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Perceptions of Gender-Based Barriers for Men in an Online Nursing Completion Program Compared to Traditional On-Campus Nursing Programs
- Gervais King
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1 Perceptions of Gender-Based Barriers for Men in an Online Nursing Completion Program Compared to Traditional On-Campus Nursing Programs John R. Kirk Medical Forces Advisor Office of the U.S. Air Force Surgeon General Falls Church, VA USA Chad E. O'Lynn Assistant to the Dean for Assessment and Quality School of Nursing University of Portland Portland, OR USA Michael K. Ponton Professor, School of Education Assistant for Academic Affairs to the Executive Vice President Regent University Virginia Beach, VA USA Abstract This paper reports on a mixed-method study that compared the perceptions of genderbased barriers experienced by 49 men who were enrolled in an online Registered Nurse to Bachelor of Science in Nursing degree completion program with those they experienced in their previous traditional on-campus nursing programs. The subjects responded to an online adaptation of O'Lynn's Inventory of Male Friendliness in Nursing Programs and provided narrative comments. There was no significant difference in total scores between the two programs, though significant differences were found for individual survey items between the two programs. Importantly, the men rated the online program significantly more accepting of them as men than their traditional on-campus programs. Narrative comments clarified the scores the men provided. This study contributes to the scholarship on gender and online learning by reporting the experiences of men in an online nursing program. Keywords: RN to BSN, nursing education, gender barriers, diversity, men, male friendliness, Inventory of Male Friendliness in Nursing Programs (IMFNP) Introduction Advances in information technology and delivery have greatly increased options for students seeking nursing education as evidenced by the larger number of nursing programs using online and blended curricular formats (Tri-Council for Nursing, 2010). Since the diversification of education delivery increases access to continued education, nontraditional delivery formats are essential in addressing a looming national nursing workforce shortage in a time of strained resources for nursing faculty (Holly, 2009). Furthermore, the Institute of Medicine (IOM, 2010) has recommended that at least 80% of registered nurses have at least a bachelor's degree by the year This recommendation has sparked an influx of nurses who do not have bachelor's degrees to enroll in Registered Nurse to Bachelor of Science in Nursing (RN to BSN) completion programs. Since many of these students are over 40, employed full time in healthcare settings, and are not receiving financial aid, the flexibility of online education is attractive and cost-effective (Dyck, Oliffe, Phinney, & Garrett, 2009). 481
2 In addition, the IOM and other organizations have called for increased diversification of the nursing workforce (American Association of Colleges of Nursing, 2011; IOM 2010). Nursing continues to be overwhelmingly Caucasian and female with only 7.1% of American nurses being male (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2010). In light of increased attention on the recruitment of men into nursing and the recent economic opportunities in nursing (O'Lynn, 2013), greater numbers of men are enrolling in nursing education programs. In 2011, men constituted 15% of students enrolled in basic registered nurse (RN) programs a historic high (Kaufman, 2012). Increased interest from men will benefit schools that offer online completion programs. Mattes, Nanney, and Coussons-Read (2003) report that men drawn to online programs are more introverted and self-reliant than men taking courses in traditional campus settings. They surmise that male online students find the flexibility, independence, and anonymity of the online classroom liberating and appealing. Despite the increased number of men enrolled in nursing programs, the attrition rates for male students far exceed those for female students (Pryjmachuk, Easton, & Littlewood, 2008; Stott, 2007; Wilson, 2005). The reasons for higher attrition are unclear but are hypothesized as resulting from perceived gender-based barriers that promote a learning environment hostile or "unfriendly" to men (O'Lynn, 2004). The unfriendly environment is pervasive and has persisted for decades (Bell-Scriber, 2008; Le-Hinds, 2010; O'Lynn, 2004, 2007, 2013). Exploration into the causes of attrition for male nursing students is important if the goal of improved gender balance in the nursing workforce is to be realized. To date, no study has explored possible gender-based barriers for male students enrolled in online nursing programs. The need to better understand barriers grows increasingly urgent as more men seek nursing education in online settings. Since the online environment offers students different benefits and challenges from traditional campus programs, this study explored initial comparisons of gender-based barriers for men between the two program types. Literature Review Despite considerable scholarly interest in classroom-based gender issues, little of the literature has examined gender issues in the online learning environment (Machado, 2011). However, some evidence exists that men perceive and experience the online environment differently from women. For example, men reported preferring self-paced learning more often than women even though maximum flexibility in scheduling was important to both genders. Anderson and Haddad (2005) found that men preferred the increased sense of control afforded in the online environment, and Sullivan (2001) report that men more often than women embrace the need to develop adequate self-discipline for success in the online environment. Acceptance for self-discipline among men was suggested by a study of 799 college students (36% male) that showed men exerted more energy toward their online program than did women (Yang, Cho, Mathew, & Worth, 2011). The extant research depicts men behaving overall very much the same way online that they would in traditional, face-to-face classroom settings (Ritke-Jones & Merys, 2010). One significant difference, however, is that men are more inclined to develop and exhibit traditionally feminine traits such as submissiveness and collaboration in order to be more successful in group or team projects required in online courses. Ritke-Jones and Merys conclude that social inhibitions influencing gendered behaviors are easier to transgress online due to the safety created by anonymity and distance. The available literature on male nursing students consists primarily of small studies describing characteristics of men who enroll in nursing school and qualitative studies describing men's experiences in traditional, face-to-face nursing education programs (O'Lynn, 2004). Nevertheless, the literature reports persistent and pervasive barriers for men in the nursing school environment, with at least some barriers present in most nursing programs both in the US and abroad (Anthony, 2006; Bell-Scriber, 2008; Brady & Sherrod, 2003; Le-Hinds, 2010; O'Lynn, 2004, 2007, 2013; Stott, 2007). Specifically, common barriers include gender-biased language and imagery, lack of role models, isolation, devaluing of men's perspectives and contributions, sexist stereotypes, and open hostility and discrimination. These barriers are multifactorial in derivation, but many stem from patriarchal structures in the larger society, nursing's backlash to patriarchy, and mindful disregard of non-feminist paradigms in nursing education culture and curricula (O'Lynn, 2007, 2013). The pervasive and persistent nature of these barriers create an unsatisfactory and possibly hostile learning environment likely leading to reported higher attrition rates for male nursing students (McLaughlin, Muldoon, & Moutray, 2010; Mulholland, Anionwu, Atkins, Tappern, & Franks, 2008; Pryjmachuk et al., 2008; Stott, 2007; Wilson, 2005). Contrary to the experiences of some male nursing students reported in these studies, men desire equal treatment with women instead of being singled out (Dyck et al., 2009). Further, men tend to prefer either autonomous, self-directed, mildly competitive learning activities, or being in charge during team-based learning that is often minimally 482
3 present in many nursing programs (Anthony, 2006; Brady & Sherrod, 2003; Dyck et al., 2009; Ellis, Meeker, & Hyde, 2006; O'Lynn, 2004; Stott, 2007). Method The setting selected for this study was an accredited, for-profit university-based online degree completion program in which registered nurses with associate degrees in nursing or nursing diplomas enrolled to earn their baccalaureate degrees in nursing (RN to BSN). After securing institutional review board approval, a detailed electronic invitation was sent to all 270 male students enrolled in at least one RN to BSN online course in late Those who agreed to participate were sent an electronic survey that was available to complete for three weeks. The survey used was an adaption of O'Lynn's (2004, 2007) Inventory of Male Friendliness in Nursing Programs (IMFNP) tool. The IMFNP assesses men's level of agreement as to whether any of 35 genderbased barriers toward men were present in their nursing programs. Scores were tabulated based on survey responses to determine the overall level of male friendliness of the nursing program. O'Lynn (2004) operationally defines male friendliness as an academic environment in which male students perceive few, if any, male gender-based barriers. O'Lynn (2004) proposes that the more barriers perceived to be present in a program, the more unfriendly the learning environment is to men. Barriers on the IMFNP were identified from a synthesis of the literature and interviews with male nursing faculty and students. Content validity was initially established in A shortened version of the IMFNP was later developed with a Cronbach's alpha of 0.84 (O'Lynn, 2007). The tool has since been used in multiple studies in several countries for evaluating numerous types of campus-based programs. Since the IMFNP was originally developed for evaluating nursing programs men complete before RN licensure, the tool required modification for evaluating the online RN to BSN program. For example, items pertaining to barriers in clinical experiences were removed as well as possible barriers men may have faced when initially deciding to pursue a nursing career. One additional item whether or not the program was overall accepting of male gender was added. The resulting adaptation included items referring to 20 unique barriers. In addition, the tool was modified to prompt men to compare their original traditional nursing program with their online RN to BSN program. Demographic items and prompts to provide narrative comments were included as well. Respondents described perceived barriers from strongly agree to strongly disagree. Reverse coded items were included to avoid response bias. A numerical rating accompanied each response to facilitate tabulation with scores of 1 corresponding to strong agreement that a barrier existed and 5 corresponding to strong disagreement that a barrier existed. Scores above 3 were determined to be relatively male friendly, whereas scores below 3 were determined to be relatively male unfriendly. Using Statistical Package for the Social Sciences (SPSS) version 17.0, quantitative scores were compared between the original and online nursing programs using paired t-tests. A Bonferroni correction was applied to alpha to control for overall Type I error at the.05 level thereby resulting in significance level of p =.0025 for each t-test. The means for all barrier items were averaged to provide an overall male-friendliness assessment. Narrative comments were reviewed to provide clarity and meaning to the responses provided by the participants. Results Forty-nine men completed the survey. The men were primarily White (78%), over 40 (66%), had earned their initial nursing degree within the last 10 years (64%), and had the support of their friends and family (98%) for enrolling in the degree completion program. The men attended 49 different schools for their initial traditional education. An overwhelming majority (98%) of the men were motivated to complete the BSN degree for career advancement and to be better-prepared professional nurses. Friendly ratings were given to online programs regarding six barriers (suggesting low barrier presence): (1) lack of group/team assignments; (2) overall male gender non-acceptance; (3) lack of encouragement to pursue leadership roles; (4) lack of invitation to participate in activities; (5) lack of use of competition as a learning motivator; and (6) lack of discussion of men's health issues. Friendly ratings were given to traditional programs regarding nine barriers including all of those noted for online programs as well as: (1) textbooks using the pronoun "she"; (2) men having to prove that they belong; and (3) lack of use of debate of issues as an instructional strategy in class. In comparing the two programs, the men rated the online program significantly more male friendly with regard to four barriers and the traditional program significantly more male friendly with regard to five barriers. Scores for each barrier item are detailed in Table
4 Table 1. Scores for each of the 20 gender-based barriers Gender-Based Barrier Online Traditional M SD M SD Lack of group/team assignments 4.53* Overall male gender non-acceptance 4.20* Not encouraged to strive for leadership Not invited to participate in all activities Competition not used as a motivator 3.90* No discussion of men's health issues Textbooks used "she" as generic pronoun * 1.21 No discussion on communication differences between men and women Program did not actively recruit men 2.88* Did not prepare male students to work primarily with women No content on men's history in nursing Men had to prove that they belong in nursing No content on appropriate use of touch Faculty used "she" to refer to generic nurse * 1.23 No debate of issues in class * 1.34 Men not encouraged to seek peer support Men portrayed as perpetrators * 1.37 Men felt isolated from other male students Gender impaired relationships with faculty Faculty made anti-male remarks in class * 1.42 *p <.025. Many of the narrative comments provided additional insights. Regarding positive aspects of the online program, men stated that they frequently participated in group assignments and frequently assumed leadership roles within groups in order to keep the group focused on tasks rather than emotion-based discussions. The men felt that their leadership activities were generally well supported and were congruent with their future career aspirations of advanced practice and administration. Interestingly, the men reported some competition for leadership roles but found that competition facilitated hard work and academic success. The men provided a number of negative comments about the online program. Men reported textbooks and faculty using feminine imagery and language when referring to nurses and nursing. Combined with a lack of review of the historical contributions men have made to nursing, minimal instruction on how to communicate and work with primarily female co-workers, little visible recruitment of men to the program, and no frank encouragement to students to form peer support networks, men were left with a sense of non-belonging and isolation. Furthermore, men reported rare but disturbing comments by faculty disparaging men as a group and men as perpetrators. These comments fostered a hostile climate for the men. Discussion In recollecting their traditional pre-licensure nursing programs, the men in this study agreed on average that 11 of 20 (55%) barriers existed with few barriers earning friendly ratings far above a neutral score. For the online program, the men agreed on average that 14 of 20 (70%) barriers existed. In comparison, in a study conducted by O'Lynn (2007), men from five different traditional pre-licensure programs agreed that six of 17 (35%) barriers exist Consequently, men in the current study found their nursing education experiences less friendly to them as men than O'Lynn's earlier study. Since the men's experiences in their online programs were more recent than those in their traditional programs, these findings are troubling. In the online program assessed in this study, overall improvement in the educational climate for men in nursing has not been realized following O'Lynn's (2004) observation nearly 10 years ago that barriers for men in nursing are pervasive and persistent. Men found the online program significantly more favorable than the traditional program in including group/team assignments and using competition as a motivator for learning. Others have noted these learning milieus can help facilitate learning for male students, including male nursing students (Anthony, 484
5 2006; Brady & Sherrod, 2003; Dunn & Griggs, 1998; Dyck et al., 2009; Ellis et al., 2006; O'Lynn, 2004; Stott, 2007). Group/team assignments are possibly seen more favorably among nursing educators in light of reports from the IOM (2010) and other organizations that recommend increased teamwork skills among nurses. As such, group/team assignments may be more prevalent today. On the contrary, the data are less informative about competition as a motivator for learning. Formal implementation of competitive activities is not typical in nursing education, particularly in light of frequent calls in the nursing education literature supporting the ideals of a caring curriculum that is aversive to competition (Brown, 2011; Evans, 2004). The men in this study commented that they had to compete for "hard to earn good grades" and for leadership positions within assigned teams. Given the positive ratings, the men perceived competition as a beneficial motivator for learning. Conversely, debate is a time-honored learning activity that fosters critical thinking and active engagement in knowledge acquisition (Doody & Condon, 2012). Yet the men commented that the online program was significantly less amenable to debate of issues than was their traditional program. One student commented that he was not free to express his conservative views. Another stated that the "freedom of education has been removed." Still another commented that he "was required to accept the information as presented without asking questions or challenging the material." It seems that competition, which the men perceived positively, occurred naturally within groups or within the self and not through structured course activities such as debate. Nevertheless, the benefits of group/team assignments, competition, and debate should not be overstated. O'Lynn (2007) notes that items on the IMFNP relating to these barriers were removed from the shortened version of the IMFNP because men had reported that these items were less important than others in creating learning environments unfriendly to men. The men rated their previous traditional pre-licensure programs significantly more friendly with regard to several other barriers. The use of the pronoun "she" to refer to the generic nurse by both faculty and in textbooks was less problematic in the traditional programs. This is a curious finding since the men enrolled in the traditional programs years prior to the online program. Since then, more textbook publishers have adopted gender-neutral language and more inclusive imagery. However, the online courses included discussion postings from faculty and other students that may have made frequent use of feminine pronouns. This finding warrants further exploration. More importantly, men rated their traditional programs significantly higher than their online programs with regard to faculty making anti-male remarks in class and portraying men as perpetrators more frequently than as victims in course content. Most disturbingly, the men were in the most agreement that anti-male remarks in class constituted the most prevalent barrier in their online program. Although the remarks were likely from a very small minority of female faculty members, even one is too many. This finding supports those of Bell-Scriber (2008) who discusses the chilling effect sexist and uncivil remarks and behaviors from faculty have on students after observing them in the classroom. It is not clear why these barriers were more prevalent in the online program. Perhaps the presence of faceless students creates an impersonal milieu that promotes less personal interactions and interactions characteristic of uncivil behavior (Gailbraith & Jones, 2010). Faculty incivility is a well-discussed topic in the nursing literature. Marchiondo, Marchiondo, and Lasiter (2010) reiterate that incivility ignored is incivility condoned, and that incivility will continue as long as the likelihood of punishment is low. Low punishment for incivility directed at male students may be poorly addressed in nursing education due to a female-dominated academy combined with a high demand for nurse educators in a time of a faculty shortage. However, as Suplee, Lachman, Siebert, and Anselmi (2008) point out, it is imperative that uncivil behavior be addressed in nursing programs and not allowed to pass into the nursing workforce environment where it could lead to adverse patient outcomes. Furthermore, in O'Lynn's (2004) study, men identified barriers relevant to faculty incivility in nursing programs as some of the most important and damaging barriers. Faculty incivility may be a causative factor for higher attrition rates for male nursing students (O'Lynn, 2013). Despite the relatively large number of barriers identified in both programs, the men rated the online program significantly more accepting of their gender than their traditional campus programs. Initially, this seems counterintuitive given that the men identified the presence of many barriers. But by the time of this study, the men had already completed one nursing program and had been working as nurses in professional settings. Negative memories of their initial programs may have persisted, resulting in lower friendliness scores. Further, many of these men reported that they had returned to school to further their careers. It is likely that these men, over time, had learned how to cope with barriers and take in stride any 485
6 perceived systemic inequities within nursing. Among the men, there may be a level of self-acceptance of the negative attitudes within nursing. Also, the men may perceive benefit and relevance of the online program offerings to their future career aspirations, thus enhancing their overall positive appraisal of the male friendliness of the online program. Nevertheless, effective coping strategies and program relevance cannot negate the concerns about an unfriendly, or even hostile, academic environment for male students. The men identified widespread problems that should not be present in today's nursing educational settings striving for just and learnercentered environments. This study supports others that suggest a discriminatory culture persists in nursing education. Even though Carol (2006) points out that nursing students have become more diverse, nursing faculty continue to be overwhelmingly white, female, and middle aged or older. A persistently homogenous faculty may perpetuate traditional educational and nursing paradigms and perspectives. Diversification of faculty and of behaviors will promote desirable changes within the culture of nursing education. Until this happens, male nursing students will continue to feel isolated and struggle to fit into the traditional, though archaic, view of the nurse archetype. The study has several limitations. The reliance upon the self-report and memory of the men is an important limitation; however, the men were still enrolled in the online program at the time of the study, and most of the men had graduated from their traditional programs within the past 10 years. Memories may likely remain fresh for these men. Also, the findings from the men corroborate the perspectives of men from multiple other studies. The study also examined the experiences of only one RN to BSN online completion program. Even though the program selected for this study is one of the nation's largest online nursing programs, given the low (18%) response rate, the findings cannot be generalized to other programs. Conclusion This study provided a glimpse into the experiences of 49 men in an online nursing program and identified the need to create a more male-friendly academic environment. The findings support the conclusions of O'Lynn (2004) that "nursing education, as whole, has failed to provide an environment optimally conducive to preparing men for the nursing profession" (p. 235) and indicates that previously documented biases in traditional campus programs transcend education delivery modalities. This study reinforces the findings from other studies that men simply want to be treated fairly and be provided with an atmosphere deemed warm (Bell-Scriber, 2008), genderless (LaRocco, 2007), and friendly (O'Lynn, 2004). McLaughlin et al. (2010) places the burden of creating a friendly learning environment on the nursing faculty, who set the tone for the entire academic experience. Although the men rated the online program generally more accepting of their gender than their traditional programs, the findings from this study present a challenge to all faculty members in online nursing programs that much improvement is still needed. Ultimately, a gender-inclusive academic culture will do much to reduce male attrition from nursing education programs and contribute to alleviating the projected nursing shortage. An academic culture that strives for the ideals of a caring curriculum and learner-centeredness must adopt actions that support the needs of all students. This study provides awareness that important barriers persist for male nursing students in both traditional and online environments. Awareness is the first step toward action. References American Association of Colleges of Nursing. (2011). Fact sheet: Enhancing diversity in the nursing workforce. Retrieved from Anderson, D. M., & Haddad, C. J. (2005). Gender, voice, and learning in online course environments. Journal of Asynchronous Learning Networks, 9(1), Retrieved from Anthony, A. S. (2006). Retaining men in nursing our role as nurse educators. In M. H. Oermann & K. T. Heinrich (Eds.), Annual review of nursing education: Vol. 4 Innovations in curriculum, teaching, and student and faculty development (pp ). New York, NY: Springer. Bell-Scriber, M. J. (2008). Warming the nursing education climate for traditional-age learners who are male. Nursing Education Perspectives, 29(3), doi: / (2008)29[143:wtnecf]2.0.co;2 486
7 Brady, M. S., & Sherrod, D. R. (2003). Retaining men in nursing programs designed for women. Journal of Nursing Education, 42(4), Brown, L. P. (2011). Revisiting our roots: Caring in nursing curriculum design. Nurse Education in Practice, 11(6), doi: /j.nepr Carol, R. (2006, Summer). Discrimination in nursing school: Thing of the past or alive and well? Minority Nurse. Retrieved from Doody, O., & Condon, M. (2012). Increasing student involvement and learning through using debate as an assessment. Nurse Education in Practice, 12(4), doi: /j.nepr Dunn, R., & Griggs, S. A. (Eds.). (1998). Learning styles and the nursing profession. New York, NY: National League for Nursing. Dyck, J. M., Oliffe, J., Phinney, A., & Garrett, B. (2009). Nursing instructors' and male nursing students' perceptions of undergraduate, classroom nursing education. Nurse Education Today, 29(6), doi: /j.nedt Ellis, D. M., Meeker, B. J., & Hyde, B. L. (2006). Exploring men's perceived educational experiences in a baccalaureate program. Journal of Nursing Education, 45(12), Evans, B. C. (2004). Application of the caring curriculum to education of Hispanic/Latino and American Indian nursing students. Journal of Nursing Education, 43(5), Gailbraith, M. W., & Jones, M. S. (2010). Understanding incivility in online teaching. Journal of Adult Education, 39(2), Retrieved from https://www.mpaea.org/docs/pdf/vol39no22010.pdf Holly, C. (2009). The case for distance education in nursing. MERLOT Journal of Online Learning and Teaching, 5(3), Retrieved from Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press. Retrieved from record_id=12956 LaRocco, S. A. (2007). A grounded theory study of socializing men into nursing. The Journal of Men's Studies, 15(2), doi: /jms Le-Hinds, N. (2010). Male nurses: Gender-based barriers in nursing school (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses database. (UMI No ) Machado, C. (2011). Gender differences in student discourse on discussion board and blogs: An instructor's quest to create a level playing field in a hybrid classroom. Journal of Interactive Online Learning, 10(1), Retrieved from Marchiondo, K., Marchiondo, L. A., & Lasiter, S. (2010). Faculty incivility: Effects on program satisfaction of BSN students. Journal of Nursing Education, 49(11), doi: / Mattes, C., Nanney, R. J., & Coussons-Read, M. (2003). The online university: Who are its students and how are they unique? Journal of Educational Computing Research, 28(2), doi: /6whx-duwa-f1yp-thej McLaughlin, K., Muldoon, O. T., & Moutray, M. (2010). Gender, gender roles and completion of nursing education: A longitudinal study. Nurse Education Today, 30(4), doi: /j.nedt Mulholland, J., Anionwu, E. N., Atkins, R., Tappern, M., & Franks, P. J. (2008). Diversity, attrition and transition into nursing. Journal of Advanced Nursing, 64(1), doi: /j x Kaufman, K. A. (2012). Executive summary: Findings from the Annual Survey of Schools of Nursing, academic year Washington, DC: National League for Nursing. Retrieved from 487
8 O'Lynn, C. E. (2004). Gender-based barriers for male students in nursing education programs: Prevalence and perceived importance. Journal of Nursing Education, 43(5), O'Lynn, C. E. (2007). Gender-based barriers for male students in nursing education programs. In C. E. O'Lynn & R. E. Tranbarger (Eds.), Men in nursing: History, challenges, and opportunities (pp ). New York, NY: Springer. O'Lynn, C. E. (2013). A man's guide to a nursing career. New York, NY: Springer. Pryjmachuk, S., Easton, K., & Littlewood, A. (2008). Nurse education: Factors associated with attrition. Journal of Advanced Nursing, 65(1), doi: /j x Ritke-Jones, W., & Merys, G. M. (2010). Making online collaboration work by transcending gender stereotypes: A study of two mixed gender online groups. MERLOT Journal of Online Learning and Teaching, 6(4), Retrieved from Stott, A. (2007). Exploring factors affecting attrition of male students from an undergraduate nursing course: A qualitative study. Nurse Education Today, 27(4), doi: /j.nedt Sullivan, P. (2001). Gender differences and the online classroom: Male and female college students evaluate their experiences. Community College Journal of Research and Practice, 25(10), doi: / Suplee, P. D., Lachman, V. D., Siebert, B., & Anselmi, K. K. (2008). Managing nursing student incivility in the classroom, clinical setting, and on-line. Journal of Nursing Law, 12(2), doi: / Tri-Council for Nursing. (2010). Tri-Council for Nursing issues new consensus policy statement on the educational advancement of registered nurses [Press release]. Retrieved from U.S. Department of Health and Human Services, Health Resources and Services Administration. (2010). The registered nurse population: Findings from the 2008 national survey of registered nurses. Washington, DC: Author. Retrieved from rnsurveyfinal.pdf Wilson, G. (2005). The experience of males entering nursing. Contemporary Nurse, 20(2), doi: /conu Yang, Y., Cho, Y., Mathew, S., & Worth, S. (2011). College student effort expenditure in online versus face-to-face courses: The role of gender, team learning orientation, and sense of classroom community. Journal of Advanced Academics, 22(4), doi: / x This work is published under a Creative Commons Attribution-Non-Commercial-Share-Alike License For details please go to: 488
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text:
Slow-Cooked Pork Stew
Recipe by bluemoon downunder
Always on the lookout for another tasty crockpot recipe, in trying this recipe, I was attracted by C. Barber's comment that "The pork and vegetables in this dish taste best when cooked slowly. The meat becomes so tender you can tear it with a fork." Sounded good to me! And I was not disappointed. The recipe I have posted here has been adapted from C. Barber's recipe in Prevention Healthy Cooking's 'Eat Up, Slim Down: Tried-and-true recipes and tips from real weight-loss winners' by Jane Kirby and David Joachim. Vary the vegetables - and adjust the quantity of garlic - to suit your taste preferences.
Top Review by WiGal
Tastes great! Timing was right on for me but did cut all the pieces as suggested. I reduced the black pepper to 1 teaspoon and did not have parsnips otherwise made as posted. Loved the 6 cloves of garlic! Served with Recipe#382235. Thanks bluemoon downunder for sharing. Made for Zaar Stars.
See Discussion:8 Reviews
Ingredients Nutrition
- 2 lbs lean pork loin, cut into 1 inch cubes
- 8 ounces baby carrots
- 3 large new potatoes, cut into 1 inch cubes
- 2 parsnips, cut into 1 inch cubes
- 1 onion, cut into wedges
- 2 leeks, thoroughly washed and sliced into 1 inch strips
- 6 garlic cloves, finely chopped
- 1 (8 ounce) packet frozen spinach, thawed and well-drained
- 2 teaspoons fresh ground black pepper, to taste
- 1 teaspoon dried thyme
- 1 teaspoon salt, to taste
- 1 pint vegetable juice
- 2 tablespoons brown sugar
- 1 tablespoon mustard
- 4 teaspoons tapioca
Directions See How It's Made
- Place the pork in a crock pot, and add the carrots, potatoes, parsnips, onions, leeks, garlic, spinach, pepper, thyme and salt.
- In a medium bowl, combine the vegetable juice, brown sugar, mustard and tapioca.
- Pour it over the pork and vegetables.
- Cover and cook on low for 6 hours or on high for 4 hours.
- Note accompanying the original recipe: This recipe can also be cooked in a large casserole dish. Cover tightly and bake at 135ºC/275ºF/gas 1 for 5 hours without disturbing.
- My Note: When I first came across this recipe, the reference to tapioca made me more than a little dubious. It sounded just a bit too nineteenth century, somehow smacking of grim British boarding school meals. Or something like that. Tapioca was an ingredient I had NEVER used, so I checked it out on the internet and learnt courtesy of Encyclopedia Britannica, that it (tapioca) was probably first harvested by the Mayans. And the sheer mystique of THAT connection was enough for me to give the recipe a try. I still haven't used tapioca in any other way, but I'm glad to have found this recipe. Tapioca and all!

subset: commoncrawl


text:
|By Gingalover
|Part of the Avatar: New Universe continuity.
Weed is a teenaged blue dog that was found by Team Avatar during the winter with Mel, Kyoushiro, and Nobutora. He and his friends had gotten lost in the winter and were saved by Katara.
It was quite a surprise however when he first began talking to them, but the team brushed it off and got used to it right away, which was good for him and his friends.
Lost Arc
He makes his first appearance during the beginning of the story with no lines said, although the story does describe how he and his friends were found.
He wakes up with Mel and Nobutora now in Altonia. At first he was trying to pick up what happened but instead he finds himself looking off into the savannah of Altonia. He and Nobutora go on with Mel's idea on looking and they head on down into the Aptonoth herd.
He continues traveling with the herd for a while longer. He tells his two friends to calm down and they'll be okay in the herd but they all end up having their first encounter with a Lightning Wolf, who was trying to hunt. Weed got Mel up and caught up with the Aptonoth.
Later on that night he woke up from an erotic dream of him being attacked by an unknown creature. As he was up, he saw a baby Aptonoth, also not sleeping. He calms her just before he hears a Kelbi grazing. But when he accidentally spooks it, he was hit by a paralyzed body and he met up with the same Lightning Wolf again. A bit shaken by his encounter, he goes back as soon as it goes away with its prey.
Later on, after the Aptonoth drove them away, Weed assured Nobutora that they'll be fine as they were traveling through the Savannah. He keeps trying to bring their spirits up as they were walking alongside a canyon but as he raced ahead he and Nobutora both end up tumbling down the slope to the canyon floor! During the fall he broke his left leg and couldn't get up as a herd of Uragaan started roaring down towards them. He was carried by the Kai dog but he ended up being tossed down another slope, out of sight.
Weed wakes up later on in an old cabin and decides to look around. The stampede he survived from but he got his leg broke during it all as he found out when he tried to walk. During his stay here he meets the barrower, Arriety, and the pup, Delath. They talked for a while and Weed was about to leave when he and the others got a special message about the Starlight Fighting Championship. Delath explains to him what the championship is and Abit about the administrator Krokhotep. Weed looks at the prize and sees 5 people, three he knew, and tells them that they got to get him in there.
Weed made it with Delath and Arriety to where the fighting event was taking place. He originally was gonna fight alone but when he finds his old friends, he agrees with Kyoushiro to join in a tag team for the event.
S.F.C Arc
After applying, he was being trained by Kyoushiro for a bit when Toube appeared. He went on and agreed when Toube offered to help them out. Later on though he was walking to find him when he finally finds Toph again, jumping at her with glee. He was very happy to see her again and was catching up on what happened.
Weed and Kyoushiro fought hard when it was their turn to fight, and managed to beat Thunder and Lector by default.
That night he grew restless and was trying mainly to figure out how he and Kyoushiro won when Thunder came by and told him why. After some talking he went off to check on their "human members", still unaware of his new gained Scar.
He and Kyoushiro started fighting the next day against Hougen and Genba. After Kyoushiro's episode, he quickly helps him snap back to reality and they both go back to their friends.
Weed and Kyoushiro were now fighting Toph for the prize in the finals. Now it didn't matter who wins or loses, they win their friends back regardless. But before the fight can end, the giant serpent monster, Raviente, ruining everything. He helps the prizes escape as the beast was making waste of the championship arena.
Colossi Arc
After directions were given to him by Xerneas, he goes off to find and fight Phaedra. The fight with her ends in success and at first he was given directions to another unknown colossi but in the end he was just given the chakra orb by Marage and gains his ultimate form that way.
Final Arc
After leaving the colossi world, he uses his ultimate form to help build the S.S. Ultimate so they can go after raviente.
See more
For the collective works of the author, go here.


text:
Assisted Living facilities in and around Zip Code 97322
1 | 2 | 3 >>
97322 Assisted Living Facilities
Regency Park Place at Corvallis
Our assisted living options offer personalized assistance, supportive services and compassionate care in a professionally managed, carefully designed, retirement community setting. It's the perfect...
Corvallis, OR 97330
Assisted Living
Emeritus at Century Fields
Emeritus at Century Fields is a one-of-a-kind assisted living facility, offering the best level of care that money can buy - at a surprisingly affordable price....
Lebanon, OR 97355
Assisted Living, Independent Living
The Oaks at Lebanon
The Oaks at Lebanon offers 104 private apartments featuring retirement and assisted living. Live comfortably in a studio or 1-2 bedroom apartment which features wall-to-wall carpeting, private...
Lebanon, OR 97355
Assisted Living, Independent Living
Stoneybrook Assisted Living
Stoneybrook Assisted Living in beautiful Corvallis, Oregon, combines the care seniors need, the convenience they value, and the independence they cherish.Stoneybrook Assisted Living is beautifully...
Corvallis, OR 97333
Assisted Living
Emeritus at Heron Pointe Campus
Emeritus at Heron Pointe Campus is a one-of-a-kind assisted living facility, offering the best level of care that money can buy - at a surprisingly affordable price....
Monmouth, OR 97361
Assisted Living, Independent Living
Farmington Square at Salem
Farmington Square offers a community style setting allowing residents the luxury of knowing a trained staff member is always close by, ready and willing to help. At Farmington Square it is our belief...
Salem, OR 97306
Assisted Living, Memory Care
Regency Woodland
Regency Woodland's assisted living options offer personalized assistance, supportive services and compassionate care in a professionally managed, carefully designed, retirement community setting....
Salem, OR 97302
Assisted Living
Redwood Heights Retirement and Assisted Living
Welcome to Redwood Heights Retirement and Assisted Living Residence, the premier Retirement and Assisted Living Community in Salem, Oregon. Redwood Heights is located in the heart of Salem, only a...
Salem, OR 97302
Assisted Living
Lakeside Assisted Living & Cottages
A Wonderful Place to Call Home!Welcome to Lakeside Assisted Living Community in Stayton, Oregon. Wonderful opportunities around for the senior lifestyle of your choice at Lakeside Assisted Living...
Stayton, OR 97383
Assisted Living, Independent Living
Meadow Creek Village
At Meadow Creek we promise to assist you with the care you need so you can live the life you want. We promise to treat you with respect, honor your privacy, encourage your independent and provide...
Salem, OR 97302
Assisted Living
Lancaster Village
Offering outstanding care at affordable prices, Lancaster Village is a one of the best assisted living communities in the region....
Salem, OR 97301
Assisted Living, Independent Living
River Road Assisted Living
River Road Assisted Living Community is dedicated to promoting the social, psychological, spiritual, and physical well being of all residents. River Road seeks to provide the highest quality of...
Keizer, OR 97303
Assisted Living
Cedar Village Assisted Living
Welcome to Cedar Village Assisted Living Community, the premier Retirement and Assisted Living Community in Salem, Oregon. This community is located in the heart of Salem, close to parks, shopping...
Salem, OR 97305
Assisted Living, Memory Care
Junction City Retirement & Assisted Living
Located in the heart of Oregon's historic Willamette Valley,Junction City Retirement and Assisted Living Communityoffers the lifestyle that's just right for you. With views of the surrounding...
Junction City, OR 97448
Assisted Living, Independent Living
Lone Oak
Everything You Need to Feel at Home. Whether you're active and on the go or need some help with activities of daily life, Lone Oak gives you the means to live life fully. For those seeking choice...
Eugene, OR 97402
Assisted Living
Deer Meadow
Deer Meadow Assisted Living is a small community with a country setting and welcoming atmosphere. Our caring staff and friendly residents will make you feel right at home. Deer Meadow is conveniently...
Sheridan, OR 97378
Assisted Living
Emeritus at Alpine Campus
Our cottages are month-to-month rent;l they are not for sale or lease. This allows you the freedom to choose where you live today as well as in the future. Our cottages include full kitchens equipped...
Eugene, OR 97402
Assisted Living, Independent Living, Memory Care
Sheldon Park
Located in the heart of the Willamette Valley and the town of the University of Oregon Fighting Ducks, residents at Sheldon Park enjoy colorful scenery, beautiful parks and college football games....
Eugene, OR 97401
Assisted Living, Memory Care
Farmington Square at Eugene
Our unique community offers three (3) separate houses, each catering to a different level of care. Each Home has between 18-23 residents and has a FULL staff to include a Manager, Activity Director,...
Eugene, OR 97401
Assisted Living, Memory Care
Spring Valley
If you're searching for the right home care facility for you or a loved one, you may find everything you're looking for in Spring Valley ....
Springfield, OR 97477
Assisted Living
Country Meadows Village
Country Meadows Village is more than an assisted living center - it's a happy community....
Woodburn, OR 97071
Assisted Living, Independent Living
Bayberry Commons Assisted Living & Memory Care
At Bayberry Commons, our mission is simple: creating environments where moments of joy, independence, and wellness are the focus each and every day.Bayberry Commons is the home of a unique, Balance...
Springfield, OR 97477
Assisted Living, Memory Care
Silver Creek
Set amidst Central Oregon's Cascade Mountains north of Salem, Silver Creek offers the lifestyle that's just right for you. With proximity to museums, galleries, wineries, andthe acclaimed Wooden...
Woodburn, OR 97071
Assisted Living, Memory Care
Emerald Gardens of Woodburn
Nestled on acres of beautifully landscaped grounds in a quiet residential area, Emerald Gardens is one of Woodburn's premiere senior living communities located at the heart of the Willamette...
Woodburn, OR 97071
Assisted Living
Cascade Park
Cascade Park Retirement community offers retirement living in uncommon luxury and comfort in a beautiful, independent setting. Centrally located between Portland and Salem in the heart of the...
Woodburn, OR 97071
Assisted Living, Independent Living
Emeritus at Springfield Campus
It only takes one look at Briarwood's beautifully landscaped courtyard, spacious apartments and elegant décor to know this is a great place to call home. At Briarwood, our goal is to give you...
Springfield, OR 97478
Assisted Living, Independent Living
Emerald Valley
Emerald Valley Assisted Living Residence has been caring for seniors since 1990 in the beautiful south hills of Eugene. With only 40 apartments (studios and one bedrooms), we are committed to...
Eugene, OR 97405
Assisted Living
Fox Hollow Residential Care -Eugene
Located in a beautiful, wooded south Eugene setting, Fox Hollow is a 51-apartment residential care community-the finest facility of its type in the Eugene area.Fox Hollow supports a resident's right...
Eugene, OR 97405
Assisted Living
Pheasant Pointe Assisted Living
Welcome to Pheasant Pointe Retirement and Assisted Living Residence, the premier Retirement and Assisted Living Community in Molalla, Oregon. The Community is nestled in a quiet neighborhood, in the...
Molalla, OR 97038
Assisted Living, Memory Care
Chehalem Springs Assisted Living Community
Located in welcoming Newberg, Oregon, Chehalem Springs Senior Living Community & Cottages is an ideal community. From a relaxing atmosphere to themed events to day trips, Chehalem Springs is a...
Newberg, OR 97132
Assisted Living, Independent Living


text: Tuesday tiny:Interesting take on the hung parliament If you're new here, you may want to subscribe to my RSS feed. Thanks for visiting!Michael Pascoe | What happens next in Canberra: 75 all. Possibly Related Posts: The other race that stopped our nation Tuesday tidbit: wish I'd known True to our word. 6WS: election day As the dust settles Pass it onFacebookWhatsAppEmailGoogleTwitter


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In a move to keep the sport clean and drugs free, the Pakistan Cricket Board today made dope testing mandatory in its domestic cricket competitions.
The national T20 championship which begins from tomorrow in Lahore will be the first domestic event in Pakistan which will witness random dope testing of players.
"All the cricketers representing the 14 regional teams in the T20 event will be subject to random dope tests," a PCB official said.
The decision to introduce dope testing in domestic cricket comes nearly six years after former pace duo of Shoaib Akhtar and Mohammad Asif had tested positive during the ICC Champions Trophy in India.
Since the spot-fixing scandal in 2010 which led to a ban on three players Salman Butt, Mohammad Asif and Mohammad Amir, the board has also introduced new anti-corruption measures in domestic cricket.
"We believe that the core of any ill is in domestic cricket and must be dealt with at that level. That is why now we are taking effective anti-corruption measures and have now introduced random dope testing," the official said.
He said the dope tests would be conducted in accordance with regulations of the World Anti-Doping Agency.
"These tests will be conducted by WADA accredited independent doping control officers throughout the competition."
A PCB statement said that since last year the board had educated approximately 500 cricketers on the subject of doping.
"Players were educated and made aware of rules and regulations related to doping through lectures. They were also provided with an urdu guide, updated list of banned drugs and a CD for revision of doping education," the statement said.
The statement added that the board in order to strive for drug free sports and to protect the basic framework of protection of athletes' basic right to participate in doping-free sport and thus promote health, fairness and equality for cricketers nationwide, has introduced this in-competition testing.
It said that under the Supervision of Dr. Sohail Saleem, GM sports medicine department of Pakistan Cricket Board has not only prepared 'Doping Code PCB' in accordance with the rules laid down by WADA, but also a strategic plan for controlling, if any, doping in the country under their domain.


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The love story between an actress and a director. Inspired by the life of the late south Indian actress Silk Smitha.
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Cephalopod by MissPHWatch
©2011-2017 MissPH
First "proper" drawing I've done in ages. Some squid woman thing!
Feeling very rusty!
Feeling very rusty!
a little rusty lol this is nice love it!
Hey there, this piece has been featured in the Things That Go Bump In The Night Art Feature VII . Feel free to check it out, have a good day!
This, is awesome. This needs to be a boss in a video game or something. I LOVE IT. D:
creepy :3
this is fucking beautiful . . . .
Pretty cool for being rusty. I like pieces related to squids, krakens stuff like that. Takes some control when putting them together.
I have never before envisioned a squid enjoying the company of a crow (as far as she can be said to be enjoying anything), and for that, I give you kudos.
awesome work!
perspective's a little rough, but conceptually very nice and pretty linework and coloring. Very creepy and sexy. I like her.
...what? I'm a little weird. ^_^, I'm allowed to think a horrific cephalofemme is sexy.
...what? I'm a little weird. ^_^, I'm allowed to think a horrific cephalofemme is sexy.
Very creepy!
creeped!!! i like


text: After Blue Eagle Islander discovered that the guys Awesomelost and Lostienumberone were one and the same person, my biggest fans!!!???. I thought, do I have to quit or not? So fans, I don't know it's all your choice. Nobody is coming to that site, only me. So it's vote time. Very simple: Quit or not?--Station7 21:13, November 11, 2009 (UTC)


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Amazing Archive designs from
Little Greene
14,949 wallpapers from
the world's favourite brands
per dbl roll
per metre
Wallpaperdirect delivers a huge choice of British and European design house wallpaper collections direct to the USA. Cole & Son, Little Greene, Farrow & Ball and many more – around 9,200 lovely wallpapers.
We'll inspire your interiors with wallpaper designs from Beaux-arts to Boho.
Free wallpaper samples to try at home, easy-peasy wallpapering guides and our expert wallpaper calculator mean you'll buy just what you need and decorate your walls perfectly.
The latest from the world of design and decor on the wallpaperdirect blog more…
To celebrate this year's international wallpaper week, we've decided to pick some favourites from our far flung collections to highlight the depth and breadth of our wonderful world of wallpaper!
Relax, deep breaths, fresh air, stunning countryside, rain (and lots more rain). No matter - it's holiday time. There's lots to take in and enjoy…
After the inspiring haul of gold, silver and bronze medals in Rio this Summer we're ready to keep the warm glow going in our choice of Autumnal interiors.


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Admire the most beautiful places of VILLAROSA and add them to your basket. YAMGU will create your trip considering distances, opening hours and weather.
The Museum is located at Villa Lucrezia, the summer residence of a prominent local family, and exposes materials ethno-anthropological heritage of civilization and local mining. Through clothes, furnishings and objects actually in use from the late 800 in early ' 900, is the villarosana life cycle — birth, baptism and first communion.


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Google has launched Screenwise, a 100% voluntary project that attempts to nail down internet usage statistics from normal, everyday users, rather than the 'power-users' that are typically monitored and seem to have the loudest voice. Google is willing to pay these regular Joes throughout the monitoring process as well, albeit via relatively meager Amazon gift cards.
What's the catch? Well, once you opt in as a panelist, your every click around the vast interwebs will be captured by a browser extension and sent back to the Google mothership, to help them better understand how everyday folks use the web.
If you're not a conspiracy theorist, or worried about being a part of a broad cross-section (and you're at least 13 years old), you could have signed up to be a panelist through the Screenwise website. However, at the time of writing, there has been an overwhelming interest for this program and Google is urging those interested to "please come back later for more details". If you got in early or the program opens back up, Google plans to reward panelists with a $5 Amazon gift card for the first month of tracking and another $5 gift card for every three months thereafter.
To take it a step further, of the folks that have already signed up, a handful have been approached to install a small black box to their home modem called a Screenwise Data Collector (SDC). Having an SDC box in your home will track your entire home network usage, no matter the time of day, chosen browser, or device you surf on. While more intrusive, the SDC program does award participants $20 for every month they participate and an initial $100 for starting the program.
So how do you feel about every keystroke, click, hover, or late-night Amazon impulse being tracked and recorded to provide the common user a better experience on the internet?


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Shivapuram Colony,barielly Gate, Near Maruti Showroom,barielly Gate, Rampur, Uttar Pradesh 244901
9650314381 ,9412340728
Locate a Mahindra Dealership in Rampur. CarDekho.com makes it easy to find authorized Mahindra dealerships and showrooms in Rampur. Locate over 1Mahindra Dealers in Rampur. We aim to provide you with all important contact details about the Mahindra car dealers in Rampur at your convenience. Details of which are listed above:
It will help us serve you better content and best deals


text:
Samsung admits to tablet flop, expects success with new Galaxy Note series
During a media roundtable today at MWC 2012, Samsung admitted that its efforts in the tablet market have missed the mark. Samsung product strategy exec Hankil Yoon was refreshingly direct, saying: "Honestly, we're not doing very well in the tablet market." However, the company appears confident in its new Galaxy Note series of tablets, which includes the 5-inch "phablet" phone-tablet hybrid version and the newly announced 10.1-inch model.


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< index - Triple Trees 5 Degree
Wide Glide Tripletrees 5° raked
TÜV approved § 19/3 German StVZO.
We offer Motorrad Burchard tripletrees like in the following list in a width of 250 mm and/or 290 mm. These dimensions are measured from the middle of fork tube to fork tube, so a total width of 290 mm, resp. 330 mm results.
All original parts like headlights, contolunits, front fork covers and so on can still be used.
All tripletrees will be delivered with the necessary accessoires like axle, spacer for the frontwheel, brake system and front fender.
You can take over the bearing from the original tripletree.
The original riser can not be taken over in most cases.
|[Deutsche Version]
|Imprint/Privacy | top of page


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Corinium Acupuncture
The Cotswold Academy
24 Thomas Street
447825360621 / 07825360621
Corinium Acupuncture
The Cotswold Academy
24 Thomas Street
447825360621 / 07825360621
Sarah Attwell-Griffiths is a qualified, accredited and experienced acupuncturist providing professional acupuncture treatment in Cirencester. At Corinium Acupuncture, she offers evening and weekend appointments, on-line appointment bookings, and card payment facilities.
Conditions that Sarah treats
As a traditional acupuncturist, Sarah aims to activate your body's own healing mechanisms. This means that treatment is effective for a wide range of conditions, as well as symptoms with no conventional medical diagnosis like low energy and poor sleep. NICE recommends acupuncture for chronic pain, back and neck pain, knee pain, headaches and migraines. Many of Sarah's patients also see her for help with fertility, difficulties during pregnancy (such as morning sickness), stress, anxiety (and conditions exacerbated by anxiety like IBS), and depression.
Can acupuncture help you?
If you are unsure if acupuncture can help you, you can book a free 15-minute assessment at Corinium Acupuncture. During the assessment, Sarah will ask questions about your condition or symptoms and examine any areas of discomfort. If acupuncture is suitable for you, she will discuss the benefits you are likely to experience and estimate the number of treatments you are likely to need. You can then take your time to decide whether you would like to go ahead with treatment. If acupuncture is not suitable for you, Sarah may recommend a different therapy that may be suitable.
Other benefits
Sarah invests time in identifying and treating the root cause of your symptoms, so you are likely to feel improvements in both your main complaint and other apparently unrelated symptoms. In particular, you are likely to sleep better and feel happier in yourself.
Opening hours
Mondays, 12:00 - 20:00
Tuesdays, 12:00 - 16:30
Thursdays, 12:00 - 20:00
Saturdays, 09:00 - 13:00
Sarah studied at the College of Integrated Chinese Medicine and holds a first class BSc (Hons) degree in traditional acupuncture awarded by Kingston University. She is also a full member of the British Acupuncture Council. In addition to her clinical practice, Sarah has published ground-breaking research into acupuncture treatment for self-injury users in the European Journal of Oriental Medicine.
Assessment to find out if acupuncture can help you (15 minutes) - Free of charge
Initial consultation, including a full Chinese medical diagnosis and your first acupuncture treatment (up to 1.5 hours) - £60
Follow-on treatment (up to 1 hour) - £43
In addition to acupuncture, your personalised treatment plan may include other Chinese medical techniques such as cupping, tui na (a form of Chinese medical massage), moxibustion and gua sha. These techniques are included in the cost of your initial consultation and follow-on treatments.
Self help advice
Sarah may give you therapeutic exercises to do at home, similar to those recommended by physiotherapists. She may also discuss changes that you can make to your diet and lifestyle that will benefit your particular condition.
Referral for other therapies
Sarah may refer you to a qualified local practitioner if you might benefit from complementary therapies other than acupuncture, such as chiropractic or nutrition therapy.
'Red flag' referrals
Sarah is trained to identify the signs and symptoms of serious conditions (called 'red flags') that require conventional medical treatment. If she identifies any red flags during your treatment sessions, she will provide you with a letter to take to your GP. She will also tell you how urgently you need to see your doctor.
If you have been diagnosed with or suspect you may have a pre-existing medical condition you should consult your GP for advice, diagnosis and treatment and always inform your health professional before starting any alternative or additional therapies, treatments or making any major changes in your diet or exercise programme.
|Sign language:
|Other languages:
Clinical hours are Tue 12:00-16:00, Wed & Thu 12:00-20:00, Fri & Sat 09:00-13:00. Sarah also practices at Cotswold Community Acupuncture on Tuesdays, 17:00-19:00


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Commercial Vehicle & Freight Mobility
The mission of the Commercial Vehicle and Freight Mobility Forum (CVFM) is to provide the transportation community with a forum that champions safety, commerce, security, and policy for commercial vehicles and freight movement through the advancement of Intelligent Transportation Systems (ITS).
Recent Webmeetings and Presentations
Robert Kreeb and Abbigail Morgan from the National Highway Safety Administration joined the forum for its September 2015 Webconference to present on recent rulemaking and research activities at the agency. A full recording of the meeting is available here.
Justin Saye, Vice President of Global Operations at Airbiquity presented to the attendees about its connected car platform and current telematics trends in the European marketplace. A full recording of the meeting is available here.
Randy Iwasaki, from the Contra Costa Transportation Authority in California, spoke to the CVFM on the National Strategic Freight Plan and its status. A recording of the webinar can be found here.
CVFM-Sponsored Technical Sessions from Previous ITS America Conferences
- Tracking Economic Trends and Activity Using ITS (2011)
- ITS For Truck Parking (2011)
- FMCSA's Expanded CVISN Program: Reports and Results from Across the Country (2011)
- Using ITS for Freight Planning and Programs (2011)
- Truck and Bus Safety Technology (2012)
- Advancements in Connected Vehicle Technology for Heavy Trucks (2012)
- ITS for Fleets: Energy Efficiency and Sustainability (2012)
- How ITS is Changing Truck Parking and Urban Delivery (2012)
- Connected Trucks: A Roundtable Discussion (2012)
- The Critical Role of ITS in Framing Freight Policy (2012)
- Trucks and Traffic: What Data Can Tell us about Reducing Congestion for Freight-Moving Vehicles (2013)
- Advancing Wireless and Innovative Safety Technologies for Trucks (2013)
Join Us!
If you are interested in joining the forum, please contact Patty Fusaro at firstname.lastname@example.com or 202-721-4238. You must be a member of ITS America in order to join the Forum. Not a member? Contact the Membership Team firstname.lastname@example.com or call 202-484-4847.


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Atmospheric but a decidedly average gangster game.
Taking outrageous liberties with brian De Palmas gangster classic, The World Is Yours opens with the brutal shoot-out in Tony Montanas mansion that brought the movie to a close, but sees the coked-up antihero escaping the carnage. And with no money, no friends and no drugs to sell, its up to you to rebuild his empire.
Liberally borrowing ideas from GTA and EAs recent Godfather game, The World is all about establishing shady businesses, with plenty of gunfights, car chases and chainsaw slayings to spice up the action. But while the game does a fine job of capturing the spirit of the movie, it feels much like every other crime caper on the shelves, and in terms of pure, gleeful fun isnt a massive step-up from 2002s Scarface-inspired GTA: Vice City.


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Walt Disney World Resort
The 3 Stages of Services
7 P's
Brand name recognition
Customer Loyalty
Target Market
Core and Supplementary Services
Disney World provides an immersive, and "magical" experience for families to come together.
Walt Disney World Resort
Sector analysis
Market Analysis
Marketing Strategy
Pricing Stategies
Immersion and Experience
Family Bonding
International Outreach
Fan Engagement
Friendly and Welcoming Staff and Hospitable Services
Intellectual property valued at $68 billion
Brand loyalty
Revenue per Atendee
Competitive advantage over other theme parks: Universal, Six Flags, Seaworld
Customer Service
Fast pass
Promotions and family packages
5 day ticket versus 1 day ticket
Ticket cost vary depending on age
Gift shops, Hotel accommodations, and Food and Beverage Services
Positive Growth
Following (Tradition)
Increase demand for emerging themes of the park
Opened in 1955
The property covers 27,258 acres
27 themed resort hotels
9 non–Disney hotels
4 theme parks
2 water parks
Additional recreational and entertainment venues.
Story-themed resorts and amusement parks, including dining, and merchandise
Comparison with other resorts & theme parks
Advertising on television, magazines, etc. to show what customers may expect
Offers free admission on birthdays to promote
Offer vacation packages
Online access to reservations/ cancellations
Service Encounter:
High contact through whole experience
Ex: Disney characters greeting you
Guests stay in resort and experience park, interact with staff through whole experience. (bellhop-vendors)
Receive promotional discounts via e-mail or post.
Follow-up surveys
word of mouth between other visitors
"Magical" family experience to enjoy a story-telling themed park and 1st class resort to sleep in (based on family values)
Packages available for all types of families incomes
"All inclusive"
"Room only Reservations"
"Annual Pass holders"
Florida Residents
Value ($100-$200's)
Moderate ($150-$300's)
Deluxe ($300's up)
Off-season rates
e-mail, mail discounts
Annual Pass ($600-$750)
*Virtually Unnecessary*
"we create happiness"
Flagship: Orlando, Florida
Other Resorts: Paris, Hong Kong, Tokyo, Cruises, California
People Processing
Check-in spending the night Dining options
Exploring the parks Interacting with staff
Transport to-and from parks
Disney's Seven Service Guidelines
The Disney Experience is ALL about people to people (character) contact
Front-Line is very important and quite expansive at Disney World
Care about the customers and know the experience is everything
Make eye contact
and smile
Greet and welcome each
and every guest
Seek out guest contact
Provide Immediate
service recovery
Display appropriate body language at all times
Preserve the "magical" guest experience
Thank each and every guest
*Huge aspect of Disney World*
Ambiance Spacial Layout Functionality
Exciting & Playful
Bright, and colorful, attractive to the eyes of children
Sounds of Disney Music heard over speakers
Aromas of restaurants and small vendors
Special Effects at every turn
Resorts, rides, attractions, stores, restaurants spread out to give the feel of an actual magical land
(over 27,000 acres)
*30% used*
Incorporate the themes to be functional into the rides. The small shops are actually real, the Castle is actually a resort to stay in.....
(Dream suite Hotel Room)
Teacup ride, etc.
Weak Management
Technological advances
New markets
International Expansion
Intense Competition
Families with children
Khelsey Silberhorn & Kara Torzullo
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Disney World
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Kara Torzulloon 3 December 2014
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text:
Also, I have a chinchilla named Leona Hopsky. If you recognize the reference for her name I'm sure we'll get along very well! Someday she will get a dog brother named Karl Barx.
Also working at an ad-data company.
movie: For me, it's more about who I'm watching a movie with, so I really enjoy movies that will inspire a good conversation, whether it's a good documentary, or an awesomely bad horror film. Killer Klowns from Outer Space is always at the top of my list! ok, maybe it is actually terrible.
shows: I'm a big fan of the 90s and I'm often watching the Adventures of Pete and Pete. Suggest things I need to watch on Netflix please!
music: lately, mostly indie/folk stuff. Currently listening to Laura Stevenson and the Cans.
food: anything vegetarian and delicious.
1. my guitars, Grandpa Martin and Eugene Shreds
2. my car, Rosa Parks
3. spotify!
4. my record collection (there's that nerdy side again)
5. peanut butter and jelly
6. green tea