text:
Corey Graves
Real Name
Matt Polinsky
Date of Birth
February 24, 1984
Place of Birth
Apparently, when Hollywood needs a Russian enforcer, Kevin Nash is the guy to call. The former WWE star has a small role in the John Wick movie, which stars Keanu Reeves. In it, Nash plays a Russian bouncer. A couple of years back, the former world heavyweight champion was cast in the Punisher movie, where he played a Russian hit man for the mob.
October 30, 2014
Reports are floating around that Kurt Angle has signed a new contract with TNA that will enable him to work part time and focus on building up his career in Hollywood. The former Olympic gold medalist attempted to get a part time deal with WWE, but the company insisted that he sign a full time deal, which Angle did not want because he was worried about the effects it would have on his body.
October 29, 2014
While he has long maintained that he has no desires to leave WWE for Hollywood, John Cena is publicly expressing interest in expanding his horizons. The former heavyweight champion wants to show the audience that he can do comedic roles. The belief is that he might have been influenced by the massive success of the Rock and Batista over the last couple of years.
October 22, 2014
While reports have surfaced that Kurt Angle has indeed been in negotiation with WWE on his final contract in the business, the former world heavyweight champion has not ruled out a potential return to TNA because the company is more than willing to give him the part time deal that he prefers. Angle has publicly stated that this will be his final contract as a wrestler, and he wants to try to gain more ground in Hollywood.
October 14, 2014
Despite a lot of critical wrestling fans predicting his failure in Hollywood, Batista is expanding his resume rather nicely. After the success of Guardians of the Galaxy, the former world heavyweight champion has cemented himself into the Marvel Universe, which is red hot right now in the industry. Now, Batista is joining the James Bond universe, where he is slated to portray a villainous henchman named Hinx.
October 13, 2014
WWE is very optimistic that they can sign the Rock to work a match at Wrestlemania 31. However, he remains noncommittal at the moment. When asked during interviews about a potential return to the wrestling ring, Rock usually brushes it off. He recently joked about not wanting to be punched in the mouth. The belief is that Hollywood executives are very much against Rock wrestling again.
October 11, 2014
Rumors have spread like wildfire about the possibility of Eric Bischoff joining Jeff Jarrett in his new Global Force Wrestling promotion. The speculations were started when a picture surfaced online of the two of them, along with Karen Jarrett, hanging out together. Since Bischoff has some stroke in Hollywood, a partnership between the two sides could greatly benefit GFW.
September 21, 2014
Due to his new found success in Hollywood, Batista is said to be holding all the cards when it comes to his career with WWE. Guardians of the Galaxy did extremely well, so he does not feel the need to return to professional wrestling. Rumors have surfaced that the former world heavyweight champion would only be interested in doing another match if it meant that he would receive a huge pay day at Wrestlemania 31.
August 31, 2014
Initially, the belief was that Batista would make a return to WWE after he was done promoting Guardians of the Galaxy. However, reports are now surfacing that he could be completely done with professional wrestling. The belief is that the movie studios are against the idea of him risking injuries by being an in ring performer again. Batista could have no choice but to comply since he wants his career in Hollywood to keep growing.
August 26, 2014
Earlier this week, Batista revealed that he was willing to work with Titus ONeil because he wanted to help his friend become a star in WWE. As of right now, management does not appear interested in the idea. While they do want to appease Batista since he is building his name in Hollywood, they seem more interested in using him against other big name performers instead.
August 19, 2014
In another sign that he is moving closer to a full jump to Hollywood, Batista recently discussed his wishes for a retirement match. The former WWE champion would like to do another big match at Wrestlemania against Triple H, who he feels is still the best worker in the business. Management might be willing to do that at Wrestlemania 31 to capitalize on his name value being increased because of Guardians of the Galaxy.
August 15, 2014
Since Hercules has been deemed a bit of a disappointment, there are talks that the Rock might miss out on some opportunities in Hollywood. Rumors have it that the WWE legend is not all that concerned. His popularity has not taken that big of a hit, and it should increase when the next Fast and Furious movie is released. Studios are still interested in the Rock as a leading man.
August 15, 2014
There are rumors floating around that Batista might not actually return to WWE after all. Guardians of the Galaxy has been quite successful, and the second movie has already been signed. Batista is already attached to the Kickboxer remake. He may come back to WWE for one more appearance, but the risk of being injured in the wrestling ring might not make much sense any more to a Hollywood star.
August 8, 2014
WWE has announced that Dolph Ziggler will be challenging the Miz at Summerslam 2014 for the Intercontinental Championship. While his popularity remains pretty strong, this is not a push for Ziggler. Management simply needed a mid card baby face to put over Miz. A title change is not expected to take place, as the company wants to see how far this Hollywood character can go.
August 5, 2014
News coming out of Comic Con is that a sequel to Guardians of the Galaxy has already been set. For WWE fans, that means that Batista will need more time off to work on the film. No word yet on whether or not he plans to remain in the professional wrestling industry since his movie career is moving forward, however. Depending on the success of the first film, Batista could land other roles in Hollywood, which would entice him to leave WWE.
July 27, 2014
Chris Jericho and Fozzy performed a concert at the world famous Whisky A Go Go in Hollywood last night. He was not the only WWE performer in the building. Miz and his wife Maryse Ouellet, a former diva, were in attendance as guests of Jericho. The concert was just a one time thing, and Jericho is expected to be back on the road with WWE soon.
July 25, 2014
Since she has a little bit of free time now, Trish Stratus is dabbling into Hollywood again. The former WWE diva has been cast in an upcoming movie called Gridlocked, where she will be portraying a lead member of the SWAT team. The star of the movie is Danny Glover. The film is being shot in Toronto and London, so Trish will not have to be away from home too much.
July 23, 2014
A lot of people backstage in WWE have been joking around lately about John Cena possibly being the next guy to leave the company to pursue a career in Hollywood. He's got a couple of parts coming up that might help him gain the attention of the studios. There are also talks that Cena is a lot more injured than he lets on, so an acting career might seem like a better option nowadays.
July 23, 2014
While doing an interview in Cleveland recently to promote his upcoming Hercules movie, the Rock was asked about a return to WWE and a potential match against his cousin Roman Reigns. The Hollywood star stated that it would not make sense right now for the match to happen because Reigns is not the top heel in the company. Rock floated the idea of returning as a heel, but that might not be something that WWE is interested in doing because they know that the fans will not root against the popular performer.
July 19, 2014
Even though he is now one of the most well known movies stars on the planet, the Rock still has a lot of ambitions in life. The former WWE star is now focused on producing movies. He is currently in negotiations with Universal to star in and produce a movie called The Janson Directive. The belief in Hollywood is that this will be a vehicle for Dwayne Johnson to do films that are similar to what Matt Damon did in the Bourne series.
July 9, 2014
A video of Jimmy Uso and Jey Uso teaming up with Sami Zayn to take on Corey Graves, Conor OBrian and Rick Victor on an episode of WWE NXT.
April 26, 2014
"When I was in first grade, I was Ultimate Warrior for Halloween. I just watched his hall of fame speech two hours ago. I don't even have words." - WWE developmental star Corey Graves on the death of the Ultimate Warrior
April 19, 2014
Through Twitter, Corey Graves posted this message, where he mocks Total Divas. He joked that the performers are sharing their secrets with a national audience and expecting people not to know. This is keeping in line with his social media character, as the WWE developmental wrestler has also mocked the Shield and the company itself.
March 24, 2014
A Twitter post from Corey Graves, where the developmental wrestler mocks WWE for keeping kendo sticks underneath the ring.
March 15, 2014
Corey Graves, a WWE developmental wrestler, took to Twitter to playfully mock the Shield about their entrance routine on Monday Night Raw.
November 19, 2013


text: Armani/Casa Heats Up The South Opening their third luxury storefront, Armani/Casa brings its sophisticated, modern home furnishings line to South Florida's Miami. It's apropos that the famed design brand would...Read More 5/24/2012 12:00:00 AM (0) comments Green Glamour Clothes are not the only thing getting brighter. Everywhere we look these days furniture seems to be getting the ultimate color treatment…and were loving it! However, there is one color in...Read More 5/23/2012 12:00:00 AM (0) comments Dream Tone A piano is a symbol of beauty—smooth ivory and sweet melodies that leave a lasting impression. But, Polish Designer Robert Majkut has taken this symbol into uncharted territory. With...Read More 5/22/2012 12:00:00 AM (0) comments experimental furnishing Jee Levin and Randall Buck are the faces behind the wallcovering design company, Trove. Most recently the duo debuted their latest creation, Chroma, at the ICFF. The Chroma pattern is a non-sequitor...Read More 5/22/2012 12:00:00 AM (0) comments Paper Perfect The more accessible we become, the more personal a handwritten letter feels. There is a certain sensation when we open a letter and see our name and message hand written. Due to the few and far...Read More 5/21/2012 12:00:00 AM (0) comments Summer Must Haves It is here people! The sun, the beach, the parties, the food…there are a million reasons why summer is one of the most luxurious times of year. Each season has an array of must have...Read More 5/19/2012 12:00:00 AM (0) comments The Sophisticated Child As the youngest of six children, even at 40, LuLu deKwiatkowski (LuLu DK) still has to be reminded that she is no longer a kid. However, it was her thinking like a child that has led to the success...Read More 5/17/2012 12:00:00 AM (0) comments Timeless Tiffany In honor of 175 years of business Tiffany & Co. has unveiled a new collection, properly named, RUBEDO. [ picture via] "In the medieval philosophy of alchemy, RUBEDO was the title...Read More 5/15/2012 12:00:00 AM (0) comments Pillow Talk I am not sure what it is about them, but pillows add a certain je ne sais quoi to a room. An area is just not complete until you have fluffed up and thrown a pillow into the mix. Now, more than ever,...Read More 5/14/2012 12:00:00 AM (0) comments Shades Of Summer Time has a funny way of making things luxurious. Take for example: champagne, furniture, even clothing. As everybody seems to have their eyes glued to the "Fifty Shades" trilogy, I...Read More 5/11/2012 12:00:00 AM (0) comments Everything's Coming Up Roses... Summer is only weeks away, but nature is not the only thing in full bloom. From home décor to fashion accessories, floral is being used as the perfect accent to our favorite luxuries. If you...Read More 5/10/2012 12:00:00 AM (1) comments Covet: Mad About Missoni Summer is all about color, which is why as the days get longer and the air warmer we turn to Missoni. The multitude of patterns used in Missoni's clothing has been luring the fashion...Read More 5/9/2012 12:00:00 AM (0) comments

subset: commoncrawl


text:
Fleets in review / vol. 1 January 2005
|1 of 15
This page
Fleets in Review Vol. 1 January 2005 A Newsletter for Fleet Emissions Inspection Facilities and Inspectors Welcome to " Fleets in Review" This issue is the first edition of Vehicle Emissions " Fleets in Review" newsletter. It is intended to keep the fleet inspector up to date on changes in the law, and in technical issues and training that affect your business. We hope to bring " Fleets in Review" to you on a quarterly basis. Produced by the Vehicle Emissions Section, " Fleets in Review" solicits your input. Please e- mail your comments and questions to: gibbons. john@ azdeq. gov. New Fleet Tests and Handbooks The fleet vehicle emissions inspection station hand-books for both Phoenix and Tucson have been com-pletely revised, as well as the inspector/ fleet agent examinations. A few of you have already experienced the new tests and handbooks in recent classes; feed-back has been positive. The revised handbooks are available for download at the ADEQ web site. For more details see " New Web Access" elsewhere in this issue. Exemption Changes Don't forget, January 1, 2005, the new vehicle exemptions move forward one year. Vehicles of model years 2001 through 2005 are exempt from testing. Alternative fueled vehicles model years 2003 through 2005 are also exempt, beginning in January. Vehicle emissions inspections are required for 2000 model year vehicles and 2002 alternative fueled vehicles. Diesel Course Coming Soon d For many years VEI has been certifying diesel inspectors, based solely on the inspector and fleet agent examinations. A diesel certification examination has not been administered. In March 2005, a diesel certification course will be offered and an examination will be required before licensure. Expected to bene-fit both the veteran and new diesel technicians, the course will cover basic diesel technology, service and inspection, as well as highlight the state of diesel tech-nology today and in the future. New Web Access The ADEQ website is now easier to access. Our new Web address is: www. azdeq. gov For Vehicle Emissions, you can go directly to the VEI page: www. carcare. azdeq. gov The revised Fleet Handbooks are on the Internet. They may be opened as a pdf file. See the " Licensed Emissions Inspector Training Manuals" link on the CarCare Web page. Current Wait Times While on the web, make use of the " Current Wait Times" link on the CarCare Web page. Up to the minute wait times are available and may assist you or a customer visit the least busy station. The wait time gates installed in January 2002, are used to track a vehicles entrance and exit. The time difference is used in the wait time calculation and allows ADEQ to track our contractors performance. IN THIS ISSUE… P Welcome to Fleets in Review P New Fleet Tests and Handbooks P Exemption Changes Coming P Diesel Course Coming Soon P New Web Access P Current Wait Times P Certificates of Inspection P 2005 Class Schedule ppppppppppppp Vehicle Emissions Inspection 600 N. 40th Street Phoenix, Arizona 85008 Contact Fleets in Review: 602- 207- 7000 Contact: John Gibbons gibbons. john@ azdeq. gov Certificates of Inspection Price increase, please note! The price of COIs increased on September 1, 2004. Please be sure your certificate orders include $ 11.50 for each certificate ordered. Checks must be for the exact amount of the order. Current order forms show the correct price. It is always a good policy to check your supply of order forms and monthly summaries, ( as well as inspector licenses) to make sure that they are current. Every time you order COIs, new monthly summaries and order forms are provided. Please destroy the old order forms to avoid any confusion. 2005 Class Schedule Inspector certification classes for all license classes have been scheduled for the upcoming year. See the chart on the right for an available class for recertification or for any new technicians in your shop. Classes are held at: 600 N. 40th Street, Phoenix ( 602) 207- 7010 or 4040 E. 29th Street, Tucson ( 520) 628- 5651 ext: 0. Month Phoenix ( gas) Tucson ( gas) Jan 4- 5 25- 26 11- 12 Feb 1- 2 22- 23 8- 9 Mar 8- 9 29- 30 15- 16 Apr 5- 6 26- 27 12- 13 May 3- 4 24- 25 10- 11 Jun 7- 8 28- 29 14- 15 Jul 12- 13 26- 27 19- 20 Aug 9- 10 30- 31 16- 17 Sep 13- 14 27- 28 20- 21 Oct 4- 5 25- 26 18- 19 Nov 1- 2 29- 30 8- 9 Dec 6- 7 20- 21 13- 14 Fleets in Review is a publication of
Object Description
|Fleets in review: newsletter for fleet emissions inspection facilities and inspectors
|Arizona. Dept. of Environmental Quality.
|Motor vehicle fleets--Inspection--Arizona; Motor vehicles--Inspection--Arizona; Automobiles--Motors--Exhaust gas--Arizona;
|Browse Topic
Land and resources
|This item contains one or more publications.
|Arizona. Dept. of Environmental Quality.
|Material Collection
State Documents
|Source Identifier
|Arizona State Library, Archives and Public Records--Law and Research Library


text:
Steve Jobs
Steve Jobs is one of the greatest managers and creators the world has ever known!His leadership and perseverance changed the world as we know...iOS Version 1.1 ... Added: 02/12/12Total Downloads4Last Week1
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|Made with a synthetic and patent leather upper, the Nike Prestige IV delivers a durable fit that lives up to an athletic lifestyle. Below the foot is a Air® heel unit for cushioning and a durable rubber outsole for a smooth ride.


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Cheap ski holidays in hundreds of ski resorts worldwide.
Nb: infants must be under the age of 2 and
children must be under the age of 12 at the time of
The Al Pigher (the Beehive) is a charming Dolomite hotel where you will be well looked after by your team of our chefs and hosts. Attractively designed in traditional local style, with lovely light and airy rooms, fresh colours and light wood panelling, the hotel offers a warm welcome in an ideal location. La Villa's pretty village centre is just a short walk away, as is the Gardenezza chairlift and the Piz la Ila gondola that takes you directly to the Alta Badia ski area which links to the famous Sella Ronda ski routes and pistes.
Ground Floor:
Reception, dining room, cosy bar, sun terrace, heated ski & boot room.
First Floor:
Rooms 101 & 105 - Continental twin* with shower/wc/balcony.
Rooms 102, 103, 104 & 106 - Continental twin* + sofa-bed with shower/wc/balcony.
Room 107 (Family Suite) - Family Suite consisting of one room with Austrian twin and balcony and one room with double sofa bed, sharing shower/wc
Second Floor:
Rooms 201 & 205 - Continental twin* with shower/wc/balcony.
Rooms 202, 203, 204 & 206 - Continental twin* + sofa-bed with shower/wc/balcony.
Suite 207 - Family Suite consisting of one room with Austrian twin and balcony and one room with double sofa bed, sharing shower/wc
Third Floor:
Room 301 & 302 - Double room (301) and separate twin room (302), shower/wc under eaves
Lounge, sauna and relaxation area with Kneipp therapy path - with panoramic views of the Sasso Croce Mountain
Breakfast – A buffet breakfast is available every day, including a choice of cereals. Fruit juices, local breads, cold meats, cheeses and preserves, accompanied by your choice of the tea or coffee. There will also be a hot 'dish of the day' six days per week, such as pancakes with fruit, or sausage and bacon, which is freshly cooked to order.
Afternoon Tea - After a tremendous day's skiing or snowboarding, return to a hot drink and a selection of freshly baked home-made cakes. Tea and coffee are also available free throughout the day in all Chalet Hotels
'Culinary Choice' Dinner - Our Chalet Hotels make dinner a highlight of the day, with our 5 – course menus served six days each week, accompanied by a choice of complimentary quality wines. Dinner starts with canapés and an aperitif, generally served in the lounge/bar, followed by a starter, main course, dessert and a cheese selection to finish. We offer choices for each course, always including a vegetarian option, and ask that you make your selection at breakfast each day, so that our chef's team can prepare everything fresh for you that evening. Dinner can be as sociable or as private as you wish, with larger tables for groups of friends, old or new, or private tables for more intimate dining for couples if preferred. Vegetarian options are always available to choose from our menu, and other special diets can be catered for at s supplement if booked with us in advance.
One evening each week your Chalet Hotels staff have the evening off, enabling you to choose from one of the local restaurants for that evening's dinner, which our Resort Representative will be delighted to help you book.
Choice of Quality Wines
Our choice of wines is selected in conjunction with our good friends, Nicolas and Veronique Perret, and their long established Savoie wine business. Nicolas is a qualified 'Master of Wine', and has help helped us select two contrasting whites, two choice reds and a rose for you to enjoy, unlimited, throughout dinner each evening.
Our Chalet Hotel Staff
Our Chalet Hotel Hosts are chosen for their friendly and helpful attitude, whilst our Head Chefs and their teams are professionally trained to provide consistently enjoyable restaurant-standard cuisine. At all times your Resort Representative is also on hand to help out with their local knowledge, and to arrange local restaurant bookings on the Chalet Hotel team's one day off per week.
Christmas & New Year Celebrations
Our Chalet Hotels are the ideal venue for your Christmas or New Year celebrations, providing the perfect festive atmosphere, wonderful food and wines, and our team of staff on hand to ensure you have fantastic week!
Useful Information
· All Chalet Hotels are entirely non-smoking
· Each has its own bar – in most cases open to residents only *-the ideal place for your choice of epres ski tipple.
· Chalet Hotel ratings shown for each property are the tour operator's own ratings; they are not 'star ratings' and not to be confused or compared with any system of official ratings or national/international hotel categories.
· Children of all ages are welcome in all our Chalet Hotels on all dates. We serve a separate High Tea at 5.30pm for children aged 11 years and under with an appropriate menu. However, parents may elect for their children (11 years and under) to eat with them at the adult meal times on payment of £39 per child per week supplement.
Iglu acts as a travel agent for disclosed principals/tour operators, further details
of which will be made available at the time of booking. Your holiday contract will
be bound by the tour operators terms and conditions.
Prices are shown for a basic room or unit, can be subject to change and are indicative
until time of booking. Please call on 0208 544 7114 for prices for other travel
and room options for this property.
The price shown includes 7 nights accommodation,
with flights from Gatwick.
Prices shown are per person per week based on maximum occupancy. Descriptions and
quality ratings are provided by the Tour Operator (or one of the Tour Operators
where similar holidays are offered by more than one supplier). We reserve the right
to make minor adjustments to the description or rating based on staff and customer
feedback. For payments by credit card, a 2.5% credit card charge (4% for AMEX) will
be added to your invoice. If you pay by a UK issued debit card, there is no charge.
All bookings are subject to a £5 per person Passenger Admin Fee charged by Iglu.com.


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Design Your Own Unknown
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Cushion Halo Engagement Ring with Pavé Set Princess Cut and Round Diamonds
Dazzling in diamonds, this spectacular halo engagement ring features 58 hand-selected round pavé-set diamonds, at approximately .68 carat total weight. Sparkling in an elegant 14 karat white gold split shank setting, two princess cut diamonds at approximately .07 carat total weight add beautiful accents. The total gem weight is approximately .75 carat. Add the diamond of your choice to complete this setting, up to a 1.25 carat cushion cut.
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text:
A Roundup Of Sandwiches
In honor of Lunch Week on The Kitchn, I've put together a collection of some of The Kitchn's most mouthwatering sandwich recipes. I don't know about you, but I sure could go for a pimento cheese sandwich now, or a Bánh Mì ... or a farmer's sandwich! I can't decide, they all look so good. Anyway, we hope you'll find this roundup inspirational and make yourself a delicious sandwich.
1st Row:
• Farmer's Lunch Sandwich
• Eggplant Caponata Sandwich with Mozzarella
• Spanglish Sandwich with Avocado
• Turkey & Cranberry Sandwich
• Cheese & Onion Sandwich
2nd Row:
• Egg Salad Sandwich
• Peanut Butter Sandwich
• Sprouts Sandwich
• Basil, Goat Cheese, and Artichoke Heart Sandwich
• Comte, Olive, and Arugula Grilled Cheese Sandwich
3rd Row:
• Grilled Cheese Sandwich
• Tomato Sandwich
• Pork Tenderloin and Onion Jam Sandwich
• Fried Green Tomato Sandwich
• Mozzacado Sandwich
4th Row:
• Pimento Cheese Sandwich
• Grilled Cheese with Tomato Chutney
• Italian Chicken Salad Sandwich
• Tea Sandwiches
5th Row:
• Vegetable Sandwich
• Vietnamese Bánh Mì with Lemongrass Tofu Sandwich
(Images: Kathryn Hill, Emily Ho, Laure Joliet, Flickr member star5112 licensed for use under Creative Commons, Emma Christensen, Elizabeth Passarella, Nina Callaway, Maren Caruso, Martha Stewart)
7 Comments
some of these sandwiches look and sound amazing! i think i know what to make for dinner.
sandwich night at our house tonight! usually its a Croque Madame... but tonight I am aiming for the Spanglish!
turkey & cranberry sauce is my faaaaavorite
The Spanglish sandwich (without avocado or bacon) is a staple at my place. Man, is it good. And with some spinach for greens? Yeah.
How can I obtain a copy of this article (color photos and recipe details included)?
You left out my favorite Kitchn Sandwich EVER: http://www.thekitchn.com/thekitchn/quick-weeknight-meals-2009/laurens-new-orleansstyle-vegan-muffuletta-quick-weeknight-meals-recipe-contest-2009-096512
Great for vegans and omnivores alike and especially wonderful for lunch with company.
Sandwiches tend to be my go-to food especially when I really don't feel like cooking. I love the basic meat & cheese with a bit of mayo or even the microwaved "grilled" cheese (really just melted cheese sandwich).
When I do cook a sandwich though, my favorite is a Philly Cheesesteak. This was our take on the classic sandwich. Let me know what you think. Philly Cheesesteak, Southern Style


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an exclamation of utter frustration or despair
"Oh, squeee!!" she said, as the freshly made potato salad flew all over the floor...
av Lisa Sheftman 4 juli 2003
It is what women and human "males", who are not MEN, write on internet forums because they think it is a cute expression of being happy. These are the same people who write "sigh". They most likely all drive a Toyota Prius or a Smart Car. If these humans are in your office, it is considered customary to beat their legs with a rubber hose.
Oh hey, there is a new episode of Dancing With The Idiots on tonight! SQUEEE!
av Jackmaster Johnny 17 februari 2014


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Commencement season is highlight of year for Livingstone's Rev. Allen
This time of the year across the country at institutions of higher learning, employees are scrambling to make final preparations for commencement ceremonies.
For some it's a stressful, pull-your-hair-out time. But for the Rev. Juanita K. Allen of Livingstone College, it's one of the highlights of the academic year.
You see Allen has a passion for students and helping them with writing skills, is a people person and enjoys making things beautiful, so adorning the stage at graduation, ordering flowers and using ribbon to designate special seating come naturally to her.
"Assisting with graduation was a duty that was assigned to me after I started working at Livingstone," said Allen, who was hired in 1986. "I enjoy helping to beautify the campus for events and special affairs because I like making things festive and it gives me a lift. I know the people at Salisbury Flower Shop very well and they know me, and with their help I enjoy being able to create a jubilant atmosphere and bring the graduation stage to life by adding plants, live flowers and greenery."
This week in addition to giving final exams to undergraduate students, Allen has been working to ensure Saturday's commencement program, which begins at 10 a.m. and features Charlotte Mayor Anthony Foxx as the keynote speaker, is beautiful and goes off without a hitch. Foxx was tapped earlier this week by President Barack Obama to replace Ray LaHood as Secretary of Transportation.
On Monday, Allen stopped by Salisbury Flower Shop to select the black and blue ribbons she'll use to designate special seating at commencement. She has also coordinated special requests this week; including making sure the Bishop's Lounge is prepared and that the college's food service company has enough bottled water on hand for commencement attendees.
Although she doesn't mind being pulled in several different directions when the college has special events like graduation and Founder's Day, Allen is quick to say she can always count on colleagues as well as students when she needs a helping hand.
Allen, a native of Ridgeway, has a bachelor's degree in communications, with a minor in English, from State University of New York at Buffalo and a master's degree in educational media technology from North Carolina Central University. Her bachelor's degree was obtained through SUNY Buffalo's teacher education program.
She worked as a substitute teacher for Durham County and Durham City public schools but applied to Livingstone after a friend told her about an opening. She was hired as director of the institution's learning center and hasn't looked back. Today her title has changed to director of the college skills program, but her duties and passion remain the same. Allen teaches students social interaction skills, how to take good notes, the proper way to study and other useful techniques. She also does testing for all entering freshmen.
"I love working with kids. That's my passion," said Allen, assistant pastor of First Calvary Baptist Church on Long Street. "I like seeing them when they come to the college and watching them mature and become more stable, more focused and more able to successfully operate in the college environment."
Manuel McGriff, dean of students at Livingstone, said he enjoys working with Allen because she's always pleasant and willing to do whatever is necessary to help the institution.
"Rev. Allen is a joy to work with because she doesn't make excuses or complain but instead rolls up her sleeves and goes to work," McGriff said. "She has worked tirelessly at the college for 27 years, but it doesn't look as though she's planning to slow down. Rev. Allen literally has her job on wheels. In her car trunk are copies of the asset freshman placement test, in her backseat are a box of calculators, in the front seat is a case of pencils and on the floor you can find convocation ribbon just about any day of the week. She's dedicated."
State Alexander, who has worked at Livingstone for about 21 years, said he couldn't agree more with McGriff's assessment.
"There is a special, spiritual glow and purpose about Rev. Allen," Alexander said. "When you get to know her you understand her life is dedicated to helping young people shine."
Alexander said Allen epitomizes Matthew 5:16: "In the same way, let your light shine before others, that they may see your good deeds and glorify your Father in heaven."
He added she has a nurturing, caring spirit that helps students feel as though they have a mother away from home while they're in Salisbury.
Allen, a widow since 1988, has a daughter, Sarita Bernadette Allen-Medlin, a supervising teacher in the Chapel Hill-Carrboro City Schools System. Her grandson, Braxton Howard Medlin, is an N.C. A&T State University graduate who plans to attend law school at Elon University.
She said it makes her feel good when students tell her she's like their mom away from home because, "they feel love from me, and that's how I want them to feel while they're away from their parents and hometown surroundings."
And she said she really feels good – and relieved – now that graduation is just one day away.


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Lily's Teacher Is Stressing Her Out
Mrs. Plank? Cam calls her "Mrs. Crank."
Mrs. Plank? Cam calls her "Mrs. Crank."
Free shoes from the neighbors? Haley's in!
Steve Zahn and Andrea Anders guest star
Blue and yellow make what?!?
Phil and Claire inadvertently scare some prospective buyers
Claire sneaks off and gets her own motel room.
Phil is in the motel pool while the kids realize he deceived them.
The big game has Coach Cam being superstitious.
Gloria disapproves of Manny's new girlfriend.
Jay consoles a devastated Manny.
Can the Dunphys live in a tiny room and get along?
Claire toughs it out, but ends up passing out.
Cam tries to coach Manny on kicking.
Lily can't keep up with her friend Sydney.
Phil and Luke act in front of the green screen.
Haley closes in for the big moment.
From "The Cold" airing WED OCT 8 9|8c.
Lily keeps forcing a giant, toothy smile in the family pic.
Alex admits she wants get away from her family.
Jay shows Manny the bunny he made in pottery class.
Should they push the button?
A boy flirts with Alex, but she thinks her mom's behind it.
Preview a scene from the all-new episode airing WED OCT 1 9|8c
Gloria smears on lipstick and straps on a fanny pack to make a point.
The honeymoon's over, but it feels like it never ended.
Claire tells Mitchell how to let the honeymoon end.
Cam shows up at Mitch's office and wants to dance.
The Dunphys' Alex-free summer was going so well...
Things seem to be better when Alex isn't around.
Sneak preview of the Season 6 Premiere. ABC WED 9|8c
Luke loses his bathing suit in Australia
Magic with Stephen Merchant, Fred Armisen and Patton Oswalt.
Ty talks about his favorite football team inviting him to NFL Draft Day.
Ty reveals that learning to ride a motorcycle isn't exciting.
Ty talks about his love scene with Bill Hader in their new movie.
See Phil get creative to connect with the Dunphy kids.


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Some of the greatest golfers from Europe and the United States will battle it out September 26-28, 2014 in Gleneagles, Scotland, to see which country is the best in all the land during the 2014 Ryder Cup. Commemorate the biennial event on the course with this collectible pin. It features the 2014 Ryder Cup logo on one side and the Gleneagles wordmark on the other. Walk among the pros with accessories fit for the championship.
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Please confirm that your email address is correct, so you can successfully receive this alert.
The authors report no financial relationships with commercial interests.
Supported by NIMH grant R01 MH076908/MH076908-04S1 to Dr. Fortney.
Clinicaltrials.gov identifier: NCT00439452.
From the Division of Health Services Research, Department of Psychiatry, College of Medicine, the Department of Biostatistics, College of Public Health, and the Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock; Health Services Research and Development and the South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock; Community Health Centers of Arkansas, North Little Rock; United Family Services, Little Rock; and the Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa.
Address correspondence to Dr. Fortney (firstname.lastname@example.com).
Copyright © 2013 by the American Psychiatric Association
28, 2012; Revised
17, 2012; Accepted
12, 2012.
Practice-based collaborative care is a complex evidence-based practice that is difficult to implement in smaller primary care practices that lack on-site mental health staff. Telemedicine-based collaborative care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multisite randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients assigned to practice-based and telemedicine-based collaborative care.
From 2007 to 2009, patients at federally qualified health centers serving medically underserved populations were screened for depression, and 364 patients who screened positive were enrolled and followed for 18 months. Those assigned to practice-based collaborative care received evidence-based care from an on-site primary care provider and a nurse care manager. Those assigned to telemedicine-based collaborative care received evidence-based care from an on-site primary care provider and an off-site team: a nurse care manager and a pharmacist by telephone, and a psychologist and a psychiatrist via videoconferencing. The primary clinical outcome measures were treatment response, remission, and change in depression severity.
Significant group main effects were observed for both response (odds ratio=7.74, 95% CI=3.94–15.20) and remission (odds ratio=12.69, 95% CI=4.81–33.46), and a significant overall group-by-time interaction effect was observed for depression severity on the Hopkins Symptom Checklist, with greater reductions in severity over time for patients in the telemedicine-based group. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence base in the telemedicine-based group.
Contracting with an off-site telemedicine-based collaborative care team can yield better outcomes than implementing practice-based collaborative care with locally available staff.
Complex evidence-based practices are difficult to implement with fidelity in routine care. One such evidence-based practice, practice-based collaborative care, involves co-located primary care providers, mental health specialists, and care managers working together on-site in a primary care setting. Practice-based collaborative care has been shown to improve depression outcomes in numerous randomized effectiveness trials (1–7). However, implementation in smaller primary care practices presents challenges where it is typically not feasible to employ on-site mental health specialists or full-time care managers. Only 25% of U.S. primary care practices have on-site mental health specialists (8). Two studies (3, 9) have demonstrated that depression outcomes can be improved in small primary care clinics lacking on-site mental health specialists by training on-site nurses to be depression care managers; however, the effect sizes have been small to medium. Moreover, based on the results of a meta-analysis of randomized trials of practice-based collaborative care, Gilbody et al. (10) concluded that collaborative care interventions with more mental health specialist involvement have larger effect sizes.
Telemedicine technologies now make possible the virtual co-location of mental health specialists and primary care providers. Telemedicine-based collaborative care involves an off-site team of mental health specialists collaborating with on-site primary care providers, from a centralized location, using telephones, videoconferencing, and electronic health records. A multisite randomized trial conducted in the Department of Veterans Affairs (VA) (11, 12) demonstrated that telemedicine-based collaborative care is more effective than usual care in small satellite primary care clinics. Telemedicine-based collaborative care has also been adopted and sustained as part of routine care in small satellite primary care clinics within the VA (13). Compared with practice-based collaborative care, telemedicine-based collaborative care has the potential to be implemented with higher fidelity in smaller primary care clinics because the off-site team can include an array of mental health specialists, and full-time care managers can practice under more intensive clinical supervision and dedicate their time to care coordination activities, resulting in higher fidelity to care manager protocols. However, there are also potential disadvantages to telemedicine-based collaborative care. Off-site care managers cannot build on established relationships with patients and may have difficulty establishing therapeutic alliances from a distance. Likewise, if off-site care managers lack access to on-site medical records, they may have difficulty integrating behavioral and physical aspects of care and face barriers communicating with on-site primary care providers. In addition, the stepped care elements of the collaborative care model (e.g., psychiatric consultation) may be less effective when delivered via telemedicine. However, patients and providers uniformly report high levels of satisfaction with videoconferencing (14–17), and there is good evidence for the clinical equivalency of psychiatric (18–21) and psychological (22–26) treatments delivered via videoconferencing compared with face-to-face.
Given that 1) practice-based collaborative care without the involvement of on-site mental health specialists improves outcomes, 2) practice-based collaborative care with involvement from on-site mental health specialists improves outcomes more, and 3) the potential disadvantages of telemedicine-based collaborative care, an important policy-relevant question is whether it is more effective for small, remote primary care clinics to implement practice-based collaborative care without the involvement of on-site mental health specialists or to implement telemedicine-based collaborative care in partnership with an off-site team of mental health specialists.
Our objective in this pragmatic (27) comparative effectiveness trial (28) was to compare the process outcomes and clinical outcomes of patients randomly assigned to telemedicine-based collaborative care or practice-based collaborative care in small, remote primary care clinics that lacked on-site mental health specialists, thereby comparing two organizational approaches (with clinical equipoise) to delivering collaborative care for depression (29). We chose to conduct a pragmatic trial design in order to compare two viable competing strategies to delivering an evidence-based practice rather than an explanatory trial designed to determine why one approach was superior to the other. We hypothesized that compared with patients assigned to practice-based collaborative care, those assigned to telemedicine-based collaborative care would receive higher-fidelity care management, more specialty mental health services (e.g., telepsychiatry and telepsychology), and higher-quality pharmacotherapy and therefore would experience greater symptom improvement. Secondary outcomes examined included health status, quality of life, and satisfaction with care.
We partnered with five federally qualified health centers serving medically underserved populations in Arkansas' Mississippi Delta region and the Ozark Highlands. With federal oversight from the Health Resources and Services Administration (HRSA), federally qualified health centers make up the nation's largest and fastest growing network of primary care providers, with 8,000 clinics providing services to 20 million Americans. Three-quarters of federally qualified health center patients live in poverty, half live in rural areas, one-third are uninsured, and one-third are from minority populations. Mental health problems are the most commonly reported reasons for visits to federally qualified health centers (30), yet only 5.5% of encounters are with on-site mental health specialists (31). Research conducted in partnership with federally qualified health centers has direct applicability to a large segment of the U.S. population at risk for experiencing health disparities.
This multisite randomized trial employed a comparative effectiveness research design (28). Patients were randomly assigned to one of two active treatment arms, both of which represent potentially feasible approaches to adapting the evidence-based collaborative care model for routine delivery in medically underserved areas. The study design also contained many elements of pragmatic trials (27), including the use of relatively few exclusion criteria, enrollment of a diverse sample of patients, monitoring of but not controlling intervention fidelity, a primary outcome measure defined in terms of changes in patient-reported symptoms, and use of intent-to-treat analyses to examine group differences.
We approached six federally qualified health centers, and five agreed to participate. Participating centers employed between 1.3 and 9.7 primary care physician full-time equivalents, served between 5,362 and 13,050 unique primary care patients, and operated one to six clinics across multiple locations. None of the participating clinic locations had an on-site mental health specialist. Between November 2007 and June 2009, 19,285 patients were screened for depression by health center staff using the nine-item Patient Health Questionnaire (see the CONSORT diagram in the data supplement that accompanies the online edition of this article). Fifteen percent of patients (N=2,863) screened positive (a score ≥10 on the Patient Health Questionnaire); health center staff obtained informed consent from 62% of potentially eligible patients (N=829), and 55% (N=364) were found to be eligible and completed the baseline telephone interview. We excluded patients that primary care providers would not be comfortable treating; exclusion criteria included pregnancy, schizophrenia, acute suicidal ideation, substance dependence, bipolar disorder, recent bereavement, and current specialty mental health treatment. We also excluded patients who were unable to participate in research because of cognitive impairment, having a court-appointed guardian, not speaking English, having no telephone, or having a life event preventing participation. Screening and eligibility results were entered into the medical record.
Eligible patients were assigned by computer randomization using a 2×2 Latin square design (stratified by clinic) to either telemedicine-based collaborative care or practice-based collaborative care. It was not feasible to blind patients or providers to randomization status.
The practice-based collaborative care intervention was designed to be the same as the model of care supported by HRSA, known as the Depression Health Disparities Collaborative (32, 33), which represents more intensive treatment than usual care. Practice-based collaborative care involved two types of providers: on-site primary care providers and on-site nurse depression care managers. Each clinic location employed a half-time depression care manager funded by the study. Depression care managers were nurses (R.N. or L.P.N.) who had no prior mental health experience. They received a care manager training manual, 1 day of training in depression care management, and access to a web-based patient registry and depression care manager decision support system (34). Patients could choose either watchful waiting or antidepressant treatment. Depression care manager encounters were conducted either face-to-face or by telephone, depending on the patient's preference. The initial depression care manager encounter included 1) symptom monitoring with the Patient Health Questionnaire, 2) education/activation, 3) barrier assessment/resolution, and 4) establishing self-management goals, including planning physical, rewarding, and social activities. Follow-up encounters, scheduled every 2 weeks during acute treatment and every 4 weeks during continuation treatment, included the monitoring of symptoms, medication adherence, side effects, and engagement in planned self-management activities. Depression care managers received no clinical supervision from a mental health specialist. Progress notes were entered into the patients' paper medical record. A trial was considered to have failed in the acute phase if the patient did not respond to treatment (response was defined as a decrease of ≥50% in Patient Health Questionnaire score) after 8 weeks of treatment. No additional on-site mental health support was available for patients who did not respond to treatment, although patients could be referred to off-site mental health providers (e.g., community mental health centers). Patients received the intervention for up to 12 months.
Telemedicine-based collaborative care involved five types of providers: on-site primary care providers and off-site depression care managers (at the R.N. level), pharmacists (at the Pharm.D. level), psychologists (at the Ph.D. level), and psychiatrists. The off-site team, located at the University of Arkansas for Medical Sciences, was funded by the study. The full-time depression care manager was a nurse who had no prior mental health experience and received the same training and tools as the on-site depression care managers. All depression care manager encounters were conducted by telephone and followed the protocol described above. Progress notes were faxed to the clinic. During weekly meetings, the depression care manager received clinical supervision and the off-site team discussed new patients and patients who were not responding to treatment, and they offered treatment recommendations to primary care providers via the depression care manager progress notes. Patients received stepped care, whereby treatment intensity was increased for patients who were not responding to treatment. If the patient did not respond to the initial antidepressant, the pharmacist conducted a medication history and provided medication management by telephone as needed. If the patient did not respond to two antidepressant trials, a psychiatry consultation via videoconferencing was scheduled. At any time, patients had access to cognitive-behavioral therapy (CBT) delivered via videoconferencing. Patients who did not respond to an antidepressant trial were specifically encouraged to initiate and complete CBT.
Fidelity to the depression care manager protocol was measured through chart review. Five of the charts (1.4%) could not be located during the site visits. The following fidelity measures were abstracted: number of depression care manager encounters with documented Patient Health Questionnaire scores; self-management activities; antidepressant adherence assessments and side effect assessments for those treated with antidepressants; and counseling adherence assessments for those referred to psychotherapy. Depression care manager fidelity was also measured from patient self-report during the 6- and 12-month telephone interviews using items that addressed education, self-management, symptom monitoring, adherence monitoring, and collaboration among providers. To measure fidelity to the stepped care protocol, we examined what proportion of patients in the telemedicine group who failed to respond to at least one medication trial had a telephone pharmacist encounter and what proportion of those who failed to respond to two trials had a telepsychiatry consultation. We also examined what proportion of patients in the telemedicine-based group attended at least one telepsychotherapy session and completed at least eight sessions.
Data were collected at baseline in a blinded telephone interview. At baseline, sociodemographic and clinical case-mix data were collected using the Depression Outcomes Module (35, 36), the Mini International Neuropsychiatric Interview (37, 38), the Duke Social Support and Stress Scale (39, 40), the Quality Improvement for Depression Treatment Acceptability scale (3, 4), and the Depression Health Beliefs Inventory (41). Zip codes were used to categorize patients' residence as rural or urban according to Rural Urban Commuting Area classification scheme C.
Blinded follow-up telephone interviews were completed for 87% of participants (N=318) at 6 months, 79% (N=287) at 12 months, and 78% (N=283) at 18 months. In addition to the fidelity measures described above, the other primary process measures included self-reported mental health service utilization, antidepressant prescriptions, antidepressant dosage (categorized as starting, usual, or high [42]), and antidepressant adherence (taking the full prescribed dosage at least 80% of days in the previous month). The primary clinical outcome measures were changes in depression severity and treatment response and remission. Depression severity was measured continuously using the 20-item Hopkins Symptom Checklist (HSCL) (43, 44). Response, measured dichotomously, was defined as a decrease of ≥50% in HSCL score between baseline and follow-up. Remission, measured dichotomously, was defined as an HSCL score <0.5. Secondary outcome measures included health status (based on the physical and mental health composite scale scores from the 12-item Short-Form Health Survey) (45, 46), quality of life (based on the Quality of Well-Being scale) (47–50), and satisfaction with care (based on the Consumer Assessment of Healthcare Providers and Systems) (51).
Patients were the unit of the intent-to-treat analysis. Clinic-level intraclass correlation coefficients for HSCL change scores were not significant. Provider-level intraclass correlation could not be calculated because patients could have multiple primary care providers. For the hypotheses examining fidelity, separate logistic regressions were specified for the first 6 months and the second 6 months. For the hypotheses examining other outcomes, we used mixed models and included data from all completed research assessments (52). Case-mix variables were selected using the method of purposeful selection (53). Case-mix variables with missing values were imputed using the PROC MI procedure in SAS, version 9.3 (SAS Institute, Cary, N.C.). PROC MIXED and PROC GLIMMIX were used with the PROC MIANALYZE procedure to model outcomes with linear, binomial, negative binomial, or ordinal distributions. All models specified clinic as a random effect to control for intraclass correlation coefficient. Time was included as a fixed effect. The model specifications included main effects for group and time (with practice-based collaborative care assigned as the reference group) and interaction effects for group by time. The main group effect was used to test the hypotheses for dependent variables not measured at baseline (e.g., treatment response). For dependent variables that were measured at baseline (e.g., HSCL score), group-by-time interaction effects were used to test the hypothesis that the rate of improvement differed across the two groups. Because there were multiple group-by-time interaction terms, an omnibus test was used to determine whether these variables collectively explained a significant amount of the variance in the dependent variable (54). If the omnibus test was significant at the conservative alpha level of 0.10, we report group differences and significance tests for each time period. Otherwise, we report group differences averaged across the time periods and one significance test. The analysis had an 85% power to detect a 15% difference (e.g., 30% versus 45%) in response rates.
The study participants' socioeconomic and clinical characteristics are summarized in Table 1. Two-thirds (64.5%) were unemployed, 69.7% had an annual household income <$20,000, 50.8% were uninsured, and 68.1% lived in a rural area. At baseline, 83.2% met diagnostic criteria for major depressive disorder, and the mean HSCL score was 1.9, indicating moderately severe depression. The mean number of chronic physical health disorders was 4.6 (SD=2.6), and psychiatric comorbidity was common. Mean physical and mental health composite scale scores were nearly two standard deviations below those for the general population. Nearly half (48.4%) were already receiving depression treatment at enrollment, indicating treatment resistance.
a There were no significant differences between groups, except as otherwise noted. Some numbers do not add up to total number of patients because of missing data, and some percentages do not add up to 100 because of rounding.
b Numbers in parentheses indicate the possible range.
c Percentages do not add up to 100 because some patients had more than one type of insurance.
d Significant difference between groups, p=0.01.
e Significant difference between groups, p=0.05.
Table 2 describes care manager fidelity. At the 6- and 12-month follow-ups, significantly more patients in the telemedicine-based group than in the practice-based group reported that a health care professional other than their primary care provider 1) gave them helpful information about depression or depression treatment (odds ratios, 2.77 at 6 months and 2.32 at 12 months); 2) made helpful suggestions about things they could do to help depression, such as exercise or becoming more socially active (odds ratios, 3.47 at 6 months and 2.50 at 12 months); 3) asked them about their depression symptoms (odds ratios, 3.60 at 6 months and 2.63 at 12 months); and 4) asked them if they were taking antidepressant medications as prescribed or attending scheduled counseling sessions (odds ratios, 4.70 at 6 months and 3.96 at 12 months). More patients in the telemedicine-based group also reported that their primary care provider worked collaboratively with a mental health specialist (odds ratios, 4.63 at 6 months and 9.05 at 12 months).
a Based on the question "How often did a health care professional other than your primary care physician give you helpful information about depression or depression treatment?"
b Based on the question "How often did a health care professional other than your primary care physician make helpful suggestions about things you can do to help depression, such as exercise or becoming more active socially?"
c Based on the question "How often did a health care professional other than your primary care physician ask you about your depression symptoms?"
d Based on the question "How often did a health care professional other than your primary care physician ask you whether you were taking antidepressant medications as prescribed or attending scheduled counseling sessions?"
e Based on the question "How often did your primary care physician work together with a mental health specialist to care for your depression symptoms?"
f Model did not include a random effect to control for intraclass correlation coefficient because when included, the variance-covariance matrix was not positive definite, indicating not enough variation in the dependent variable attributable to variation in the random effect.
g Antidepressant analysis conducted on subsample of 187 patients. Counseling analysis conducted on subsample of 42 patients.
Compared with patients in the practice-based group, those in the telemedicine-based group had significantly more depression care manager encounters in which Patient Health Questionnaire depression severity scores were documented in the medical record during both the first 6 months and the second 6 months (incidence rate ratios, 4.10 and 4.64, respectively). Patients in the telemedicine-based group also had significantly more depression care manager encounters in which self-management goals were documented during the first 6 months (incidence rate ratio=5.62). Among patients who received a prescription for an antidepressant, those in the telemedicine-based group had significantly more depression care manager encounters in which medication adherence was documented during both the first 6 months and the second 6 months (incidence rate ratios, 2.69 and 2.49, respectively). Likewise, patients in the telemedicine-based group who received a prescription for an antidepressant had significantly more depression care manager encounters in which the presence or absence of side effects was documented during both the first 6 months and the second 6 months (incidence rate ratios, 4.22 and 4.46, respectively). Among patients who were referred to counseling, there were no significant group differences in the number of depression care manager encounters in which session attendance was documented in the medical record.
Among patients in the telemedicine-based group who failed to respond to at least one medication trial (N=73), 8.2% (N=6) had a telephone encounter with the pharmacist. Among those who had failed to respond to two trials (N=29), 48.3% (N=14) had a telepsychiatry consultation. Another seven patients had an ad hoc telepsychiatry consultation. Also, 16.6% of patients (N=30) attended at least one telepsychotherapy session, and 7.8% (N=14) completed eight or more sessions.
Table 3 summarizes the treatment provided to the two groups. There were no significant group differences at baseline, and no significant group-by-time interactions for number of primary care visits or number of depression-related primary care visits, or mental health visits. With respect to antidepressant treatment, there were no significant group main effects for receiving an antidepressant prescription, number of prescribed antidepressants, dosage level (starting, usual, high), or adherence.
a Number of primary care visits during which depression symptoms were discussed.
b Any visit to a mental health specialist, either face-to-face with a provider in the community or via videoconferencing with a study telepsychologist or telepsychiatrist.
c Adherence coded as 1 if taking antidepressant ≥80% of days in past month, and 0 otherwise.
d Analysis conducted on the subsample of patients with an active antidepressant prescription and not reporting antidepressant discontinuation as a result of primary care physician instruction; at the 6-month follow-up, N=187; at the 12-month follow-up, N=166; and at the 18-month follow-up, N=150.
e Analysis conducted on the subsample of patients with an active antidepressant prescription with nonmissing dosages; at 6-month follow-up, N=190; at 12-month follow-up, N=171; and at 18-month follow-up, N=148.
Clinical outcomes are presented in Table 4. A significant group main effect was observed for both response (odds ratio=7.74) and remission (odds ratio=12.69), with patients in the telemedicine-based group having better outcomes. We also observed a significant overall group-by-time interaction effect for HSCL score (χ2=40.51, df=3, p<0.001), with greater reductions in severity for patients in the telemedicine-based group (Figure 1). There was also a significant overall group-by-time interaction effect for mental health composite scale score (χ2=11.46, df=3, p=0.01) and Quality of Well-Being score (χ2=6.55, df=3, p=0.09), with greater improvements among patients in the telemedicine-based group. There were no significant overall group-by-time interaction effects for physical health composite scale score, although this finding is likely an artifact resulting from the orthogonal factor rotation and negative weights used to score the physical and mental health composite scales (55). There were no group differences in satisfaction at baseline, but the omnibus test of the group-by-time interactions was significant at the 0.10 level (χ2=6.69, df=3, p=0.08), with the telemedicine-based group having higher satisfaction.
a Satisfaction coded 1 if patient reported very satisfied or satisfied and 0 if patient reported very dissatisfied, dissatisfied, or neither satisfied or dissatisfied.
b Response coded 1 if patient experienced a reduction of ≥50% in depression severity according to the Hopkins Symptom Checklist, and 0 otherwise.
c Remission coded 1 if patient reported a Hopkins Symptom Checklist score <0.5, and 0 otherwise.
a The graph shows least square means of scores on the Hopkins Symptom Checklist. Least square means, or marginal means, are the estimated group means controlling for the covariates, which are held constant at their mean values. Error bars indicate 95% confidence intervals.
Study participants were recruited from small, remote primary care clinics associated with the largest publicly funded health care system in the country. The sample was predominantly rural, unemployed, and uninsured. Patients had numerous comorbidities, and their depression was treatment resistant. The high degree of treatment resistance likely contributed to the low response and remission rates among those assigned to the practice-based collaborative care group. Compared with patients assigned to the practice-based collaborative care group, those in the telemedicine-based group had significantly and substantially greater treatment response rates, remission rates, reductions in depression severity, and increases in mental health status and quality of life. Improved outcomes were achieved in the telemedicine-based group without increasing the number of primary care visits. Improved outcomes appear to be due to higher fidelity to the care manager protocol in the telemedicine-based collaborative care model, despite the fact that off-site and on-site depression care managers had similar levels of clinical experience at baseline and underwent identical training. The higher fidelity to the care manager protocol in the telemedicine-based model may have been due to the fact that the off-site depression care manager practiced under more intensive clinical supervision and dedicated 100% of her time to depression care manager activities.
The greater fidelity to the care manager protocol did not translate into improvements in the quality of pharmacotherapy for the telemedicine-based group. The majority of patients in both groups initiated antidepressant treatment at therapeutic dosages, and adherence was high. Likewise, the psychotherapy available to patients in the telemedicine-based group via videoconferencing was not highly utilized and was not likely to have contributed substantially to improved outcomes. Our findings were essentially unchanged when patients who received telepsychotherapy were excluded from the analytical sample. Because group differences in outcomes are not likely to be attributable to either pharmacotherapy or psychotherapy, we hypothesize that patients assigned to telemedicine-based collaborative care were more likely to engage in self-management activities, such as physical, rewarding, and social activities. This hypothesis is based on the finding that patients in the telemedicine-based group received more encouragement from the depression care manager to engage in self-management activities. Previous research has demonstrated that behavioral activation is a clinically effective stand-alone treatment for depression (56, 57). Also, patients in the practice-based collaborative care intervention in Project Impact (58) were found to have significantly better treatment response rates if the depression care manager documented in the medical record that the patient scheduled physical, rewarding, and social activities. This hypothesis needs to be tested using an experimental dismantling study specifically designed to estimate the incremental treatment effect of scheduling self-management activities. Another possibility is that the more frequent depression care manager encounters provided to the telemedicine-based group resulted in greater social support, which in turn reduced depressive symptoms. This was the conclusion of Hunkeler et al. (59), who similarly reported that a depression care manager program at Kaiser Permanente did not improve antidepressant management, but did reduce depression symptoms.
An inherent limitation of this pragmatic trial is that the results are not conclusive with respect to identifying treatment mechanisms. Explanatory trial designs are needed to determine why patients assigned to receive telemedicine-based collaborative care had better outcomes than those assigned to receive practice-based collaborative care. However, for policy makers at HRSA and federally qualified health centers lacking on-site mental health personnel, these results clearly indicate that contracting with an off-site depression care team yields better depression outcomes than implementing collaborative care with staff available on-site. Future research should also examine whether having on-site nurse care managers supported by off-site psychiatrists, psychologists, and pharmacists via telephone and videoconferencing is an effective organizational approach to delivering collaborative care.
The authors gratefully acknowledge the patients and staff at the Boston Mountain Rural Health Center, Community Clinic NWA, Corning Area Healthcare, East Arkansas Family Health Center, and Jefferson Comprehensive Care Systems, as well as staff at the Community Health Centers of Arkansas. They also acknowledge the important contributions of project staff, including Amanda Davis, Loretta Ducker, Debbie Hodges, Choi Lai, Liya Lu, Michael McCarther, Camille Mack, Jennifer Stephens, and Vera Tate, as well as the contributions of the anonymous manuscript reviewers.
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Don't you dare forget!
My name is Benjamin.
My pass time is spent ether driving, watching movies, smoking, listening to music or playing video games.I drive a Audi A6. sports suspension, 19" rims, Stage 2 tune. Also drive a TDI jetta, she is my daily driver. Currently work full time in tech support, and part time at Old navy.


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Wednesday, 15 June 2011 12:47
Johnny E. Swafford age 44 passed away unexpectedly on Thursday morning, June 9, 2011 after a motorcycle accident. He was a resident of Franklin. He was born December 6, 1966 in Franklin to Rev. Bobby & Rosetta (Hobbs) Swafford. Johnny attended school in Brown County and was a member of Blue River Church Separate Baptist Church. He is survived by his loving mother: Rosetta Swafford of Franklin, two daughters: Elizabeth Elaine (husband, Joshua) Billeaudeaux of Franklin & Victoria Rose Swafford of Indianapolis. Johnny was the brother to: Juanita (husband, Ronnie) Bowles and Patricia Hogue both of Franklin & Ronald (wife, Natalie) Swafford of Brown County. He was grandpa to Kailey Grace Billeaudeaux. Johnny will be remembered by his long time companion: LaLeaka Swafford of Indianapolis and his nieces and nephews: Brandy & Jacob Hogue, Alisha, Bobby & Evan Savage and Christopher Bowles. Johnny was preceded in death by his father: Rev. Bobby Swafford, one brother: Jimmy Swafford and a brother in law: Ricky Hogue. He was a 25-year member of the International Union of Operating Engineers Local 103 in Indianapolis. Johnny retired as a Superintendent for Gradex Construction in Indianapolis and prior to that worked for Central Engineering in Indianapolis for many years. He enjoyed riding his motorcycle, playing golf and was a fan of NASCAR. He loved spending time with his daughters and especially his new granddaughter: Kailey Grace. The Rev. Jarrod Becknell will conduct a funeral service 2 PM Monday at Britton Funeral Home 27 Old US 421 in Manchester, KY. Friends may call from 2 to 8 PM Saturday at Meredith- Clark Funeral Home Cremation & Personalization Center, 179 E. Mulberry Street, in Morgantown and from 11:00 AM till service time on Monday at Britton Funeral Home. Interment will be at Swafford's Branch Family Cemetery. Expressions of caring and kindness can be made to the Swafford Family at www.meredith-clark.com
Information: (812) 597-4670
Last Updated on Wednesday, 15 June 2011 12:47
Wednesday, 15 June 2011 12:46
James Lee Hacker, 72, Lexington, passed away Friday, June 10, 2011. Born in Oneida, Kentucky, he was the son of the late Millard Hacker, and Myrtle Bowles Hacker. Survivors include one brother; Dr. William Douglas (Kaye) Hacker, Lexington, KY, two nieces; Sharon Mazetta (Dr. Kyle) Childers, Lexington, KY, and Millicent Pate (Todd) Childers, Corbin, KY, one nephew; Douglas Millard (Neeley) hacker, Glendale, KY, and six great nieces and nephews. Services were held Saturday, May 11 at Kerr Brothers Funeral Home – Main St. Burial was in Lexington Cemetery.
Last Updated on Wednesday, 15 June 2011 12:46
Wednesday, 15 June 2011 12:45
The family of T.J. Hibbard would like to express our deepest appreciation to everyone for their thoughts, prayers, food, kind words & deeds. A special thanks to the staff of Laurel Creek Health Care for taking such good care of our husband/daddy. Thanks to Reverend Johnny Adamson and Jerry Hacker for the special words of remembrance. Manchester Gospel Mission for the beautiful music and the pallbearers especially, Thomas Smith his namesake. Much love and thanks to Pleasant Run Church for your kindness, concerns and the special meal after the service. Thanks to Rominger Funeral Home for your kindness.
The Family of T.J. Hibbard
Billie Jean, Bob, Kathy & Families
Last Updated on Wednesday, 15 June 2011 12:46
Wednesday, 15 June 2011 12:44
Emma Spurlock, 79, of Horse Creek, passed away Wednesday at the Manchester Memorial Hospital. She is survived by her husband, Robert Spurlock and the following children: Roy Lee Spurlock, Dayton, Ohio, James Spurlock & Wife Ann, Tyner, KY, Carl Gene Spurlock & Wife Vonda, Clara France & Husband, Lester Jr., all of Manchester, Glenn Spurlock & Wife Alice, Woolum, KY, and Evelyn Hensley & Husband David, Hamilton, Ohio. She is also survived by 14 grandchildren, 11 great grandchildren, and the following brothers & sisters: James Roberts, Burnside, KY, Nelson Roberts Jr., South Carolina, Donald Roberts, Pennsylvania, Billy Roberts, Matamoura, IND., Malvery Wright, Hamilton, Ohio, Martha Beaver, New Palistine, IND & Minnie Jones, Brookville IND. She was preceded in death by her parents, Nelson & Laura Gilbert Roberts and 2 sons, Jimmy Ray Roberts & Millard Sherdon Roberts. Funeral services for Emma Spurlock were held Saturday at 11:00 AM at the Britton Funeral Home Chapel with George Roberts, Lyle Sizemore, Don Hubbard & Sill Lee officiating. Burial followed at the Vaughn Cemetery at White's Branch. Visitation was Friday evening at the Britton Funeral Home.
Last Updated on Wednesday, 15 June 2011 12:45
Wednesday, 15 June 2011 12:43
Armilda Hoskins, 76, of Manchester, passed away Saturday at the Jackson Manor Nursing Home at Annville.
She was a member of the Pleasant Point Baptist Church.
She was survived by 2 children, James Hoskins & Wife Susie, of Nancy, KY. & Linda Robinson & Husband Larry of Tyner, KY.
She is also survived by 2 Grandchildren, April Renee' Robinson & John Shelby Hoskins & 1 great grandson, Jaydon Austin James Hoskins, 1 brother, Roscoe Gray, London & Clyda Hubbard, Goose Rock.
Funeral Services for Armilda Hoskins will be held Tuesday at 3:00 PM at the Britton Funeral Home Chapel with Barry Hubbard officiating. Burial will follow at the Manchester Memorial Gardens.
Visitation will be after 12:00 noon Tuesday at the Britton Funeral Home.
She was preceded in death by her husband, Charlie Hoskins & her parents, John & Allie Gray.
Last Updated on Wednesday, 15 June 2011 12:44
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National Opera Association Membership
Opera Production Competition
Reminder that the deadline for entries in the Opera Production Competition is June 30, 2014. There is a new electronic video submission process, so make sure to read the instructions carefully!
Eligible productions are those presented between June 1, 2013, and June 15, 2014. The submitting institution or a member of the production staff must be an NOA member.
Posted by: severtki
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Main Content
Whether it's action sports or kickin' it at a party, you're always playing hard! But when it comes time to choose quality boardshorts, you don't play. Make sure you provide yourself with the right equipment for however you play by rockin' the Fader boardshort from Fox. As the name implies, Fox's Fader Boardshorts have a killer fading color-scheme amidst aggressive lines and a durable and comfortable Micro Suede construction. Hit the waves with confidence!
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- Antique Jewelry
- The Ages
- Engagement Rings
- Antique Rings
- Diamond Jewelry
- So Much More
Magnificent Citrine Dinner Ring
During the course of the history of jewelry converting a piece of jewelry from one type to another was a frequent occurrence. It was routine to change out gemstones as well as entirely transform the jewel. Here we have a modern interpretation of the practice in the guise of a ring which was formerly a brooch.
The top cluster is circa 1880 and features a very large oval faceted citrine (18 mm by 25 mm) of an estimated 24 carats. The golden gem is a tiger lily citrine with bright orange highlights and is complemented by its 14k yellow gold bezel setting with scalloped edge and framed with a triple corded gold rope border. The outer surround is configured with a gold cannula or tube wound with double lengths of twisted gold wire. The tiered top has been fashioned with a modern under gallery and shank of 14k yellow gold with side details similar to that of a classic antique column of a scroll design.
Date: Top cluster is circa 1880; under gallery and shank are modern.
Measurements: 1-1/2 of an inch (3.7 cm) in length north to south on the hand and rises 1/2 of an inch (1.2 cm) in height off the finger. Weight of 25.4 grams (16.3 dwt).
Ring Size: US 9-3/4 (UK T; Euro or Int. Circum. 61.4 mm; Int. Dia. 19.6 mm; Japan over 19) and easily can be sized to fit most. Ring sizing information.
Hallmarks: 14k to modern shank.
Condition: Excellent; top has been converted from a Victorian brooch; shank is modern and new.
Origin: Shank is American.
Note: Gemstone was not removed to preserve the integrity of the setting. Weight is approximated by measurement and formula and may vary from actual weight.
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Layaway information and for full details see Payment Methods.
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This page contains Bleach: Soul Carnival 2 Unlockables for PSP called "Released Ulquiorra Form" and has been posted or updated on Dec 16, 2009 by torello33. Let us know what you think of this Unlockable by thumbs voting.
- Developer: Racjin
- Publisher: SCEI
- Genre: Role-Playing Action RPG
- Release Date: Dec 10, 2009
- ESRB: Not Set
Released Ulquiorra Form
These are the following requirements: 1.Complete all maps. (100%) to unlock stage 36. 2.Beat stage 36 (Ichigo vs. Ulquiorra) 3.Equip Ichigo as a supporter and link with Ulquiorra 4.Finally press L to change form into Ulquiorra (Released)
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Why Cable TV in Sevier, UT
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If you thirst for cable TV knowledge, we can help. CableTV.com has cold-filtered cable data on tap and ready for consumption. Try this (it's on the house): almost everyone, or 97% of Americans, watches television as it is aired and roughly 33% of those TV viewers have at least four televisions in their homes. Upwards of 50% of people also stream video content online. Among those with cable TV, almost three-fourths bundle their service with high-speed Internet. Cable's ubiquitous national presence also helps explain how DVRs account for about 7% of America's total TV viewing.
All those stats mean that if you don't own at least one TV for every room in your house, chances are your neighbor to the left or right of you does. It also means that almost everyone you meet today will watch a TV tonight, and 57% of them will use either their DVR or their Internet to do so.
About Sevier Cable Internet
Cable providers have so much more to offer than TV. That is why so many Sevier residents bundle cable services. Cable Internet is faster than most DSL services, providing downstream speeds 25%-100% faster than the national average. People who choose cable bundles also save money, roughly $400 every year they bundle TV and Internet. Both are very good explanations why cable Internet subscribers represent 32% of households, and how broadband penetration in Utah grew to 80% by 2010. Enter your zip code to find out more about cable Internet, bundles and providers in Sevier.
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Alex O'Laughlin was recently included in TV.com's Most Popular Actors list for his portrayal of Lieutenant Commander Steve McGarrett in the popular CBS series "Hawaii Five-O," which you can catch on CBS. Alex was born Alexander O'Lachlan in Canberra, Australia in 1976. His previous television roles include Det. Kevin Hiatt in "The Shield" and Mick St. John in "Moonlight," which are fan favorites in Sevier, UT. He is a 2002 graduate of Australia's prestigious National Institute of Dramatic Art and currently resides in Hollywood, California.
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