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The below terms and conditions are designed for your use in relation to our website and any enquiries or purchases you make, your statutory rights are not affected.
APEX GRANGE DIRECT is the online trading name of APEX GRANGE LTD. The company sells tiles and accessories for walls and floors and its registered office is at 14 Little Mundells, Mundells Industrial Centre, Welwyn Garden City, Herts, AL7 1EW. Company Registration number for England and Wales is 2818974 and VAT number is GB 627012080. APEX GRANGE LTD can be contacted on 01707 338 800 or by email at firstname.lastname@example.com
We recommend that customers purchase sample tiles before making their complete purchase to give a true, accurate and clear appraisal of the product and its suitability for its installation. To order a sample tile, you need to select price as 'per tile' on the product page of the tile you want to order a sample of. Then you can proceed to add one tile to your basket. You can purchase as many single tiles to sample as you require (standard shipping charges will apply to all tile samples). Please keep in mind that shades and calibration of tiles can vary, especially with natural products. Therefore, before fixing please ensure you are entirely happy with the product as any claims once the product has been fixed will not be considered. Any purchases of samples are also governed under these terms and conditions.
Our order process allows you to check and amend any errors before submitting your order to us. Please take the time to read and check your order at each page of the order process.
When you submit an order to us, you are offering to purchase the products from us at the prices indicated on the website. Our acceptance of your order will take place as described below.
When an order is placed online, we request authorisation for the value of the order through our third party payment provider to ensure that the funds are available for the value of your order. Your payment details will also be checked by our screening service, this is designed to protect the company and the customer from fraudulent activity.
By submitting an order to us through the website and by clicking the 'pay now' button, you confirm that the payment details provided on your order are valid and correct and that when your order is accepted and processed by us, payment will be made in full.
Acceptance of an order placed by you online and the completion of the contract between you and us will take place when you receive an email from us that confirms that the products have been dispatched. The contract between us will only be formed when we send you this dispatch confirmation. Once we have sent you this dispatch confirmation, you will not be able to amend your order and any cancellations to your order must be made in accordance with the paragraph titled 'Returns' below.
If we are unable to supply you with a product, for example because that product is no longer available, or because of an error in the price on the Website, or we are unable to obtain authorisation or verify your payment, or where you do not accept our terms, we will inform you of this by email or telephone and we will not process your order. If you have already paid for the products we will refund you the full amount as soon as possible and in any event within 14 days.
Please note: acceptance by us of a payment made by you in connection with any products does not constitute our acceptance of your order and a legally binding contract is not formed until you receive our order confirmation email and we will not be obliged to supply products to you until then.
If at any point there are any problems with your order, please contact us by calling 01707 338 800 or send an email to firstname.lastname@example.com. Alternatively, you can contact us using the contact form on our Contact us page.
The prices of the goods will be as quoted on the website from time to time. We only accept payment for orders in pounds (£) sterling. We take all reasonable care to ensure that the prices of the goods are correct at the time when the relevant information was entered onto the system.
Prices for our goods may change from time to time but changes will not affect any order which we have confirmed with an order confirmation.
The price of our goods includes VAT (where applicable) at the current applicable rate chargeable in the UK for the time being. Please note that if the rate of VAT changes between the date of your order and the date of delivery, we will adjust the VAT payable by you, unless you have already paid for the Products in full before the change in VAT takes effect.
Delivery charges will also be payable on your order and these will be added to the price of your order prior to you submitting payment to us. For details of our delivery charges please see our Delivery & Returns page.
Our website contains a large number of goods. It is always possible that, despite our best efforts, some of the goods on the website may be incorrectly priced. We will normally check prices as part of our dispatch procedures so that:
- Where the correct price for the goods is less than the price stated on the website we will charge you the lower amount when dispatching the goods to you; and
- If the correct price for the goods is higher than the price stated on the website we will contact you as soon as possible to inform you of this error and we will give you the option of continuing to purchase the goods at the correct price, or to cancel you order. We will not process your order until we have your instructions. If the pricing error is obvious and unmistakable and could have been recognised by you as an error in pricing we do not have to provide the products to you at the incorrect (lower) price. If we are unable to contact you using the contact details you provided during the order process, we will treat the order as cancelled and notify you in writing.
Payment for the goods must be made using the payment facilities available through the website. We may withhold the goods and/or cancel the contract between us if payment is not received from you in full in cleared funds.
Please refer to our Delivery & Returns page for specific details on delivery, including any particular restrictions that may apply from time to time depending on our third party delivery company. Whilst we will use all reasonable endeavours to ensure that your order is delivered to you within the times stated on our Delivery & Returns page. Our deliveries are normally carried out by a third party provider and as such this process is largely out of our control. If an event does occur which may affect your delivery and/or is otherwise outside of our control we will attempt to contact you.
Your delivery may need to be signed for when it is delivered to you so please ensure you make necessary arrangements for someone to be at your address to accept delivery of goods. If nobody is able to accept delivery of your goods, this may result in the goods returning to us and as a result any charges for redelivery may need to be paid by you.
Your delivery will be delivered to the nearest accessible location to the delivery address that you provide to us (kerb side delivery). Please ensure that any hazards that may prevent your delivery being taken off of the delivery lorry are removed, to the extent possible. If there are immovable hazards or obstructions (e.g. steps, uneven or gravel paths or driveways for example) your delivery may be made to an alternative location between the delivery vehicle and your property. If your property has limited or difficult access you must let us know at time of placing your order, using the comment box. The goods will become your responsibility at the point of delivery.
Please be aware:
- As part of our service we are happy to assist with working out measurements and the suitability of products for a particular installation, but it remains ultimately the customers' responsibility to ensure suitability and quantities prior to fixing. We will not be responsible in the event that the wrong quantity of tiles, or tiles that are not suitable for any particular placing have been ordered.
- Due to the manufacturing process products may vary in shade, tolerance and calibration this is especially prevalent in natural products. The variance in colours and textures is not a defect, but merely a characteristic and most natural products will require sealing prior to grouting and may require ongoing maintenance.
- You should not arrange for fitting until all goods are received and your order is complete. All lead times are quoted with goodwill, but we cannot be responsible for any failure to meet these or any consequential loss.
- If you are in any doubt about the suitability of the product, do not proceed to fitting but please contact our customer services team using the details on our Contact Us page.
- Please check all goods prior to fitting as we are unable to accept any claims after the tiles have been installed except in the cases of any inherent non visible defects.
- Please be aware that there may be slight variations in colour, shades and dimensions from batch to batch. We advise you to order enough product to cover your needs accordingly as we cannot accept any liability for any minor differences in any subsequent batch or batches that you may need to order.
- Any products displayed on the website alongside your order are suggested accompanying products only. We cannot guarantee the suitability of these suggested accompanying products for your particular project and you should not rely on these suggestions. Save for circumstances where any accompanying product is faulty, we do accept any liability once tiles have been fixed if that product is unsuitable.
You have the right to cancel this contract within 30 days without giving any reason. The cancellation period will expire after 30 days from the day on which the products are delivered to your address as set out in your order. Products can be returned as long as they are in the original unopened box. We are unable to accept any returns of any perishable items.
To exercise your right to cancel, you must inform us of your decision to cancel the contract by a clear statement (e.g. a letter sent by post or e-mail). You should exercise your right to cancel by contacting us at the address or e-mail address set out on our Contact Us page.
To meet the cancellation deadline it will be sufficient for you to send your communication notifying us of your cancellation of the contract before the 30 day cancellation period has expired.
If you cancel the contract you will need to arrange to send the goods back to us at 14 Little Mundells, Mundells Industrial Centre, Welwyn Garden City, Herts, AL7 1EW, without delay and in any event within 14 days of you notifying us of your cancellation of the contract. You will bear the cost of returning the goods to us except where the goods are returned because they are either faulty or mis-described in which case we will refund any reasonable costs you incur in returning the goods to us.
If you cancel this contract, except in the circumstances set out below, we will reimburse you for all payments received from you, including the costs of delivery.
We may make a deduction from any reimbursement to you for any loss in value of the goods supplied, if the loss is due to any unnecessary handling of the goods by you (which means any handling other than to check that the goods delivered to you comply with your order you submitted to us).
Please note that we are unable to accept returns for any tiles after the tiles have been installed, even if this is within the 30 day cancellation period. Please ensure that you check all goods carefully prior to fitting.
We will reimburse you for any returned goods without delay and in any event not later than 14 days after the day that we either receive the goods back from you or we receive evidence from you that you have returned the goods supplied.
We will make the reimbursement using the same means of payment as you used for the initial transaction unless we have expressly agreed otherwise. In any event you will not incur any fees as a result of the reimbursement.
As a consumer you will always have legal rights in relation to products that are faulty or not as described. These legal rights are not affected by this returns policy. Advice about your legal rights is available from your local Citizens' Advice Bureau or Trading Standards office.
If you wish to return the goods to us because they are faulty and mis-described, you should notify us that the goods are faulty as soon as possible after delivery by contacting us using the number or email provided on our Contact Us page. We will ask you to return the goods to us and provide you with a refund for the cost of arranging such return.
We will not be liable or responsible for any failure to perform or delay in performance of any of our obligations under our contract with you that is caused by an Event Outside Our Control.
An "Event Outside Our Control" means any act or event beyond our reasonable control, including without limitation strikes, lock outs or other industrial action by third parties, civil commotions, riot, invasion, terrorist attack or threat of terrorist attack, fire, explosion, storm, blizzard, flood or other inclement and unordinary weather condition, subsidence, epidemic or other natural disaster or failure of public or private telecommunications networks or impossibility of the use of railways, shipping, aircraft, motor transport or other means of public or private transport.
If an Event Outside Our Control takes place that affects the performance of our obligations under our contract with you:
- We will contact you as soon as reasonably possible to notify you of this; and
- Our obligations to you will be suspended and the time for performance of our obligations will be extended for the duration of the Event Outside Our Control. Where the Event Outside Our Control affects our delivery of the goods to you, we will arrange a new delivery date with you after the Event Outside Our Control is over.
If you have any queries or complaints regarding your order please contact us using the contact details you can find on our Contact Us page.
- Only valid during offer period
- Cannot be used in conjunction with any other offer
- Can only be used once per household
- Excludes sale items
- Available whilst stocks last
- Apex Grange LTD reserve the right to remove any offer without prior notice


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Event's Website
Oct 23, 2018
8:30 am - 9:30 am
The Original Pancake House
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NW Networking was established in 2008 and has continued to evolve into a new way to network while remaining beneficial to both new and experienced business minded professionals.
The purpose of NW Networking is not to create simply an environment in which business minded professionals can network, but something much more than that. At NW Networking we are creating and environment for you to grow both personally and professionally. We want you to be able to develop relationships with people on both a business and personal level as one of the greatest things about building relationships is people. Through these relationships that you are developing, we hope to foster an environment for partnership amongst group members so that we can work together to grow our businesses.
We are able to increase our reach and to provide a great environment for even more at our 3 locations: Puyallup (Wednesday's at 11:45), Auburn/Kent (Wednesday's at 8:30am) and Tacoma (Tuesday's at 8:30am). Come join us!!

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Coffee Table High Gloss Finish Lift Up Top MDF White Ash Colour Interior Storage
Coffee Table High Gloss Finish Lift Up Top MDF White Ash Colour Interior Storage
Product Description:
Glossy and Beautiful
A high gloss finish in white & black colour combine to make this Coffee Table an essential piece of furniture for your living room. A thick rectangular MDF top makes for a secure surface to hold any drinks or books. The contemporary design ensures this coffee table will make a stylish living room centerpiece, while effortlessly blending within any style of home interior.
Please note: this listing is for the coffee table only, other accessories aren't included.
Firm Support
The coffee table is provided a firm support by its aesthetic pole shped legs. If you are searching for a furniture range that is firm and durable, then buy our Grandora series confidently.
Key Features:
Modern and Gorgeous Design
High Gloss Finish
Premium Quality Material
Strong and Sturdy Construction
Aesthetic Pole Shaped Legs
Matching TV Cabinet Available
Fully Assembled
Smart Packaging to Ensure Safe delivery
Product Specifications:
Product Dimension: L-120 x W-70 x H-42cm
Box Dimension: L-125 x W-79 x H-20cm
Product Weight: 43.4kg
Box Weight: 46.4kg
Packaging Type: Knock Down
Package Content
1 X Grandora Coffee table White Ash Colour
Images are for illustration purposes only. The colours may slightly vary from actual product.


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Manchester United forward Chicharito is hoping to force his way into a regular role at Old Trafford after his last-ditch winner against Newcastle.
The Mexican netted in the final minute to give the Old Trafford side a massive victory on Boxing Day which, with rivals Manchester City losing to Sunderland, puts them seven points clear at the top of the table.
The 24-year-old was granted a first-team role with both Wayne Rooney (knee) and Danny Welbeck (illness) unavailable, but the match was only his fourth start in the league this season, with the striker not yet reaching 20 league starts in a full term.
The former Chivas Guadalajara man acknowledges that Sir Alex Ferguson has other high-quality options to select but is determined to prove his worth and eventually become a regular choice.
"Ask any player in the world and they will tell you they want to play every game," he told reporters.
"But the competition here is incredible. It is the biggest club in the world. You need to be aware there are five strikers who want to be part of the games.
"I have to prove, in one minute or 90, that I want to start."
Though he did net the eventual winner late in the game, Hernandez wasted two golden opportunities to, possibly, seal the vital three points earlier in the day.
However, the Mexican insisted that he never dwells on missed chances in order to stay focused for the next one, while stating the most important thing was that they secured victory in the end.
"I didn't have those things in my mind," he added. "You cannot afford to regret every chance you miss because if you do you will never be concentrated for the next opportunity.
"You are never going to play the perfect game. You will never score five goals from five opportunities. That is the beauty of football. The most important thing was the win because here there are no heroes.
"It doesn't matter if I score in the last minute or we score four goals. We won and Manchester City lost. That is very good news."


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Article Text
The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I–IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
- Osteoarthritis
- Nursing
- Occupational therapy
- Physcial therapy
- Psychology
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Osteoarthritis (OA) is one of the most common chronic diseases, with an estimated overall prevalence in the general adult population of 11% and 24% for hip and knee OA, respectively.1 OA is age related, with manifestations often not occurring until middle age. In elderly people, OA is the most common cause of disability, including pain and limitations of activities and participation.2–4 As life expectancy is increasing the number of people living for prolonged periods with severe OA is expected to grow.
The need for high-quality care for a condition with major personal and societal impact is generally recognised and several guidelines for such care are available.5–9 International recommendations for management of OA are often divided into three main categories: non-pharmacological, pharmacological and surgical.6 During the past decade, much emphasis has been put on non-pharmacological management. However, recommendations are not sufficiently specific about the content, timing, intensity, frequency, duration and mode of delivery of each non-pharmacological option. This lack of detailed guidance may be one of the reasons why the quality of care for people with hip or knee OA is found to be suboptimal in several studies.10 ,11
In order to deal with this problem, the European League Against Rheumatism (EULAR) convened a group of experts to produce evidence-based recommendations for the non-pharmacological management of people with hip or knee OA, in accordance with the EULAR standard operating procedures,12 and to develop a research and educational agenda for future activities. These recommendations would provide more detail and would therefore be an addition to existing management guidelines and would be easier to implement. The target groups for these recommendations are all healthcare providers involved in the delivery of non-pharmacological interventions, researchers in the field of OA, officials in healthcare governance, reimbursement agencies and policy makers. In addition, people with hip or knee OA can use the recommendations for information on non-pharmacological management strategies.
The task force aimed to aggregate available information on non-pharmacological management of hip and knee OA into practical recommendations, using EULAR standardised operational procedures.12 These involved the assembly of an expert committee to develop consensus, based both on research evidence provided by a systematic literature review and expert opinion.
The task force comprised 21 people with particular knowledge of OA from 10 European countries, specifically: two nurses (SO, JdlT); one psychologist (RG); one dietician (PC); two occupational therapists (AH, IK); three physiotherapists (KBH, HL, TN); five rheumatologists (JWJB, PGC, MD, KP, JAdS); two orthopaedic surgeons (LSL, GZ); one general practitioner (CDM); two persons representing people with hip and/or knee OA (OA, IP); a clinical epidemiologist (TPMVV); and a research fellow (LF).
The process was based on both research evidence and consensus (see online supplementary appendix tables S1–S2 and figures S1–S12), and included, between June 2011 and May 2012, two task force meetings, systematic literature reviews (SLR) and extensive discussions. If a recommendation was shown to be inaccurate, based on data from the SLR, it could be rejected. Research evidence was graded in categories I–IV (table 1).12 During the second task force meeting, votes for level of agreement (LOA) were cast anonymously, by giving a score on a numeric rating scale from 0 (total disagreement) to 10 (total agreement) for each recommendation; mean and 95% CI of scores were calculated. Topics for the research and educational agenda were formulated based on discussions of the lack of evidence to substantiate the recommendations and weaknesses in current healthcare delivery.
Development of the recommendations
After the first meeting, a total of 168 propositions were suggested by the experts. Propositions that were identical were merged and propositions containing one word only were excluded. The second Delphi round comprised 140 propositions, with topics being very broad and including far more non-pharmacological interventions than currently included in these recommendations. After five Delphi rounds, consensus on 11 recommendations was achieved, which are presented with complete formulation in table 2 with the accompanying level of evidence (LOE) and LOA. The 11 recommendations are ordered in a logical sequence or procedural and chronological hierarchy rather than by any considered importance.
The terms 'non-pharmacological' and 'non-surgical' management were discussed by the expert group. The terms were considered to be negative owing to their prefix 'non' and were therefore not considered optimal; finding a new terminology was included in the research agenda (table 3). In addition, research evidence specifically for hip OA was sparse and, in general, recommendations for the management of people with hip OA were derived largely from trials including people with both hip and knee OA or with knee OA only.
Initial assessment
Research data on how a comprehensive assessment of people with hip or knee OA should best be carried out are scarce. Since initial assessment will always be a part of the management in any person with hip or knee OA, controlled trials evaluating assessment will have difficulties in selecting the most appropriate comparator. One randomised, controlled trial (RCT) comparing a comprehensive assessment and management approach with usual care showed no difference in pain or physical function.13 However, in that study, both approaches included initial assessments, but with different content and were executed by different professionals.13
The group considered a comprehensive initial assessment to be a prerequisite for the individualised management strategy described in recommendation 2. The recommendation on the initial assessment included the following elements: the person's physical status, activities of daily living, participation, mood and health education needs, health beliefs and motivation to self-manage. In the absence of evidence from studies on the effectiveness of various forms of assessment, the group based the recommended content of the initial assessment on the main areas of disease consequences, including potentially interacting personal and environmental factors described in the literature.14–22 Evaluation of cardiovascular disease, people's expectations and self-efficacy were also discussed as important aspects in a biopsychosocial approach.14 ,17 Moreover, the group found that a comprehensive assessment, which is applicable to the initial consultation, should also be repeated during regular follow-up of the person.
Individualised treatment
The task force agreed unanimously that the overarching principle for treatment of a person with hip or knee OA should be individualised, which is in line with previous guidelines.7–9 ,23 Individualised treatment does not imply that every treatment should be individually provided, it means rather that treatment is personalised, or tailored. RCTs on individualised non-pharmacological management are scant. The available studies showed reduced pain (mean difference, 95% CI (0–20 point scale): −1.19, −2.1 to −0.3 and −1.10, −1.84 to −0.19; and (0–100 scale): −17.0, −23.6 to −10.4) and improved physical function (mean difference, 95% CI (0–68 point scale): 3.65, 1.0 to 6.3 and 3.33, 0.78 to 5.88) compared with usual care,24–26 but not compared with group-based rehabilitation25 ,27 ,28 or information on healthy lifestyle.29 ,30 Follow-ups at 9, 18 or 30 months showed no effect on pain.31 ,32
As the data underpinning this recommendation are limited the factors to be considered for the tailoring of management were mainly based on prognostic factors shown in the literature. An important and modifiable risk factor for knee OA is weight,20 ,33 ,34 implying individualised targeting at weight reduction in people who are overweight or obese.
Moreover, individualised treatment being the standard of care in OA and chronic disease in general7 ,35 ,36 was considered to imply informed, shared decision-making, taking into account the person's wishes and preferences. The group noted that with the conduct of an RCT to study the impact of individualisation, the patient's view cannot be wholly taken into account and that some element of individualisation will always be incorporated in any treatment. To better understand individualised treatment, the group found that future research should focus on factors that affect outcome—that is, moderators, not individualisation as such.
Comprehensive package of care
This recommendation deals with the provision of an integrated package of care rather than single treatments alone or in succession. The group recommended five core interventions to be considered comprehensively in every patient with hip or knee OA. The recommendation specifically implies that a person with hip or knee OA should receive education about her/his condition (3a), and be managed accordingly (3b–e).
With the exception of walking aids and assistive technology and dealing with adverse mechanical factors, the literature supports the delivery of combined interventions including information and education, exercise and/or weight reduction.
In people with hip and/or knee OA the combination of patient education or self-management intervention plus exercise was found to have a significant effect on pain, but a less marked effect on function.26 ,31 ,37–40 In people with hip OA the effect of such combinations was mainly seen on function (0–100 point scale) at 3 and 6 months after intervention (mean difference, 95% CI −7.5, −13.9 to −1.0; and −8.4, −15.1 to −1.7).41 ,42 In people with knee OA effects on pain and/or function were seen in eight studies,24 ,25 ,43–48 whereas no effect was seen in four studies.32 ,49–51 The addition of advice from a dietician for overweight or obese patients to the combination of patient education or self-management intervention plus exercise was found to improve both pain and function in patients with hip or knee OA.52–55
Principles of lifestyle changes
Recommendation 4 deals with key elements of the delivery of interventions aimed to initiate and maintain lifestyle changes. It is known that behavioural changes are difficult to achieve and maintain, and the effect of advice and counselling by healthcare providers is disappointing.56 The literature search for this recommendation was limited to lifestyle changes considered most relevant for hip and knee OA—that is, exercise and weight loss.
The common feature in the trials supporting this recommendation was to teach and encourage behavioural change strategies through goal setting of physical activity and weight changes, action plans to maintain changes and regular follow-up over at least 1 year to re-evaluate and discuss goals and action plans.28 ,39 ,40 ,53 ,57–62
Reports examining the effectiveness of specific elements to be included in interventions aiming to change behaviour are scarce. The literature suggests that the following factors improve adherence to exercise or physical activity: individual exercise, graded activity, individualisation according to the person's exercise goals, feedback on progress made towards the goals, iterative problem solving with emphasis on skills that will improve adherence, reinforcements of maintaining exercise such as additional motivational programmes, exercise plans and log books, written information and audiotape or videotape, and booster sessions.28 ,39 ,40 ,61–63 In addition, some studies found an effect on pain39 ,40 or function59 from lifestyle interventions that integrate such elements. A systematic review including a mixed population of people with OA and/or rheumatoid arthritis found effect sizes of 0.21 (95% CI 0.08 to 0.34) for pain and 0.69 (95% CI 0.49 to 0.88) for increased physical activity from lifestyle interventions aiming at increasing physical activity.64 Over 40% of the included lifestyle interventions prompted problem solving, self-monitoring, goal setting and regular feedback.64
For people with knee OA or knee pain, improvements were seen in pain, function and weight loss from diet interventions that included individual weight-loss goals, problem solving on how to reach these goals and follow-up visits to re-evaluate and discuss goals in combination with exercise.53 ,60 In obese patients, weight-loss programmes with explicit weight-loss goals showed a higher mean change in weight than programmes without explicit goals.65 This indicates that the elements in recommendation 4 are important for the change and long-term maintenance of behaviour. The group discussed the importance of regular follow-up that includes feedback on the progress towards explicit goals and extends over a long time to achieve long-term effects of a healthy lifestyle.
Principles of information and education
Recommendation 5 is concerned with the content and method of delivery of various forms of educational programmes to best benefit the person with hip or knee OA. It is grounded in the general recognition that appropriate information and education are indispensable in prompting adequate self-management in chronic diseases. The recommendation is underpinned by the majority of studies on education interventions provided to patients with hip and/or knee OA. In general, small, but statistically significant effect sizes on pain (0.06, 95% CI 0.02 to 0.10) and physical function (0.06, 95% CI 0.02 to 0.10) have been reported from attending education or self-management programmes.6 ,66 Lower costs of community-based care and medication up to 12 months has been achieved from attending a combined self-management and exercise programme, and a reduced number of medical consultations from attending self-management programmes in patients with hip and/or knee OA have been reported.32 ,67 ,68
The literature review included trials that compared education or self-management programmes with usual care, attention controls or no intervention. These trials described one or several elements from 5c to f (table 2) in their interventions.69–85 The literature did not support the additional value of spouse-assisted coping skills training,79 and no trials were found for individualisation according to illness perception and educational capability, or for inclusion of education in every aspect of management. The group, however, considered the inclusion of spouses in the intervention to be a question of individualisation and appropriate in some cases. One systematic review found that, in people with OA, effective self-management interventions followed a protocol, included elements of cognitive behavioural theory or social cognitive theory and were led by trained health professionals.86 These elements are not specifically dealt with in the recommendation, yet they were supported by the group.
Principles of exercise education
Recommendation 6 deals with the principles of the delivery of education about exercise and physical activity. There is convincing evidence for the overall effectiveness of exercise on pain (ES, 95% CI: 0.40, 0.30 to 0.50) and function (ES, 95% CI: 0.37, 0.25 to 0.49) in people with knee OA,87 and to a lesser extent in people with hip OA (ES, 95% CI, pain 0.38, 0.08 to 0.68).88
Few studies have directly compared different exercise 'dosage' (frequency, intensity and duration) and progression approaches in people with OA.87 ,89 ,90 One RCT reported reduced pain from attending a progressive functional strengthening programme compared with a non-progressive programme in people with knee OA,90 but two trials could not show any differences from attending various intensity levels of aerobic or resistance-exercise programmes.89 ,91 Hence, the optimal exercise 'dosage' and rate of progression remain uncertain.
In patients with knee OA different delivery modes (individual, group-based or home programmes) have all been shown to effectively reduce pain (individual, ES, 95% CI 0.55, 0.29 to 0.81; group-based, ES, 95% CI 0.37, 0.24 to 0.51; and, home, ES, 95% CI 0.28, 0.16 to 0.39) and improve function (individual, ES, 95% CI 0.52, 0.19 to 0.86; group-based, ES, 95% CI 0.35, 0.19 to 0.50; and, home, ES, 95% CI 0.28, 0.17 to 0.38) compared with education, telephone calls, waiting list, relaxation, ultrasound, hot-packs or no treatment.87 In patients with hip and/or knee OA, water-based exercise was found to significantly reduce pain (ES, 95% CI 0.19, 0.04 to 0.35) and improve function (ES, 95% CI 0.26, 0.11 to 0.42) compared with education, telephone calls or no intervention.92 Home-based exercise was found to be as effective as water-based exercise in one small RCT in people with hip OA.93 Water-based exercise can include swimming and/or different types of exercise programmes. Since the different modes of delivery are equally effective, the person's preference, findings of the initial assessment and local availability should determine the choice of mode of delivery in clinical practice.
The literature suggests that pacing of activity and/or integrating physical activity into daily living as part of a comprehensive exercise regimen is more effective in people with hip or knee OA or with knee pain than usual care or written information, but not compared with standardised exercise or a pharmacy review.24–26 ,29 ,31 ,38 ,46 ,57 ,58 ,77–79 ,94
This recommendation suggests the need for an increase in the intensity and/or duration of exercise over time. This is based on the literature, where most strength training exercise programmes evaluated in people with knee OA included dynamic exercises with progression over time.95 Moreover, in one study comparing progressive and non-progressive approaches in people with knee OA, the former was found to reduce pain more effectively.90 General recommendations for dosage and progression of exercise in older people and people with chronic disease are aerobic moderate-intensity training for at least 30 min/day or up to 60 min for greater benefit, and progressive strength training involving the major muscle groups at least 2 days/week at a level of moderate to vigorous intensity (60–80% of one repetition maximum) for 8–12 repetitions.96 ,97 These recommendations emphasise that in people with chronic disease who do not reach the recommended level, they should be as physically active as their abilities and condition allow.97
Exercise regimen
Before considering the evidence for specific exercises in hip and knee OA, it should be noted that although exercise has been shown to reduce pain in patients with hip OA,88 overall there is a lack of information to support treatment effects of exercise in hip OA.8 ,88 ,98–103 The LOE for the recommendation of different types of exercise in people with hip OA therefore could not be graded. For knee OA, however, high-quality research evidence has reported that exercise reduces pain and improves physical function.6 ,87 ,104 Results for the effect of exercise on quality of life are inconsistent.90 ,92 ,95 ,99 ,102 ,104 ,105
Research about strengthening exercises in knee OA shows that both specific quadriceps strengthening exercises or strength training for the lower limb reduce pain effectively (ES, 95% CI 0.29, 0.06 to 0.51 and 0.53, 0.27 to 0.79, respectively) and improve physical function (ES, 95% CI 0.24, 0.06 to 0.42 and 0.58, 0.27 to 0.88, respectively).87 The literature on strength training in people with knee OA in most cases describes dynamic exercises, whereas research on isometric exercises is sparse.95 Hip strengthening exercises have been poorly evaluated in people with hip OA.103 However, in people with medial tibiofemoral knee OA, hip strengthening exercises reduced knee pain and improved physical function.106
Aerobic training (walking) is effective in reducing pain (ES, 95% CI 0.48, 0.13 to 0.43) and improving physical function (ES, 95% CI 0.35, 0.11 to 0.58) in patients with knee OA.87
The evidence for mixed exercise programmes, including strengthening, aerobic and flexibility components, in patients with knee OA is conflicting.107 ,108 One type of exercise has not been shown to be better than another (strength, aerobic or mixed exercises).87 ,107 ,108
The group reached consensus that mixed programmes should be recommended. However, it was noted that with mixed programmes the minimal requirements to improve or maintain muscle strength, aerobic capacity and/or joint range of motion need to be met,97 as some reports suggest that mixed programmes may be less effective than focused programmes.108
This recommendation states that initial instruction is required, but that in the longer term the person should integrate exercise into daily life. This part of the recommendation is substantiated by studies showing that the number of supervised sessions influences outcome in people with knee OA.87 Twelve or more directly supervised sessions have been shown to be more effective than a smaller number on pain (ES 0.46, 95% CI 0.32 to 0.60 vs ES 0.28, 95% CI 0.16 to 0.40, p=0.03) and physical function (ES 0.45, 95% CI 0.29 to 0.62 vs ES 0.23, 95% CI 0.09 to 0.37, p=0.02).87
In addition, it was noted that research evidence is growing for tai chi and yoga. Though not included in the literature review, tai chi has been found to be effective for the reduction of pain in patients with hip or knee OA, with ES ranging from 0.28 to 1.67.108
Education on weight loss
In recommendation 8, the principles of education about weight management are included. The recommendation is mainly supported by the literature in knee OA, as no evidence to support the effect of weight loss in patients with hip OA is available. However, being overweight or obese has been shown to be associated with hip OA (OR=1.11, 95% CI 1.07 to 1.16).33
In patients with knee OA, the effectiveness of weight-loss programmes on body weight, pain and/or physical function was demonstrated in programmes delivered as weekly supervised sessions for a range of 8 weeks to 2 years.54 ,60 ,109–113 The effects on pain, function and weight loss from attending weight-loss programmes were small but significant (ES, 95% CI, pain 0.20, 0.00 to 0.39; physical function 0.23, 0.04 to 0.42; mean weight loss, 95% CI, 6.1 kg, 4.7 to 7.6).109 The interventions included strategies on how to reduce calorie intake by meal plans, reduce fat and sugar, reduce portion size, meal replacements, and comprised behavioural modifications, self-monitoring, weight-loss goals and maintaining body weight in participants who had reached their goals and/or exercises for some of them.54 ,60 ,109–112 Overall, the evidence from RCTs for the maintenance of achieved weight loss after the interventions have ended is absent in people with hip and knee OA.
In general, in overweight or obese populations, healthy eating, limiting fat and salt intake, eating at least five portions of fruit and vegetables a day, being physically active for at least 30 min/day and elements such as self-monitoring, explicit weight-loss goals, and motivational interviewing have all been suggested to promote weight loss and that regular follow-up over 4 years helps in maintenance of the weight loss.65 ,114–118 Weight-loss programmes in older obese people that included explicit weight-loss goals showed mean changes in weight of −4.0 kg (95% CI −7.3 to −0.7), which was significantly more than programmes without explicit weight-loss goals (mean change, 95% CI, −1.3 kg, −2.9 to 0.3).65 To achieve a structured meal plan with a balanced combinations of low calorie and sufficient vitamin and mineral intake, meal replacement bars or powders can be an addition to healthy eating.54 ,60 ,109 ,110 Though not included in the literature review, it has been suggested that bariatric surgery should be part of comprehensive weight management in people with hip or knee OA who are morbidly obese, and could help reduce weight and joint pain.119 ,120
Although research evidence is scant, the group was unanimous in its view that the use of appropriate footwear should be recommended in patients with hip or knee OA. Shoes may help through different mechanisms, such as acting as shock absorbers or controlling foot pronation.121 ,122 Appropriate shoes implies no raised heel, thick, shock-absorbing soles, support for the arches of the foot and a shoe size big enough to give a comfortable space for the toes.121–123
In patients with hip OA there is no evidence to support the effect of specific shoes or insoles on pain or function. In patients with knee OA, the use of shoes with shock-absorbing insoles for 1 month reduced pain and improved physical function in a pre–post test design.124 No differences in knee pain from the use of specialised shoes (unstable Masai technology shoe or variable-stiffness shoe) compared with conventional athletic shoes have been seen, but reduced pain was seen in both groups over time.125 ,126 In addition, decreased knee joint loads were found when specialised mobility shoes were used.121
The literature on the effectiveness of the use of lateral wedged insoles in patients with medial knee OA found no significant effect on pain or function.121 ,127 ,128 There is no support for whether one type of insole would be better than another,129 and adverse effects including foot-sole pain, low-back pain and popliteal pain have been reported.121 ,128 ,129 In light of evidence for no clinical effects of the use of lateral wedged insoles and the report of adverse effects, the group rejected the recommendation (table 2, 9b).
Assistive technology and adaptations at home and/or at work
The frequent use of assistive technology and the high satisfaction rates with its use indicate that walking aids, assistive technology and adaptations are important and useful for people with hip or knee OA.130–133 There are, however, no clinical trials to substantiate elements in this proposition, except for the use of a cane in patients with knee OA.134 However, the group was unanimous in its view that in all patients with hip or knee OA walking aids, assistive technology and adaptations at home and/or at work should be considered systematically and recurrently. The group noted that the value of some of these interventions is so obvious and has an immediate effect in individual cases that further research into the effectiveness of specific devices or adaptations can hardly be expected. Cross-sectional studies show that walking aids, assistive technology and adaptations at home and/or work are important and often used by people with hip or knee OA. Most people with severe hip (63%) or knee pain (90%) reported the use of walking aids.130 ,131 In people with arthritis, a mean of 9.9–10.8 devices has been reported to be in use and the satisfaction rate for all categories of device was more than 87%.132 Moreover, unmet needs for new assistive technology to help perform activities that individuals could not do were identified.132 Having access to a walking aid or other assistive technologies can be a help and provide security for individuals with constant or fluctuating symptoms. The group found that future observational studies on the use, satisfaction from and suggestions for new technology or improvements of existing technology are needed.
Management of work ability
Recommendation 11 deals with the effectiveness of work-related interventions. The proportion of employed people who have work disability due to OA is substantial. Although there are known occupational risk factors for knee OA and its progression—for example, heavy work, knee squatting or bending, lifting and specific sports,18 there are no studies to support the effect of vocational rehabilitation on pain, physical function or quality of life specifically in patients with hip or knee OA. One study in patients with peripheral OA found that a specialist-run, protocol-based early intervention significantly reduced the number of days of sick leave compared with standard primary care.135 The intervention was administered by a rheumatologist and comprised three main elements: education, protocol-based clinical management and administrative duties. The educational part included information about the condition, reassurance that serious disease was not present, self-management, exercises, ergonomic care, booklets, optimal level of physical activity and early return to work. Descriptive studies have found that environmental factors, such as having access to public transport or a car for mobility outside home are facilitators and that the absence of these is associated with limitations to daily activity.136 ,137 Some elements in this recommendation may have to be adapted to the country in which they are executed, since availability and accessibility of services in the healthcare and social security system may vary greatly. The group concluded that there is a clear paucity of research evidence for work-related interventions in people with hip and knee OA.
Eleven recommendations for the core non-pharmacological management of people with hip and knee OA were developed based on research evidence and expert consensus. While the 11 evidence-based recommendations are not exhaustive and do not include all existing non-pharmacological treatments, they cover the main principles of non-pharmacological management. The selected recommendations support a patient-centred, multidisciplinary approach rather than a discipline-specific approach.
There was a considerable body of evidence underlying the recommendations, with systematic reviews and/or RCTs available for most. It is worth noting, however, that overall the research evidence for hip OA was poorer than for knee OA, limiting conclusions about the effectiveness of non-pharmacological interventions in this patient group. Moreover, most trials found in the literature review used pain or physical function as the primary outcome and surprisingly few included quality-of-life outcome measures. Mental health, physical independence, autonomy and social participation have been reported as important domains by people with OA and older adults.138 ,139 Given these observations, the task force recommends that future research should include well-powered studies to evaluate the effect of core non-pharmacological treatments specifically in people with hip OA, moderators of effect and the inclusion of quality-of-life measurements that reflect physical, mental and social health in their evaluation.
Several RCTs found in the systematic literature review compared two non-pharmacological interventions and found no significant differences in pain or physical function between them. This does not mean that the interventions were ineffective, but that neither was better than the other. For example, a well-powered RCT compared a behavioural graded activity intervention with education and exercise following the Dutch physiotherapy guideline for patients with hip and/or knee OA and found no differences between groups.57 Nevertheless, both groups showed improvements in pain and physical function over time. Moreover, it was found that non-pharmacological interventions often consisted of combinations of different treatments, with the combinations varying largely between studies. This hampered comparisons between studies and also the ability to define the effect of the individual components, so that the underpinning of every specific element in some of the recommendations proved to be difficult. Hence, the aim of developing detailed recommendations could not always be fulfilled. However, compared with previous recommendations5–9 the current recommendations are more specific. They provide substantiated and more detailed recommendations about content (for patient education, exercise, weight reduction and combined treatment), frequency (at least 12 sessions, activity pacing and follow-ups) and mode of delivery (1 : 1, group-based or home exercise) than previously published recommendations. In addition, principles for optimising long-term adherence and effect are described. The optimal exercise volume ('dose') could not be substantiated. Exercise volume is difficult to investigate as it includes exercises performed at a gym or at the physiotherapy clinic and the total amount of exercise performed in daily life. Exercise volume therefore varies widely between individuals. The matter of timing lacks research evidence and the topic was included in the research agenda. Furthermore, the effect sizes for several non-pharmacological interventions reported in the literature were generally relatively low. It should be noted, however, that the costs of these interventions are generally limited, and the occurrence of adverse effects is low. The results of the LOA in addition to the traditional determination of the LOE are therefore important, as this reflects the experts' interpretation of all the above-mentioned aspects.
Limitations to the methodological quality of the systematic literature review were that only one person (LF) extracted data from the literature. According to the assessment of multiple systematic reviews,140 at least two independent data extractors are recommended. However, the research fellow (LF) presented and discussed all results with the conveners (JWJB, KBH, TPMVV) and the extracted data were, thereafter, reviewed by experts in the committee. Another limitation was that, owing to limited time and resources, no scoring of the methodological quality of the systematic reviews or individual trials included in the literature review was done. Also, owing to limited resources, some potential healthcare providers playing a role in the management of hip and knee OA, such as the podiatrist or rehabilitation specialist, were not represented in the task force.
To obtain a broad consensus and practical applicability of the recommendations, the task force had an inclusive and multidisciplinary approach. Nine different professional disciplines and people with OA were included in the committee. The task force followed a procedure similar to that used for other management recommendations, such as for the general management of OA, rheumatoid arthritis and ankylosing spondylitis,8 ,9 ,141 ,142 but is the first with such an inclusive approach. It has been strongly recommended that a minimum of two patient research partners with the relevant disease are included in development of recommendations.143 The participation of the people with OA in this task force was successful, with their experiential knowledge ensuring that clinical relevance was integrated throughout the process.
Finally, the task force reached consensus on a research and educational agenda, with general topics including the definition and nomenclature for non-pharmacological and non-surgical management and the need for more knowledge on their effectiveness in hip OA. Specific needs for additional research and/or education included the optimisation of tailoring of treatment and the mode of delivery, the long-term effects of lifestyle interventions, vocational rehabilitation and footwear, the measurement of adherence and participation and the conduct of studies with a sufficient sample size. An important subject regarding education pertained to lifestyle interventions, highlighting the need for educational activities not only for healthcare providers, but also for people with OA and the public.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Files in this Data Supplement:
- Data supplement 1 - Online supplement
- Data supplement 2 - Online figure
Handling editor Francis Berenbaum
Contributors All authors have contributed to the development of the recommendations, commented on the manuscript and approved the submission.
Funding This study was funded by EULAR (2010).
Competing interests LF, KBH, JWJB, OA, PC, PGC, MD, RG, AH, IK, HL, CDM, TN, KP, IP, JAdS, JdlT, TPMVV: none declared. LSL: honoraria for consultancies and educational lectures from Flexion, MerckSerono, NicOx, Pfizer and SanofiAventis. LSL is the editor-in-chief of Osteoarthritis and Cartilage. SO: honoraria for speaker fees or educational training from Servier Laboratories and Pfizer in the past year. GZ: Please, see attached document for Dr Zanoli's competing interest.
Provenance and peer review Not commissioned; externally peer reviewed.


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It's also more of a concept than a recipe - a way to cook roast chicken that makes it really moist and tender and gives it a hint of flavour from the drink - though don't worry, you don't end up with a chicken that tastes of beer! I used a can of ginger ale rather than beer - which had Jim Beam honey in it - giving a lovely gingery, slightly sweet flavour. In fact while I haven't tried it with beer (as per the recipe I found) I think this way is a lot better!
Your chicken will take the same amount of time as normal to roast so check the packet - usually about 20 mins per 500g plus an extra 20 mins but don't take my word for that. Preheat the oven and make sure there aren't any giblets inside the chicken cavity.
Open your beer can or ginger ale can and drink or pour out a little so the can is about 3/4 full. Rather unceremoniously up-end the chicken so the beer can stands up inside the cavity with your chicken upright on top!
Roast until the juices run clear. The steam from the liquid in the can will almost steam the chicken from the inside while it roasts on the outside (I'd advise you throw away what's left in the can - I know some people make gravy from meat juices but in this case the can will have what's dripped from directly inside the chicken... not fat that comes from roasting the skin).
I had to take the middle shelf out of my oven so it would fit. It does look quite funny, doesn't it?
Carefully remove the can from the chicken and carve the chicken as normal to serve - a bit unconventional I admit, but delicious!


text: Immunity May Be Compromised by Vitamin D DeficiencyOlder individuals who are vitamin D deficient also tend to have compromised immune function, according to new research accepted for publication in the Journal of Clinical Endocrinology & Metabolism. Vitamin D plays an important role in helping the body absorb calcium needed for healthy bones. The skin naturally produces vitamin D when it is exposed to sunlight. People also obtain smaller amounts of the vitamin through foods, such as milk fortified with vitamin D. More than 1 billion people worldwide are estimated to have deficient levels of vitamin D due to limited sunshine exposure. "Our data suggest vitamin D may be involved in maintaining the health of the immune system as well as the skeletal system," says one of the study's authors, Mary Ward, PhD, of the University of Ulster in Coleraine, UK. "This study is the first to find a connection between vitamin D levels and inflammation in a large sample of older individuals." The observational study of 957 Irish adults who were at least 60 years old examined vitamin D levels as well as biomarkers of inflammation. Participants who were vitamin D deficient were more likely to have high levels of these biomarkers, which are linked to cardiovascular disease and inflammatory conditions such as multiple sclerosis and rheumatoid arthritis. "The results indicate immune function may be compromised in older individuals with vitamin D deficiency," Ward says. "Ensuring older individuals have optimal vitamin D levels may be a way to boost immune function in this population, but this needs to be confirmed through additional studies." Source: The Endocrine Society |


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Interview with Kevin Lesko, Senior Physicist at Lawrence Berkeley National Lab and former Spokesperson for LUX-ZEPLIN (LZ), an international collaboration searching for dark matter. Lesko explains why so many different kinds of physicists are involved in dark matter searches and how theorists have provided guidance for experimental and observational work to understand dark matter. He recounts his upbringing in northern California, the scientific influence of his parents and older siblings, and his decision to attend Stanford, where he worked on a tandem Van De Graaff in the nuclear physics lab. Lesko discusses his graduate work at the University of Washington, where he worked under the direction of Bob Vandenbosch on nuclear fission research, and he describes his postdoctoral appointment at Argonne, where he pursued experiments in nuclear fusion and neutrino physics. He explains his decision to join the staff at Berkeley Lab and how his interests centered increasingly on astrophysics with the Sudbury Neutrino Observatory. Lesko discusses his collaborations in Japan and KamLAND's discovery of the absolute measurement of neutrino oscillations and the origins of the Homestake collaboration. He describes the transition of support for Homestake from the NSF to the DOE and he explains his entrée to the LUX collaboration and the reasons for the merger with ZEPLIN. Lesko explains how LZ needs to be ready to detect dark matter either as a singularity or is comprised of multiple components, and he considers what it might look like for dark matter to be detected. He recounts LZ's success in ruling out dark matter candidates and he reflects on LBNL serving as a home base while his collaborative research has always been far-flung. At the end of the interview, Lesko considers what we have learned about the universe as a result of LZ, and why mystery and curiosity will continue to drive the field forward.


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When analyzing Tiffany & Co. (NYSE:TIF) through the lens of FAST Graphs™ we see a company that appears to have been overvalued for the most part over the last 10 years.
About Tiffany & Co: Directly from their website
"Tiffany & Co. operates jewelry stores and manufactures products through its subsidiary corporations. Its principal subsidiary is Tiffany and Company. The Company operates TIFFANY & CO. retail stores and boutiques in the Americas, Asia-Pacific, Japan and Europe and engages in direct selling through Internet, catalogue and business gift operations."
Earnings Determine Market Price: The following earnings and price correlated FAST Graphs™ clearly illustrates the importance of earnings. The Earnings Growth Rate Line or True Worth™ Line (orange line with white triangles) is correlated with the historical stock price line. On graph after graph the lines will move in tandem. If the stock price strays away from the earnings line (over or under), inevitably it will come back to earnings.
Earnings & Price Correlated Fundamentals-at-a-Glance
A quick glance at the historical earnings and price correlated FAST Graphs™ on Tiffany & Co shows a picture of overvaluation based upon the historical earnings growth rate of 11.5% (orange circle) and a current PE of 17. Reviewing the forecasting graph below, the stock appears overvalued and analysts are forecasting the earnings growth to continue at about 12% (orange circle).
Tiffany & Co: Historical Earnings, Price, Dividends and Normal PE Since 2003
Performance Table Tiffany & Co
The associated performance results with the earnings and price correlated graph, validates the principles regarding the two components of total return; capital appreciation and dividend income. Dividends are included in the total return calculation and are assumed paid, but not reinvested.
When presented separately like this, the additional rate of return a dividend paying stock produces for shareholders becomes undeniably evident. In addition to the 10.5% capital appreciation (green circle), long-term shareholders of Tiffany & Co. (NYSE:TIF), assuming an initial investment of $1,000, would have received an additional $210.37 in dividends (blue highlighting) that increased their total return from 10.5% to 11.4% per annum versus 6.6% in the S&P 500 (red circle).
The following graph plots the historically normal PE ratio (the dark blue line) in conjunction with 10-year Treasury note interest. Notice that the current price earnings ratio on this quality company is as normal as it has been since 2003.
A further indication of valuation can be seen by examining a company's current price to sales ratio relative to its historical price to sales ratio. The current price to sales ratio for Tiffany & Co. (NYSE:TIF) is 2.14 which is historically normal.
Looking to the Future
Extensive research has provided a preponderance of conclusive evidence that future long-term returns are a function of two critical determinants:
1. The rate of change (growth rate) of the company's earnings
2. The price or valuation you pay to buy those earnings
Forecasting future earnings growth, bought at sound valuations, is the key to safe, sound, and profitable performance.
The Estimated Earnings and Return Calculator Tool is a simple yet powerful resource that empowers the user to calculate and run various investing scenarios that generate precise rate of return potentialities. Thinking the investment through to its logical conclusion is an important component towards making sound and prudent commonsense investing decisions.
The consensus of 24 leading analysts (light purple highlighting) reporting to Capital IQ forecast Tiffany & Co's long-term earnings growth at 12% (orange circle). Tiffany & Co has low long-term debt at 19% of capital (red circle). Tiffany & Co. (NYSE:TIF) is currently trading at a P/E of 17, which is inside the value corridor (defined by the five orange lines) of a maximum P/E of 18. If the earnings materialize as forecast, Tiffany & Co's True Worth™ valuation would be $99.07 at the end of 2017 (brown circle on EYE Chart), which would be a 10.8% annual rate of return from the current price (yellow highlighting).
Earnings Yield Estimates
Discounted Future Cash Flows: All companies derive their value from the future cash flows (earnings) they are capable of generating for their stakeholders over time. Therefore, because Earnings Determine Market Price in the long run, we expect the future earnings of a company to justify the price we pay.
Since all investments potentially compete with all other investments, it is useful to compare investing in any prospective company to that of a comparable investment in low risk Treasury bonds. Comparing an investment in Tiffany & Co. (NYSE:TIF) to an equal investment in 10 year Treasury bonds, illustrates that Tiffany & Co's expected earnings would be 6.2 (purple circle) times that of the 10 year T-Bond Interest. (See EYE chart below). This is the essence of the importance of proper valuation as a critical investing component.
Summary & Conclusions
This report presented essential "fundamentals at a glance" illustrating the past and present valuation based on earnings achievements as reported. Future forecasts for earnings growth are based on the consensus of leading analysts. Although, with just a quick glance you can know a lot about the company, it's imperative that the reader conducts their own due diligence in order to validate whether the consensus estimates seem reasonable or not.
Disclosure: No position at the time of writing.
Disclaimer: The opinions in this document are for informational and educational purposes only and should not be construed as a recommendation to buy or sell the stocks mentioned or to solicit transactions or clients. Past performance of the companies discussed may not continue and the companies may not achieve the earnings growth as predicted. The information in this document is believed to be accurate, but under no circumstances should a person act upon the information contained within. We do not recommend that anyone act upon any investment information without first consulting an investment advisor as to the suitability of such investments for his specific situation. A comprehensive due diligence effort is recommended.


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Although it is of less academic interest, and therefore not included in our chapter, the geographical relationship between zombies and other undead is of clear practical value. After all, one should never bring a wooden stake to a zombie fight. While some independent researchers have studied the zombie versus vampire relationship, their findings seem of limited value, cinematically or otherwise. So we instead offer our nervous readers these helpful observations based on the maps below...
The Undead in the U.S. of A.
Zombies and Vampires in Europe
Be sure to check out the previous iterations of our Preparing for the Zombie Apocalypse series in Parts I,


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Keep track of where in the world people are coming from to visit your website. And Visitor Heat Maps show heavy traffic from various regions.
Monitor what websites are referring you traffic in real time. Real-time site statistics means that you can watch as people visit. Easily resolve visitor IP addresses to hosts as needed.
Take a look back up to 5 years. See how your traffic has changed and look for annual trends. Compare historical page views, returning visitors and unique new, first-time visitors. Download to Excel Spreadsheets or CSV format as well.
View a breakdown of your traffic by weekday. Doing your Email Marketing on the right days of the week is very important for success. Monitor new visitors and returning visitors.
Detailed graphs
display all your traffic.
Keep your stats private or
open to the Public.
Statistics are stored and
ready to export to Excel.
Monitor which sites
are sending you traffic.
Global heat maps show
where most traffic comes from.
Check out what countries
visitors are coming from.
Every style, shape, and color
available for your site.
View visitor IP addresses and
resolve them to hostnames.
Simply paste our special code
onto your pages.


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1619.Past Debts of Beneficiaries
1619.1Can creditors seize funds?
In order to assure an income for a beneficiary's current needs, Section 207 of the Social Security Act specifically exempts funds from seizure by creditors. However, some exceptions may apply.
1619.2What are the exceptions?
Section 459 of the Social Security Act permits garnishment for the legal enforcement of providing child support and alimony, and the IRS may levy for taxes owed. In addition, SSA may seek refund of a Social Security or SSI overpayment.
1619.3Should representative payees use funds to cover bills incurred before the payee began receiving the payments?
Provided the beneficiary's current and reasonably foreseeable needs are met, a representative payee may use funds to pay bills incurred by a beneficiary before the first month we began to pay benefits to the representative payee.
1619.4What if the beneficiary owes a debt to the representative payee?
If a debt is owed to the representative payee, the payee must obtain approval from SSA prior to using funds for self-reimbursement.
1619.5Where can a representative payee obtain further information on payment of past debts?
Refer questions concerning payment of past debts to the local Social Security office.
Last Revised: Nov. 16, 2010


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Applescript: Arranging Multiple Windows
A while ago, I wrote about how to move and resize windows to specific locations on the screen. Â What if you instead want to just automatically arrange every window of a given application in a pattern? Â Here's a quick script to layer every window in Safari such that each window is a little bit down and left of the window before, resulting in a cascading pattern.
tell application "Safari"
set _theWindows to every window
repeat with i from 1 to number of items in _theWindows
set this_item to item i of _theWindows
set the bounds of this_item to {(109 + (20 * i)), (10 + (10 * i)), (1164 + (20 * i)), (786 + (10 * i))}
end repeat
end tell


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So I know that you guys have been wanting to see some videos. Here they are. But don't get too excited- this little monkey usually shuts down when he sees me pull out the camera. He definitely knows when I'm filming and doesn't want to perform. But these are just a few short little clips of what our daily life consists of (well, when he's standing up, at least:)
This is something he actually just did today. He was making a "pig" noise with his trach and "wrinkling" his nose with his finger :)
This is hilarious. It's the sign language he knows that we put together in a sentence.
"I'm gonna read a book about poo-pooing in the potty. And I need help"
haha... don't judge- it's cute and you know it.
Finally caught a VERY short clip of him "holding his breath" :) He's so funny.
My Uncle Ray makes this child laugh and smile like no other.
As soon as he hears his voice at the door, he pops up and wants to play.
Also, Tripp got the pleasure of meeing Meghan Linsey from the hottest new duo Steel Magnolia (who are nominated for two ACM (Academy of Country Music) awards this Sunday:) Meghan is from Ponchatoula also. We went to high school together and then she moved to Nashville right after high school to pursue her music career. And boy did she succeed! She and her boyfriend, Josh won on the CMT show "Can you Duet?" Well, anyway, I'm sure you all know the rest... since then they've had quite a few hit singles :) They are awesome. I didn't get to meet Josh... but I was so touched that Meghan took time out of her crazy schedule to stop by and visit. Especially since we haven't seen or spoken to each other since high school. She came with my awesome friend Brittany and her adorable little man Carter- check out those beautiful eyes. This picture does them no justice!!
But Tripp wasn't having it!! :)
But Tripp wasn't having it!! :)


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Why was the arrest of Pinochet a topic of international controversy?
Ricardo Lagos
Date Filmed
September 25, 2009
Related Units
Competing Visions of Human Rights: Questions for U.S. Policy
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Analysis and Modeling at High Angular Resolution
Principal investigator: Armando Domiciano
AMHRA develops and provides online astrophysical models and data analysis tools dedicated to the scientific exploitation of high angular and high spectral facilities such as ESO-VLTI. It is aimed at users seeking to prepare, model, and analyze interferometric observations, notably those from the second generation of VLTI instruments, GRAVITY and MATISSE, with unprecedented capabilities on high spectral and spatial resolution.
AMHRA provides:
- Polychromatic images from astrophysical models with fast computation time (real time models)
- Polychromatic images from a precalculated grid of astrophysical models
- Spectro-interferometric observables from model images (OIFits modeler)
- Analysis and model-fitting tools for spectro-interferometry
This service was initially published under the name "Analyse et Modélisation en Haute Résolution Angulaire".
AMHRA is a working group of MOIO/JMMC and is supported by the Observatoire de la Côte d'Azur (OCA) through the DOMINO expertise center. MOIO is a French AA-ANO5 SNO supported by CNRS-INSU.
Real time astrophysical models
Disk and stellar continuum – DISCO
Model of the continuum emission from a star surrounded by a gaseous circumstellar disk (free-free and bound-free), with partially ionized and geometrically thin disk with a physical structure given by the viscous Keplerian decretion disk model. DISCO is well suited to model Be stars.
Analytical Limb-darkening Elliptical or Spherical – ALDES
ALDES provides intensity maps (images) or 1d intensity profiles for spherical or elliptical stars showing the limb darkening (LD) effect. Different LD laws are offered: uniform disk, linear, power law, quadratic, square root, logarithmic and four-parameter.
Precalculated grids of astrophysical models
Supergiant B[e] with HDUST
Grid of models for B[e] supergiant stars computed with the 3d Monte Carlo radiative transfer code HDUST. The non-spherical circumstellar envelope (CSE), composed of gas (hydrogen) and dust (silicate), is modelled considering a bimodal outflow description (two-component wind).


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NASA's Mars rover Perseverance, the most advanced astrobiology lab ever sent to another world, streaked through the Martian atmosphere on Thursday and landed safely inside a vast crater, the first stop on a search for traces of ancient microbial life on the Red Planet.
Mission managers at NASA's Jet Propulsion Laboratory (JPL) near Los Angeles burst into applause, cheers and fist-bumps as radio beacons signaled that the rover had survived its perilous descent and arrived as planned on the floor of Jezero Crater, site of a long-vanished Martian lake bed.
The six-wheeled vehicle came to rest about 2 kilometres from towering cliffs at the foot of a remnant fan-shaped river delta etched into a corner of the crater billions of years ago and considered a prime spot for geo-biological study on Mars.
"Touchdown confirmed," Swati Mohan, the lead guidance and operations specialist announced from the control room. "Perseverance safely on the surface of Mars."
The robotic vehicle sailed through space for nearly seven months, covering 293 million miles (472 million km) before piercing the Martian atmosphere at 12,000 miles per hour (19,000 km per hour) to begin its descent to the planet's surface.
Moments after touchdown, Perseverance beamed back its first black-and-white images from the Martian surface, one of them showing the rover's shadow cast on the desolate, rocky landing site.
Because it takes radio waves 11 minutes to travel from Mars to Earth, the SUV-sized rover had already reached Martian soil by the time its arrival was confirmed by signals relayed to Earth from one of several satellites orbiting Mars.
The spacecraft's self-guided descent and landing during a complex series of maneuvers that NASA dubbed "the seven minutes of terror" stands as the most elaborate and challenging feat in the annals of robotic spaceflight.
Acting NASA chief Steve Jurczyk called it an "amazing accomplishment," adding, "I cannot tell you how overcome with emotion I was."
Deputy Project Manager for the rover, Matt Wallace, said the descent and landing systems "performed flawlessly."
The landing represented the riskiest part of two-year, $2.7 billion (roughly Rs. 19,620 crores) endeavour whose primary aim is to search for possible fossilised signs of microbes that may have flourished on Mars some 3 billion years ago, when the fourth planet from the sun was warmer, wetter, and potentially hospitable to life.
Scientists hope to find biosignatures embedded in samples of ancient sediments that Perseverance is designed to extract from Martian rock for future analysis back on Earth – the first such specimens ever collected by humankind from another planet.
Two subsequent Mars missions are planned to retrieve the samples and return them to NASA in the next decade, in collaboration with the European Space Agency.
Thursday's landing also came as a triumph for a pandemic-weary United States, still gripped by economic and social upheaval from the COVID-19 pandemic. The public health crisis emerged in the months before the rover was launched in July and complicated execution of the Mars mission.
US President Joe Biden, watching NASA coverage of the event at the White House, tweeted his congratulations, saying, "Today proved once again that with the power of science and American ingenuity, nothing is beyond the realm of possibility."
Congratulations to NASA and everyone whose hard work made Perseverance's historic landing possible. Today proved once again that with the power of science and American ingenuity, nothing is beyond the realm of possibility. pic.twitter.com/NzSxW6nw4k
— President Biden (@POTUS) February 18, 2021
In a special salute in keeping with virtual communications emblematic of the era, the JPL webcast included a Zoom-like video collage flashing the faces of hundreds of Perseverance team members from home offices where many worked remotely through the pandemic.
Search for ancient life
NASA scientists have described Perseverance as the most ambitious of nearly 20 US missions to Mars dating back to the Mariner spacecraft's 1965 fly-by.
Larger and packed with more instruments than the four Mars rovers preceding it, Perseverance is set to build on previous findings that liquid water once flowed on the Martian surface and that carbon and other minerals altered by water and considered precursors to the evolution of life were present.
Perseverance's payload also includes demonstration projects that could help pave the way for eventual human exploration of Mars, including a device to convert the carbon dioxide in the Martian atmosphere into pure oxygen.
The box-shaped tool, the first built to extract a natural resource of direct use to humans from an extraterrestrial environment, could prove invaluable for future human life support on Mars and for producing rocket propellant to fly astronauts home.
Another experimental prototype carried by Perseverance is a miniature helicopter designed to test the first powered, controlled flight of an aircraft on another planet. If successful, the 4-pound (1.8-kg) helicopter could lead to low-altitude aerial surveillance of distant worlds, officials said.
The daredevil nature of the rover's descent to the Martian surface, at a site that NASA described as both tantalising to scientists and especially hazardous for landing, was a momentous achievement in itself.
The multi-stage spacecraft carrying the rover soared into the top of Martian atmosphere at nearly 16 times the speed of sound on Earth, angled to produce aerodynamic lift while jet thrusters adjusted its trajectory.
A jarring, supersonic parachute inflation further slowed the descent, giving way to deployment of a rocket-powered "sky crane" vehicle that flew to a safe landing spot, lowered the rover on tethers, then flew off to crash a safe distance away.
Extra cameras designed to shoot video of Perseverance as it plunged toward the surface are believed to have captured the first footage ever recorded of a spacecraft descending onto another planet, JPL officials said. That video may be ready to show the world as early as next week, Wallace said.
Perseverance's immediate predecessor, the rover Curiosity, landed in 2012 and remains in operation, as does the stationary lander InSight, which arrived in 2018 to study the deep interior of Mars.
© Thomson Reuters 2021
Is Samsung Galaxy S21+ the perfect flagship for most Indians? We discussed this on Orbital, our weekly technology podcast, which you can subscribe to via Apple Podcasts, Google Podcasts, or RSS, download the episode, or just hit the play button below.


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The band saw arm uplift is manual; the feed into cut is carried out by the weight of the arm, with the possibility of continuous regulation by the oil damper butterfly valve. When the cut is finished the band saw drive automatically switches off. To facilitate easy arm uplift the machine is equipped with adjustable tension springs that allow for setting of optimum force required for the arm uplift according to characteristics of the material to be cut.
Vice system provides bilateral continuous setting of the cutting angle within the ranges 60° to the right and 45° to the left. The turntable rotates along with the saw band. Thanks to that the saw band does not cut into the loading surface of the vice.
- Robust machine framework composes of castings from grey cast iron and therefore ensures vibration absorption.
- Modern concept of the band saw arm allows for large cutting ranges in upright and angular cuts.
- Simple locking and adjusting of the desired cutting angle on the angle scale with stops fixed at 45°, 60° and 90°.
- Massive quick-clamping vice ensures easy and reliable material clamping.
- Maximum cutting accuracy and saw band service life in this category of band saws.
- High-precision three-side hardmetal band saw guidance.
- Overdesign of running wheel bearings, tensioning wheel system and all rotary parts ensures long service life of the machine.
- Noiseless and maintenance-free band drive is provided by an industrial electric motor with worm gearbox.
- Three-phase two-speed motor (400 V) allows for the selection of band speed between 40 and 80 m/min.
- The machine is connected to a complete cooling system with a high-performance pump and possibility of regulating the flow on both guiding heads independently. Coolant tank with a pump is placed in the base of the machine.
- Easy control by ergonomically placed controls (electrical and hydraulics) on the base of the machine.
- The machine is equipped with a 250 mm workpiece stop.