text:
- Research article
- Open Access
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Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial
© Dehbarez et al. 2015
- Received: 18 September 2014
- Accepted: 18 September 2015
- Published: 28 September 2015
Learning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitation programme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure.
The study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standard rehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical training and education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal cost perspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjusted life years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preference weights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped standard errors.
An additional cost of DKK 6,043 (95 % CI −5,697; 17,783) and a QALY gain of 0.005 (95 % CI −0.001; 0.012) was estimated for LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention. The probability that LC would be cost-effective did not exceed 29 % for any threshold values of willingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62 % over the threshold values.
The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-up should be evaluated before a definite conclusion is drawn.
Future research should assess the LC strategies' long-term efficacy and cost-utility.
Trial registration
- Cost-utility analysis
- Rehabilitation
- Patient education
- Ischemic heart disease
- Heart failure
Cardiac rehabilitation (CR) programmes have become an integral part of the standard of care in modern cardiology. These programmes rely on early detection of the disease process and the application of interventions to prevent disease progression [1]. However, few patients complete CR or succeed with lasting lifestyle improvements [2]. Despite the established value of CR, the participation rates are disappointingly low [3], and there is a lack of visibility and recognition of the importance of CR by the public [4].
In the light of the favourable effects of CR, it is important to develop patient education strategies which can help patients to improve adherence to CR and make changes towards a healthier lifestyle [5, 6]. To enhance patient attendance in the cardiac rehabilitation programme, a patient-education strategy called "Learning and Coping (LC)" was implemented within a randomised controlled trial (RCT) at the Regional Hospitals West Jutland in Denmark. This method was developed in Norway to address some of the challenges in patient education. Theoretical basis and study protocol of LC strategies has been published before [7, 8].
Economic evaluation of CR has been reported since the 1980s, and all of the studies have supported the implementation of CR [9]. The cost-effectiveness of CR is supported by evidence from 15 health economic evaluations conducted in North America and Europe [10]. Recent studies have focused on comparison among various modes of delivery of CR, such as programmes that were outpatient, inpatient, home-based or telephone coaching programmes [9, 11].
The aim of this study was to evaluate whether a LC method was cost-effective compared with the standard rehabilitation of patients with ischemic heart disease (IHD) and heart failure (HF).
Study design and population
The study was conducted alongside a RCT of patient education in cardiac rehabilitation. The participants in this trial included 827 patients over 18 years who had been admitted with IHD or HF. Two patients were excluded; one because he was mistakenly randomised twice and the other because she was due for an eye operation and could not start the CR program. A total of 825 patients undergoing the CR programme, were randomised in to one of two education methods. Randomisation was computer generated and stratified by hospitals, diagnosis and gender. Use of stratified randomisation should be viewed as an insurance policy against a potential imbalance and, because it has virtually no cost, it should be routinely used in RCTs [12]. Of these patients, 413 were randomised to the LC group and 412 to the control group. All of the patients received 8 weeks (approximately 2 months) of training and education and were followed for an additional 3 months.
Elements of educational strategies in cardiac rehabilitation
Learning and coping
- Initial individual clarifying interview
- 8 week group-based:
- 8 week group-based:
Physical training 1½ h × 3/week
Physical training 1½ h × 3/week
Education 1½ h/week
Education 1½ h/week
- Weakly team evaluation
- Final individual clarifying interview
We assessed costs from the societal perspective to estimate the long-term average costs of the routine provision of education. A micro-costing approach was used to calculate the cost of intervention. Micro costing is a method that provides crucial and detailed cost data. An accurate cost of the intervention at the micro-level is required to perform accurate economic analysis, such as cost-effectiveness or cost-benefit analyses, which gives a complete analysis of outcomes alongside the cost at which they are achievable [13].
The cost of implementing the intervention was not included in the present analysis; it should be seen as estimating the long-term average costs of implementing the intervention in routine practice. The intervention includes the cost of both formal and informal time of all persons involved.
A load factor of 1.5 was applied to the cost of health professional's formal time to account for non-productive time. Their productive time was assumed to amount to 45 min of an hour (load of 0.25) due to pauses, walking distance between locations, private time, etc. The remainder load (0.25) was considered to include vacation, sickness, participation in seminars and educational courses etc.
The valuation of formal care was based on the average gross salary of nurses and physiotherapists involved in patient education, which was provided by Regional Hospital West Jutland. Regional hospital's standard overhead rate of 21 % was applied to account for capital costs.
The valuation of informal time; time spent by patients and expert patients, was undertaken using the opportunity cost method, in which the value of a person's time is reflected by his or her wage rate. The average age of expert patients was 65 years, and the valuation of their time was based on their net salary assuming they are pensioner. National average gender- and age-matched salaries were used to value the leisure time (net salary) and productive time (gross salary) [14].
The patient's time was calculated based on the recorded data on the number of training and education sessions they attended in both arms.
Item costs used for estimating the costs of patient education in cardiac rehabilitation programme
Time cost of formal care
Nurse (DKK /hour)
Regional Hospital West Jutland
Physiotherapist (DKK/hour)
Regional Hospital West Jutland
Load-factor for personnel time (weight)a
Researcher assumption
Expert patient, 65 years old, net salary (DKK/hour)
Statistics Denmark
Capital cost
21 %
Hospital standard rate
Time cost of informal time (examples)b
Male, 60-64years old, gross salary (DKK/hour)
Statistics Denmark
Male, 60-64years old, net salary (DKK/hour)
Statistics Denmark
Female, 60-64years old, gross salary (DKK/hour)
Statistics Denmark
Female, 60-64years old, net salary (DKK/hour)
Statistics Denmark
Transportation cost, expert patients (DKK/way)
Regional Hospital West Jutland
Transportation cost, patients (DKK/kilometres)
Danish Government
The DREAM database, which contains information on all social benefits, was searched for events of inability to work. Productivity losses are due to sickness leave, early pension and re-schooling and, were calculated using weeks of inability to work for those who did not reach the age for pension during follow-up (67 years old). All cost estimates were adjusted for time preference and, inflated to the common price year of 2013, using the consumer price index where relevant (DKK 100 ≈ GBP 10 ≈ USD 18).
Data on primary health care use (number of visits and the related activity-based tariffs) were extracted from the National Health insurance service register [15], and the data on the use of secondary health care services (number of services and national average Diagnostic-related grouping (DRG) tariffs) were extracted from the National Patient Registry (NPR) [16]. The data for prescribed medicine were extracted from the national prescription registry [17]. The DRG is revised every year and is based on the average use of resources in each group. The NPR includes administrative information, diagnoses, diagnostic and treatment procedures using several international classification systems, including the International Classification of Disease and Related Health Problems 10th revision [18].
Outcome parameter
The outcome parameter in the study was health-related quality of life, as defined by the SF-6D. The SF-6D scores were preference-weighted using British weights [19]. QALY was estimated as the area under the health utility curve over time using linear interpolation between observations [20].
The data suffered missing values on the SF-6D scores, while complete data on cost were obtained from administrative national registers with full coverage and thus were not subjected to imputation. To avoid the loss of information on the outcome parameters, the missing values were replaced using multiple imputation, which is generally used to address data missing at random [21].
Imputation was produced using a chained equation approach [22] because the non-response was of a non-monotonic character (e.g., a non-response at baseline could return and become a response after intervention or follow-up). Furthermore, sensitivity analysis was conducted for the alternative analytical choice of carrying the baseline observation to impute missing values after the intervention and carry the after intervention observation to impute missing values on the 3-month follow-ups.
The data on patient attendance at education sessions were not registered in the first six months of the study. In this case, missing data was completely random and did not depend on observed or unobserved values [23], and to avoid loss of information, the missing values were imputed by a mean within the randomisation groups.
Statistical methods
Baseline characteristics were summarised using conventional summary statistics. The comparative analysis of the individual parameters and of the net benefit was based on the means with bootstrapped standard error [24]. Non-parametric bootstrapping with 10,000 replications was applied due to the skewed nature of both resource use and cost, and a general significance level of 0.05 was used.
The analytical strategy was implemented for two scenarios: cases with a complete response of the outcome parameter and, an imputed dataset in which missing values of the outcome parameter were imputed. Although both scenarios are shown, the latter was considered the main analysis.
Economic evaluation is subject to uncertainty not only because of sample variation but also because of assumptions made and generalisability issues [25]. We therefore conducted an analysis of alternative scenarios to test the methodological uncertainty of the imputation procedure and costs. The impact of the alternative scenarios was also illustrated using cost-effectiveness acceptability curves. All analyses were conducted in STATA version 13.
Cost-utility evaluation
We estimated the net benefit using a range of hypothetical threshold values for decision-makers' willingness to pay for a QALY (from DKK 0 to DKK 500000) and presented the incremental cost and incremental effects visually in a so-called cost-effectiveness acceptability curve (CEAC). The CEAC was used to illustrate the probability of the intervention being cost-effective for the range of threshold values for willingness to pay for a QALY [26, 27]. These curves illustrate the probability that an intervention (LC) is cost effective compared with the control (standard) for a continuum of hypothetical threshold values of willingness to pay for a QALY.
Approval from Central Denmark Region ethics committee is obtained (journal number 20100230) and all participants provided written informed consent.
Population characteristics
Learning and coping (n = 413)
Standard (n = 412)
Age at randomisation, mean (range)
63 (33–92)
63 (27–89)
Male gender, n (%)
313 (76)
312 (76)
Ischemic heart disease, n (%)
326 (79)
323 (78)
Heart failure, n (%)
87 (21)
89 (22)
Adherence to programme sessions
Physical training, mean (range)*
19.61 (1–24)
18.48 (1–24)
Education, mean (range)*
6.46 (0–9)
5.97 (0–9)
Intervention cost
Cost of cardiac rehabilitation programme (DKK)
Learning and coping
Number of units
Total cost
Number of units
Total cost
Training sessions (hours)
Education sessions (hours)
Interviews (hours)
Weekly team evaluation (hours)
Load for unproductive time
Training sessions (hours)
Education sessions (hours)
Interviews (hours)
Weekly team evaluation (hours)
Load for unproductive time
Expert patient
Training sessions (hours)
Education sessions (hours)
Weekly team evaluation (hours)
Transportation time (hours)
Not applicable
Total cost for 10 patients
Average cost per patient
Resource utilisation and cost
Resource use during 5 months of follow-upa
Learning andcoping
(n = 413)
(n = 412)
Primary health care (contacts)
General practice
13.58 (0.56)
12.93 (0.58)
0.65 (−0.94;2.23)
Medical specialist
0.93 (0.10)
0.90 (0.11)
0.03 (−0.26;0.32)
1.98 (0.39)
1.84 (0.35)
0.14 (−0.89;1.16)
1.66 (0.10)
1.49 (0.09)
0.17 (−0.09;0.44)
0.09 (0.03)
0.09 (0.03)
0.005 (−0.07;0.08)
Prescribed medicine
15.46 (0.59)
14.58 (0.68)
0.89 (−0.87;2.65)
Secondary health care
Outpatient visits*
26.61 (0.43)
2.10 (0.80;3.41)
Hospital bed days
1.54 (0.34)
1.38 (0.29)
0.17 (−0.71;1.05)
Hospital admissionsb
0.49 (0.06)
0.57 (0.08)
−0.09 (−0.28;0.11)
Sick-leave weeks
4.69 (0.44)
4.54 (0.44)
0.15 (−1.07;1.37)
0.02 (0.02)
0.05 (0.05)
−3.03 (−0.15;0.08)
Disability pension
2.12 (0.31)
1.60 (0.28)
0.52 (−0.30;1.33)
Sick Weeks
2.13 (0.31)
2.33 (0.31)
−0.2 (−1.06;0.66)
Informal time of patients
Patient time in course (hours)*
40.92 (0.64)
36.68 (0.76)
4.23 (2.28;6.18)
Patient time in transportation (hours)
18.59 (0.28)
16.30 (0.34)
2.28 (1.42;3.14)
Patient transportation (kilometre)
557.71 (8,68)
489.13 (10.28)
68.58 (42.39;94.77)
Mean cost (SE) during 5 months of follow-up (DKK)
Learning and coping
(n = 413)
(n = 412)
Primary health care
General practice
1361 (6042)
1314 (66.33)
47 (−128.50;221.89)
Medical specialist
252 (33.16)
234 (35.65)
17 (−77.51;112.57)
120 (28.35)
112 (26.01)
8 (−66.59;82.49)
186 (14.38)
160 (10.30)
26 (−8.67;60.52)
28 (9.47)
31 (12.60)
−4 (−34.93;26.10)
1947 (81.49)
1853 (86.85)
94 (−140.80;329.06)
Prescribed medicine
2064 (95.18)
2022 (108.45)
42 (−239.60;323.62)
Secondary health care
Outpatient visits
44,050 (800.01)
41,513 (1018.42)
2537 (−16.31;5090.90)
Hospital admissions
17,644 (3056.81)
19,250 (3027.52)
−1608 (−10091.22;6875.10)
61,692 (3171.31)
60,763 (3172.60)
929 (−7863.18;9721.64)
Productivity loss
116 (114.41)
242 (237.63)
−126 (−679.55;428.17)
Disability pension
13,392 (2030.54)
10,336 (1847.17)
3056 (−2290.51;8402.31)
Sick Weeks
14,450 (2120.91)
15,660 (2144.589)
−1210 (−7203.09;4783.19)
27,958 (2738.37)
26,238 (2708.10)
1720 (−5885.65;9326.14)
Informal time
Patient time in course
5354 (95.36)
4752 (105.19)
602 (321.84;881.86)
Patient time in transportation
2433 (42.35)
2112 (47.08)
321 (196.77;444.68)
7788 (134.64)
6864 (153.19)
923 (523.95;1322.82)
Patient transportation
2130 (32.34)
1868 (38.88)
262 (162.93;361.03)
Total costs
108,388 (4245.75)
102,345 (4199.11)
6043 (−5697.02;17783.36)
The number of sick-leave weeks due to disability pension was higher in the LC arm, and it was higher in the standard arm due to re-schooling and sick leave. However, these differences were not statistically significant.
Patient time was statistically significantly higher in the LC arm due to participation in clarifying interviews at the beginning and the end of the intervention in addition to more adherence to training and education sessions.
The total societal costs of the intervention and caring for a patient with IHD or HF were estimated to average DKK 108,388 and DKK 102,345 in the LC and standard arms, respectively.
Health outcomes
The analysis that was based on the completed response on out-come parameter at all steps consisted of 58.19 % cases in the LC arm and 54.42 % in the control arm.
QALY during 5 months of follow-up
Learning and coping
Complete response-based analysis
0.016 (−0.006;0.039)
After intervention (2 months)
0.018 (−0.003;0.040)
After follow-up (5 months)
0.002 (−0.020;0.025)
0.005 (−0.003;0.014)
Multiple imputation-based analysis
0.014 (−0.003;0.032)
After intervention (2 months)
0.016 (−0.001;0.034)
After follow-up (5 months)
0.006 (−0.011;0.023)
0.005 (−0.001;0.012)
Because the discharge date from the hospital for some patients occurred after the follow-up period, we performed a sensitivity analysis that excluded these admissions from the study. This sensitivity analysis resulted in the probability of cost-effectiveness reaching 30 % over the threshold values.
The present economic evaluation examined the cost-utility of patient education in CR and was designed to assist health care providers in determining which education strategy should be provided. The main finding was that LC is unlikely to be cost-effective because it led to a higher average usage of all care categories except inpatient care, and the additional QALY generated was not statistically significant. The LC education was also associated with higher costs compared with standard education. This higher cost was primarily driven by higher outpatient costs, productivity loss costs and patient time costs.
The lower rate of hospital admissions in the LC arm could be due to more effective education, which may have led to seeking medical interventions earlier in the disease process. Because we analysed health care utilisation during a limited period of 5 months, the longer-term health care utilisation and costs are unclear.
To the best of our knowledge, this is the first report on cost-utility of various patient education strategies in CR of patients with IHD or HF in Denmark. In a review of patient education in the management of coronary heart disease, James P.R. Brown stated that five studies reported healthcare utilisation and costs, but no study reported on cost-effectiveness. Reflecting on the various education modalities and intensities of the intervention, the reported cost of provision per patient varied from 49 to 453 lb. He found no strong evidence that education reduced all-cause mortality, cardiac morbidity, revascularisation or hospitalisation compared with the control. However, there is some evidence that patient education may be cost saving compared with usual care because of a reduction in downstream healthcare utilisation [28].
In a systematic review on patient education strategies for hospitalised cardiovascular patients, Yvonne Commodore-Mensah stated that it is unclear which educational intervention elements or strategies are most effective for educating hospitalised cardiovascular patients and their families. Her review showed that there are various patient education strategies that can be implemented for hospitalised cardiovascular patients and families; however, interventions need to be feasible as well as cost-effective [29].
In a recent study in Australia, Sangster et al. compared the cost-effectiveness of a telephone-delivered Healthy Weight intervention to a telephone-delivered Physical Activity intervention and reported an average gain of 0.007 additional QALY and a difference of $852 in cost, both in favor of the Healthy Weight intervention.
We did not find a significant improvement in health status as assessed with the SF-6D in both the LC and standard groups. Additional studies have also indicated that if the follow-up period is 6 months or less, no significant improvement in quality of life or functional status of patients with coronary heart disease is found [30]. A systematic review and meta-analysis performed by Rod S. Taylor on exercise-based rehabilitation for patients with coronary heart disease identified 12 trials that assessed health-related quality of life using a range of outcome measures. Although all trials demonstrated an improvement in quality of life with cardiac rehabilitation, an improvement was also reported consistently in control patients [31].
Strengths and weaknesses of the study
Complete data on the costs derived from the national registries was one of the strong aspects of this study [15–17]. Additionally, using the SF-6D is suitable to measure health-related quality of life [32]. Another strength of the study was that rather than ignoring non-responders, we chose to use a multiple imputation strategy. The validity of the imputation procedure was based on the assumption that the data were missing at random.
In this study, we demonstrated that there were no significant differences in either costs or outcomes between LC and standard education methods from a societal perspective during 5 months follow-up. We concluded that LC was not a cost-effective intervention in the short term; however, analysing a longer period of follow-up seems necessary because a higher cost of outpatient care in LC may result in future cost saving. Therefore, it could be suggested that health problems may be identified at an earlier stage, thereby resulting in better health outcomes.
The authors would like to thank the nurses, physiotherapists and expert patients, as well as the project coordinators for their contribution to patient recruitment, intervention and data collection.
The Danish Ministry of Health funded the RCT in 2010.
The Danish Ministry of Health, the Health Research Fund of Central Denmark Region andthe Danish foundation 'TrygFonden' funded the RCT.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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|Google announces on their website : "We've got a fresh, new look! Now it's easier than ever to find the articles, news, and tools you love right from the homepage. Take a few minutes to explore our new story collections for in-depth insights on everything from branding to SPAN, and visit our new and improved jobs page to find out what it's really like to work with us. We've got a few more surprises in store, so sign up for our newsletter and keep an eye on design.google."
The page includes five main sections :
The site metatag is : At Google we say, "Focus on the user and all else will follow." With this in mind, we seek to design experiences that inspire and enlighten our users.
Home Dot Fage
|Fage International S.A. (Greek: Φάγε) is one of the major dairy brands in the country of Luxembourg. It manufactures dairy products including milk, yogurt and ice cream.
Fage's international website is now HOME.FAGE and includes the corporate information dedicated to investor or financial news. Fage's digital presence actually mirrors the company organization. Consequently, Fage has published local websites in six main countries.
Youtellus dot SCB
|Siam Commercial Bank is the first bank of Thailand and was informally established in 1904 as Book Club. It operates dot scb dotbrand domain.youtellus by scb is a very interesting concept, where dot brand gives an additional finishing touch.
The website actually says : "Youtellus is designed to give every customer the ability to tell the level of satisfaction to the bank clearly not straightforward. By setting the level of satisfaction into 4 levels according to the mood of the face, not satisfied, very dissatisfied, satisfied and satisfied, so customers can tell all the feelings clearly".
Youtellus concept is actually also available on google play and app store as a mobile app. The app uses a similar look and feel as the website. Global consistency and branding is a key benefit of dotbrand structure.

subset: commoncrawl


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Over the past month, I've been watching an episode of 'Child Of Our Time' which looked at gender roles in children. (As you can gather from the fact that it took me this long to watch a one-hour episode, this was something squeezed into ten-minute slots here and there, around everything else; however, as this particular episode was actually produced by my sister I wanted to get to see all the bits she's been telling me about working on. Besides, she does some of the interviewing of the children and so every so often while watching the programme I suddenly hear her voice coming from off-camera to ask one of the children something, whereupon I can yell "That's Ruthie! That's Ruthie!" Which is pretty cool.)
Anyway, the other day I was squeezing in yet another brief segment of watching and got to the bit where the voice-over told us that one of the girls, Megan, would now have to confront gender roles in a new way because "Megan has a boyfriend."
Er, no, she bloody well doesn't. She's seven.
One of Megan's many friends happens to be a boy. And, yes, she and her friends probably are getting a bit silly and giggly about her 'boyfriend', because that's the sort of thing kids do. Why on earth are the adults playing into this misnaming? Megan's mother professed herself unbothered by the whole thing because, after all, he obviously wasn't really a boyfriend and they were just kids having fun. Which is totally reasonable. But why not point that out to the children? The lesson that, just because one of your friends happens to be of the opposite sex it doesn't automatically mean they're your boyfriend or girlfriend, is such an important one to learn. Why miss the chance to convey it?
If Katie or Jamie, in prepubertal years, tries telling me they have a boyfriend/girlfriend (says she with the confidence of someone who's not yet dealt with this stage of parenting and therefore knows exactly how to deal with it), then I will gently correct them: No. You have a friend who happens to be of X gender. Having a boyfriend or a girlfriend involves more complicated stuff. There is a difference. Being friends with a boy, without making them your boyfriend, is perfectly OK, and will continue to be so, no matter what messages anyone else may give you to the contrary.


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Former NZ PM Helen Clark has faced off against her fellow candidates for the role of UN Secretary-General in a televised debate.
Ten of twelve candidates gunning for the role of UN Secretary-General appeared on the podium in two groups of five, with Ms Clark among the second group.
Eight of the twelve candidates are from Eastern European countries and six are women.
It's the first time the UN has broadcast a candidates' debate live on television, and the new Secretary-General will be appointed in January 2017.
Newshub's World News editor Tony Wright has been following the debate and has rated how Clark went, along with her opponents.
The first group of five candidates:
Vesnar Pusic (Former deputy PM of Croatia)
Ms Pusic talked a lot about the Secretary-General needing conviction and courage.
She claimed there was sufficient blame within the UN for the current situation in South Sudan, but didn't seem to have much of a plan to fix the conflict.
Not a strong presence on the podium by any stretch.
Rating 5/10
Antonio Guterres (Former PM of Portugal)
Mr Guterres tried hard to be noticed and talked up the multicultural aspects in trying to combat climate change.
He decried the bias towards African nations in the international court of law, but rather strangely suggested Africa was an example for others to follow.
Seemed confused at times but was largely successful in getting his points across.
Wants gender equality at the top of the UN.
Mr Guterres started strong but stumbled towards the end.
Rating 6/10
Susana Malcorra (Foreign Minister of Argentina)
Ms Malcorra struggled to get her points across at times and would have been largely disappointed with her time at the podium.
She touted the need for change in the UN Security Council, but didn't appear to have a plan to fix it.
Ms Malcorra called for gender equality in the UN's middle management and said it's up to the people of the world to understand climate change before it can be fixed.
Rating 5/10
Vuk Jeremic (Serbia, former President of the UN General Assembly)
Mr Jeremic claimed to have written his own 54-point-manifesto on how the UN should be run, and said the UN had become stagnate and was failing.
At times, he seemed almost arrogant and certainly backed himself to make a great Secretary-General.
Was big on conflict prevention, saying there should be less paper shuffling in New York and more engagement on the ground.
Supports reform of the UN Security Council and says he is committed to women's rights.
Mr Jeremic was by far the best of the male candidates.
Rating 7/10
Natalia Gherman (Former deputy PM of Moldova)
Ms Gherman preached to protect human rights, and rolled out a few tired phrases such as "I'm convinced there is no justice without peace, and no peace without justice."
She urged the UN to go back to its original charter and start delivering on its promises.
Ms Gherman claimed the people of the world are the UN's greatest ally, but I'm not sure the General Assembly warmed to her at all.
Rating 5/10
The second group of five candidates:
Helen Clark (New Zealand, heads the UN Development Programme)
Ms Clark had the advantage of being the only candidate to speak in her main language, and her English was indeed excellent.
She received warm applause after every response, when most other candidates did not.
She was measured but strong and knowledgeable on subjects such as the sexual abuse by UN peacekeepers, on the refugee crisis and on fixing the myriad of broken systems within the UN.
Moreover, she had a concrete plan to fix most issues and seemed to be the 'fan favourite' of the debate, even getting the crowd to laugh.
Overall, Ms Clark was very impressive and the best of the ten candidates on show.
Rating 9/10
Irina Bokova (Bulgaria, Director of UNESCO)
Ms Bokova is considered one of the favourites and Ms Clark's biggest rival.
I expected more from her and I think the UN General Assembly did as well.
She spoke of the need for greater investment in education and of the empowerment of young women, but a lot of her thoughts appeared obvious and uninspired.
Rating 6/10
Christiana Figueres (Costa Rica, former Executive Secretary of the UN Framework Convention on Climate Change)
The debate's other outstanding candidate just behind Helen Clark, Ms Figueres showed she is made of stern stuff, with a forthright approach lacking from most on stage.
Very strong on climate change and the refugee crisis and said she had zero tolerance for UN peace keepers who abuse their status.
Ms Figueres announced herself as Ms Clark's main competition for the post of UN Secretary-General.
Rating 8/10
Igor Luksic (Former PM of Montenegro)
At 40, Mr Luksic was by far the youngest candidate on stage, and his youth and inexperience showed.
His rhetoric was poor, and he seemed largely overawed by the occasion.
Claimed to understand the problems of a war-torn nation and the refugee crisis, but appeared not to have the tools to fix these issues.
Mr Luksic was probably the worst candidate on show.
Rating 4/10
Danilo Turk (Former President of Slovenia)
An elder statesman of international politics with three decades under his belt, Mr Turk appeared staid and at times even bored by the debate.
Hardly made an impact by stating the obvious, it would be hard to see a Turk led UN enacting any meaningful change.
Rating 5/10


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Accommodation Reservation
Tour Reservation
Experience 100% Live Beatbox and Rediscover the Art of B-Boying!
100% live beatbox with no special effects or recordings! Dynamic b-boying showcases process of how the food is made!
The upgraded musical 'CHEF' fun-packed with rich sounds and vivid visualizations!
It's an explosive stage where a world-class level of b-boying and beatbox are deliberately combined.
New name of 'BIBAP'! An upgraded Musical 'Chef!
"BIBAP' was shown tremendous love for the past 6 years since its premiere in 2011. Now 'BIBAP' is beginning a new chapter with a new name, 'CHEF'. Not only has the name changed, but the music and choreography are also enhanced with more musical elements and upgraded scenes to showcase a truly dynamic performance.
A show filled with comedy!
What is the biggest differentiation of 'CHEF'? Comedy! Every facial expression and movement of the performers is thoroughly calculated, naturally incorporating slapstick comedy in the show. The raw comedy and the element of surprise brings vivacious laughter in the audience. Also, 'Chef' is an interactive performance that encourages participation from different audience members, which in turn generates unexpected laughter!
Legacy of non-verbal performances! The Ultimate Know-How of Choi Cheol Ki's Team!
Choi Cheoul Ki directed and produced many non-verbal performances such as NANTA, Jump, Beat, Flying, etc.! 'CHEF' is a performance exhibiting Choi's know-how from 10 years' experience. Although there is no dialogue in 'CHEF,' the overall story is told in a natural and fun way because of Choi Chul Ki's 10-year devotion to non-verbal performances.
Ring Ring! The sound of orders ringing from customers from all over the world.
From preparation of ingredients to the delivery of food,
There is no single moment that is not out of the ordinary.
However, the food made from 100% live beatbox and world-class level of b-boying will make you exclaim with awe!
After finishing orders of sushi, pizza, chicken noodle, here comes the last order of Bibimbap!
Intense competition between Green Chef and Red Chef to be chosen as the best chef!
Finally, the secret recipes of two chefs are revealed
|Show Time
|Running Time
|Mar. 20, 2012 ~
Open Run
|Mon 8pm / Tue~Sat 5pm & 8pm /
Sun 3pm & 6pm
|75 minutes
First order: Sushi
A restaurant suddenly changed into the deep blue ocean?
A vivid ocean happening right in front of your own eyes!
From a lively group choreography of fish to a struggling pair of jellyfish…
Gratify your five senses with various flavors of the ocean!
Second order: Pizza
Customers on blind dates while chefs serenade with opera arias! Overcome the jealous situation created by the cute chef. Witness struggle of chefs to become Cupid for the customers!
Third order: Chicken Noodle
Experience Chicken noodle soup made from gooey dough by customers themselves! Served by the sexy chef will blow your mind! And a diabolic flavor will make the customer's legs shake and give away.
Last order: Bibimbap
The final winner changes every day depending on the choice of the customers! Red Chef makes Bibimbab with the help of the harmony of musicals! Green chef uses the power of martial arts to make his bibimbab! Secret recipes of two chefs will be revealed to determine the winner.
Finale is a glamorous after-party of chefs who finished their rounds of the food competition!
100% live-Beatbox with explosive energy!
Slick moves of b-boys, showing off their fantastic abs!
The restaurant is moving with a sexy finale of chefs that you can't see anywhere else!
|Normal Price
|Special Price
*Seat_376 in Total
*Age Limit_36 months and older
*For more information, contact our travel agent


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Anachronism: What is it?
Anachronism is a Card Game obviously. As such, it has card, sets, rules, and rarity. But, it stands apart from the rest of the cards games made. How?
The answer is simple yet powerful. It is history with an attitude. You can have Blackbeard fight against William Wallace, despite the fact that they are centuries apart! How? you may ask.
Let us take a look at the name for starters. 'Anachronism'. Anach=Anarchy which means no order and confusion. Ronism=Time, which is all over history. So, in essence it is 'history with no order.' Cool, right? But, it gets better then that.
You can have Blackbeard armed with a spear, wearing a Romanian breastplate, worshipping Ra, and having Johnston's Army in command. You can also have William Wallace armed with a French sword, wearing Indian buckskins, worshipping the Great Spirit, and having Ninja abilities. You don't just fight history; you remake it.
Official Description From Wikipedia
The game is a contest of arms between two warriors from numerous historical periods. Each game lasts a maximum of five rounds. The game is unusual for a card game in that it does not use shuffling as a randomization technique. Anachronism "decks" consist of five cards, and players do not draw cards or have a "hand" of cards. Despite the relatively small number of cards used in each game, card interactions and strategy can become surprisingly intricate, especially in the later rounds. Each player places their chosen warrior card on the playmat and their four support cards, face down, in slots corresponding to the first four rounds. The support cards may be any combination of inspiration, weapon, armor, or special cards. Each player flips their leftmost face-down support card at the beginning of each round. Initiative numbers on the support cards determine which player goes first in each round. The warrior cards may move and be turned (faced) as in a miniatures game. Support cards represent a variety of historical weapons, armor, items, deities, people, places or concepts such as the Norse sverd or Japanese book Go Rin No Sho. The game's name is derived from the ability to mix the various support cards such that the ancient Greek Leonidas wearing a kimono may fight a Japanese ninja who is wielding a gladius. Dice are used by both the attacker and defender to determine the outcome of battles.


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Menopause. Yes, it takes away your period - for good. And considering that the average number you've had in your lifetime hovers somewhere around 450, you might be happy to say buh-bye. But in return, menopause ushers in some other things you might not be so happy about: anxiety, depression, mood swings, panic attacks. That wild roller-coaster of high-pitched emotional craziness. If you suffered PMS back in the day, this is PMS on steroids; a newer - yet hardly improved - version. Estimates vary on just how many women experience psychiatric problems during menopause. But that number hardly matters { Read More }
Menopause and Anxiety
Why do some women going through menopause feel like they're out of control, irritable, short- fused and just plain crazy? And why do others pass through seamlessly with nary a hot flash or mood swing? Back in 2005, when blogging was still fairly new, I created the blog, Midlife Matters. As a health writer, I was excited about sharing accurate and timely health information in an intimate setting which fostered a dialog with other like-minded midlife women, something that's not possible via standard print magazines and websites. To date, my most popular post was about Menopause and Anxiety { Read More }


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NordicTrack is the flagship treadmill brand of the global fitness giant Icon and their running machines are known for their quality, innovative technology and interactive features in the consoles. Icon are the world's largest fitness equipment manufacturer, and they're not that for no reason. They have a track record in producing quality fitness machines and are a tried and trusted company: you know what you're getting when you purchase an Icon machine.
NordicTrack treadmills tend to always offer the best specifications at every price point. Compare treadmills from different brands in the same price bracket and the NordicTrack machine will usually have a motor with more power, a larger running deck and a better range of workout programmes.
What's more, there are usually more extras as well, such as cooling fans and music speakers, compared to other manufacturers. Whilst this isn't essential, it's just another sign of their quality and the fact that you get more for your money. And NordicTrack models are reliably built as you would expect, with the more expensive machines in their range offering particularly good build quality.
Another fantastic aspect of Icon machines, and therefore these NordicTrack ones, is iFit Live compatibility. Whilst a number of other brands do have similar features, iFit Live is an all-encompassing fitness service that will really help you get much more out of your treadmill and take your enjoyment up a level. Google Maps™ functionality lets you run on routes around the globe. Download a fitness course designed by real personal trainers that can be specifically tailored to you for a personalised and effective fitness experience every time you use the treadmill. Enjoy more programmes, user profiles and loads of other top features on this unique piece of technology.
Plus, all the NordicTrack treadmills carry a lifetime warranty for the frame, a 10-year warranty for the motor and 2 years for onsite parts & labour (subject to registering the machine within 28 days of purchase). This gives you real peace of mind when buying a NordicTrack running machine.
We have been selling sports and fitness products for over ten years through our
website and central London showroom. We pride ourselves on our unparalleled customer
We are committed to providing the best possible deals online. If you find the same
product cheaper somewhere else, let us know and we will do our best to match it.
We're not a faceless Internet only retailer! We have a store in the west-end of
London, between Oxford Circus and Great Portland Street tube stations. For expert
face to face advice on product selection, just visit us!
We deliver literally 1000's of orders every week on time and have a fully staffed
and pro-active customer service department that can provide assistance in the rare
cases where there is an issue.
We're not a faceless Internet only retailer! We have a store in the west-end of
London, between Oxford Circus and Great Portland Street tube stations. For expert
face to face advice on product selection, just visit us!
Change your mind within 14 days and we will give your money back as long as you
return the item to us as new and in its original packaging.
Rated 4.7 / 5
based on 4,415
Customer Reviews on Google Shopping


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HALLia VENEZiA – a special kind of carnival
The spectacle takes place every year exactly eight days before Carnival Monday in the picturesque old town of Schwäbisch Hall. Get enchanted by the mysterious play of masks where everyone can participate.
On the
24th of February 2019 (12 am – 4 pm)
the masks are crossing the city again.
HALLia VENEZiA peaks out at the stairs of the church St. Michael with the great parade of masks starting at 2 pm.


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I know several people that would like to lose arm fat and a few others that would love to lose leg fat.
Not to mention how many want to lose belly fat, including me at periods.
We have talked about how to lose belly fat fast here, and I imagine that many of you are thinking that if we can burn belly fat, we can also burn fat in our arms, legs and any other area of our body that has more fat.
Some keep running miles a day to lose leg fat and notice big changes, great improvements and tell others that all they have to do is running or riding an exercise bike to burn fat in their legs.
Some spend hours at the gym doing arm exercises to lose arm fat and get frustrated because it doesn't work. Basically never.
So...jeez...why does it work for legs and it doesn't work for arms?
Fat Burn Affects the Entire Body
The fact is that it's not possible to target fat loss in specific areas of our body. Fat Burn is something that affects the entire body.
If you lose fat, some comes from your belly, some from your butt, arms, legs etc. From everywhere. There is nothing you can do to just lose leg fat for example.
Nothing natural I mean. If there is some surgery or other crazy stuff that they can do...well that I don't know and I don't care because I'd never go for it and neither I would suggest it if it worked...
But we said that running helps losing leg fat right? Am I contradicting myself?
Not really.
Running is one of the best cardio exercises to burn fat, especially if performed at low intensity (Click here to read more about the best heart rate to burn fat), and like any cardio activity it helps to burn fat.
Burning body fat of course includes also leg fat, so that's why you feel like exercising your legs on treadmills, ellipticals and exercise bikes helped you lose leg fat.
If you have noticed that, you must have noticed that you lost arm fat and belly fat too even if you didn't do arm exercises of a bunch of sit ups.
Arm Exercises Don't Help Lose Arm Fat
True story, there's not such thing.
The only exercises that help you burn fat are cardio exercises. Period.
You need to tone your arms and leg, we agree on that, therefore you need to exercise and lift some weights.
But if you think that doing bicep curls, tricep pushdowns and tricep extensions will magically make you lose arm fat...I am sorry to disappoint you. Yes they help you build arm muscles, but the real benefit is visible only after you get rid of that layer of fat that covers them.
When your arm fat percentage decreases, then the muscle can give your arm a nice looking shape and you can finally distinguish the rounded shape of your deltoids, biceps and triceps.
At the end of the day, with strength training you build muscle and somehow having more muscle makes you burn more calories because muscles require energy to be maintained. Burning more calories makes you lose more fat for certain.
Despite that, you can get much faster results by doing cardio exercises and following a proper diet.
Click here to read more about the best way to burn fat
One more thing, don't get fooled by who tells you which exercises you should do to lose arm fat or lose leg fat. Don't believe it. The only arm or leg exercises that work involve aerobic training, which is part of cardio indeed.
Return from Lose Arm Fat and Leg Fat to How to Lose FatReturn to Home Page


text:
Member Login
Pennsylvania Farm Bureau offers its members special group pricing
on many products and services.
Individual counties may offer additional benefits.
Check for more information in your county newsletter.
- Accidental Death Insurance - Free Accidental Death policy with membership
- Farm Bureau Bank
- MSC Business Services - including payroll, tax planning and preparation, business analysis, legal service plan and much more
- Nationwide Insurance - full line of insurance products
- ClearValue Hearing Aids - discounts and free hearing assessment. Hearing aids by Starkey.
- PFB Health Insurance Plans - health insurance plans compliant with the health insurance marketplace, group plans and vision and dental
- ScriptSave® WellRX Prescription Savings Program- Where caring meets savings. Accepted nationwide at more than 62,000 pharmacies, ScriptSave WellRx is free to join for PFB members. Save on brand name and generic prescription drugs for your entire household – even your pets.
- Amerigas - propane supplier
- Grainger - wide variety of household, business and farm supplies
- Ford/Lincoln - Save $500 and $750 on a new vehicle purchase
Jiffy Lube - 10% oil change discount for Farm Bureau members
- John Deere
- NRG energy supplier - formerly Energy Plus
- Sherwin Williams - paints, brushes and other painting supplies
- Avis & Budget Rental Cars -Save 5-25% on daily, weekend and weekly on Avis and Budget car rentals
- Choice Hotels - 20% off hotels
- Hersheypark ® - 2019 Rates are Now Posted! Tickets are available for sale. Up to 33% off 2019 summer season gate rate admission. Plus seasonal admission discounts. Purchasing park tickets requires an account in our online membership system. If you just became a member, you will not be able to register in the Members Only section until you receive your membership number. Please plan ahead.
- Wyndham Hotels -10% off best available hotel rate
- CASE IH Tractors - $300 to $500 discount on selected series tractors
- Caterpillar - Save up to $2,500 on your next Caterpillar ag construction equipment purchase!
- Horseloverz.com - equine supplies
- Lancaster Farming - 10% discount on new or renewed subscriptions for members
- Safemark - tires for autos and tractors, tire chains, baler twine, tillage
- Staples- office supplies


text:
Kevin J. Flinn email@example.com (360) xxx-xxxx
Associate of Applied Arts in Audio Production
Art Institute of Seattle, March 1999
Seattle, Washington
Graduated with Honors
Audio Club Vice-President
AES Student Chapter Committeeman
Student Member of the Audio Engineering Society
Liberal Arts Classes
Clark Community College, Running Start student 1996-1997
Vancouver, Washington
|September 2000 - Present
|Apprentice (NECA/IBEW Local 48) - Limited Energies Electrician;
security, alarm systems, access control, network installation.
The Stoner Group; Oregon Electric Group; Netswork, Inc. (for more detail, contact me below)
|June 1999 - August 2000
|Contracted Worker - Load-in and load-out, setup sound systems and operate, etc.
|August 1999 - February 2000
|Dub Engineer - Audio dubs: DAT, 1/4" reels, cassette, CD, vinyl and more. Other responsibilities included, shipping, music recordings, front desk, and recycling.
If you would like a printable copy of my resume, please email me at firstname.lastname@example.com
I am in the process of putting audio clips of my portfolio on here. If you would like, I can send you sample files if you request them, my current formats are Real Audio and MP3.
Updated July 2001.
Copyright © 1998 - 2001 Kevin Flinn. All rights reserved.


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HOST Research programme
Cities have been attributed a crucial role in Europe's history over the past millennium: as engines of specialization, commercialization, industrialization, social differentiation and individualization, as determining factors in processes of state formation, as cradles of new ideas, art forms and social relations, and as hallmarks of modernity. Notwithstanding a wide acknowledgement of cities' roles as catalysts of social change, the actual dynamics of change remain elusive, as do the interactions between dynamics of change on the one hand and the observed resilience of the urban fabric on the other hand. European cities' capacity to harness their own transformative power is indeed a remarkable achievement in global historical perspective, which has manifested itself in an overall resilience of the urban network and the urban condition since Europe's High Middle Ages. The question of how the interactions between diverse social groups shaped urban dynamics of change and stability forms the basic point of departure for HOST's research agenda.
The spatial and temporal setting of HOST's research agenda is that of the cities of Brabant and Flanders from the late Middle Ages to the long nineteenth century, two core regions of the Southern Low Countries with a distinct political and economic setting and an early and long-standing urban tradition. By adopting a long-term perspective from the fourteenth to the nineteenth centuries, it is possible to dissociate analytically the impact of long-term structural transformations from conjunctural effects when exploring the dynamics of urban change and stability, while the implementation of an internationally comparative perspective allows to establish the generality and typicality of the urban developments studied. On a social scale, the HOST research agenda adopts a broad scope to allow for a focus on the interactions between urban elites, middling groups and the labouring poor.
Given its broad spatial, temporal and social scope, HOST's concrete research agenda is operationalized analytically by concentrating on nodes of interaction: six related core themes in the social-economic (income), social-political (power) and social-spatial (space) sphere, namely: (1) guild history, (2) social mobility, (3) social policy, (4) elite formation, (5) neighbourhood relations, (6) migration. While each of these themes have been studied in their own right, HOST aims to take research further by focussing on the interrelations between these connected nodes of interaction, employing an analytical framework cross-linking income, power and space with social interactions.
|Social Policy
|Social Mobility
|Elite Formation
Underlying the analytical framework is a twofold approach to social interactions. The arenas of interaction refer to the different ways in which social groups are confronted and interact with one another and where conflicts of interests or alliances crystallize, such as the relations between merchants, entrepreneurs and workers, the supported poor and relief administrators, and landlords and tenants. Transgressions in turn refer to the different ways in which the boundaries between social groups are constantly modified by processes of migration, upward and downward social mobility, and group formation. Whereas arenas focus on the agency of different social groups, transgressions in other words highlight how the boundaries between these social groups are in permanent flux through the agency of aspiring individuals, families and social networks. The two types of interaction also broadly correspond to different sources and methods: whereas arenas of interaction can best be studied by employing qualitative materials such as administrative documents, petitions and court records, transgressions will be approached mainly by using prosopography, social network analysis and life course analysis on the basis of relational nominal databases. The thematic focus on income, power and space, and the six nodes of interaction identified at the crosslinks of the analytical and thematic focus, link up with HOST's established expertise in social-economic and social-political urban history. Although this necessarily implies a selective view on urban developments, we maintain that the relational approach provides a fruitful inroad into the dynamicsof social change in a long-term and comparative perspective, of which the insights will provide important leads for other aspects of urban change more generally.
WP1: Guilds
Contrary to earlier views on guilds as conservative and homogeneous institutions, recent trends in guild history have highlighted how these corporative occupational institutions played a pivotal role in social dynamics of premodern European cities as arenas for conflicts and negotiations between merchants, entrepreneurs, master-artisans and workers over labour conditions, labour and product markets and product development, especially in the Low Countries. At the same time, these core urban institutions represented an important channel for both the integration of newcomers and upward and downward social mobility. HOST aims to continue its strong research tradition with regard to guild history in relation to the other WP's in order to gain further insight in the multilayered nature of social-economic regulation, negotiation and conflict in medieval and early modern cities.
WP2: Social Mobility
The fourteenth to the early twentieth centuries witnessed the gradual transformation from the protean and diverse groups whose income is to be situated in the middling range of the spectrum into a well-articulated ideological category known as the 'middle class'. While older historiography is often inclined to see this as a given and to define its genesis as an inexorable evolution, the HOST-team aims to contribute to the deconstruction of this teleological narrative by focussing on the processes of social mobility in Flemish and Brabantine cities between the labouring poor and the middling groups on the one hand, and between those middling groups and the lower ranks of the elite on the other – processes of social mobility that were also permeated by dynamics of geographical mobility. The primary analytical focus here is on the level of individual and household strategies with regard to income, survival and/or wealth accumulation and intergenerational property management.
WP3: Social Policy
This work package is concerned with the attempts of local and central institutions to regulate the social sphere in the Southern Low Countries. From the Late Middle Ages onwards, states were increasingly prone to develop ambitious legal programmes to cement or to restore the public order, ranging from sartorial and heraldic rules of precedence to contain status conflicts among the elite to extensive legislation about poor relief and migration. Yet, for the implementation of such policies, states were largely dependent on urban administrations, who developed social policies of their own and often ignored or modified the directives of the central administration to suit local needs and interests. Intermingling with the interactions between cities and states were local interest groups and actors on the ground, who executed, implemented, negotiated and influenced social policy in practice. What makes HOST's approach to this theme innovative is its radical long-run perspective, its dedication to the multi-layered arena of negotiation and strife surrounding social policy practice, as well as its contention that social policy was essentially shaped by the interactions between cities and the state.
WP4: Elite Formation
The ambition of this work package is a quantitative and qualitative research into the elites of the large and middling cities of Flanders and Brabant. While the urban elites of the Northern Low Countries are the subject of a long-standing research tradition, remarkably little is known about the constituents of urban political inequality in the Southern Low Countries. Recent research suggests that an in-depth study of those urban elites will significantly alter our current understanding of the intense city-state relations in the pre-modern era, while this WP also directly ties in with the WP on social mobility. The sources for the Southern Low Countries are sufficiently rich to study the processes of upward and downward social mobility between corporate middle groups and the elites in core cities.
WP5: Neighbourhoods
Existing research has demonstrated that neighbourhoods fulfilled pivotal roles in both informal social ties and formal means of regulation in preindustrial and early industrial cities. Neighbourly relations and street life provided important support networks, especially for new arrivals, and functioned to mediate and sanction social norms on public behaviour. The functioning of neighbourhoods was also shaped by attempts by urban authorities to integrate semi-formal neighbourhood organizations in the regulation of social life, by delegating administrative and policing tasks such as street maintenance, the registration of newcomers and the settling of minor conflicts. With regard to this WP, HOST strives to explore how dynamics of extensive immigration, building activity, social segregation and the reorganization of local administration impacted upon the viability and scope of neighbourhood life from a long-term perspective.
WP6: Migration
Contrary to earlier visions of migration as an essentially modern phenomenon and of preindustrial Europe as an essentially static society, recent research has demonstrated how migration was a pervasive and vital characteristic of city life already under the ancien régime. While these revisions have helped to break down artificial divisions between 'premodern' and 'modern' urban society, they have brought to the fore new challenges as to explaining the important changes in migration levels and patterns that did take place between the late Middle Ages and long nineteenth century. HOST's approach to these research questions is to further develop its innovative methodology on migratory change, based on the analysis of relational nominal databases and centred around a three-tier framework taking into account the interactions between macro (structural social change), meso (social networks and migration information) and micro levels (individual and household strategies) of migration patterns.


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The Electoral Commission has released the official result for the first referendum on the New Zealand Flag. The referendum asked the question:
"If the New Zealand flag changes, which flag would you prefer?"
The most preferred alternative flag design chosen through the first referendum is Option A: Silver Fern (Black, White and Blue).
The next most preferred flag design is Option E: Silver Fern (Red, White and Blue), followed in order of preference by Option B: Red Peak, Option D: Silver Fern (Black and White) and Option C: Koru.
The total votes received were 1,546,734, which includes 149,747 informal votes (9.68%) and 3,372 invalid votes (0.22%).
Voter turnout is 48.78%. Turnout is calculated by taking the total votes received as a percentage of the total number of voters enrolled as at 19 November 2015 (3,170,726).
The breakdown of the iterative count process of the votes received is available online at www.electionresults.govt.nz. Information on the turnout by each electorate is also available at www.electionresults.govt.nz.
The second binding referendum on the New Zealand flag will be held from 3-24 March 2016. Voters will be asked to choose between Silver Fern (Black, White and Blue), being the most preferred flag design selected in this referendum, and the current flag. The flag that receives the most votes will be the official flag of New Zealand.
Voters should ensure that they are enrolled and their enrolment details are up to date well before voting begins in the second referendum at www.elections.org.nz/enrol.
NOTE: This media release will be the Commission's only comment on the result. No further comment will be made.


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Established in 1995 Cotswold Motor Group is a privately owned group. Currently owned by two share holders, Peter Harris and Andrew Hulcoop (Managing Director).
The Group consists of Retail Centres across the Cotswolds, including BMW and MINI Centres in Cheltenham in Gloucestershire and Hereford in Herefordshire, BMW Motorrad in Cheltenham, plus an Approved Bodyshop and PDI Centre in Tewkesbury. In May 2017 Cheltenham and Gloucester Centres came together as one large flagship Cotswold BMW, MINI and Motorrad Retail Centre in a new location in Cheltenham. The new Retail Centre represents a very significant investment by the shareholders, underlining their strong beliefs in the BMW and MINI brands and their commitment to offering the best possible facility for our employees and more importantly, for our customers.
We're passionate that every customer that enters each Centre should be greeted in a polite, courteous and helpful manner; opinions are formed in the very first 10 seconds of walking through the doors. Every team member, regardless of their job role, is responsible for offering a great customer experience and treating each customer as an individual.
Our Sales and Aftersales teams are committed to delivering a five star service, working hard to ensure each customer's needs are met to their satisfaction. Our manufacturers BMW and MINI survey our customers after a visit via email. Each Centre is ranked on their customer satisfaction percentage and then measured by survey results, the results of these surveys are shown on the home page of each Centre's website in a 1 to 5 star ranking.
The best investment a company can make is in its staff. At Cotswold we aim to employ the correct staff that share our vision - together we can be, and can deliver, the best.
Meet Cotswold Cheltenham BMW team.
Meet Cotswold Hereford BMW team.
Meet Cotswold Cheltenham MINI team.
Meet Cotswold Hereford MINI team.
Meet Cotswold Group Bodyshop team.


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Scrap Car Molash, Scrap your car for free
The free scrap car collection service in Molash, Kent. If you have an old car that you are not using you will still be expected to keep it taxed whilst it is on the road. You don't have to pay to get your old vehicle taken away. We will collect your vehicle at no cost to you and recycle it in the most environmentally sound way!
Latest News in Molash
As well as offering a completely free collection, we are also currently able to offer cash for scrap cars in Molash depending upon the weight of the vehicle!
If you'd like us to make you an offer just ask when calling or add 'CASH QUOTE PLEASE' in the 'Additional Info' box when submitting our online form.
- Nationwide coverage
- Environment agency approved recycling facilities
- Convenient collection times
- DVLA notification
- Completely free collection!
Call a member of the team today on 0800 043 5100 or simply fill out our online form!
Choose Scrap Car Molash
Scrap Car Molash offer a local service to Kent and have provided car collection in Molash for over a decade resulting in many happy customers. We are a local company and will be with you at the specified time, we don't do late! We pride ourselves on being prompt and arriving to take your scrap car at the time you arrange with us. Our collection service is there for you so we will dedicate a specific time slot to work around any commitments you may have.
We take care to ensure that your vehicle is disposed of in the right way. Some scrap car collection companies might sell on your car for profit a lot of the time the DVLA will not be notified that you are no longer the registered keeper of the vehicle. This can cause you to receive fines, legally the car is still registered to you. When we tow away any old scrap car we always ensure that the DVLA are notified, giving you complete of peace of mind. We always recycle anything that we can when we strip an old car, this minimises the impact on our local environment.
Ensuring that your car is disposed of correctly will in time make a difference to Kent in terms of keeping it clean and tidy. Having old broken down cars littering the streets makes the area look very run down and untidy, so scrapping your car will make your neighbours happy. Got an old car? We can help you, call today!
The car scrappage scheme
The car scrappage scheme may at first seem like a fantastic idea. But you can not get any car, you are infarct restricted as to what car you can buy. It is not possible to go out and buy any car you wish. This can be a very frustrating process as you have to buy a car that is currently in the scrappage scheme.
Reasons to scrap your car
There are a lot of reasons for wanting to scrap an old banger. Experience shows that most of the time a car is scrapped as it is no longer road worthy, usually failing it MOT. If your car is not working and has broken down you will need to still keep it taxed, so scrap it and save yourself some monies.
How to scrap your car
You won't believe how easy it is to scrap your old car in Molash. Pick up your phone and call us today and learn how to scrap your car. Rather than giving us a phone call straight away please feel free to have a look at our helpful guide to see what the process is.
Just call us on 0800 043 5100 or fill out the following form:


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Browse through helper profiles
Interview your shortlisted candidates
Hire and process the work visa
Janet is an outstanding helper. She was diligent, cheerful and independent. She cooks well and is eager to learn to make new dishes. She is extremely reliable. We left her in the house many times while we went on extended trips and always came back to an immaculate house and a warm welcome.
Vrengky was a wonderful addition to our family for the 2 years that we were in Singapore. She was great with our 3 boys ages 4, 5 and 7. Our youngest son has multiple food allergies and she was able to successfully manage them at all times. We really miss her and hope she is able to find a nice and wonderful family to be with.
Bel was very helpful to us. Nice person helping her family back in Phillppines. Popular among kids. She helped raise our younger child from 1 to 5 yrs old. I can highly recommend her.


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A long time ago in a not so distant land, there was a company called Enron, a natural gas pipeline company, which had the following core values: Respect, Integrity, Communication and Excellence. These key words were to be the cultural DNA of the company and were to guide all employees in how they worked with each other and their customers. And as the history books point out, having these core values is not the same as understanding and living those core values.
As leaders, the concept of integrity is very important. We want to be people who adhere to a code of moral values and to work for a company where ethics and morals are more than words on a page or a section in an employee handbook. We want to be people who do things right and who do the right things.
Yet, as an executive coach, I often have to point out that while every company wants to put integrity in their core values, few spend ample time exploring and teaching what it means. Because within a successful company and with successful leaders, integrity is a mindset, i.e. a mental framework, and a core set of behaviors that is utilized daily and lived daily. It is an inside the person thing rather than an outside the person thing.
This week, sit down with your team and begin the conversation about what is the definition of integrity. Explore with them what is an ethical mindset and what are the ethical behaviors that come from this mindset. You will find it a helpful and in-depth learning process for all involved.