... in WHITE! (lever+brake) ref. 2216