text:
I promised Joe I'd get the review out before the end of the year. I know, I'm cutting it close.
What the publisher says:
Barnabus' nephew is behaving oddly.
Calling upon Doctor Humphrey for assistance has not been particularly helpful, because the good doctor's diagnosis of demonic possession is clearly preposterous. Even the demon currently ensconced on the front room couch agrees it's preposterous. But then, how else to explain the portal to another world through which his nephew and Humphrey have just now disappeared? Barnabus knows their only chance of rescue is for Barnabus J. Wildebear himself to step up and go through that portal.
Thus begins an existential romp across space and time, trampling on Barnabus' assumptions about causality, freewill, identity, good, and evil. Can Barnabus save his nephew—and incidentally, all of humanity?
My thoughts:
I liked A Time and a Place and there's a lot to like in Mahoney's novel. I loved the T'Klee, the race of alien cats (distantly related to felis catus) with opposable thumbs. At one point in his journey, Barnabus inhabits other animals (including a T'Klee) as part of his education and it reminded me of Merlin teaching Wart about the responsibilities of power in T.H. White's The Sword in the Stone.
At another point, Barbabus uses his new ability to time travel in an attempt to save his wife before she died. Replaying the events of the night again and again, Barnabus fails, no matter what he attempts to change. This trope alludes to Groundhog Day and serves to reinforce the hypothesis that the past protects itself from interference. But then, Barnabus discovers that others have successfully messed with the timeline, throwing him and that hypothesis under the bus.
Unfortunately, Barnabus seems pulled through the events of the story by external forces and lacks the level of agency I like to see in a protagonist. Much of the time he comes across as bewildered. I actually thought B. Wildebear a clever bit of wordplay until the author disabused me of the notion.
A Time and a Place is a complex story and an ambitious novel, but I found that the execution wasn't quite up to the premise. It's still an entertaining and worthwhile story and I hope you consider giving this Canadian speculative novel a read over the holidays.
My rating:
Three out of five stars.


text:
Nutrition Education for the Health Care ProfessionsView this Special Issue
Analysis of Nutrition Education in Osteopathic Medical Schools
Purpose. Describe nutrition education at US colleges of osteopathic medicine; determine if it meets recommended levels. Method. We surveyed 30 US colleges of osteopathic medicine (US COM) with a four-year curriculum about the amount and form of required nutrition education during the 2012/13 academic year. The online survey asked about hours of required nutrition across all 4 years and also in what types of courses this instruction occurred. We performed descriptive statistics to analyze the data. Results. Twenty-six institutions (87% response rate) completed the survey. Most responding US COM (22/26, 85%) do not meet the recommended minimum 25 hours of nutrition education; 8 (31%) provide less than half as much. Required nutrition instruction is largely confined to preclinical courses, with an average of 15.7 hours. Only 7 of the 26 responding schools report teaching clinical nutrition practice, providing on average 4.1 hours. Conclusions. Most US COM are inadequately preparing osteopathic physicians for the challenges they will face in practice addressing the nutritional concerns of their patients. Doctors of osteopathy cannot be expected to properly treat patients or guide the prevention of cardiovascular disease, obesity, cancer, diabetes, and metabolic syndrome if they are not trained to identify and modify the contributing lifestyle factors.
1. Introduction
Seven of the top 10 causes of death in the US are chronic diseases [1]. Most of those (heart disease, cancer, stroke, and diabetes) have a strong nutrition component as a contributing factor, with risk increasing as BMI or waist circumference increases. Therefore, a large amount of the observed premature morbidity and mortality in the US is due to lifestyle habits related to nutrition and exercise habits [2]. Nutrition and lifestyle treatment strategies are integral to the care of patients with obesity, cardiovascular disease, diabetes, and cancer, as well as a multitude of other conditions, including anemia, malnutrition, gastrointestinal disease, and kidney disease. Physicians, especially primary care providers, play a critical role in overseeing the nutrition care and related concerns of their patients, by assessing nutrition risks, providing lifestyle counseling, and referring to other healthcare providers, such as registered dietitian nutritionists, who can aid the patient in achieving dietary and other lifestyle goals. Moreover, nutrition continues to be a leading topic of fraud and deception for consumers; everything from weight loss to cancer therapies is susceptible to nutrition-related misinformation [3]. It is critically important that physicians understand how to prevent and treat nutrition-related conditions by separating high quality nutrition evidence from quackery to complement patient care needs and help reduce the high rates of lifestyle-related morbidity and mortality. Primary care practitioners thus face a number of barriers to providing nutrition care to their patients who could benefit from it [4]. Proper nutrition care improves patient outcomes and reduces costs [5]; without evidence-based nutrition education for physicians professional in training, there is no guarantee that every practitioner will obtain the essential competencies [6, 7].
Despite the importance of nutrition to health, nutrition education at US medical schools remains a very minor part of medical school curricula, and time spent covering nutrition lags far behind most other science topics. Most medical students unfortunately receive little training on how to make sense of applied nutrition topics during their medical training. The most commonly cited reason for these deficiencies is the already-packed undergraduate medical school curricula [8]. Calls for changes to this approach have been published many times over [2, 8–10], and in spite of nutrition being historically inseparable from medicine [11], it continues to receive little attention throughout the traditional four years of medical school. In fact, most US and European allopathic medical schools are failing to provide even the minimum of the 25 hours of nutrition instruction during a 4-year undergraduate medical program as recommended by the National Academy of Sciences and reported elsewhere in this supplement [10, 12].
Osteopathic medical training, founded in the US over 130 years ago, emphasizes patient-centered whole-person care. Osteopaths account for almost a quarter of all US medical school graduates, and more than 60% of osteopathy graduates become primary care providers [13]. Osteopathic physicians have full practice privileges in more than 65 countries around the world [14]. Osteopathy training in the US is similar to allopathic medical training in many ways. Both doctors of osteopathy (DOs) and allopathic physicians (MDs) need to have a four-year degree prior to entering medical school; both complete four years of medical school with a curriculum that primarily teaches basic sciences during the early months or years, while clinical training in the major medical specialties (family medicine, internal medicine, pediatrics, surgery, etc.) occurs in rotations (i.e., clerkships) throughout the latter years; both are required to pass state medical licensing exams if they want to practice medicine; both may prescribe medications and perform medical/surgical procedures after they passed licensing exams; and both work in a variety of health care settings from hospitals to long-term care facilities to private practices. During their clinical clerkships, osteopathic medical students are more likely than allopathic medical students to have required rotations in community settings such as rural clinics, rather than academic or tertiary care medical teaching centers. More osteopathic graduates pursue primary care practice specialties [15–17]. The biggest difference between these two medical degrees is that DO students receive training in manipulative medicine, typically throughout their first two years during osteopathic principles and practice (OPP), osteopathic manual medicine (OMM), or osteopathic manipulative treatment (OMT). Manipulative medicine involves a hands-on approach to diagnosis and treatment of patients in a primary or adjunctive way [18]. The tenets of osteopathic medicine recognize that the human body is capable of self-healing, self-regulation, and health maintenance [19]. Thus, nutrition education fits nicely within the osteopathic philosophy and practice framework.
For decades, many osteopathic medical schools have been attempting curriculum transformation or reformation, without any substantial changes overall [20–22]. Changes at some osteopathic schools have lagged behind those of allopathic medicine, despite the recognition that change is needed [23]. Many schools undertake curriculum reform in an effort to maximize real-world relevance and early clinical experiences, while reducing the isolated nature of basic versus clinical science courses. Nutrition is frequently taught in this environment under the auspices of biochemistry or physiology courses [24] although nutrition as an applied science overlaps with topics in biochemical, physiological, behavioral, clinical, and psychosocial courses.
The Nutrition in Medicine (NIM) Program, fully described elsewhere [25], is a web-based nutrition curriculum administered through the University of North Carolina at Chapel Hill's Department of Nutrition. The evidence-based, free online modules for medical students, residents, and physicians include learning objectives, visually appealing graphics, short video-vignettes, and quizzes. Currently more than 120 US medical schools and colleges of osteopathic medicine take advantage of at least one of these online modules. The NIM team has conducted and published four nutrition education surveys at four-year intervals since 2000 [10, 24, 26]. The NIM team collected data from osteopathic schools as part of these surveys; however, this is the first published report of any of the data from osteopathic schools, and, to the best of our knowledge, the first published analysis of nutrition education at US osteopathic medical schools.
The purpose of this study was to collect survey data on the required nutrition education at US colleges of osteopathic medicine during the academic year 2012/13 and gauge how well these schools met the recommendation of the National Research Council to include a minimum 25 hours of nutrition education in the curriculum [27].
2. Methods
Schools and colleges accredited by the Commission on Osteopathic College Accreditation (COCA) that had graduated a class of students by the summer of 2013 were surveyed by emailing nutrition educators and curriculum administrators. A hyperlink for easy survey access was included in the email. If schools did not respond to the initial email request, the NIM team made follow-up phone calls and emails. At the time of our survey origin, 28 schools were accredited by COCA. We also included two campuses that were in vastly different geographic locations (different states) from their parent school since their nutrition offerings were not necessarily representative of the parent institution. Therefore, a total of 30 campuses were asked to respond to the survey.
Except for the most recent addition of questions directly assessing obesity-related teaching, the NIM survey has remained the same since 2000. The survey contained 17 questions and a general comments section. For most answers, respondents were able to enter free text, to allow us to capture descriptions of unique and sometimes complex curricula. The first two questions asked about the size of the medical school and whether nutrition instruction was required, optional, or not offered. Questions 3–4 asked respondents to estimate the total number of required nutrition contact hours, specifying in which years the instruction was provided (1st/2nd years or 3rd/4th years combined), and to indicate the type of course in which the nutrition content was taught (nutrition, physiology/pathophysiology, biochemistry, integrated, etc.). Questions 5–6 inquired about the use of the NIM curriculum at that institution, and questions 7–9 asked about the respondent's teaching assignments. Questions 10–17 inquired about required and optional obesity and weight management education, contact hours addressing obesity, and a ranking of the barriers to expanding obesity education. Participation in our survey was voluntary. The institutional review board at the University of North Carolina at Chapel Hill made the determination that this project was exempt. The survey data was collected between November 2012 and November 2014, but the survey itself asked about the nutrition education offered during the 2012/13 academic year only.
We performed calculations based on several predefined parameters. We specified zero hours of required nutrition instruction if a respondent indicated only optional nutrition education was offered at an institution. If someone gave a range of hours (e.g., 10–20 hours) in a survey response, we used the midpoint of the range in all calculations (e.g., 15 hours). In the rare case where respondents provided incomplete information, we performed basic calculations wherever possible, such as totaling the amount of nutrition education over four years. We did not predefine for respondents or place any limits on what qualifies as a "nutrition course." Educators and administrators themselves determined whether their schools provided nutrition in the various course categories.
We converted the dataset from the survey responses into a spreadsheet software program (Excel 2013, Microsoft Corp., Seattle, Washington) to perform the calculations. We calculated means and standard deviations from the survey data. This phase of our data analysis focused on the amount and type of overall nutrition education across the curriculum. The portions of the survey related to obesity teaching were not analyzed and are not reported in this publication.
3. Results
We received responses from 26 of the 30 targeted US colleges of osteopathic medicine and campuses (87% response rate). Respondents from 2 (8%) of the schools indicated that they did not require any nutrition education during the 2012/2013 school year. However, elective nutrition education was offered at both of these institutions. Overall, osteopathic colleges required 17.0 hours (standard deviation 12.5 hours) of required nutrition instruction. Almost all of the required nutrition instruction ( hours) occurred during years one and two. Only 7 of the 26 responding schools required nutrition instruction during years three and four, comprising hours of the curriculum at those institutions.
Considering the context of nutrition instruction (e.g., dedicated nutrition instruction, biochemistry, physiology, integrated courses, or clinical nutrition practice), the greatest amount ( hours) was taught together with other topics as part of integrated courses (Table 1). The four schools that reported that they required a designated nutrition course provided hours in that course alone, which provided 79% of their total nutrition teaching. More than half of responding colleges taught at least some nutrition in an integrated format (16/26, 62%). Nutrition topics were also presented in the context of biochemistry ( hours) and physiology ( hours) courses. Seven curricula taught clinical nutrition practice with an average number of 4.1 hours (standard deviation 2.9 hours).
Most of the responding schools (22/26, 85%) did not meet the benchmark of at least 25 hours of required nutrition education across the 4-year curriculum (Figure 1). Nearly a third of them required less than half of that number of hours.
4. Discussion
In light of the ongoing obesity and diabetes epidemics and morbidity and mortality related to these conditions, ensuring that physicians are ready to address the nutritional aspects of patient care seems essential. With osteopathy providing a focus on primary care and preventive medicine, it was surprising to find that most osteopathic medical schools are providing inadequate hours of nutrition instruction. The survey data show that only small percentage of responding DO schools are requiring the minimum recommended amount of nutrition education hours during their four-year curricula. All medical schools, in particular osteopathic schools, should be offering a solid training program in something as fundamental to health maintenance and disease prevention as nutrition [6]. For medical school graduates to be competent in a field, they need to be adequately trained in terms of both hours of content delivery and practical real-world experiences. These findings that only 4 of the 26 responding osteopathic medical schools met the minimum recommended 25 hours of required nutrition education show that most of these DO students are not receiving the training they need to effectively treat their patients in maintaining health and preventing the most commonly encountered problems in the American health care system today such as obesity, diabetes, and cardiovascular disease. While we realize that this benchmark of 25 hours was a recommendation made several decades ago [27], before many medical schools moved to a more integrated or problem-based curriculum, it still can be used as a gauge for whether all students at a school are receiving the knowledge and practice skills that they need. For future DOs to be fully prepared to address the nutritional health of their patients, they need to be taught specific skills and mentored in clinical nutrition interactions. These survey results show that the amount of nutrition covered in the clinical years is very sparse and unlikely to instill the confidence and knowledge base physicians need to be skillful at effectively educating patients on nutrition issues. This is also supported in medical resident literature, where a survey found that the vast majority (86%) of residents felt inadequately prepared to provide nutritional guidance to their patients [28], highlighting the fact that something needs to change at the medical-school level so that physicians feel more prepared to provide competent nutrition care.
4.1. What Would It Take to Increase the Number of Nutrition Instruction Hours?
For many medical schools, the increasing content needed to fulfill basic requirements has created a very crowded curriculum [29], making for difficult decisions by curriculum administrators regarding what and how much instruction is necessary. State medical licensing exams (COMLEX for DOs and USMLE for MDs) do not put much emphasis on nutrition; therefore, some argue that until licensing exams change, curricula will not substantially change [30–32].
There are multiple curricular approaches that can be used within medical schools to increase both the quality and quantity of nutrition education during the undergraduate medical education years. The Nutrition in Medicine modules offer a convenient, economical, and unique opportunity for medical schools to increase nutrition content in their curricula. The modules are well received by students and offer medical schools both flexibility and affordability. Retaining nutrition content experts on the faculty, especially ones with real-world patient and clinical experience, and having them oversee all aspects related to nutrition and lifestyle within the curriculum to ensure all relevant topics are being addressed adequately can be very beneficial in improving the quality and quantity of nutrition education. Working with clinical faculty to include nutrition and exercise patient history-taking skills and teaching students how to assess key indicators of disease risk such as waist circumference are also valuable. Additionally, an institution's standardized patient program should include assessing and counseling overweight and obese patients for more clinically oriented experiences. For those schools using a systems-based curriculum, nutrition-related topics such as eating disorders should include a nutrition content expert as part of the behavioral medicine course. For lifestyle nutrition such as those covering issues related to pregnancy and lactation, a reproductive system course director should be sure to include pertinent nutrition topics. Collaborating with course directors for the cardiovascular and endocrine [33] systems will facilitate how and when lifestyle-related obesity, hypertension, and diabetes topics can be covered. The renal system should include information on renal diets and how these significantly impact outcomes in chronic kidney disease [33]. The musculoskeletal system can include instructional discussions on sports nutrition and physical activity needs for health maintenance and weight loss. For schools following a traditional first-year basic sciences curriculum, course directors in biochemistry and physiology should ensure adequate (but not excessive overlap) coverage is given to topics such as digestion, macro- and micronutrients, and metabolism. And finally, clinical practice sites during years three and four offer an important avenue to helping ensure medical students receive patient training in nutrition topics; however, this is often a big challenge because most osteopathic training sites are at smaller clinics, which are rightly concerned about time management and costs.
Regardless of what type of curriculum or teaching methods are in use, understanding where topics such as counseling techniques (e.g., motivational interviewing) are being taught and when students have the opportunity to practice these skills is invaluable. Surveying the curriculum to find when and where students learn about nutrition and obesity and how to talk to an obese patient to facilitate lasting behavior change is both patient-centric and practical. Teaching students to look beyond the BMI into related variables like waist circumference and family/social habits related to eating and exercise can help physicians solve problems with patients to find solutions that are more likely to work [34]. Helping today's physicians to understand health and wellness emphasizing prevention should be the goal. Adopting nutrition-related graduation competencies would be another approach to raising the likelihood of increased nutrition education during medical school. Lastly, taking advantage of organizations that are key stake-holders in nutrition education, such as the American Society for Nutrition (ASN), the Academy of Nutrition and Dietetics (AND), or the Association of Biochemistry Course Directors (ABCD), is important because these groups have many members who have been in the past or are currently involved with teaching nutrition or overseeing its delivery in a medical school setting.
Osteopathic schools, like their allopathic peer institutions focusing on training physicians for rural and underserved areas, often have a strong community service expectation for their student body [35]. In some cases, these are required components in the curriculum, whereas in other cases they are simply strongly encouraged and supported by administration. Exposing medical students to the reality of the social-health issues related to nutrition, such as childhood obesity and diabetes or hunger in their community, is highly valued by many osteopathic medical schools and their students, and anecdotal reports support their effectiveness in increasing awareness. Students who are involved in community wellness events report making the connection between what they learn in the classroom setting and what they see and do at such events. Getting a school's student body involved in community issues that have a strong focus on nutrition, obesity, and wellness is an important approach used in many osteopathic schools to increase community service and enrich the relationship between the community and the school. Some osteopathic medical schools turn to their local K-12 school system, partnering to provide nutrition education to youth while providing teaching opportunities to their student doctors. Others partner with charity or community groups (e.g., free clinics targeted at the homeless population, YMCA, local food banks, etc.) within the communities their school serves. Some schools create completely novel programs and work with the student government associations to ensure the event/program continues into the future after the students have moved on in their education. Whatever the venue, providing medical students a chance to teach what they have learned about nutrition is an effective way to enhance their learning experience and benefit the community at large.
4.2. Strengths
A great strength of our survey is its 87% response rate. Another strength is the established survey methodology, as this study builds on already-existing data which have been published previously but only included analysis of allopathic medical schools. We asked respondents to indicate the number of required nutrition hours in two different ways, allowing us to seek clarification if the numbers do not match up.
4.3. Limitations
Any survey that allows for descriptive responses requires a great effort on behalf of respondents, and researchers need to clarify and quantify the data whenever respondents do not provide ordinal numbers as part of the response. There were a few duplicate responses from some schools whereby different people submitted surveys with conflicting numbers, requiring additional one-on-one follow-up to get a determination of the actual hours offered.
5. Conclusions
These data highlight deficits in nutrition education at colleges of osteopathic medicine that have huge public health ramifications, especially in light of the fact that 60% of DOs practice in primary care [36]. Most schools do not dedicate enough time to prepare DOs for the daily patient encounters that require in-depth nutrition knowledge and specific practice skills. The findings reinforce the understanding that nutrition is not as well-represented in colleges of osteopathic medicine as their philosophy of holistic medicine demands. To the best of our knowledge, this is the first report of its kind looking specifically at nutrition education in osteopathic medical schools. Future studies should seek to understand the connection between undergraduate and residency-level nutrition education and knowledge, skills (proficiency), and self-confidence in nutrition counseling and related practice behaviors of osteopathic physicians.
Ethical Approval
The institutional review board of the University of North Carolina at Chapel Hill made the determination that this project has exempt status.
Conflict of Interests
The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors thank all the colleges of osteopathic medicine faculty and administrative members who completed surveys and provided many helpful comments. The Nutrition in Medicine project was supported in part by Grants R25CA65474 and R25CA134285 from the National Cancer Institute, by Grant DK56350 for the UNC Clinical Nutrition Research Unit, and by funds from the UNC Nutrition Research Institute.
Centers for Disease Control, Leading Causes of Death, CDC, 2014, http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
R. F. Kushner, L. van Horn, C. L. Rock et al., "Nutrition education in medical school: a time of opportunity," The American Journal of Clinical Nutrition, vol. 99, no. 5, supplement, pp. 1167S–1173S, 2014.View at: Google Scholar
B. Wansink, "Position of the American Dietetic Association: food and nutrition misinformation," Journal of the American Dietetic Association, vol. 106, no. 4, pp. 601–607, 2006.View at: Google Scholar
K. M. Kolasa and K. Rickett, "Barriers to providing nutrition counseling cited by physicians: a survey of primary care practitioners," Nutrition in Clinical Practice, vol. 25, no. 5, pp. 502–509, 2010.View at: Publisher Site | Google Scholar
B. S. Rosen, P. J. Maddox, and N. Ray, "A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition," Journal of Parenteral and Enteral Nutrition, vol. 37, no. 6, pp. 796–801, 2013.View at: Publisher Site | Google Scholar
P. M. Kris-Etherton, S. R. Akabas, C. W. Bales et al., "The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness," The American Journal of Clinical Nutrition, vol. 99, supplement 5, pp. 1153S–1166S, 2014.View at: Publisher Site | Google Scholar
J. E. Harris, V. Hamaday, and E. Mochan, "Osteopathic family physicians' attitudes, knowledge, and self-reported practices regarding obesity," The Journal of the American Osteopathic Association, vol. 99, no. 7, pp. 358–365, 1999.View at: Google Scholar
R. A. Dimaria-Ghalili, M. Edwards, G. Friedman et al., "Capacity building in nutrition science: revisiting the curricula for medical professionals," Annals of the New York Academy of Sciences, vol. 1306, no. 1, pp. 21–40, 2013.View at: Publisher Site | Google Scholar
C. M. Lenders, D. D. Deen, B. Bistrian et al., "Residency and specialties training in nutrition: a call for action," The American Journal of Clinical Nutrition, vol. 99, no. 5, supplement, pp. 1174S–1183S, 2014.View at: Publisher Site | Google Scholar
K. M. Adams, M. Kohlmeier, and S. H. Zeisel, "Nutrition education in U.S. medical schools: latest update of a national survey," Academic Medicine, vol. 85, no. 9, pp. 1537–1542, 2010.View at: Publisher Site | Google Scholar
D. S. McLaren, "Nutrition in medical schools: a case of mistaken identity," American Journal of Clinical Nutrition, vol. 59, no. 5, pp. 960–963, 1994.View at: Google Scholar
M. Chung, V. J. van Buul, E. Wilms, N. Nellessen, and F. J. P. H. Brouns, "Nutrition education in European medical schools: results of an international survey," European Journal of Clinical Nutrition, vol. 68, no. 7, pp. 844–846, 2014.View at: Publisher Site | Google Scholar
American Association of Colleges of Osteopathic Medicine (AACOM), "Osteopathic Medical Profession Report. 2012," http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2012-OMP-report.pdf.View at: Google Scholar
American Osteopathic Association (AOA), DOs Around the World, 2015, http://www.osteopathic.org/osteopathic-health/about-dos/dos-around-the-world/Pages/default.aspx.
D. J. Colegrove and B. E. Whitacre, "Interest in rural medicine among osteopathic residents and medical students," Rural and Remote Health, vol. 9, no. 3, p. 1192, 2009.View at: Google Scholar
M. Cummings and K. J. Dobbs, "The irony of osteopathic medicine and primary care," Academic Medicine, vol. 80, no. 7, pp. 702–705, 2005.View at: Publisher Site | Google Scholar
A. S. Peters, N. Clark-Chiarelli, and S. D. Block, "Comparison of osteopathic and allopathic medical schools' support for primary care," Journal of General Internal Medicine, vol. 14, no. 12, pp. 730–739, 1999.View at: Publisher Site | Google Scholar
American Association of Colleges of Osteopathic Medicine (AACOM), "Overview of osteopathic medical education/accreditation/the four-year curriculum," in Osteopathic Medicine Information Book, American Association of Colleges of Osteopathic Medicine, 2015, https://www.aacom.org/docs/default-source/cib/2015cib_p10-11.pdf?sfvrsn=2.View at: Google Scholar
American Osteopathic Association, Tenets of Osteopathic Medicine, 2014, http://www.osteopathic.org/inside-aoa/about/leadership/Pages/tenets-of-osteopathic-medicine.aspx.
R. Hopkins, D. Pratt, J. L. Bowen, and G. Regehr, "Integrating basic science without integrating basic scientists: reconsidering the place of individual teachers in curriculum reform," Academic Medicine, vol. 90, no. 2, pp. 149–153, 2015.View at: Publisher Site | Google Scholar
B. Ross-Lee, D. L. Wood, D. D. Mann, R. P. Portanova, L. E. Kiss, and M. A. Weiser, "An osteopathic prescription for medical education reform. Part 1. Curriculum and infrastructure," The Journal of the American Osteopathic Association, vol. 97, no. 7, pp. 403–408, 1997.View at: Google Scholar
S. C. Shannon, "Reevaluating osteopathic medical education for the 21st century and beyond," Journal of the American Osteopathic Association, vol. 114, no. 4, pp. 228–230, 2014.View at: Publisher Site | Google Scholar
S. C. Shannon and H. S. Teitelbaum, "The status and future of osteopathic medical education in the United States," Academic Medicine, vol. 84, no. 6, pp. 707–711, 2009.View at: Publisher Site | Google Scholar
K. M. Adams, W. S. Butsch, and M. Kohlmeier, "The state of nutrition education at US medical schools," Journal of Biomedical Education. In press.View at: Google Scholar
K. M. Adams, M. Kohlmeier, M. Powell, and S. H. Zeisel, "Nutrition in medicine: nutrition education for medical students and residents," Nutrition in Clinical Practice, vol. 25, no. 5, pp. 471–480, 2010.View at: Publisher Site | Google Scholar
K. C. Lindell, K. M. Adams, M. Kohlmeier, and S. H. Zeisel, "The evolution of nutrition in medicine, a computer-assisted nutrition curriculum," The American Journal of Clinical Nutrition, vol. 83, no. 4, pp. 956S–962S, 2006.View at: Google Scholar
Committee on Nutrition in Medical Education Food and Nutrition Board, Commission on Life Sciences, and National Research Council, Nutrition Education in U.S. Medical Schools, The National Academies Press, Washington, DC, USA, 1985.
M. L. Vetter, S. J. Herring, M. Sood, N. R. Shah, and A. L. Kalet, "What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge," Journal of the American College of Nutrition, vol. 27, no. 2, pp. 287–298, 2008.View at: Publisher Site | Google Scholar
P. Gallagher, N. Wilson, and R. Jaine, "The efficient use of movies in a crowded curriculum," Clinical Teacher, vol. 11, no. 2, pp. 88–93, 2014.View at: Publisher Site | Google Scholar
C. Lo, "Integrating nutrition as a theme throughout the medical school curriculum," The American Journal of Clinical Nutrition, vol. 72, no. 3, supplement, pp. 882S–889S, 2000.View at: Google Scholar
J. Haddad, "Nutrition needs to be taught in medical school," KevinMD.com Blog, 2011, http://www.kevinmd.com/blog/2011/12/nutrition-taught-medical-school.html.View at: Google Scholar
N. P. Morris, "The neglect of nutrition in medical education: a firsthand look," JAMA Internal Medicine, vol. 174, no. 6, pp. 841–842, 2014.View at: Publisher Site | Google Scholar
M. M. Estrella, B. G. Jaar, K. L. Cavanaugh et al., "Perceptions and use of the national kidney foundation KDOQI guidelines: a survey of U.S. renal healthcare providers," BMC Nephrology, vol. 14, no. 1, article 230, 2013.View at: Publisher Site | Google Scholar
J. Stubbs, S. Whybrow, P. Teixeira et al., "Problems in identifying predictors and correlates of weight loss and maintenance: implications for weight control therapies based on behaviour change," Obesity Reviews, vol. 12, no. 9, pp. 688–708, 2011.View at: Publisher Site | Google Scholar
A. Vohra and Z. Meyler, "The Disaster Reserve Partner Group at NYCOM," Journal of the American Osteopathic Association, vol. 103, no. 11, pp. 505–506, 2003.View at: Google Scholar
American Osteopathic Association, What is a DO?2014, http://www.osteopathic.org/osteopathic-health/about-dos/what-is-a-do/Pages/default.aspx.

subset: commoncrawl


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Janitors Describe Their Most WTF Stories
Everybody's had a crappy job, but imagine if your job was just that. Janitors and custodians are the unsung heroes running the scenes behind any well-operating school, hospital or office. They stay until the wee hours of the morning cleaning up wee. When sh*t hits the wall, it is literally their duty to wipe it off. Custodial work is not for the lazy or the faint of heart, so we've learned.A brilliant mind over at Reddit posed the ultimate question to janitors across the world: what was the most WTF moment of their career? If you think it's just cleaning up your run of the mill mess, you will be very rudely awakened. Grab your mops and barf buckets, because it's about to get dirty.
Diarrhea explosion plagues Walmart bathroom
"When I was janitorial at Walmart, I had to clean one of the most unholy messes I have ever seen. It was a Saturday like any other, I was messing around in the back trying to look busy, and I get a page to the front bathrooms for a mess. I thought it was something minor, maybe a spill, full trash, etc. BUT NO. I get up there and the lady that I was working with was walking out of there gagging. So I mentally prepare myself for what I am about to see. I walk in with my cart, open the stall, and I see what I can only imagine is what hell looks like. It looks as if someone had exploded diarrhea F*CKING EVERYWHERE. Just climbed to the ceiling like some sort of white trash Spiderman, and let lose. It was horrifying, and of course I was the only one who could clean it, the other folks couldn't stand the smell without puking. So I manned up and got to it. It took almost an hour, and a whole jug of bleach, and I got it clean. That was about the point I realized $7.70 an hour isn't nearly enough to deal with that."
Summer campers take a group dump in attempt to prank custodians"I used to work custodial at a summer camp and it never failed that at least once every other week the kids decided it would be hilarious for all of them to take a collective sh*t. They would all go to one stall and sh*t one after the other without flushing. Eventually, there would reach a point where the water to sh*t ratio would flip and there would be more sh*t in the toilet that they would then leave for us at night to clean. The only thing more disgusting than the smell of sh*t on top of sh*t on top of sh*t is having to clean it up."
Rancid lunch box causes janitor to projectile vomit"One night we noticed an above average amount of flies congregating around a Dora the Explorer lunch bag hanging off a coat hanger in the hallway. It also kind of stinks, so I prod it with my broom, and a Ziploc bag full of brown sludge falls out and explodes on the floor. The putrid stench of whatever was in the bag hits me like a truck and I instantly projectile vomit on the floor. My friend who was also working with me as a janitor comes over and can't even come within 20 feet because it smells so bad. We shovel it into a snow shovel and dump it in the dumpster, but by then the smell has permeated the entire building. We had to open every window and basically mop the whole building with this powerful anti-odor stuff that we had. To this day, I have no idea what could have been in that bag, my hypothesis is that it was a porkchop sandwich that had liquefied and fermented over the course of several months."
Loaf-of-bread-sized poop clogs park toilet
"When I was a kid I did maintenance for the county park system. In a women's restroom at the home base park we started the day at, someone left a turd the length and almost width of a loaf of bread. It was bent and you could tell they tried their hardest to flush it. We called several guys over the radio to drive over and see this thing. Then we used a piece of wood to finally chop it up and flush it down for good.
I've never seen a sh*t that big since, and I've always wondered how something like that could even be passed."


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The PayScale Index anticipates average U.S. wage growth of 0.6 percent year over year in Q4 2015, which indicates that many regional economies are bouncing back and the job market is stronger than ever. On top of that, 29 states and the District of Columbia have minimum wages above the federal minimum wage, and many more cities are increasing wages to keep up with the cost of living. All of this should be good news for employers, but some are not exactly thrilled about it.
What's going on?
Increasing wages often signal an increase in consumer spending, and for most small businesses that rely on community support, this can be a good thing. But there is reason for concern for small businesses, who represent the largest increase in wages (0.9 percent). They are also responsible for more than half of the number of new jobs created (around 2 million new jobs in 2015). This puts added pressure on small businesses to increase payroll, provide adequate benefits under the ACA, and ensure they can compete with larger businesses for talent.
Small business sector is getting nervous
According to the October 2015 Small Business Economic Trends report from the National Federation of Independent Business, small business optimism is flat-lining. The survey indicated that 11 percent of the businesses polled plan to increase hiring, with 27 percent job openings and another 13 percent believing this may be a good time to expand. However, the report also revealed that confidence in earnings trends dropped by 16 percent and there was a drop by 4 percent in their view on the economic outlook.
The main concern that employers have in the small business sector is how they can attract the right talent, when bigger companies can offer higher starting salaries and benefit programs. If small businesses are destined to keep supporting wage hikes, as indicated by the PayScale Index data, then there must be an even playing field so that they can recruit and retain great talent.
What do you think?
We'd like to hear from you, and especially our small business folks. What concerns do you have regarding wage increases and talent acquisition?


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Creating a Sense Of Place. Spurring Economic Growth.
Stallings envisions a pedestrian-oriented urban form that will protect existing neighborhoods, while strategically locating multi-family housing and mixed-use densities.
The Town of Stallings has begun a comprehensive planning process which includes developing a 50-year build-out and illustrative small area plans for 6 major nodes:
Monroe Bypass
Idlewild Road
Stallings Elementary
Smith Farm Business District
Downtown Stallings
Plan Goals
Stallings Will….
- PROTECT and Enhance the Town's Existing Neighborhoods
- PROMOTE a Resilient Transportation Network that Ensures the Broadest Level of Community Access to the Town's Live, Work, Play Environment
- CREATE a Local Market that Supports Town Based Businesses and Employment
- DEVELOP a Comprehensive Open Space and Greenway System
- ESTABLISH Key Centers for Civic Life Throughout Stallings
Major Node Small Area Plans
Monroe Bypass CorridorThe new Monroe Bypass is a regional scaled infrastructure improvement connecting Stallings to Metropolitan Charlotte. The impacts on development and growth along the Corridor centered within this Study Area will be dramatic.
The Concept Plan packages "development" into clusters that are designed to:
- foster an inter-connected network of streets, the ability to mix uses within clusters
- integrate with different uses in immediately adjacent clusters
- provide continuation of access to services and amenities for residents by foot or car that do not depend solely on the two exits planned along the expressway
The goal of the Concept Plan for Highway 74 is to capture and orient the inevitable development so as to benefit as much as possible the local residents of Stallings.
Stallings Elementary School NodeThe Stallings Elementary School Study Area is located at the intersection of Stallings and Stevens Mill Road, north of the Monroe Bypass plan area.
The Concept Plan envisions a Civic Center for Stallings, focusing on the development of active and passive recreational facilities geared toward local community needs, abutting multi-family and single-family housing to complete the surrounding neighborhoods. The Area offers the Town an opportunity to develop a high-quality public amenity in a single concentrated and central location to a majority of its residents.
The goal of the Concept Plan is to focus the Town's existing plans for development of parks and other recreational and gathering facilities into centers that connect with and support community-wide infrastructure.
Idlewild Road CorridorThe Idlewild Study Area extends from the I-485 expressway to Stevens Mill Road.
The Concept Plan envisions an integrated development supported by uses that are typical for markets within metropolitan areas having similar accessibility and locational contexts. The intent of the Concept Plan is to capture and orient these users to support not only regional needs sustained by the auto-oriented access provided by I-485, but to also create a critical mass that enables the creation of jobs, fosters a good proportion of retail servicing local needs, and integrates these options in close proximity.
Blair Mill Park offers another lifestyle amenity to the development of the Idlewild Road Study Area. The Park's location at Stevens Mill and Town ownership of property to its north along the creek tributary serves as a major recreational node and trailhead for future Stallings greenway network. The Concept Plan extends this future Greenway into planned neighborhoods and commercial areas within the Study Area to offer access to residents.
ChestnutLocated at the intersection of Matthews Weddington Road and Chestnut Lane, the Chestnut Small Area Plan anchors the far western end of the Town's comprehensive planning effort.
The Concept Plan envisions leveraging the pending development to create a western gateway for Stallings so that the Town's new greenway master plan has a connection to Mecklenburg County's Colonel Francis Beatty Park immediately adjacent to the west.
The goal of creating a western gateway into Stallings requires the small area plan to pay attention not only to the development and redevelopment at the Chestnut Lane intersection, but also a second intersection to the south at Antioch Church Road and Matthews Weddington Road.
Downtown StallingsLocated along Stallings Road at the intersection of Old Monroe Road and Potter Road, the Downtown Small Area Plan lies at the center of the comprehensive planning effort commissioned by the Town.
The Concept Plan envisions the redevelopment to take the form of a mixed-use downtown to provide Stallings the center it currently lacks. It would focus on the creation of employment, the provision of residential, and the focus of government within a walkable network of streets and civic spaces anchored by the Town's existing Town Hall and Community Park.
Both are planned for expansion and improvement and their redevelopment serves to tie together the surrounding plans for high-density residential and mixed-use commercial.
Smith Farm Business DistrictLocated immediately adjacent to the east of the Downtown Small Area Plan and to the west of the Monroe Bypass Small Area Plan, the CEM/Smith Farm concept plan serves to stitch together two mixed-use, walkable, and transit ready centers.
The Concept Plan's goal is to properly merge two large master plans that are community and regional in scale and intensity over the long term, while also permitting appropriate development to occur given existing market dynamics in the short to mid-term.
The plan works to improve the look of development to encourage the future transition of the existing workplace environment into a mix of uses common to post-industrial neighborhoods experiencing redevelopment.


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The measure of success for a Leader of the Opposition must really be a straightforward one – winning a General Election. For a Prime Minister there is a bit more to it. Thus for Tony Blair simply winning three General Elections does not mean that he can claim to be as successful as Margaret Thatcher who managed the same score. We have to take into the equation what they actually did. But it is hard to deny that the 1997 General Election result showed that Mr Blair was a successful Leader of the Opposition.
A new volume British Conservative Leaders considers the varying fortunes of Conservative Party leaders. Interviewed for the book William Hague points to the test for a Leader of the Opposition in seeing the Party's strength in local government increase:
He says:
"Institutional capacity in local government is really important. Active and numerous councillors with a ward-level organisation are important for fighting campaigns. Facing a long-term challenge, I gave a lot of attention to party recruitment in local government. I spent, what would have been for most leaders in those circumstances, an excessive amount of time on local government. But the Conservative Party had gone down to being third in the number of councillors in the UK. The Conservative Party was third. I think by the end of that parliament we were back to being the biggest party in local government.
"Now, strength in local government happens almost of its own accord in opposition, but not entirely of its own accord. You need to put some time in. I spent a lot of time going around the country saying that we had to put in a full slate of council candidates and put a national effort behind local campaigns."
Ed Miliband can claim to have narrowed the gap among councillors. In 2010 there were 10,088 for the Conservatives against 4,733. The current tally is 8,766 for the Conservatives and 6,873 for Labour. Being ahead on the number of councillors is a necessary – but not sufficient – hurdle for a political party to gain power in a General Election. Labour were ahead on councillor numbers in 1992. The Conservatives were ahead by that criteria in 2005. Both lost the General Elections. But in 1979 and 2010 the Conservatives had a clear lead in terms of councillors. Labour were in 1997.
So it is a key challenge. We will get a bit of clue how Jeremy Corbyn is doing as the Council by-elections dribble through each week and a much better test in May next year.


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A home is not something you build for others to admire; it is something you build for yourself and your family to have your personal space and convenience in your day-to-day living. This simple yet comfortable and cozy metal home in Oklahoma is the perfect model to base on.
With its neat and simple facade, you can't help but be surprised with its exquisitely beautiful interior. This humble abode radiates simplicity with an exceptional elegance in the inside. From its comfortable living room, stunning kitchen with a touch of modern appliances, homey bedrooms to its separate garage, everything is just perfectly put together as one smashing work of art.
A rural life documentary is initiated by certain group of people with their blog Black Fox Homestead. They have been making uproars in the world of social media since 2012 with their rural journey featuring this lovely metal barn home. Check out their blog to know more of their journey featuring this lovely metal barn home.
Feel free to contact the contractor to have your very own metal home building!
Stats: 30 x 50, 1500 sq. ft.
Plan: owners do not share it publicly, feel free to contact them.
Source: Black Fox Homestead


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Mozilla announced Tuesday that its proposal for an Extended Support Release (ESR) of Firefox, which was initially proposed after negative corporate feedback of its new rapid-release development cycle, is now a plan of action. According to the blog post announcement, the ESR version is designed for use by enterprises, public institutions, universities and other organizations that centrally manage their own Firefox deployments.
Releases of the ESR version will occur only once a year, unlike the standard version of the browser, which now updates every six weeks. The faster pace of the standard release cycle was met negatively last year by businesses and other organizations who need to test their software and custom add-ons, which could be broken easily in new versions of the browser. With two separate versions of Firefox, Mozilla can now focus on staying competitive with Chrome and Internet Explorer through frequent updates in the standard version, while also providing the stability that corporations demand in the Extended Support Release.
"Releases of the ESR will occur once a year, providing these organizations with a version of Firefox that receives security updates but does not make changes to the Web or Firefox add-ons platform," wrote Jay Sullivan, Mozilla's vice president of products, in the blog post announcement. "We have worked with many organizations to ensure that the ESR balances their need for the latest security updates with the desire to have a lighter application certification burden."
Details of the plan can be found on Mozilla's wiki. So far, no date or timeline for ESR's introduction is known, though the blog post noted that implementation specifics would be posted within the week.


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English Essay on "Mountains"
The mountains, which appear to us so gigantic, are really, compared to the size of the earth, only small irregularities on the earth's surface. They have been compared to the wrinkles on the rind of an orange. All mountains and hills are formed of hard rock, otherwise they would long ago have been leveled to flat plains. The great ranges were probably formed when the substance of the earth which was once molten, was cooling; but their shape and size have been much modified during the ages by the action of waier frost and volcanic force.
Mr. Ruskin has pointed out that mountains are of the greatest possible use to man in three ways in connection with air, water and earth.
The mountains have a great deal to do with keeping the air circulating, and renewing its purity. The snow covered summits of high mountains make the air in contact with them very cold; and as cold air tends to sink, it descends to the plains and lowlands in cooling winds: while the hot air of the plains rises up to the higher altitudes to be cooled and descend purified again to the lower levels. The air can, therefore, never remain stagnant in one place, but is always moving and being refreshed by the cool rocks and snows of the mountain.
Mountains, again, are the great reservoirs of the earth's fresh water, and are the source of the rivers and streams, without which men could not live. They catch the rain and store it up in the following way. Warm moisture laden winds are cooled down when they blow against a lofty mountain range, and in summer condense in rain, and in winder in snow. All the winter, the high mountains are storing up water in the form of snow and when the summer Comes, a great deal of this snow melts and pours down in torrents and streams of water to feed the great rivers. Much of the snow, too, descends from the higher levels, where it never melts, in the form of glaciers, which at a lower level melt, and are the source of rivers: and a good deal of the rain that falls on mountains finds its way through crevices in the rocks to underground caves, which become reservoirs of water to feed perennial streams.
Lastly, mountain province the material that forms the fertile soil of the plains. The rocks at high levels on the mountain are constantly being split, and broken by the intense frost. The fragments -of rock fall into the valleys and the smaller ones are carried down by the rushing torrents, and gradually, broken and rubbed and ground down into sand and gravel and mud. The mountain torrents carry this sand and mud into the big rivers; and the rivers when they are in flood deposit it on the land and thus enrich it. Even a small stream will bring down tons of sand and mud in one year. We therefore own to the mountains, fresh air, fresh water and fertile soil.


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By: Marilyn L. Davis
When I read Whitney McKendree Moore's book, Whit's End, the first thing that stood out was how self-sufficient, poised, and seemingly together she appeared. However, we all know that looks are deceiving.
Adeptly moving from one type of crisis to another, she finally realizes she can't fix the problems, can't control the outcomes, and she certainly can't make anyone in her family or herself better.
Although she had shouldered responsibilities for years – hers, and the feelings and actions of others, eventually, she learns what she is capable of, and what she had to give to God.
For anyone contemplating writing a memoir, this book is full of examples of how to keep the reader engaged, entertained, and connected to the underlying issues of addiction, family relations, and hope. Click To Tweet
Whit's End is the biography of a breakdown, which might make this book sound like a depressing read, but it is just the opposite. Instead, it is a victory story, a true story, a story that brings hope to anyone who wants to make serious changes in their life. Whit's End is a memoir that shows how to write one by reliving, reviving, and finding restoration in the process of writing.
The journey that unfolds in these pages begins with the author's shocked realization that such a thing as "functional alcoholism" even exists. When the problem is finally revealed, she seeks help in Twelve-Step recovery and finds strength in the miracles people share in these meetings.
But the road to recovery and ultimate victory is never easy. Along the way, the author finds herself expecting a child at the age of 44, followed by complete adrenal exhaustion. At the end of her rope, she discovers the paradox of powerlessness.
It was the breakdown that caused her to finally say, "I can't; God can; I need to let Him." God then moved in power to accomplish The Impossible.
Moore's story shows clearly that there is hope for the hopeless and help for the helpless; that a mess can be made a message and that a trial can be turned to triumph.
Bio: Whitney McKendree Moore
Voice and pen became Whitney's personal ways to be heard. After she married in 1971, she published an article every year as she pursued her professional career and she continued to "sing constantly."
Whitney McKendree Moore has published numerous articles in magazines such as Cruising World, Connecticut Magazine, YANKEE, Greenwich Magazine, Maine Boats and Harbors, and The Nautical Quarterly.
In 1987, she authored a book entitled Where to Next? that focused on making a successful career change; she also co-authored a book called Academy Days, a history of the school she attended while growing up in Greenwich, Connecticut.
Whitney has published 12 books.
She has also helped other people publish their stories using Createspace.
Whitney and her husband, Barry, have been married for forty-six years. They have just one child, a son who was born two weeks after they celebrated their twentieth year of child-free marriage. At the time, they were brand-new in recovery from alcoholism, which is a family disease. For a while, it looked like the disease might win, but God won instead.
A turning point for Whitney came in 1989, when she found her way into Twelve-Step recovery.
There, people were sharing "dirty laundry" and seeking God's guidance to overcome. Now her writing is focused on encouraging others that God is still in the miracle-making business.
Websites: Recovery in the Bible
Whitney's posts on Two Drops of Ink
Whitney's post on From Addict 2 Advocate
Two Drops of Ink: The Literary Home for Collaborative Writing
Books help us connect with the thoughts and feelings of others. Sometimes it's a how-to; other books entertain us, and a few enchant us. Do you have a book that changed the way you wrote, thought, or acted? Then consider submitting an Amazon book for consideration.
If you do, please include reviews, links to the book, website, or other articles that can help our readers get excited about reading the book.


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Stimulate Your Life: Rebecca Knoblauch on Photography
By Aaris A. Schroeder August 9, 2011 In the oversaturated business of photography, one person, Rebecca Knoblauch has been able to get through to the other side and she is not stopping there. Knoblauch is best known for her involvement as a photographer in the regional hip-hop community however her passion in photography started at a young age capturing stories through images. "I never wanted … Continue reading Stimulate Your Life: Rebecca Knoblauch on Photography


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Mama liked to cook breakfast for supper every now and then.
I recall one evening in particular when, after a long, hard day at work, Mama placed a plate of eggs, grits, sausage and extremely burnt biscuits in front of Daddy. I remember waiting to see if he would notice. But, all daddy did was reach for his biscuit, smile at Mama and ask me how my day was at school. I don't remember what I told him that evening, but I do remember watching him smear butter and jelly on that ugly, burnt biscuit. He ate every bite of that thing... never made a face or said a word about it!
When I got up from the table that evening, I remember hearing Mama apologize to Daddy for burning the biscuits. And I'll never forget what he said. "Honey, I love burned biscuits every now and then."
Later that evening, when I went to kiss Daddy goodnight, I asked him if he really liked his biscuits burned? He wrapped me in his arms and said, "Your Mama put in a hard day at work today and she's real tired. Besides, a little burned biscuit every now and then never hurt anybody!"
As I've grown older, I've thought about that evening many times. Life is not always fair. It's full of imperfect things and imperfect people. I'm not the best at much of anything, either. I forget birthdays and anniversaries, just like everybody else. But one thing I've learned over the years, is that accepting each other's faults, and choosing to celebrate each others differences, is one of the most important keys to creating a healthy, growing, and lasting relationship.
And that's my prayer for you today... that you will learn to take the good, the bad, and the ugly parts of your life, and give them over to God. After all, He's the only One who can give you a heart to have the kind of relationship where a burnt biscuit every now and then isn't such a big deal.
Keep in mind that this can be extended to any relationship. In fact, understanding is the real basis of all relationships; be it brother-sister, husband-wife, parent-child, partners, or just plain old friendship. Be kinder than necessary to everyone, because everyone you meet, is fighting some kind of battle.


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Do you have mold damage to your home or business and are looking for a certified mold damage remediation company in Royal Oak MI?
Emergency Restoration has decades of experience in mold damage repair and clean up and is an IICRC certified mold remediation company serving Royal Oak MI.
Are you looking for a licensed mold removal, clean up, and repair contractor because of black or toxic mold in your Royal Oak MI home?
Emergency Restoration's technicians have many hours of training to properly mitigate mold damage, including black mold. We will quickly asses the problem and advise the proper course of action to clean up and remove the mold damage in Royal Oak MI.
Mold was considered a mere household nuisance, now it is associated with many health disorders. Emergency Restoration is a Certified Mold Remediator (CMR). We use state of the art products, equipment, and techniques to restore your indoor environment to a healthy state. We are mold abatement professionals with the training and tools to clean up and remove your mold problem.
Emergency Restoration's air-tight containment area prevents mold spores from becoming airborne and contaminating other areas in your home or business. With the Omni Guard pressure sensor, our containment areas are guaranteed to be sealed to industry standards. We use negative air machines to safely remove air from containment areas and filter it to the outside.
Using powerful HEPA (High Efficiency Particulate Air) vacuums we remove settled mold spores from flat surfaces. Dry ice blasting removes mold from wood and other surfaces in a matter of seconds with very little mess. This process is very safe, effective, and can greatly reduce the time needed to get your home back to a safe living space.
If you have a mold problem including black mold and are looking for a certified mold damage restoration company in Royal Oak MI to clean up, remove, and repair mold damage call Emergency Restoration today at (248) 299-4500.


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City of Newton
Newton is a suburban city in Middlesex County, Massachusetts, United States. It is approximately 7 miles (11 km) west of downtown Boston and is bordered by Boston's Brighton and West Roxbury neighborhoods to the east and south, respectively, and by the suburb of Brookline to the east, the suburbs of Watertown and Waltham to the north, and Wellesley and Needham to the west. Rather than having a single city center, Newton is a patchwork of thirteen villages. According to the 2010 U.S. Census, the population of Newton was 85,146, making it the eleventh largest city in the state.
Newton's proximity to Boston along with its historic homes, good public schools, and safe and quiet neighborhoods make it a desirable community for those who commute to Boston.[1] Newton is served by three modes of mass transit run by the MBTA: light rail, commuter rail, and bus service.
Newton has consistently ranked as one of the best cities to live in in the country. In August 2012, Money magazine named Newton fourth best small city among places to live in America[1] and has been named the safest city in the country according to Aneki.[2]
Newton was settled in 1630 as part of "the newe towne", which became Cambridge in 1638; it became its own town in 1688. There are several historical sites of interest in the Newton area. These include Crystal Lake (which is fronted by several historical homes), the East Parish and West Parish Burying Grounds, and the Jackson Homestead, which now houses the Newton History Museum. Historian and local resident Diana Muir has written about the history surrounding Bullough's Pond; a scene from the 2008 production of The Women was also filmed there.
Courtesy of Wikipedia.com


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Nipro Middle East FZE
Nipro Corporation was founded in 1954 with its head office in Osaka Japan.
Nipro employs 35,251 people worldwide with net sales Japanese ¥442,516 million with operating income of ¥26,240 million through its 7 business units; hemodialysis (Renal Care), hospital consumables (Hospital Products), blood glucose diagnostics (Diabetes Care), oxygenators and accessories (Cardiopulmonary, medical glass products (Pharma Packaging), enzymes and in-vitro diagnostic products (Enzymes & IVD) and Pharmaceuticals. Our main manufacturing sites are located in Japan, China, India, Thailand, Indonesia, Vietnam, Brazil, Germany, France, and the USA.
Nipro has built its reputation on consistent high levels of quality and service. With multiple offices throughout the world, it prides itself in being close to the customers and servicing to local needs.
In our Renal Care division, Nipro offers the full portfolio of products to optimally treat our patients in the safest and most cost-efficient way. The Surdial X dialysis device is a state of the art device offering the full range of procedures from HD to HDF and SLED treatments. The device has been developed to be easy to use, ease to maintain and to reduce the total cost of ownership over the life-time of the device.
Nipro has Surdial 55 and Diamax Dialysis Machine models.
The same is true for the Nipro water treatment system Phoenix One DS. The Phoenix One DS is made with high-end PVDF piping to reduce significantly reduce the biofilm formation and a connected PLC operated system for remote monitoring of the device. This, in combination with a fully redundant design, guarantees a full permeate output at all times, even if a membrane or pump would be defective allowing your dialysis center to continue treating your patients at all times.
Our range of dialyzers, the Elisio and Solacea, have unique features that make these the preferred product for patients and doctors.
The Elisio is Bisphenol free and studies have shown that due to the unique design of the product less Heparin is needed than in competitive products.
The Solacea is the only dry CTA membrane currently available that is designed for online HDF treatments. At last, patients with a tendency to allergic reactions have a solution for comfortable and efficient dialysis.
In addition to our innovative products, Nipro prides itself in trained and experienced staff that know our products and customers personally.


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The King of Soul, Otis Redding, was honored July 15 with a Gibson Art Guitar on The Sunset Strip at the Whisky A Go-Go. His son, producer, musician and recording artist OTIS REDDING III autographed the nearly 10-foot tall Gibson Guitar along with artist RAPHAEL SAADIQ and then performed acoustically "I've Got Dreams to Remember" and "(Sittin' On) The Dock of the Bay" in tribute to his father.
The painted guitar was created by artists RAPHAEL SAADIQ and UPENDO TAYLOR as a tribute to Grammy Lifetime Achievement Award recipient and Rock and Roll Hall of Famer Otis Redding and will be displayed on the legendary music boulevard in conjunction with Gibson GuitarTown Sunset Strip.
This guitar along with many others will be featured as part of the Gibson Experience during the Sunset Strip Music Festival (SSMF) on September 20 and 21, 2014. The art guitar signing event signified Redding's West Coast debut at the Whisky A Go-Go in 1966 and the impact he made on the famous Sunset Strip Boulevard.
Known for such legendary hits as "(Sittin' On) the Dock of the Bay," "Try a Little Tenderness" and "These Arms of Mine," Redding was one of the greatest singer/songwriters of our time and influenced many musicians performing today.
Gibson GuitarTown was launched on the Sunset Strip in 2010, a public arts project that features 10-foot tall fiberglass Gibson Les Paul model guitars strategically placed on the legendary Sunset Strip in West Hollywood. The oversized Gibson guitar sculptures were created by locally and nationally acclaimed visual artists and placed along the 1.6-mile Sunset Strip in front of the boulevard's landmarks and businesses, including the Whisky A Go-Go,
News4usonline is a multi-ethnic driven website focused on providing readers with an alternate view on social issues, sports, lifestyle news, entertainment and culture as it relates to the various communities we cover. The end goal for News4usonline is to provoke thought as well as to uplift, inspire and encourage through artful storytelling.


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<< Back
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About the PNAS Member Editor
Coffman, Robert L.
University of California, Santa Cruz
Primary Field
Immunology and Inflammation
Secondary Field
Medical Genetics, Hematology and Oncology
Election Citation
Coffman, with his colleague Tim Mosmann, demonstrated that CD4+ (helper) T cells existed in two types, TH1 and TH2, with different patterns of cytokine production and distinct properties. The TH1/TH2 model is a cornerstone of immunology and is fundamental in our understanding of autoimmunity and the development of vaccine strategies.
Research Interests
I have spent most of my research career studying basic mechanisms of regulation of immune response. In particular, I have been interested in how different classes of both B and T lymphocyte responses to foreign antigens are controlled. In many cases, the class of an immune response will determine whether it protects from and infectious or allergic disease, or causes it. More recently I have focused on the innate immune system, an evolutionarily ancient system of recognition and response to conserved microbial molecules that provides a rapid "front line" of defense against pathogens. Cells and molecules of this innate response provide many key regulatory signals determining the class of subsequent adaptive T and B lymphocyte responses. I have been particularly interested in manipulating the link between innate and adaptive immunity to treat immunological diseases and to develop more effective vaccines. My current research is focused on preclinical and clinical development of molecules that either stimulate or inhibit specific arms of the innate immune system, with particular interest in developing new therapies for allergic and autoimmune diseases.
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The SPCA International has launched Operation Baghdad Pups to bring home the dogs and cats befriended by US soldiers. It's great to see these animals cared for after they've provided comfort and companionship to our soldiers in Iraq. I think the fact that soldiers keep rescuing these needy animals shows just how important they are to moral.
Operation Baghdad Pups has rescued Liberty who was found during a house raid, K-Pot who was found ensnarled in razor wire, and Charlie who was found as a puppy close to death. The program is now working to rescue 13 more animals rescued by US servicemen.


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Images from the "Extreme Beauty In Vogue" photography exhibit in Milan (red carpet here) are up, and while some are simply stunning, others are a testament to the humiliation models often endure.
"Oh, what a beautiful instep you have! Let's put a tarantula on it."
"Foot," Hiro, April 1982.
"My, what lovely lips you have! Let's put a bee on them."
"Bee On Lips," Irving Penn, December 1995.
Sure, maybe it's just milk, but you get the sense that she is not splashing herself — she is forced to stay passive while being doused. Or is this a case of bukkake alert?
"Cult Creams," Irving Penn, June 1996
This one is a composite, but still creepy.
"Cleopatra's Eye," Irving Penn, August 1990.
Obviously, this shot was to be used in some kind of skin-preservation story. Don't want to be leathery! But honestly: Models are human. Can this woman breathe?
"Football Face," Irving Penn, November 2002.
Was there a chiropractor on the set?
"Skirting The Issue," Steven Klein, February 2001.
"Mascara Wars," Irving Penn, July 2001.
Vogue's site claims that these images "investigate the role of beauty in our culture." And some of them are truly beautiful: Irving Penn's "large nude woman seated", Richard Avedon's shot of Twiggy, and Annie Leibovitz's shot of Venus Williams. But it's interesting that the most beautiful photo is the noseless face from 1950. Before things got "edgy." No bugs or bukkake, just some pretty makeup and an interesting concept.
Extreme Beauty In Vogue [Vogue.com]


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As part of the Abu Dhabi Securities Exchange's, ADX, strategy aimed at bolstering its leading position in the region and extending its cooperation with global financial markets, Khalifa Salem Al Mansouri, Acting Chief Executive of ADX, met senior officials at the London Stock Exchange,LSE, recently
ABU DHABI, (Pakistan Point News - 25th May, 2019) As part of the Abu Dhabi Securities Exchange's, ADX, strategy aimed at bolstering its leading position in the region and extending its cooperation with global financial markets, Khalifa Salem Al Mansouri, Acting Chief Executive of ADX, met senior officials at the London Stock Exchange,LSE, recently. The meeting was part of the ADX delegation's visit to the British capital. As part of the trip, the ADX delegation also participated in the MSCI Annual Global Investing Conference and workshops and visited iov42 Limited. The latter specialises in financial technology solutions and applications related to Blockchain.
During his visit to the LSE, Al Mansouri held several meetings, including one with Nigel Ratti, Chief Executive of London Stock Exchange, during which he discussed the prospects of cooperation between ADX and the LSE. He also met Gary Rynhoud, Director, FTSE Russell MEA. As part of the meeting, they discussed joint business opportunities for indices and market data.
Also during the visit, Al Mansouri met Charlie Walker, Head of Primary Markets LSE; Martina Garcia, Head of Emerging Markets Strategy, LSE; Gokul Mani, Head of Primary Markets in the Africa, middle East, India, LSEG & Team; and Umerah Akram, Head of Elite Growth UK & Licensing LSE. They deliberated the possibilities of cross listings on the financial markets and more.
Commenting on the visit, Al Mansouri stressed the importance of opening channels of communication and cooperation between ADX and major international stock exchanges and promoting the Exchange as a preferred destination for listing and trading in the region. He said: "This, and our other global visits underscore ADX's international presence and our commitment to implement Abu Dhabi's Economic Vision to foster sustainable economic development by enhancing the financial services sector in the emirate and providing a competitive business environment that attracts foreign investment."
He participated in the MSCI Annual Global Investing Conference and workshops, which took place in London with a group of investment leaders and officials. Discussed at the meeting were sustainable investments, the importance of detailed financial reports that align with the principles of transparency and the requirements of stakeholders. The conference highlighted the long-term risk to investments and the need to provide new sources of data to maintain the competitiveness of those investments.
Al Mansouri also visited iov42, which specialises in fintech solutions and Blockchain. Iov42 gave an overview on its global identity-centric blockchain operating platform, and its unique architecture and capabilities. The two parties discussed the possibility of enhancing their relations further in fields of identity management and verification technology, as well as using tokenization to protect digital assets, enhance efficiency, liquidity, while reducing cost. Virtually all other types of traditional assets can be traded after being tokenised.
Al Mansouri added: "ADX continues to enhance its infrastructure by embracing modern technology solutions that are a key attraction for both companies and investors. We proactively participate in various international forums and meetings to learn about the latest international developments in this field, and assess ways to apply them to enhance ADX's leading position in the region."
The Abu Dhabi Securities Exchange is one of the preferred markets for British investors in the region. The number of British investors in ADX by the end of the first quarter of 2019 reached 3,052 investors of which 922 are institutional investors whereas 2,130 are individuals. Furthermore, the total trading value of British investors, Buy + Sell, reached AED3 billion during the first quarter of 2019 while their net investment reached AED 860 million thus representing the highest net investment among foreign investors during the first quarter of the current year.


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The Emergency Management Organisation, NEMO, will receive additional funds today to assist with the ongoing recovery effort, in the wake of floods during the Christmas holidays.
The donation is being made by the National Lotteries Authority.
The presentation will take place at the Headquarters of the National Lotteries Authority at Paul's Avenue, at ten thirty this morning.


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Emergency Breakdown Recovery in Mulhussey
Breakdown Recovery from a Local Company in the
Mulhussey Area
Among the reasons our company has chosen to focus mainly on the Mulhussey region is that we would like to have the ability to minimise the time you are left stood around and because it's our place. We believe in good old fashioned customer service and healing our clients how they need to be handled. As soon as you end up in need of breakdown recovery you are at a disadvantage and may feel vulnerable. Towing 247 friendly yet professional approach can set you at ease rather than having to wait for hours on end for someone to come out to you will produce the incident much less traumatic.
We are a company who understand the need to return on the road whenever possible with the minimum of fuss in case of a breakdown. We're a frequent sight in the Mulhussey area and locals are used to seeing our breakdown recovery travelling to and from, in and about Mulhussey. Our reputation for quick responses when there is a car in need of attention is what keeps people coming back time and time again.
Our committed staff also specialise in accident recovery. Being involved in an accident on the street is a less than pleasant experience. Our fast response staff will be on hand to assist you whenever you need it most as soon as we have police clearance we will take care of the elimination of your vehicle so it repaired and might be examined as appropriate.
As with breakdown recovery companies we endeavour to fix your car or van and then, getting you back to the road and on your way. If the vehicle want the interest of a garage we'll make sure your vehicle is quickly and efficiently packed onto the transporter (even though occasionally towing is a choice ) so that you might get your car fixed and yourself home.
About being a business, the excellent thing is having the ability to call upon residents and previous clients for trusted recommendations. On getting the job we put a high value. Whether you are just passing through or new to the area, you might make confident our first class service is just as good as our reputation indicates.
When it comes to restricting the aggravation that comes with being included at a breakdown in or around the Mulhussey area we're the experts. Call us when you need us and rescue our details in your vehicle so that you understand that in the event you want us, our variety is still close at hand.
Without a vehicle many people would find themselves seriously inconvenienced. Public transportation is often unreliable and men and women enjoy the notion of hanging round a train station. Until something goes wrong being on independent and the road is much more suitable. If the worst should happen and you're in the Mulhussey region you need not worry as help is at hand.
Mulhussey (Irish: Maol Hosae, meaning "Hussey's Summit") is a village in County Meath, Ireland. It has a school, a castle with accompanying cemetery, a nearby church (or the 'Little Chapel', as it is commonly known) at the edge of the Kilcloon parish in Kilcock, and a religious antiquity, St Bridgid's Well, located in Calgath, a townland near Mulhussey.


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Wildlands still sits on the top of the list of software sales in the UK
After setting a new week one record for 2017, and receiving the honour of being the "second fastest selling Tom Clancy title ever", Wildlands is still going strong.
Lego Worlds took the second place from which is now at number 3. FIFA 17 took the number five spot from Grand Theft Auto V, which is now fourth.
fell to number 6, followed by Rocket League and Call of Duty: Infinite Warfare.
Minecraft: Xbox edition and Forza Horizon 3 broke into the top 10, taking the ninth and tenth spot, respectively.
The top 10 for last week looks like this:
- Tom Clancy's Ghost Recon: Wildlands
- LEGO Worlds
- Horizon Zero Dawn
- The Legend of Zelda: Breath of the Wild
- Rocket League
- Call of Duty: Infinite Warfare
- Minecraft: Xbox One Edition
- Forza Horizon 3
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The Pin Group - s/t
Siltbreeze's Retrospective is a re-issued collection of recordings by New Zealand's seminal Pin Group (fronted by Roy Montgomery) -- the disc includes the "Ambivalence"/"Columbia" 7" (actually the first single issued on the Flying Nun label), the "Coat"/"Jim" 7", the Pin Group Goes to Town EP, a live cover of War's "Low Rider" and two low-fi studio tracks recorded during the group's 1993 "reunion." The band's sound -- a huge influence on the incredible New Zealand pop scene of the '80s -- was a decidedly post-punk approach that started off sounding very much like Joy Division or an extremely stripped-down version of Echo and the Bunnymen's early work -- over the band's brief career, however, the shimmery, jangly aspects of antipodean pop slowly emerged. Retrospective is a perfect collection of this material, since most of the band's original releases are incredibly scarce -- it's a vital addition to the record collection of anyone with an interest in the New Zealand/Flying Nun pop scene, and an excellent example of post-punk and its influence in New Zealand.
Link in comments!


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Prep roundup: Madison County softball defeats North Oconee
In a non-region matchup, the Lady Red Raiders picked up a win at home, beating the Lady Titans 8-5 on Wednesday.
Gabby Gillespie got the win on the mound for Madison County (22-5, 8-0), pitching seven innings.
Ivie Drake (2-3, two doubles, RBI), Abby Morgan (1-2, triple, three RBIs) and Dani Lukas (1-3, double, two RBIs) led Madison County offensively.
North Oconee (12-14) got solid nights from Jacqueline Truluck (4-4, RBI, two doubles), Emily Dobberstein (2-4) and Brianna Abrey (2-4, RBI).
Madison County plays at Oconee County today at 5:55 p.m. North Oconee plays at Union County today at 5 p.m.
NORTH OCONEE SPLITS: At Lithonia, North Oconee took Shiloh to three sets but lost and then defeated Druid Hills 2-0.
The Lady Titans (22-10) lost to Shiloh 22-25, 25-22, 25-27 and beat Druid Hills 25-13, 25-17.
Macy Banks led the way with 13 kills and was followed by Tori Vadaboncoeur (10 kills), Sarah Parr (eight kills) and Abby DeFabio (seven kills).
North Oconee will host George Walton at 6 p.m. today for Senior Night.
LADY SPARTANS WINS TWO: The Athens Academy volleyball team beat Tallulah in three sets and then Athens Christian in two sets.
The Lady Spartans got the win over Tallulah 25-23, 19-25, 25-5 and best the Lady Eagles 25-12, 25-22.
Alette Duan registered 8 kills, two aces and two digs, as M.E. Eberhardt tallied nine kills, 10 aces, 17 assists and 3 digs. Hannah Lupton (eight kills, two aces, five digs) and Grace Griffith (seven kills, four aces, six digs) also played well for Athens Academy.
The Lady Spartans finish up the regular season in area play on Oct. 2 against Providence Christian.
JEFFERSON SWEPT: The Lady Dragons volleyball team lost three matches Tuesday night. Rabun County, Greater Atlanta Christian and Wesleyan all handed Jefferson losses.
The Lady Dragons took Rabun County to three sets before losing 23-25, 25-14, 22-25, but were defeated by GAC (17-25, 17-25) and Wesleyan (7-25, 15-25) in two sets.
Sarah Wood had a team-high 33 kills on the night to go along with 13 digs. Grace Williamson posted 29 assists on the night.
Jefferson plays Hart County and Chestatee tonight.


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How New York City can afford Fair Fares
Here's how New York City can afford Fair Fares.
For the second straight year, the New York City Council expressed support for subsidizing transit fares for low-income New Yorkers. This year's council budget response, released last week, called on Mayor Bill de Blasio to include $212 million in funding for half-price MetroCards for individuals and families living below the federal poverty line and for veterans enrolled in New York City colleges. De Blasio said the Fair Fares proposal would only be affordable if a personal income tax surcharge on very high earners was enacted to back it. Such a tax is unlikely to be adopted, and it is also unnecessary; the Fair Fares proposal can be funded within the city's current operating budget.
Mass transit is the lifeblood of the city. It connects New Yorkers to their schools, jobs, communities, open spaces, recreational activities and world-class cultural institutions. For many people, their monthly MetroCard functions as an all-access pass to a transit system and city that operate 24/7, and is well worth the $121 cost. But for low-income workers, the cost is a notable share of their household budget. For some, it may even be unaffordable.
Offering half-price fares to low-income adults is a sensible way to promote work, increase education and job training, and make New York City more affordable – all policy goals de Blasio supports.
The council's version of the proposal is projected to cost $212 million annually. While this is a sizable spending commitment, its magnitude is best understood in the broader context of the city's operating budget. In fiscal year 2019, total annual expenditures are projected to be $90 billion – not including $1.25 billion in reserves. The Fair Fares proposal represents just 0.2 percent of total spending and 0.3 percent of city-funded spending.
The mayor said Fair Fares would only be feasible with a new revenue source and he proposed the income tax surcharge. Such a tax has little to no chance of being adopted by the state Legislature. Furthermore, research shows New York City's high income tax rates hinder its competitiveness, and recent federal tax changes are likely to compound the problem.
A new income tax surcharge is politically infeasible, counterproductive and, most importantly, unnecessary. The Fair Fares proposal can be accommodated within the city budget by exercising greater restraint in hiring and more aggressively tackling inefficiencies in its operations.
The city's workforce has grown to record levels; since fiscal year 2014, its headcount has grown by 25,000 positions, and is projected to grow by an additional 8,550 by the end of fiscal year 2018. While most of the hiring has taken place in the city Education Department (the bulk of the new positions are related to the expansion of universal pre-kindergarten), headcount is up across the board and agencies continue to hire. There are currently 2,225 vacant positions, and the City Council projects a savings of $75 million from attrition and hiring delays for the balance of the 2018 fiscal year. The average cost of compensation, including salary and benefits, for a city employee is $140,000; eliminating long-term vacancies and only hiring for essential positions can easily generate the savings needed to fund Fair Fares.
The Citizens Budget Commission has written extensively about how savings programs under de Blasio have been comprised mostly of re-estimates, funding shifts to state and federal revenue streams, and debt service savings. Our most recent review showed the sum of agency efforts to generate savings from more efficient operations was a mere 0.2 percent of city-funded expenditures in the most recent five-year financial plan, a total of $465 million between fiscal years 2018 and 2022. Several large agencies – including Fire, Sanitation, Parks and Buildings – have not contributed any efficiency initiatives in the past five financial plans.
Many initiatives to modernize and streamline operations – for example, redesigning garbage truck routes to increase per-shift tonnage collected for a savings of $75 million – require negotiating with labor unions. This should not be a reason to ignore these ideas; rather, boosting productivity and finding savings should be at the forefront of the city's agenda in labor negotiations this year.
In addition, the city's back-office operations deserve more scrutiny. The Office of Management and Budget has started examining issues that span multiple agencies, such as office space and fleet management, and there is more to do. A 2013 CBC review indicated the city's procurement practices were highly decentralized, extraordinarily lengthy and cumbersome, and had not kept up with digital advances. The city could've saved at least $170 million by overhauling how it purchases goods and services.
Managing city operations more efficiently can make room in the budget for Fair Fares. If the mayor supports the proposal and wants to exercise caution, instead of advocating for a millionaires tax, he could fund a pilot program and/or phase it in over several years. As all commuters know, moving on a slow track is preferable to stalling.
NEXT STORY: Michael Cohen is Trump's new Roy Cohn


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The other day I was introduced to Chad Hoeft Designs via Pinterest, and I just couldn't wait to share this amazing home from his portfolio with you. The Bermuda-style bungalow, located on the north end of Palm Beach, is owned and designed by Chad Hoeft himself, and it was the cover story of the January 2009 issue of Florida Design's Palm Beach Home & Decor! When he first located this 3,000 square foot 1950s home, Hoeft immediately recognized its potential and ability for indoor-outdoor living.
"I wanted to design an elegant, classical interior and exterior scheme that was contextual to the heyday of Palm Beach in the '50s and '60s, while also incorporating a fresh, modern perspective," Hoeft said. "I also wanted to make the home at once elegant and livable, comfortable for entertaining small groups and large gatherings, and to bring in the beauty and warmth of the outside."


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Five things We Learned from the Saints/Bears game
1. Saints can strike fast AND beat you slow
Oct 6, 2013; Chicago, IL, USA; New Orleans Saints running back Pierre Thomas (23) jumps over a Chicago Bears defender during the first quarter at Soldier Field. Mandatory Credit: Matt Marton-USA TODAY Sports
Many people know that New Orleans runs an up-tempo offense built on big plays by quarterback Drew Brees. The Saints proved in this game that they can also wear down defenses and control the clock. That is a huge advantage because it gives their defense time to rest and allows Drew Brees and Sean Payton to dictate the game to the opposing defenses.
Pierre Thomas was able to shine today with 55 yards receiving and two touchdowns because he is a reliable and agile receiver and runner. The Saints may not have put up flashy individual player stats (outside of Jimmy Graham) but each carry and catch is crucial to being able to control the time of possession.


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On October 3, 2016 at 6:30 am Premier Parking planted its second flag in Florida! Premier Parking is excited to open its newest Florida operation at Capital Regional Medical Center in Tallahassee. Premier will initially be providing valet services for the Main Entrance and Emergency Room Entrances of this state of the art healthcare facility. Like our other healthcare operations, within a short period of time we hope to expand our scope of services to include concierge and greeter services.
Capital Regional Medical Center, which opened in September 1979, is a fully accredited 242 bed acute care facility with more than 1,100 employees and 500 physicians.
John Burnett, Premier's General Manager for Florida, has played a pivotal role in getting this operation up and running. John and his new team will provide valet parking services to hospital visitors and patients from 7:00 am – 6:00 pm Monday through Friday and will bring a refreshed look to the operation with new signage, podiums and uniforms.
Vice President, Eric Teter, commenting on the new operation states that "Premier's success in Florida will only continue as we look to expand our unique level of healthcare services to other properties across the state. We continue to provide exceptional service at West Florida Hospital in Pensacola where we commenced operations on May 16, 2016 and see vehicle volumes and patient satisfaction scores increase dramatically under our management."
Congratulations John and the entire Premier Parking Tallahassee Team on a job well done!