text:
Piechoski named as new USABS Board of Directors chairman
June 27, 2015
COLORADO SPRINGS, Colo. (June 27, 2015)- USA Bobsled & Skeleton (USABS) announced Pete Piechoski as the organization's newest Board of Directors chairman on Friday. Piechoski will take over for former chairman John Rosen, who steps aside after serving six years as chairman.
USABS national team camp photo gallery
June 25, 2015
The USABS national team participated in camp at the Colorado Springs Olympic Training Center June 23-27. Check out all the action by clicking on the photo gallery.
Bobsled duo takes time to speak with future minority leaders
June 16, 2015
USA Bobsled athletes Elana Meyers Taylor and her husband, Nic Taylor were married last April. Both world-class athletes, Meyers Taylor and Taylor don't live the ordinary married life, but they definitely make it work. After their wedding, the couple launched right into preparing for the 2014-2015 season, where they made history together. Meyers Taylor became the first female to pilot a four-person bobsled in an international competition. Taylor joined her in the historic sled.
Photo Gallery Ajoku, Garrett and Koplin lend a helping hand in Mexico
June 15, 2015
Check out images from Maureen Ajoku, Cherrelle Garrett and Kristi Koplin's trip to Mexico.
Ajoku, Garrett and Koplin lend a helping hand in Mexico
June 15, 2015
The bobsled and skeleton sliding season ended with the National Championships in March earlier this year. As you may imagine, as a world-class athlete, it isn't enough to just train during the season. Instead, USA Bobsled & Skeleton athletes spend endless hours training around the calendar, whether it is the middle of the offseason in June or the middle of the season in January. But three USA Bobsled athletes, Cherelle Garrett, Kristi Koplin and Maureen Ajoku, took time out of their training regiments to do something that they felt was of the upmost importance.
The developer of bobsled nations
June 12, 2015
Patrick Brown was in his high school science class as a 17 year old, when he learned something that altered the course of his life. Contrary to what you are probably thinking, it wasn't anything related to the class curriculum.
#TeamUSATuesday in 10 photos
May 26, 2015
Sometimes pictures can express our thoughts and feelings better than words. As we celebrate #TeamUSATuesday, we take a look at 10 images that best express what it means to be a part of USA Bobsled & Skeleton and represent our great nation!
From Florida to Olympic glory: The story of Brian Shimer
May 21, 2015
Bobsled wasn't on Brian Shimer's radar as a young kid growing up in southern Florida. After all, it's hard to get into a sport that features winter and lots of ice, two things that look very different in Florida. Sure, there is wintertime, when the temperature drops into the low 60s. And there is definitely ice in Florida. Ice is used to cool off beverages on a hot, sunny day. There is certainly no bobsled in the Sunshine state, but there is absolutely football, which gave Shimer his first passion in the sporting world.
USABS Board of Directors proposes bylaw amendments
May 12, 2015
As stated in my earlier message a few months ago, the Board of Directors of USABS have proposed changing the designation of the board's Technical Director and Club Director to be Sport At-large Directors.
Vote for your favorite photo!
May 11, 2015
Make sure to visit our homepage, www.usabs.com to submit your vote for your favorite photo. Be sure to share this page with your friends and followers on social media and check back on Thursday for the results!


text:
NPR Newscast
4min 45sec
October 31, 2013 A panel of the 5th Circuit Court of Appeals says the state can go ahead with implementing the new restrictions, which require abortion doctors to have admitting privileges at a hospital within 30 miles of their practice.
October 31, 2013 Health officials said that they were mistaken about a polio outbreak in Somalia spreading to South Sudan. Despite previous reports, South Sudan has not recorded any polio cases this year. The new information means that the spread of the virus around the Horn of Africa is more limited than previously thought.
Students Amanda McComas, Rose Marie Chute and Sari Schwartz are approached in October at Santa Monica City College in California about signing up for insurance with the Affordable Care Act.
Robyn Beck/AFP/Getty Images
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October 31, 2013 The success of the Affordable Care Act rests in part on getting young, healthy people to purchase coverage. But despite marketing attempts to reach them, some young people feel they're too healthy or cash-strapped to buy something they say they're unlikely to need.
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This shop in the GrowNYC Greenmarket in New York's Union Square accepts Electronic Benefits Transfer (EBT), or food stamp benefits.
Andrew Burton/Getty Images
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October 31, 2013 Starting Friday, a family of four will receive $36 less each month in benefits from the federal Supplemental Nutrition Assistance Program.
October 31, 2013 Texting terms of endearment seems to shore up relationships. Affectionate affirmations help mitigate hurts and frustrations, a study finds. But men who get flooded with texts from their significant other tend to say the relationship is unsatisfactory. Women tend to say the more texts the merrier.
Halloween candy is offered for sale at a Walgreens store on September 19, 2013 in Wheeling, Illinois.
Scott Olson/Getty Images
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October 31, 2013 The National Confectioners Association says weather was one factor in keeping Halloween candy sales flat for the last two years. But could consumers also be heeding the messages to cut back on sugar and empty calories?
October 31, 2013 Breast Cancer Awareness Month in the U.S. is a fanfare of pink paraphernalia. But in developing nations like Uganda, cancer is stigmatized to the point that families often lie about their loved one's cause of death. Host Michel Martin speaks with journalist Joanne Silberner about her award-winning reporting on cancer around the world.
<iframe src="http://www.npr.org/player/embed/242105914/242105916" width="100%" height="290" frameborder="0" scrolling="no">
October 31, 2013 The Obama administration is defending the Affordable Care Act over its faulty website, and reports that Americans are losing insurance coverage because of the law. To sort out the truth from the rumors, host Michel Martin speaks with Mary Agnes Carey of Kaiser Health News and technology developer Clay Johnson.
<iframe src="http://www.npr.org/player/embed/242105911/242105913" width="100%" height="290" frameborder="0" scrolling="no">
These HIV viruses even look a little like bull's-eyes.
A. Harrison and P. Feorino/CDC
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October 31, 2013 A monkey virus that's a stand-in for HIV plummeted to undetectable levels when animals got potent antibodies of a type recently discovered in some humans. A single antibody injection was enough to do the job.
"I apologize," Health and Human Services Secretary Kathleen Sebelius said Wednesday at a congressional hearing on problems with HealthCare.gov.
J. Scott Applewhite/AP
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October 31, 2013 Twin embarrassments framed HHS Secretary's Kathleen Sebelius' day Wednesday on Capitol Hill. Criticism over the rocky rollout of the HealthCare.gov website was expected. But Sebelius also had to answer questions about insurance companies canceling policies for people who buy their own coverage.
<iframe src="http://www.npr.org/player/embed/241907309/242028722" width="100%" height="290" frameborder="0" scrolling="no">
October 31, 2013 Sesame Street is waiving licensing fees for two years so its characters can join forces with the Produce Marketing Association and first lady Michelle Obama's campaign against childhood obesity. On Thursday, Sesame Street's Rosita and Elmo announced the partnership with the first lady.
<iframe src="http://www.npr.org/player/embed/242028456/242028721" width="100%" height="290" frameborder="0" scrolling="no">
Rep. Mike Rogers, R-Mich., asks about website security questions Wednesday at a House Energy and Commerce Committee hearing on problems with HealthCare.gov.
Chip Somodevilla/Getty Images
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October 31, 2013 To the long list of problems plaguing HealthCare.gov, add data security. The enrollment site for the new health insurance exchanges had a security flaw that didn't get patched up when the exchange marketplace went live.
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Gilroy Hain's only source of income is the $1,500 a month he receives from Social Security.
Ina Jaffe/NPR
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October 31, 2013 Gilroy Hain's only source of income is the $1,500 a month he receives from Social Security. The 64-year-old spends $500 a month for a rented bedroom in Los Angeles, and the rest goes for food and little indulgences. For the former aerospace industry worker who was homeless for a time, it's not an easy life.
<iframe src="http://www.npr.org/player/embed/236305692/242028439" width="100%" height="290" frameborder="0" scrolling="no">
A smoker in New York City in April.
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October 30, 2013 The law, which Mayor Michael Bloomberg has promised to sign, would make New York one of a very few U.S. cities to adopt such strong restrictions.
One person who got a letter canceling his health insurance was Rep. Cory Gardner, R-Colo. He holds up the letter during a congressional hearing Wednesday on insurance problems. He says his family chose to buy private insurance rather than use the congressional plan.
J. Scott Applewhite/AP
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October 30, 2013 President Obama repeatedly said that anyone who likes their current health insurance policy would be able to keep it. But insurers have sent hundreds of thousands of cancellation notices to people who buy their own coverage — and some of them face significantly higher costs to get new policies under the Affordable Care Act.
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ENN CommunityENN Community
Featured AffiliateECOreport
Trouble Brews in Germany as Biofuel Boom Jacks Up Price of Beer
May 28, 2007 12:00 AM - Kirsten Grieshaber, Associated Press
In the last two years, the price of barley has doubled to euro200 (US$271) from euro102 per ton as farmers plant more crops such as rapeseed and corn that can be turned into ethanol or bio-diesel, a fuel made from vegetable oil.
Do Trees Make It OK to Drive an SUV?
May 28, 2007 12:00 AM - Michael Hill, Associated Press
If you plant some trees, is it OK to drive an Escalade? The question isn't as silly as it sounds. People worried about global warming increasingly are trying to "offset" the carbon dioxide _ the leading greenhouse gas _ they spew into the atmosphere when they drive, fly or flick on a light.
Costa Rica Aims To Win Carbon Neutral Nation Race
May 25, 2007 12:00 AM - John McPhaul, Reuters
Green trail-blazer Costa Rica is drawing up plans to cut its net greenhouse gas emissions to zero before 2030, the government said Thursday, and aims to be the first nation to offset all its carbon.
Killer Hurricanes Thrived in Cool Seas
May 24, 2007 12:00 AM - Timothy Gardner, Reuters
Hurricanes over the past 5,000 years appear to have been controlled more by El Nino and an African monsoon than warm sea surface temperatures, such as those caused by global warming, researchers said Wednesday.
Two-Base EU Parliament Seeks Carbon Neutral Status
May 23, 2007 12:00 AM - Reuters
The European Parliament, accused of contributing to climate change by holding sessions in both France and Belgium, discussed proposals on Tuesday aimed at cutting its carbon dioxide (CO2) emissions.
Study Shows that Climate Change Could Harm Crops
May 23, 2007 12:00 AM - Ariel David, Reuters
Climate change could drive many wild relatives of plants such as the potato and the peanut into extinction, threatening a valuable source of genes necessary to help these food crops fight pests and drought, an international research group reported.
Film Stars and Their Green Credentials
May 22, 2007 12:00 AM - Reuters
Leonardo DiCaprio is in Cannes for its 60th film festival with "The 11th Hour," an environmental documentary and the latest product of Hollywood's growing concern over global warming.
World Growth Spurs Faster Climate Change, Report Says
May 22, 2007 12:00 AM - Michael Perry, Reuters
Global warming is occurring faster than predicted because rapid economic growth has resulted in higher than expected greenhouse gas emissions since 2000, said an Australian report on Tuesday.
Australian Foreign Minister Says Regional Carbon Trading Scheme Unlikely Soon
May 21, 2007 12:00 AM - Rod McGuirk, Associated Press
Chinese and U.S. opposition to international carbon trading make a regional scheme to place a price on pollution unlikely in the near future, Australia's foreign minister said Monday.
Polar Bears at Risk as Warming Thaws Icy Home
May 21, 2007 12:00 AM - Alister Doyle, Reuters
Time may be running out for polar bears as global warming melts the ice beneath their paws. Restrictions or bans on hunting in recent decades have helped protect many populations of the iconic Arctic carnivore, but many experts say the long-term outlook is bleak.


text:
Empty Netter Assists - 9-24-09
(Apologies for this being late today. G-20 duties kind of kicked our butts last night/this morning.)
-The 2009-10 version of Alex Goligoski (above) looks a lot more mature than the 2008-09 version.
-A repeat for the Penguins will be tough.
-The Penguins are bussing it to Columbus tonight.
-Someone compiled most of the Penguins' overtime goals from the past three seasons:
-Is Brian Strait the next Brooks Orpik or Rob Scuderi?
-According to RDS, former Penguins forward Michel "Miss-The-Net" Ouellet has signed with HC Freiburg Gottéron in Switzerland.
-Former Penguins defenseman Richard Lintner has joined HK Dukla Trencin in Slovakia.
-Happy 28th birthday to former Penguins forward Tomas Surovy. During last season's IIHF World Championship, Surovy, a member of Team Slovakia, smacked his goaltender, Jaroslav Halak, in the head after he gave up a poor goal to the Czech Republic:
Atlantic Division
-Despite a right knee injury, Rangers forward Sean Avery is expected to be ready for his team's season opening game at Mellon Arena.
-Does anyone want the Islanders?
-The Islanders demoted forwards Sean Bentivoglio, Justin DiBenedetto, Tyler Haskins, Jesse Joensuu, Tony Romano and goaltender Nathan Lawson to Bridgeport of the AHL.
-A goal and an assist from Niklas Bergfors helped the Devils beat the Islanders, 4-2.
-Islanders defenseman Mark Streit tagged Devils tough guy Andrew Peters with a big hit then "fought" Olivier Magnan-Grenier:
Northeast Division
-"I can do anything and I still can't get a six-pack." -Bruins forward and fomer Penguin Mark Recchi on his physical condition.
-Hall-of-Fame defenseman Brad Park slammed the NHLPA for firing Paul Kelly as the association's leader and took Bruins defenseman and former Penguin Andrew Ference to task for comments critical of Kelly.
-The Bruins demoted defensemen Jeff Penner, Andrew Bodnarchuk, goaltender Kevin Regan and forward Jamie Arniel to Providence of the AHL.
-Former Canadiens defenseman Patrice Brisebois officially retired.
-Someone thought the world had gone on long enough without a 600-foot tall image of Canadiens legend Jean Beliveau in a cornfield in New Brunswick.
-Former Wilkes-Barre/Scranton Penguins defenseman Matt Carkner has had a strong training camp with the Senators.
-As we've seen the past week or so, forward Viktor Stahlberg has had a strong preseason for the Maple Leafs.
-Ryan Miller made 23 saves for the Sabres in a 3-2 defeat of the rival Maple Leafs.
-Check out this gutsy all-out effort by Toronto's Tyler Bozak to prevent one of us:
Southeast Division
-The Panthers named defenseman Bryan McCabe as their next captain.
-Florida demoted assigned the following players defensemen Peter Aston, Clay Wilson, Luke Beaverson, Michael Caruso, James DeLory, Matt Duffy, Keaton Ellerby, Jordan Henry, forwards Evgeny Dadonov, David Brine, Brady Calla, Jamie Johnson, Kenndal McArdle, Graham Mink, Andrew Sweetland, Victor Oreskovich, goaltender Chris Beckford-Tseu, Tyler Plante to Rochester of the AHL, relseased forwards Mike York, Adam Keefe Eric Himelfarb and defenseman Martin Skoula and returned Scott Timmins to his junior team.
-Former Capitals goaltender Olaf Kolzig, a one-timer winner of the Vezina Tropy, officially announced his retirement. Kolzig, on the losing end of a few Penguins-Capitals playoff battles, was the goaltender who gave up this goal:
-The Staals are brothers. And now they're uncles (and a father).
-Mike Knuble and Alex Ovechkin each had two goals and an assist for the Capitals in a 6-2 rout of the Blackhawks.
-Josh Gratton scored two goals for the Thrashers in a 5-4 defeat of the Predators.
-A goal and an assist from Radek Dvorak helped the Panthers beat the Stars, 4-1.
Central Division
-Forward R.J. Umberger (right), a native of some dump near a couple of rivers, is expected to be in the Blue Jackets' lineup tonight against the Penguins despite a wonky hip flexor.
-Columbus forward Kristian Huselius (flu), defensemen Mike Commodore (flu, groin) and Marc Methot (hip flexor) are also dinged up.
-The Blue Jackets demoted goaltenders Dan LaCosta and Kevin LaLande to Syarcuse of the AHL.
-Columbus has brought in former Wild defenseman to camp on a tryout agreement.
-The Red Wings have brought in former Maple Leafs forward Brad May on a tryout basis.
Northwest Division
-Former Avalanche forward Peter Forsberg has signed a one-week contract with MoDo in Sweden and hopes to sign with an NHL team by Oct. 1.
-Wild goon Derek Boogaard is dealing with a concussion.
-Craig Anderson made 31 saves for the Avalanche who beat the Kings, 3-2.
-Two goals from Curtis Glenncross gave the Flames a 5-3 win against the rival Oilers.
Pacific Division
-New Sharks forward Dany Heatley (right) is a pretty polarizing figure.
-San Jose officially signed former Blue Jackets forward Manny Malhotra to a one-year deal worth $700,000.
-The Coyotes slashed tickets prices. Lower bowl seats can be had for $25
-Phoenix forward Francis Lessard has been suspended the rest of the preseason and three regular season games for an illegal hit on Ducks forward Ryan Donnally.
-Kings defenseman Sean O'Donnell has been suspended for the rest of the preseason and two regular season games for a cross check on Islanders forward Matt Martin.
-Rich Hammond of the Los Angeles Daily News, who provides one of the best beat blogs in the NHL at Inside The Kings, has been hired to produce content for the Kings.
-It turns out the Penguins might've dealt some damaged goods to the Thrashers two seasons ago when they acquired Marian Hossa. Forward Erik Christensen, currently with the Ducks, has had a shoulder ailment since before the trade.
-Shootout goals by Radim Vrbata and Peter Mueller gave the Coyotes a 4-3 win against the Lightning.
-Shootout goals by Alexander Edler and Mason Raymond gave the Canucks a 4-3 win against the Sharks.
-Check out Edler's and Raymond's goals:
Adams Division
-Check out Versus' campaign for it's opening night game between the Capitals and Bruins:
-Today would've been the 107th birthday of Albert Holway, a former defenseman with the NHL's Pittsburgh Pirates.
(Photos: Goligoski-Abelimages/Getty Images; Umberger-Bruce Bennett/Getty Images; Heatley-Jeff Gross/Getty Images)


text:
Rapid purification of microRNA from urine without phenol
|Cat. #
|Urine microRNA Purification Kit
|25 preps
Urine microRNA Purification Kit
Norgen's Urine microRNA Purification Kit provides a rapid method for the isolation and purification of small RNA molecules (< 200 nt) from urine samples. These small RNAs include regulatory RNA molecules such as microRNA (miRNA) as well as tRNA and 5S rRNA. Small RNA molecules are often studied due to their ability to regulate gene expression. Typically miRNAs are 20-25 nucleotides long, and regulate gene expression by binding to mRNA molecules and affecting their stability or translation. Several recent studies have shown that miRNA regulates cell growth and apoptosis. Furthermore, clinical and experimental analyses suggested that miRNAs may function as a novel class of oncogenes or tumor suppressor genes. MicroRNA expression profiles of different tumor types, relative to their normal tissues, have recently been shown to provide phenotypic signatures for particular cancer types. Unique patterns of aberrant miRNA expression may serve as molecular biomarkers for tumor diagnosis, prognosis of disease specific outcomes, and prediction of therapeutic responses.
Kit Specifications
Minimum Urine Input
0.5 mL
|Maximum Urine Input
1 mL
|Size of RNA Purified
< 200 nt
|Time to Complete Purification
< 30 minutes
Storage Conditions and Product Stability
All solutions should be kept tightly sealed and stored at room temperature. These reagents should remain stable for at least 1 year in their unopened containers.
Kit Components
|Feasibility of urinary microRNA detection in breast cancer patients and its potential as an innovative non-invasive biomarker.
|BMC Cancer. 2015.
|Thalia Erbes, Marc Hirschfeld, Gerta Rücker, Markus Jaeger, Jasmin Boas, Severine Iborra, Sebastian Mayer, Gerald Gitsch and Elmar Stickeler.
|Urinary microRNA-29 correlates with urinary albumin in type 2 diabetes mellitus.
|Chinese Journal of Nephrology. 2014.
|Meirong Z, Hui P, Wenbo Z, Cheng W, Jun Z, Xun L, Yuanqing L, Paudel S, Qianqian W, Tanqi L.
|Urinary miR-29 Correlates with Albuminuria and Carotid Intima-Media Thickness in Type 2 Diabetes Patients.
|PLoS One. 2013.
|Peng H, Zhong M, Zhao W, Wang C, Zhang J, Liu X, Li Y, Paudel S, Wang Q, Lou T.
Copyright © 2015 - Norgen Biotek Corp.


text:
Bugzilla – Bug 6650
Dispose not being called when exiting using block when using LLVM
Last modified: 2014-11-18 22:18:01 EST
Are you using the 'Use LLVM optimizing compiler' option ?
We are using LLVM.
And does turning that off fixes the problem ?
Yes, actually, it does.
Is anybody working on this bug? I gather from our discussion that this is a
problem with the LLVM compiler. Turning off LLVM is just not an option for us;
we are close to release, and as you can imagine, swapping out the compiler at
the last minute is a little risky. Can I get an update on what's being done on
this issue?
Committed a workaround to mobile-master in
What does that mean for us? When would this workaround be available in a
stable release?
Can somebody answer the question above ?
David: there should be another stable release (with this fix) at latest by the
end of next week.
This is not fixed, there is only a workaround. David, could you share the
binaries with email@example.com on google drive ?
Bug #7449 might be related to this one.


text:
US rapper Bow Wow has used the Sydney mansion of controversial Auburn deputy mayor Salim Mehajer to shoot his latest music video. Continue reading »
Australian DJ Alison Wonderland has taken to Facebook to call out two commenters who joked about raping her on social media. Continue reading »
Social media-savvy Prime Minister Malcolm Turnbull has shown that even he can get the Hemsworth brothers confused. Continue reading »
The TODAY Show hosts have recreated the opening sequence of the popular show Friends in a fun skit, each taking on the role of one of the shows iconic characters. Continue reading »
US Presidential hopeful Hillary Clinton has poked fun of herself and Republican rival Donald Trump during an appearance on the premiere of Saturday Night Live. Continue reading »
British pop star Ellie Goulding took to the stage this afternoon to perform at the AFL grand final, but a technical glitch has left some wondering if the singer was lip-synching. Continue reading »
This weekend will see AFL and NRL fans across the country crowding around televisions and into pubs for the much anticipated Grand Finals, but it will also see the latest in a long history of artists to brave the stage for the pre-game and half-time entertainment. Continue reading »
Former NRL star Beau Ryan returned to the NRL Footy Show for its Grand Final special last night after being absent following allegations of infidelity. Continue reading »
His name is Edward, and he's been cast out of mainstream society due to his actions – some call him a hero, others say he's a dangerous rebel who needs to be stopped. Continue reading »
Caitlyn Jenner will not be charged over a fatal chain-reaction crash on Malibu's Pacific Coast Highway earlier this year. Continue reading »
Singer Chris Brown has used twitter to state a case for his entry into Australia, saying he would "raise awareness about domestic violence". Continue reading »


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Bob Kravitz: Now it's time for Pacers to get greedy
May 12, 2013
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Bob Kravitz: Now it's time for Pacers to get greedy
Now it's time to get greedy. Now it's time for the Pacers to put the Knicks on their heels and send Spike Lee back to New York with nothing to show for his little vacation in Central Indiana. (Hope
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In Western Australia (WA), health policy recommends encouraging the use of active self-management strategies as part of the co-care of consumers with persistent low back pain (LBP). As many areas in WA are geographically isolated and health services are limited, implementing this policy into practice is critical if health outcomes for consumers living in geographically-isolated areas are to be improved.
In this prospective cohort study, 51 consumers (mean (SD) age 62.3 (±15.1) years) participated in an evidence-based interdisciplinary pain education program (modified Self Training Educative Pain Sessions: mSTEPS) delivered at three geographically isolated WA sites. Self report measures included LBP beliefs and attitudes (Back Pain Beliefs Questionnaire (BBQ); Fear Avoidance Beliefs Questionnaire (FABQ)), use of active and passive self-management strategies, and health literacy, and global perceived impression of usefulness (GPIU) recorded immediately pre-intervention (n = 51), same day post-intervention (BBQ; GPIU, n = 49) and 3 months post-intervention (n = 25).
At baseline, consumers demonstrated adequate health literacy and elements of positive health behaviours, reflected by the use of more active than passive strategies in self-managing their persistent LBP. Immediately post-intervention, there was strong evidence for improvement in consumers' general beliefs about LBP as demonstrated by an increase in BBQ scores (baseline [mean (SD): 25.8 (7.6)] to same day post-intervention [28.8 (7.2); P < 0.005], however this improvement was not sustained at 3 months post-intervention. The majority of consumers (86.4%) reported the intervention as very useful [rated on NRS as 7–10].
To sustain improved consumer beliefs regarding LBP and encourage the adoption of more positive health behaviours, additional reinforcement strategies for consumers living in remote areas where service access and skilled workforce are limited are recommended. This study highlights the need for aligning health services and skilled workforce to improve the delivery of co-care for consumers living in geographically isolated areas.
Persistent low back pain (LBP) is poorly managed and consequently the associated health and economic burden for consumers and for society are substantial [1,2]. For consumers with persistent pain (of which in Australia, LBP represents a significant proportion of the musculoskeletal contribution [1]), less than 10 per cent of patients gain access to effective management, yet according to recent international data, up to 80 per cent could feasibly receive effective care [2,3]. Furthermore, reliable data indicate that the burden of persistent pain for consumers and society can be markedly reduced when available evidence-based management is implemented [2,4].
Many factors contribute to this gap in healthcare for consumers with LBP, including the failure of evidence to be translated into best practice [5-7], an inadequately trained and skilled health workforce [8,9] and a lack of co-ordinated interdisciplinary care [10], the latter being a favoured model for consumers with persistent LBP [11]. To obtain effective care is difficult because persistent pain is often poorly understood by the general community, by educators, researchers and health professionals [3,12], often resulting in stigmatization and conditions not being legitimized [13,14]. While there is overwhelming neurobiological evidence of changes in the brain which typically underlie persistent pain [15-18], many health professionals still view consumers with persistent pain within a framework that is biomedical rather than biopsychosocial [19], thereby missing the importance of taking a whole person approach to pain management.
Additional disadvantage exists for consumers with persistent LBP who reside in geographically isolated regions, where there is even less access to evidence-based pain services and community support [12,20]. This is the case for many Australians, where a large landmass is populated with low densities of people, dispersed outside of urban centres, particularly in Western Australia (WA). In this study, we targeted three remote WA locations, which included Kununurra, Albany and Kalgoorlie. Taking the shortest travel route, these towns are situated 3206 kms, 595 kms, and 409 kms respectively away from the state capital Perth. Kalgoorlie and Kununurra lie in the most sparsely populated areas in the state, having a population density of less than 0.1 persons per sq km [21]. Developing innovative models of service delivery based on a contemporary perspective of persistent pain and aligning these models with a skilled workforce, is one strategy targeting the needs of people in these remote areas [22]. Integral to such a model of care for the management of persistent LBP is the facilitation of consumer use of active self-management strategies [23-25], as these are associated with significantly lower rates of health care utilization compared to solely using passive options [23,26].
The focus in this study was the implementation of an interdisciplinary model of care for consumers with LBP living in remote areas of WA using a previously established and consumer-oriented Self Training Educative Pain Sessions (STEPS) program [25]. In a tertiary setting, STEPS has demonstrated significantly reduced wait-times, costs per new patient episode and volume of outpatient appointments and in parallel, an increased utilization of active pain management strategies and increased patient satisfaction [25]. The aim of this project was to deliver and evaluate the effectiveness of a modified STEPS program (mSTEPS) to consumers with persistent LBP living in geographically isolated areas of WA.
Study design/setting/population
Consumers from three remote WA centres (Kununurra, Albany and Kalgoorlie) were invited to attend mSTEPS in their area through flyer advertisements distributed by Rural Health West (rural health medical services) and Arthritis and Osteoporosis WA, the peak advocacy organization for musculoskeletal disease in WA. The three mSTEPS interventions were run during 2010–2011. Those who consented to participate in the evaluation component of the intervention were enrolled in a prospective cohort study. Inclusion criteria required consumers to be able to give voluntary, informed consent for the collection of data and to have persistent LBP. Participants who were not fluent in written and spoken English were excluded from the study. The study was approved by the local Institutional Ethics Review Committees and adhered to the Code of Ethics of the Declaration of Helsinki.
Participation, consent and anonymity
Eighty consumers and carers registered and attended mSTEPS. Excluding carers from whom data were not collected, 55 consumers were recruited. Of this number, 4 were excluded, 3 of whom were blind and could not complete the data requirements and one of whom did not meet the inclusion criteria (no LBP). The remaining 51 consumers consented to use of their data for the purposes of this study.
At baseline and immediately prior to mSTEPS (i.e.; same day), consenting participants completed a uniquely-coded battery of questionnaires. The educational team remained blinded to the data collection, entry and analysis. At 2.5 months post-intervention, consumers were mailed a post-course questionnaire set with the same unique ID codes, with instructions to complete and to return within 2 weeks (i.e. by 3 months post). Non-responders were contacted by phone on not more than 2 occasions, to request the completion of the post-course questionnaires. In a related study, a subset of 14 of these 51 consumers drawn from each of the 3 locations were also purposively sampled and interviewed in order to better understand their experience of access to health information and services and use of self-management strategies [27]. To contribute to sustainability, the Albany mSTEPs intervention was captured on DVD and provided to mSTEPS consumers post 3 month data collection.
Study intervention
The mSTEPs program involved the same components as the original STEPS model [25], with the modules delivered in a more compressed format of 6.5 hours over a single day (these components are summarized and presented as Additional file 1).
Additional file 1. Components of the modified Self Training Educative Pain Sessions.
Format: DOCX Size: 12KB Download file
Outcome measures
A battery of self-report questionnaires was administered to participants at baseline, and this battery was repeated at 3 months after mSTEPS (Table 1). In addition, on the same day and immediately following mSTEPS, one measure related to back pain beliefs was repeated (Table 1) and participants were also asked to rate the usefulness of the intervention, as described below. To limit responder burden, and given the considerable time required for completion of the baseline battery of questionnaires (30–40 minutes at baseline), the same day post measures were limited to these 2 items. Additionally, it was anticipated that repeating the full battery at this time point would not provide any meaningful data at that time. The battery was designed to align with the core domains and measures of outcomes as outlined in the IMMPACT recommendations [28] and which, while directed at clinical trials, also have broad utility for all clinical pain research [29,30].
Table 1. Self report measures administered to consumers with low back pain
Demographic data
Consumers' age, gender, marital status, country of birth, language spoken, level of education, employment status, medical benefits eligibility, injury compensation status and injury litigation status were recorded.
Healthcare utilisation
Consumers were asked whether they had ever sought care for their back pain in the past and if so, to indicate from whom, by selecting from pre-specified categories of healthcare practitioners including doctors, allied health professionals and alternative practitioners, using an 'other' category [23,25].
Clinical data
Elements of the Nordic Musculoskeletal Pain Questionnaire [31] were used to confirm LBP prevalence and to measure pain duration. Mean LBP intensities (current; past week; past month) were measured using an 11 point numerical rating scale (NRS) of 0 to 10, with the left anchor 0 = no pain and the right anchor at 10 = maximal imaginable pain [32]. Consumers were asked to self-nominate up to 3 functional activities that they were unable to do or had difficulty with due to their LBP and to rate the level of difficulty using an 11 point numerical rating scale (NRS) of 0 to 10, with the left anchor 0 = unable to perform activity; and the right anchor at 10 = able to perform activity at pre-injury level. As participants were not asked to re-estimate the level of difficulty with the same activity at post mSTEPS, and thus a change in activity-specific disability could not be calculated, we chose to tabulate the frequencies of reported difficulties with commonly listed activities, and to use the data for a baseline sample description only.
Use of self-management strategies
Consumers indicated their use of active and passive pain coping strategies when responding to the question 'Which of the following approaches helps to relieve your back pain?' (Table 2). These coping strategies were based on those originally described by Brown and Nicassio [33] and subsequently represented [23,25] as four categories: active behavioural, active cognitive, passive behavioural and passive conventional. Consumers could select as many strategies as they considered relevant to their persistent LBP. Definitions for these categories have been well documented elsewhere [23,25].
Table 2. Use of self management strategies for consumers with low back pain
Pain-related cognitive-behavioural instruments
Coping skills questionnaire (subscale 2; catastrophizing)
The catastrophizing subscale of the Coping Skills Questionnaire (CSQ)[34] was used to assess general pain catastrophizing beliefs, as the subscale appears to demonstrate greater utility in terms of examining coping, appraisals, and pain adjustment compared to the composite scores [35]. This subscale lists 6 items which are scored using a 7-point Likert scale with responses 0 indicating 'never' to 6 indicating 'always'. Scores can range from 0–36 with higher scores indicating greater catastrophizing beliefs. The internal consistency of the subscale is reported to be α=0.85 [36].
Back pain beliefs
Beliefs about the inevitable consequences of future life with low back problems was measured using the Back Beliefs Questionnaire (BBQ)[37,38]. The BBQ consists of 14 items, each of which is rated on a 5 point Likert scale, ranging from 1 (completely disagree) to 5 (completely agree), yielding a possible range of 9 to 45. A higher score indicates more positive beliefs, suggesting better ability to cope with LBP. The internal consistency (α=0.70) and test-retest reliability (ICC = 0.87) of the BBQ have been established previously [38].
Fear avoidance beliefs
The Fear Avoidance Beliefs Questionnaire (FABQ) [39] was administered to assess fear avoidance beliefs around work and physical activity. Items are rated using a 7 point Likert scale, with 1 indicating 'completely agree' to 7 indicating 'completely disagree'. Two subscales are calculated with a total possible score of between 0–24 for the FABQ-physical and between 0–42 for FABQ-work. For both subscales, a lower score is consistent with fewer fear-avoidance beliefs. Internal consistency for FABQ-physical and FABQ-work were reported as α=0.77 and α=0.88, respectively [39]. Thresholds of > 14 (FABQ-P) and > 29 (FABQ-W) suggest elevated fear avoidance beliefs [40].
Emotional functioning
A measure of negative emotional functioning was assessed using the Depression, Anxiety and Stress Scale (DASS21) [41]. The rating scale for DASS uses a 4 point Likert scale with 0 (indicating 'did not apply to me at all') to 3 (indicating 'applied to me very much, or most of the time'). As DASS is based on a quantitative dimensional measure of distress along the axes of depression, anxiety (symptoms of psychological arousal) and stress (the more cognitive, subjective symptoms of anxiety), we limited questions to the two top loading items for each subscale, determined through earlier factor analysis [42] and represented these within the rating categories outlined above (i.e.; indicating degree of difference). Questions and loading were as follows: depression: question 10 (.53) and question 21 (.42); for anxiety: question 7 (.46) and question 19 (.43); and for stress, question 1(.38) and question 14(.42) [42].
Health literacy
Information about the broader elements of health literacy [43] including the ability to seek, understand and utilize health information, was measured using the Health Literacy Measurement Scale (HeLMS) [44,45]. This tool consists of eight independent domains including patient attitudes towards health, understanding health information, social support, socio-economic considerations, accessing general practice healthcare services, communicating with health professionals, being proactive, and using health information. Each of the 29 items is rated on a 5 point Likert scale with the 1 indicating 'unable to do' to 5 indicating 'able to do without difficulty'. By summing and averaging the items for each domain, a score is calculated for each domain.
Clinical usefulness of the mSTEPs intervention
Consumers used a Global Perceived Impression of Usefulness (GPIU) scale to rate usefulness of the mSTEPs, scored with an 11-point NRS scale, 0 indicating 'not at all useful' to 10 indicating 'extremely useful' [46].
Statistical analyses
Demographic variables for participants were described using mean and standard deviation (SD) for continuous variables or frequencies and percentages for categorical variables. The within-subject changes in questionnaire scores from pre to post intervention were analyzed using dependent t-tests. Responses for each HeLMS item were also dichotomized as 'no difficulty' (i.e.; a score of 5 on the Likert scale) or 'any difficulty' (i.e.; a score of 1–4 on the Likert scale) and the proportion of scores in each category was calculated, consistent with an earlier approach [47]. Statistical significance was set at α = 0.05.
Demographic and clinical data
Demographic data are shown in Table 3 and health care utilization regarding LBP is shown in Table 4, while baseline clinical data are presented in Table 5.
Table 3. Demographic characteristics of consumers with persistent low back pain
Table 4. Health care utilisation for consumers with persistent low back pain
Table 5. Baseline clinical characteristics for consumers with persistent low back pain
Use of self-management strategies
At baseline, a range of active and passive self-management approaches were reportedly used by consumers to help relieve their LBP (Table 5). On average, more active strategies were employed than passive strategies. The three most frequently nominated strategies within each of the four categories (data not shown) were: (i) active behavioural: did small bits often, modified activity, exercise and corrected posture/stretches (equal); (ii) active cognitive: relaxation, improved diet, ignored pain; (iii) passive: rest, hot bath/shower, massage; (iv) passive conventional: took medication, physiotherapy treatment and surgery/operation.
Pain-related cognitive behavioural measures
Baseline mean (SD) scores for each belief measure are shown in Table 5.
Emotional functioning
The majority of responses to the DASS fell into the 0 and 1 categories for all three dimensions (less negative emotional functioning) (Table 5). A small percentage of consumers endorsed either categories 2 and 3 for various items (suggesting more negative emotional functioning).
Health literacy
While the mean scores for each of the eight domains on the HeLMS ranged from 4.2 to 4.7, suggesting overall adequate health literacy, the range data highlight that some individuals experienced difficulty within some domains (Table 6). To indicate what proportion of consumers had any level of difficulty with an item, versus the proportion who reported no difficulty, a further analysis was undertaken on each domain to examine the proportion of people who scored 1 to 4 on each item, versus those who scored 5.
Table 6. The Health Literacy Measurement Scale (HeLMS) was used to measure consumers' health literacy
Same day immediately post-intervention evaluation
There was a clinically-important increase in consumer BBQ scores (N = 46) comparing baseline [mean (SD): 25.8 (7.6)] to same day post-intervention [28.8 (7.2)] [mean difference (95% CI): + 3.0 (0.9 to 5.1); P = 0.005] indicating more positive consumer beliefs about back pain. The majority of consumers (86.4%) rated mSTEPs as useful (NRS: 7 to 10), with a small proportion (9.1%) indicating the intervention was moderately useful (NRS: 4 to 6) and only 2 (4.5%) consumers rating the intervention as not that useful (NRS: 0 to 3).
Baseline to 3 month post-intervention evaluation
Twenty five subjects (49% response rate) responded to the three month postal questionnaire (Table 7). There were no baseline differences in demographic, clinical, health literacy or any belief measure between responders and non-responders.
Table 7. Comparison data (mean(SD); baseline and 3 months post-intervention) for responders with persistent low back pain
Analysis of responders alone demonstrated for the same-day evaluation, a similar significant increase in BBQ scores as the whole group [mean difference (95% CI): +2.8 (0.0 to 5.7); P = 0.049], but the improvement was not sustained at 3 months [mean decrease from same-day post (95% CI): - 2.0 (−0.4 to −3.6); P = 0.018]. The number of self-management strategies used by consumers did not change significantly and none of the pain-related cognitive-behavioural measures indicated any significant changes from baseline scores at 3 months post-intervention. Health care utilization and pain intensity measures did not change significantly (data not shown).
This study evaluated the outcomes of delivering a consumer-oriented, evidence-based interdisciplinary pain education intervention, mSTEPS, to consumers with persistent LBP residing in three geographically-remote areas in WA. At baseline, consumers demonstrated scores suggesting positive back pain beliefs, adequate health literacy and positive health behaviours, the latter reflected by the use of more active than passive strategies in self-managing their persistent LBP. Immediately following mSTEPS, consumers' general beliefs about back pain were significantly more positive indicating a short term improvement in beliefs and the vast majority of consumers rated the program as useful. At 3 months post-mSTEPS intervention, there was no evidence for significant improvement in any baseline measure. This lack of longer term effect may reflect the already high baseline measures or could indicate that additional reinforcement strategies are required in order to sustain improvements in back pain beliefs. Whether a sustained improvement in back beliefs facilitates the adoption of more positive health behaviour is unclear, although it is likely that additional reinforcement strategies are required for this to occur.
In our study, general back pain-related attitudes and beliefs were similar to those reported in other Australian populations with and without LBP [43,48,49] and to other international cohorts [50]. Immediately following mSTEPS, the clinically significant shift towards more positive beliefs about back pain and its consequences was an important outcome, given negative attitudes and beliefs in consumers with persistent LBP can significantly contribute to disability [39,48,51,52]. The magnitude of the positive shift was similar to that previously demonstrated following an Australian population-based intervention designed to improve beliefs about back pain [51,53]. However, the positive shift in the same-day beliefs in the present study was not sustained when examining differences in 3 month-responder scores at baseline (27.2 ± 6.9), same-day (30.3 ± 7.0) and at 3 months post-intervention (28.4 ± 6.8). These consumers demonstrated a significant decrease in scores at 3 months from their significantly improved levels immediately post-course. The pattern of decrease in BBQ scores is unclear, as data were not collected between the same-day post and the 3 month test points. Therefore, we can safely surmise that a brief intervention such as mSTEPS, used as a stand-alone intervention, appears insufficient to generate a sustained improvement in back beliefs and it is likely that additional measures are required to achieve a sustained positive shift in consumer back pain beliefs. Support measures may involve the repetition of simple evidence-based messages using multimedia [53,54]; supplemental educational written materials [50]; reinforcing strategies delivered via internet-based educational approaches [55]; or active management and group-based cognitive-behavioural approaches [56,57]. The use of internet approaches may be particularly well-suited to geographically-isolated consumers with LBP. Furthermore, we suggest that regular community-based group sessions for consumers with LBP with limited access to pain services and community support [12,20], should be considered by health funding bodies, given the available data demonstrating their cost effectiveness and positive health outcomes [57]. Collectively, our findings suggest that it is important to use any transient change in beliefs as a potential 'therapeutic window' to encourage the adoption of positive behavioural change, as beliefs and behaviour for consumers with persistent LBP do not necessarily match [43].
In our study cohort, pain catastrophizing scores were lower compared with those previously reported for people with persistent LBP [58], but higher than those reported for a younger WA urban population with persistent LBP and high disability [43]. Half of the consumers in the present study had elevated fear avoidance beliefs scores, similar to those reported in other LBP populations [59,60]. The need for these cognitive and emotional factors to be addressed is highlighted given that catastrophizing and elevated fear avoidance beliefs can interfere with the adoption of beneficial health behaviours [61]. In this context, the use of timely cognitive-behavioural group sessions, which appear to provide reassurance, lessen isolation and enable participants to learn strategies from each other and re-engage earlier into the workforce [57], could align well with the delivery of a community-based LBP management program. The manner in which messages are conveyed to consumers by health professionals should also be considered as our data highlight a proportion of consumers have some level of difficulty understanding health information and communicating with health professionals, while other evidence points to poor quality communication strategies adopted by health professionals in the context of LBP, particularly with consumers who experience persistent LBP [62].
For treatment of their LBP, consumers accessed primarily general practitioners and physiotherapists or chiropractors, possibly reflecting the available services and accessibility. Notably, almost half of the cohort had also consulted a specialist regarding their persistent LBP, and on most occasions, this would have required them to visit a tertiary facility in Perth. The provision of additional services to assist in reinforcing key health messages and to encourage positive health behaviour could be achieved, in part through community-based educational programs combined delivered by 'virtual' interdisciplinary teams using novel information technologies, or by the provision of reliable, accessible and evidence-based information resources at the community level, a need previously highlighted by consumers [27]. Such innovative solutions could potentially improve health system efficiencies by providing opportunities to simultaneously upskill both health care professionals and consumers and reduce the need for these consumers to travel to tertiary centres, thereby supporting contemporary health policy directions.
An additional and important component of any optimal model of care for the management of persistent LBP is the facilitation of consumer use of active cognitive and behavioural self-management strategies [23-25]. At baseline, consumers used more active cognitive-behavioural self management strategies than an urban WA population of consumers with persistent spinal pain [25] and more active than passive strategies. Using active strategies to assist in self-managing persistent LBP is important as such approaches substantially reduce the likelihood of consumers having high levels of pain-related disability [23]. Furthermore, adherence to specific self-management strategies can predict reductions in pain, disability and depressive symptoms even after controlling for the moderating effects of catastrophizing, fear-avoidance and pain self-efficacy beliefs [63]. In our study, consumers most frequently employed simple active behavioural approaches that aligned well with their functional limitations, however associated qualitative data from a subset of these consumers suggests that assistance may be required with the adoption and maintenance of long term self management strategies [27]. This may be particularly true for those consumers (up to 71%) reporting difficulty with the broader elements of health literacy, potentially reducing their capacity to engage in positive lifestyle behaviours [27].
Active self management behaviours did not increase significantly at 3 months, although at baseline use of these strategies was already quite high. Several factors which impinge and encourage uptake of self-management strategies have been identified [23,64], and require consideration in the context of our cohort. These can be summarized as follows: 1) limited resources and access to resources; 2) ineffectiveness of pain-relief strategies (evident by those passive conventional strategies chosen by consumers as not helping to relieve their LBP and which included surgery, operations, physiotherapy, chiropractic, acupuncture and medication); 3) time constraints and other life priorities ([27,43]; 4) avoiding activity because of fear of pain exacerbation; 5) a lack of tailoring strategies to meet personal needs (possibly incorporating the lack of coordinated interdisciplinary care or limited access to such services); 6) not being able to maintain the use of strategies after the mSTEPS intervention; 7) physical limitations (reflected in consumers' functional limitations); 8) sub-optimal patient-physician interactions; 9) difficulty in the broader aspects of health literacy.
Standardized evidence-based approaches to chronic health conditions with flexible and tailored self-management and personalized co-care plans could better match consumer needs to resources [65,66], although readiness for change [67] and adherence to these evidence-based approaches is important in optimizing patient outcomes [68,69]. To encourage appropriate service delivery and facilitate the uptake of active self-management and co-care for consumers with persistent spinal pain, we recommend that policy makers and health professionals address the following key considerations: 1) timely provision of integrated evidence-based interdisciplinary co-care [70,71]; 2) ensuring the availability of supportive health professionals [72] and carers; 3) providing a menu of different self-management strategies allowing better matching of consumer profiles with appropriate resources to optimize health outcomes [66,73]; 4) facilitating adherence to self management [63] and providing reinforcement to help encourage the adoption of positive behavioural change [64,74] with reference to an operationalized stages of change framework [75] and readiness to adopt self management [67]. To address these changes requires system plasticity at the individual level (preferably using a whole person engagement model, which we term the HOPE model), in primary care (appropriately skilled interdisciplinary workforce), at a community level (community-based training programs), and at a tertiary level (integrated interdisciplinary co-care). The novel use of information technologies may facilitate such system plasticity for the benefit of health consumers living in geographically-isolated areas.
Our study has several limitations and the applicability of these findings to other populations of consumers with persistent LBP may be limited because of the following factors: a randomized controlled trial would strengthen the study design, as currently the lack of a control group precludes a comparison of the natural time course of outcome measures with change specifically attributed to mSTEPS; data were based on self-report measures; a modest sample size (therefore we cannot control reliably for potential confounding factors like socio-economic status, high and low disability); responder bias (response rate of 49%); and selection bias (consumers in this study were predominantly female (68.8%) and educated (62% had completed high school)). Additionally, consumers were self-referred to mSTEPS and their motivations for attending this educational intervention may differentiate them from consumers not seeking care for persistent LBP.
The implementation of health policy through a consumer-oriented intervention, set within a contemporary pain management evidence-based framework, can be successfully delivered within primary care. In order to focus management on the whole person and to encourage positive consumer health behaviour, appropriate post-intervention support systems, including access to health services and to appropriately skilled workforce, are recommended. Our findings highlight the need for health delivery change if the current best research in spinal pain is to be effectively and sustainability translated from policy into practice for consumers with persistent LBP living in remote areas.
LBP, Low back pain; mSTEPS, Modified Self Training Educative Pain Sessions (STEPS) program; CSQ, Coping Skills Questionnaire; BBQ, Back pain beliefs questionnaire; FABQ, Fear avoidance beliefs questionnaire; DASS, Depression, Anxiety and Stress Scale; HeLMS, Health Literacy Measurement Scale.
Competing interests
The authors declare they have no competing interests.
Authors' contributions
HS, AB, SD, AS, and JQ contributed to the study design and coordination. SB managed the data collection and entry. AS completed the statistical analyses. HS, AB and AS interpreted and reported on the data. All authors contributed to the intellectual content of the manuscript and the manuscript preparation. HS drafted the first and final manuscript versions and acts as guarantor of the paper. All authors contributed to editing the manuscript, contributed to revisions and approved the final manuscript.
Authors' information
HS is a clinical researcher and a Specialist Musculoskeletal Physiotherapist with Honorary position at Fremantle Hospital, Pain Medicine Unit. AB is a senior researcher supported by a Fellowship from the Australian National Health and Medical Research Council (NHMRC). SD is a Pain a Medicine Specialist and Head of the Fremantle Hospital, Pain Medicine Unit and Director is Statewide (WA) Pain Medicine Services. AS is a senior researcher and biostatistician who is supported by a Fellowship from Curtin University. JQ is a Rheumatologist and Pain Medicine Specialist. SB is a doctoral student and research assistant.
The following authors received honoraria for delivering the mSTEPS programs: SD and JQ.
The authors acknowledge financial and in kind support from the Department of Health (Government of Western Australia), Arthritis and Osteoporosis WA, Rural Health West, School of Physiotherapy, Curtin University, the Pain Medicine Unit at Fremantle Hospital Health Service, and the WA Musculoskeletal Health Network. Elizabeth Forrester, Melanie Galbraith, Eric Visser, Carl Graham, Jennifer Roe, Sue Wilkinson and Diana Barron are acknowledged for their contribution to the regional education forums. The WA State Health Research Advisory Council (SHRAC) translational research scheme is acknowledged for providing competitive grant funding to develop the original STEPS project in 2007–2008.
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Pre-publication history
The pre-publication history for this paper can be accessed here:


text:
Bajirao Mastani | 'Gajanana' OFFICIAL Song Launch | Ranveer Singh | Deepika Padukone
- published: 15 Sep 2015
- views: 2550
WATCH Bajirao Mastani | \'Gajanana\' OFFICIAL Song Launch | Ranveer Singh | Deepika Padukone - Ranveer Singh and Deepika Padukone were seen at the grand launch of the song \'Gajanana\' from the film \'Bajirao Mastani\' at Shivaji Sports Complex, Pune. Take a look at all the fun and hungama that happened at this memorable event. Don\'t miss! Watch more Exclusive Celebrity Interviews right here http://www.bollywoodhungama.com/ Like BollywoodHungama on Facebook: https://www.facebook.com/bollywoodhungamacom Follow BollywoodHungama on Twitter: https://twitter.com/Bollyhungama Circle BollywoodHungama on G+: http://bit.ly/1uV6Qba...


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3 of 7
Space Saving Ideas for a Small Condo
The Living Room
- Fake soaring ceilings. Rooms seem taller when the walls and ceiling are painted a continuous color. Here, an airy white shade camouflages the living area's decidedly un-loftlike 8-foot-6-inch height—especially when contrasted with the dark floor.
- Let there be (natural) light. Notice how much cleaner windows look when they're not cluttered up by curtains and valances. To say nothing of how the sunshine bounces off the walls and tiles for an expansive, mirrored effect.
- Choose convertible furnishings. By folding down the back and arms of this Ligne Roset daybed, the couple can turn their rainy-day movie-watching perch into a comfy guest bed.
- Don't forget flooring. "Another trick we used to make the space feel larger," says Gregory De Peña, "is laying tile diagonally from corner to corner." The tactic highlights the condo's longest axis instead of chopping up the floor plan into individual rooms.


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Orange County rider Jose Chavez turned a father's gift into his dedication.[read more]
Car Features
Luxury & Exotic: 2012 Mercedes-Benz CLS550
The Wald Black Bison kit has this Benz ready to run with the bulls.[read more]
New-School Sedans: 2011 Chrysler 300
This Pearl Blue 300 would give Steinbeck plenty to write about![read more]
1968 Chevrolet Impala: Final Ride
David "Mr. Topo" Tiscareno's gorgeous '68 Impala Custom is now his legacy.[read more]
2008 Bugatti Veyron: Bug Life
With the help of Platinum Motorsport, BC rendered this $2 million ride priceless.[read more]
Matte Blue Mercedes-Benz CL63 AMG By R1 Motorsport
S Dot B and Royal Muffler put together one[read more]
Clean ATL Donk Via Street Whipz!
This '71 Impala brings the goods.[read more]
RIDES Versus Edition: Escalade Vs. Escalade
Two different takes on the luxury SUV king of the streets.[read more]
1965 Chevrolet Impala
Just call it "Addicted Desire."[read more]
RIDES Versus Edition: Chevelle Vs. Chevelle
These custom Chevelles are ready for the boulevard or Barrett-Jackson.[read more]
RIDES Versus Edition: Camaro Vs. Camaro
Two Tampa titans prove their pastels are proper.[read more]
1961 Chevrolet Impala
Yet another Alvarez brother reps the Lowrod movement with his beautiful bubble top.[read more]
2008 Cadillac Escalade EXT
A six-inch chop and a slam to the floor make this EXT unlike any other.[read more]


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A year after he suddenly proposed greater fiscal freedoms for the District, Rep. Darrell Issa dangled yet another enticing plan in front of D.C. officials on Thursday.
Mr. Issa, California Republican, said the time has come to examine whether the city deserves a commuter tax in light of the large number of out-of-state residents who work in the nation's capital.
He made the comments at the end of a hearing on potential changes the Height Act, a 1910 law that limits the height of buildings in the city.
Earlier in the hearing, D.C. Chief Financial Officer Natwar M. Gandhi complained that the city cannot tax income from about two-thirds of the people who come in each day and use the city's roads and services.
"For Mr. Gandhi's pleasure, I think we should — after the election — start to think about how we are going to deal with the only place that doesn't have the ability to tax people who earn their income in that place," Mr. Issa said from the dais, without offering more details.
The notion of a commuter tax would face stern opposition from officials in Annapolis and Richmond. It has in the past, and will at any time in the future, officials said.
Delegate Eleanor Holmes Norton, the District's non-voting member of Congress, said she appreciated Mr. Issa's gesture, yet realizes that Virginia and Maryland can throw four senators and all of their House members at the issue.
"This is a war I don't think can be won," Mrs. Norton said.


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Andros Town Hotels
Small Hope Bay Lodge
We stayed for a long weekend at Small Hope and although we are not into scuba, we enjoyed ourselves....more
Tiamo Beach, 33309, Caribbean
Satisfaction: Excellent
Good for: Business
Emerald Palms by the Sea
The Bluff, Driggs Hill, Caribbean
Satisfaction: Excellent
Good for: Business
Andros Lighthouse Yacht Club and Marina
Fresh Creek, Bahamas
Satisfaction: Poor
Good for: Couples
Seascape Inn, Andros
Mangrove Cay, Caribbean
Satisfaction: Excellent
Good for: Business
Andros Island Bonefishing Lodge
Cargill Creek, Bahamas
Satisfaction: Excellent
Good for: Couples
Coconut Grove Resort & Fishing Lodge
Staniard Creek, Bahamas
Andros Town Off The Beaten Path
Blue holes on land
About 6 miles north of Fresh Creek (near telephone pole 209) is a small path on the right hand side. A 10 minute walk through the bush will get you to the Rainbow Blue Hole. Absolutely quiet, and perfect for swimming.Related to:
- Eco-Tourism
- Hiking and Walking
Andros Town Favorites
Go diving for Counch and while...
Favorite thing: Go diving for Counch and while down there you see a whole other world.
Fondest memory: I did free diving for lobster, grouper and counch.
These fresh meals you just can not beat.
Instant Answers: Andros Town
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