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4-year-old observed by nursery to be extra intelligent, expert called in - what now?(26 Posts)
I don't quite know the terms - was delighted but startled... anyway, DS is 4.2 so will not go to school till next September. He is in a private nursery where he has always been happy (2.5 days a week), and the nursery manager has just called me to say that they are getting an educational adviser or something in to make suggestions as to how they can keep him happy and interested and challenged as he is so very clever at numbers, reading, etc.
Does anyone else have a bright 4-year-old and can you advise me or tell me what it;s like?
What does he do that makes them think that?
'They' do say, very bright children get bored and disruptive. Have to say, with my DS, we never found this at all. He'd join in with whatever was going on and very bright children enjoy finger painting as much as the next kid, IM(limited)E!
Maybe nursery are looking for ways to extend his learning, so they're edging in to the reception class curriculum with him but because it's a private nursery, they need the ed.specialists because they can't just nip across to reception to ask the teachers there!
Enjoy the ride with him but keep an eye on his social skills at the same time. We found that DS lost it a bit with these skills and part of the problem may have been due to him being ahead of his peers and finding more in common with older children.
Finally, if he doesn't want to do summat, don't push him - just rock along with the stuff that interests him, otherwise there's a danger of putting him off something before he's had time to grow into it, IYSWIM?!
My dn is 4.1 and just had the same thing. They had a meeting with sil and will go away and advise the nursery what they should be doing to help her.
He can almost read (recognises familiar words, can work out what new words are from the phonics), he can count up to a least 400, do simple arithmetic, and nearly tell the time.
I don;t thinkg he is being disruptive BTW, I think they are hoping to address his needs before that happens.
I have no intention of pushing him, I want him to be happy and reach his potential in his own time (but I don't want him to be bored and lose interest either, obviously)
Thanks for the point about a nursery not being able to ask reception - they did say that he was ahead of the Early Learning Goals or seomthing, hence their seeking advice.
Well it is really good that the nursery are seeking extra advice on how to challenge him but I don't think it makes any difference to how you need to treat him IYSWIM? If he is so good with his numbers, bright etc then you must be doing something right at home already, so I would let them do what they need to do and just concentrate on the usual 4 year old stuff. I agree with Doodle2U, the social skills are important too and that is where you can be extra vigilant.
My son was observed by an external person in Nursery when he was just 4 because considered very intelligent. He could read well, write and was very good with numbers. Vey chatty etc. He was my first child so didn't realise that he was smart. I didn't treat him any differently. Didn't have any problem with social skills as he had lots of friends very outgoing. A good all rounder really and still is. Just let your child be themself. Enjoy and have fun. He is 18 now and only ever had older friends which isn't always a good thing when they are a teenager.
You must be proud. Like Doodle - I don't think all very bright kids are easily bored or disruptive - my ds is very enthusiastic about everything at school.
Similar scenario to you - his (private) nursery picked up he was very bright, but they didn't have the advice of early years teachers to call on. Once at school, I'm sure it will get picked up pretty quickly, and any curriculum adjustments made. My ds gets seperate maths, but enjoys everything else they do at school(perhaps a bit more vigorously on occasion!)
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I think this is becoming more common sgb. Our dd had two visits. One when she was 3.2 where they assessed her reading age as being 7.9 and then a 2nd visit last June when she was 3.10 in order to inform the school. She also exceeded all the ELG's except the physical and socio-emotional goals where she was 'green'. Nursery were actually advised that they should concentrate on keeping her included and not worry about her academic development as she would continue to develop in this area anyway. She is now part time at school - but will be full time reception from January. I don't think the school really gave too much weight to her nursery report. They have done their own assessments, as they do on all children, and are certainly differentiating work for her. They also keep able children in their own year groups which I'm pleased about for her social development. Obviously the teacher has to be more creative in her differentiation but I think its better than the 'lazy' option of just moving them up a year (where they still might not be challenged). I know we are lucky that she is one of the youngest in her year group (she's 4.4 now) - if she had been born a few weeks later then we would be in your position with another 9 months in nursery and I think she would have become bored - even though I think the nursery staff were fab. She is now in a good school and so I'm confident that she'll be fine. School doesn't make a big thing of G&T either - its not mentioned to parents as they have a strong ethos around allowing every child to reach their potential. Nursery gave us the name and number of the county G&T school coordinator which might be useful for you to get for your area if you have school concerns but we never needed to go down that route. We just really enjoy our dd as she keeps us on our toes and it sounds as though your ds is delightful too
I have a 3.5 year old ds who is at the same stage as yours with reading, can tell me the letter sound and name for pretty much any word I say, can do very simple arithmetic (can't count that far as refuses to go past 30 as apparently it's boring!), starting to tell the time etc. etc. From other posts on here, other than the counting as far as 400 thing, I don't actually think he sounds THAT unusual for 4.2. Not saying it's usual either of course, as he clearly is ahead of average but there are plenty of Mnetters with kids of 4 who are reading even though they're not in reception.
My ds goes to two nurseries - part time (long unrelated story to do with my working hours). Anyway, at his parents eve at nursery 1, I was told 'oh he's fine with letters and numbers' and the best they managed was 'he's very articulate'. They then went on at length about social skills etc.
At the other nursery the keyworker didn't seem to know much about him (although other staff have long said he's very bright indeed) and started talking about how the class would be doing phonics soon which would be good....when he's known his letters since he was two. She didn't have a blardy clue. And I KNOW the other worker in his room knows he knows this stuff so it's not like he doesn't 'do it' at nursery.
So, my point is I'm very, very impressed that the nursery is making such an effort for your ds. At the same time, I want ds to focus on social skills as that's where he needs more support and I figure he picks up the academic stuff anyway.
The saving grace for us is he'll start school at 4.2.
Curious - when you say 'he can nearly tell the time' what exactly does he do - does he round up to the nearest half or quarter hour?
Might I add, before someone flames me, I do just want him to play at nursery, which is why I haven't pushed the issue with either nursery.
Chipmunks: he understands the difference between quarter to and quarter past, half past and the hour etc.
I am very pleased with the nursery too - he has been going there since he was 1 and has always been happy.
His social skills are OK too: he has two or three particular friends and gets on with other kids about the same as most 3/4 year olds do (best mates one minute and squabbling over the toy bus the next).
I have to say I am rather chuffed though - it's nice to have your DC praised by other people (because obviously he's my PFB and therefore wonderful)...
God my ds's nursery is crapola isn't it.
Chipmunks: well if you want him to play and be happy and he's doing that then probably no need to worry - but I don't think I would like the parents' evenign thing of his alleged keyworker not seeming to know anything about him. Mind you, she could have been the one dingbat there and now have left.
Whereabouts in the country are you?
I didn't think nurseries did stuff like phonics?
I think this may be a relatively new development: am sure I read something about it only coming in over the last year or so that now all pre-schools and nurseries are supposed to be 'implementing educational goals' and stuff.
It's the Early Years Foundation Stage - came in in Sept. All quite controversial and often called something like the 'nappy curriculum' in a tongue in cheek way.
The keyworker kind of knows him but not the letters/ counting side of thing. She might have been slightly tiddly too as the staff were on the wine during the parents evening....
I knew it was something pretty recent. I would, generally, sort of be on the side of those who say let DC just play and enjoy themselves when they are so little, and we definitely don't sit DS down with flashcards or anything... I have always liked the nursery because he has seemed to be happy there (even though he used to yell at drop-off time... once I realised that he had stopped crying and started giggling and playing while I was still folding up the buggy I decided he was doing all right there...)
Basically if your DS is enjoying himself then there's probably no need to worry about changing nursery.
Dd1 was bright at nursery (still is), her nursery (not private) taught her to read and write. She is also good with numbers (could add and subtract at 3.5 years). She is now at school (started in september) and is roughly a year ahead for her age. Dd loves learning but struggles with the social side of things (she has aspergers syndrome). She's getting a bit bored at school at the momment as they have been busy doing christmas things and havn't had time to change her reading books.
We bought the Oxford reading Tree home pack so she could read at home last summer holidays.
She didn't start learning phonics as such until she started school.
So this is my first post so please be kind! I have two girl. 7 and 4. They are both very bright. The 7 year old, girl has an almost photographic memory. Can speak many words in several languages. Watch a film once and recite whole scenes from it. She is a lovely caring girl. Very sociable, kind etc. She went to a public school for reception and year 1 and part of year 2. She never really made a friend and was horribly bullied for being "different" so we moved her to a private school. A smaller class. She was often left to her own devices in the other school. When she was 6 they said she had a reading age of 12. Anyway, she struggles to make friends. Two reasons. One - she was bullied at the first school and trusts no one. Second - she is different. She isn't into LOL dolls or charging round the playground. She wants to talk about animals and space etc. She plays at home with her sister, Lego, painting, dressing up. And she has friends outside of school who she is confident around who come round to play. But she is struggling to make friends at school because of past experiences. I encourage her to just "do what they want to do" then next time "you suggest a game" but it doesn't seem to work. She is still resistant. Any suggestions from anyone in a similar situation? Thanks.
I would say take a chill pill and don't take things too seriously. Enjoy your child in the moment. Whatever you do don't make your child feel different or special, just love them
It's easy to say "take a chill pill" but when your child comes home from school and says that the other children have called her weird that's a bitter pill to swallow. I don't make her feel different or special. I earn a modest wage and didn't go to University. . I haven't pushed this on her.
hello, do you know you have added your message onto a post from 2008? maybe the earlier insensitive comment about chill pills is targeted at the original post from 2008? you might be best to start a fresh post.
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I wanted to keep these thoughts separate from my review of the Killers show because they have no bearing on the actual show itself, but rather indicate other trends at work in our culture.
Point the First: What's up with half the audience wearing Killers shirts to a Killers show? Seriously? Didn't any of you see PCU? The scene where Droz lambastes Gutter for wearing the shirt of the band he's going to see to the concert? Nobody does that. You don't wear the shirt for Frog and Toad are Friends to the Frog and Toad are Friends concert. You don't wear Killers gear to a Killers show. Seriously, people, are you not aware of the rules governing such events?
Point the Second: I had to have seen 50-100 LCD screens lit up on the floor in front of the stage. There must be a complete video/picture record of the concert last night between the various kids with cameras. What's that trend mean? Is this an issue of trying to capture more memories? Is it perhaps something related to the ephemeral nature of culture and an attempt to grasp pieces of that for posterity? What's it mean? This one's a bit more interesting than the first point, I'll admit, but I'm not sure I can grasp it entirely.
This post appeared in its original form at DC Metblogs

subset: commoncrawl


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Trump will lose, or I will eat this column
I never expected to write these words, but I miss Mitt Romney.
On Wednesday, the day the front-runner for the 2016 Republican presidential nomination was in New Hampshire alleging that Syrian refugees fleeing for their lives may actually be clandestine terrorists, the 2012 Republican presidential nominee was in Washington, talking sense.
"Donald Trump will not be the nominee," Romney told a group of business-school students at Georgetown University. And why won't Trump, who, when he isn't besmirching Syrian refugees as terrorists, is maligning Mexican immigrants as rapists, get the nod? Because, Romney said, "when all is said and done, the American people usually do the right thing."


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What's New in Hip Replacement 2019
Every month, JBJS publishes a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries. This month, Mengnai Li, MD, co-author of the September 18, 2019 "What's New in Hip Replacement," selected the five most clinically compelling findings from among the more than 100 studies summarized in the article.
THA Dislocation
–Pathology involving the spinopelvic relationship has dominated the recent literature on THA dislocation. For patients presenting with a flatback deformity and stiff spine, who had the highest risk of dislocation, the authors of a recent study suggested the use of a dual-mobility implant construct with targeted 30° of anteversion relative to the functional pelvic plane, based on a standing anteroposterior radiograph.1
Preferred Implant Designs
–A study comparing data from the American Joint Replacement Registry with national registry data from other countries found that cementless stem fixation with the use of ceramic and 36-mm heads was the current US preference, while non-US registries indicated that cemented implants and metal and 32-mm heads were used most commonly.2
Opioid Use
–The ongoing effort in the orthopaedic community to reduce opioid consumption without compromising quality of life for joint-replacement patients may be aided by findings from a recent randomized controlled trial. The study found that prescribing 30 immediate-release oxycodone pills instead of 90 pills was associated with a significant reduction in unused pills and decreased opioid consumption without affecting pain scores and patient-reported outcomes.3
Penicillin Allergy
– A retrospective review of >4,900 patients who underwent THA or TKA found that 16.2% reported a history of penicillin allergy. No patients among those with a stated penicillin allergy who were given cefazolin had an adverse reaction. Also, there was no increased rate of surgical site infections among those with a stated penicillin allergy who received clindamycin or vancomycin, although the authors acknowledged that this part of the study was underpowered due to the low overall rate of infection.4
Use of TXA
–Recent guidelines on the use of tranexamic acid (TXA) state that no specific routes of administration, dosage, dosing regimen, or time of administration have been shown to provide clearly superior blood-sparing properties.5
- Luthringer TA, Vigdorchik JM. A preoperative workup of a "hip-spine" total hip arthroplasty patient: a simplified approach to a complex problem. J Arthroplasty.2019 Jan 18. [Epub ahead of print].
- Heckmann N, Ihn H, Stefl M, Etkin CD, Springer BD, Berry DJ, Lieberman JR. Early results from the American Joint Replacement Registry: a comparison with other national registries. J Arthroplasty.2019 Jan 5.
- Hannon CP, Calkins TE, Li J, Culvern C, Darrith B, Nam D, Gerlinger TL, Buvanendran A, Della Valle CJ. The James A. Rand Young Investigator's Award: large opioid prescriptions are unnecessary after total joint arthroplasty: a randomized controlled trial. J Arthroplasty.2019 Feb 4. [Epub ahead of print].
- Stone AH, Kelmer G, MacDonald JH, Clance MR, King PJ. The impact of patient-reported penicillin allergy on risk for surgical site infection in total joint arthroplasty. J Am Acad Orthop Surg.2019 Feb 27. [Epub ahead of print].
- Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Bini SA, Clarke HD, Schemitsch E, Johnson RL, Memtsoudis SG, Sayeed SA, Sah AP, Della Valle CJ. Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty.2018 Oct;33(10):3065-9. Epub 2018 Aug 7.
In THA, Less Blood Loss with Multidose Postop Oral TXA
The recent orthopaedic literature, including a 2017 JBJS study, provides substantial evidence that oral and intravenous tranexamic acid (TXA) are equivalent in their effectiveness at reducing blood loss after total hip arthroplasty (THA)—with oral administration being less expensive and more convenient. But what are the optimal doses and timing of oral TXA in the setting of THA?
The findings of a randomized controlled trial by Wang et al. in the March 6, 2019 issue of JBJS go a long way toward answering that question. The authors randomized 200 patients undergoing primary THA to 1 of 4 groups, with all patients receiving an intraoperative topical dose of 1.0 g of TXA and a single dose of 2.0 g of TXA orally at 2 hours postoperatively. In addition,:
- Group A received 1.0 g of oral placebo at 3, 9, and 15 hours postoperatively
- Group B received 1.0 g of oral TXA at 3 hours postoperatively and 1.0 g of placebo at 9 and 15 hours postoperatively
- Group C received 1.0 g of oral TXA at 3 and 9 hours postoperatively and 1.0 g of placebo at 15 hours postoperatively
- Group D received 1.0 g of TXA at 3, 9, and 15 hours postoperatively
The mean total blood loss during hospitalization was significantly less in Groups B, C, and D (792, 631, and 553 mL, respectively) than in Group A (984 mL). Groups C and D had lower mean reductions in hemoglobin than did Groups A and B. No significant between-group differences were observed regarding 90-day thromboembolic complications (there were none) or transfusions (there was only 1, in Group A), but the authors said "this study was likely underpowered for establishing meaningful comparisons concerning [those 2] outcomes."
Although this study documented significantly lower total blood losses in patients who were managed with multiple doses of oral TXA postoperatively, additional studies are required to determine whether the 3-dose regimen is superior to the 2-dose regimen.
Confirmed: TXA Works Well in Adolescent Scoliosis Surgery
The evidence favoring tranexamic acid (TXA) for reducing surgical blood loss is ample and growing, but until now robust data were sparse regarding its efficacy in the setting of adolescent idiopathic scoliosis surgery. In the December 5, 2018 issue of The Journal of Bone & Joint Surgery, Goobie et al. report on a randomized, blinded, placebo-controlled trial showing that, in that population, TXA reduced perioperative blood loss by 27%, compared with blood loss in a placebo group.
Even with recent advances in scoliosis surgical technique, blood transfusions are common. And, because transfusions are associated with significant morbidity and mortality, limiting operative blood loss and reducing the need for transfusion have become focal points for orthopaedic surgeons.
In this Level-I trial, >100 patients between the ages of 10 and 18 years undergoing elective posterior instrumented spinal fusion were randomized to receive either TXA (infusion of a 50-mg/kg loading dose and a 10-mg/kg/h maintenance dose) or normal saline (delivered in the same way and dose) during surgery. The TXA group demonstrated an overall 27% reduction in cumulative blood loss and a 2-fold reduction in the percentage of patients with clinically relevant blood loss (defined as >20 mL/kg).
The cumulative effect of reduced blood loss was enhanced over time, with the positive effect of TXA being most evident in procedures lasting >4 hours. None of the patients in the TXA group required a transfusion or developed side effects such as thromboembolism or seizures.
In an interesting sidenote, the authors asked the participating orthopaedic surgeons, who were blinded to the randomization, to guess which group each patient had been assigned to by evaluating the relative ooziness of the surgical field. The surgeons guessed correctly 72% of the time.
Overall, these findings prompted the authors to conclude that "the use of TXA as part of a multimodal blood management strategy, as was employed in this study, should be considered the standard of care for patients undergoing surgery for adolescent idiopathic scoliosis."
Tranexamic Acid: Effective—and Safe—in THA
Prior research has established that total hip arthroplasty (THA), in and of itself, is associated with a small increased risk of venous thromboembolism (VTE). Hence the concern that routinely administering the antifibrinolytic drug tranexamic acid (TXA) perioperatively, as is commonly done nowadays to reduce blood loss during surgery, might further increase the risk of THA-related thromboembolic events. But the findings from a large population-based cohort study by Dastrup et al. in the October 17, 2018 JBJS, should allay many of those concerns.
The authors evaluated >45,000 Danish patients who had a THA between 2006 and 2013. Approximately 85% of those patients received intravenous TXA perioperatively, while the rest did not. Dastrup et al. evaluated adverse cardiovascular events (VTE, deep venous thrombosis, pulmonary embolism, myocardial infarction, and ischemic stroke) among those patients over 30 postoperative days, and they found no increased risk in any of those outcomes among the patients who received TXA relative to those who did not. These optimistic findings were essentially the same when the authors analyzed the data using a multivariable model and with propensity-score matching.
Dastrup et al. conclude that TXA in the setting of THA is safe with respect to VTE, and David Ayers, MD, commenting on the study, concurs. However, Dr. Ayers cautions that the study did not have the statistical strength to evaluate the potential cardiovascular risks of TXA in THA patients who have undergone previous cardiac procedures, such as stent placement. He therefore suggests that "further safety evaluation should be directed toward [such] patients at higher risk for complications after receiving TXA."
What's New in Hip Replacement 2018
Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.
This month, Mengnai Li, MD, co-author of the September 19, 2018 Specialty Update on Hip Replacement, selected the five most clinically compelling findings from among the more than 100 studies covered in the Specialty Update.
The Benefits of HXLPE
–A double-blinded study that randomized patients to receive either a conventional polyethylene liner or one made from highly cross-linked polyethylene (HXLPE) found that, after a minimum of 10 years, the HXLPE group had significantly lower wear rates, lower prevalence of osteolysis, and lower revision rates than the conventional-liner group.
Outcomes for Hip Fracture vs OA
–A propensity score-matched cohort analysis of NSQIP data found that total hip arthroplasty (THA) undertaken to treat hip fractures among Medicare beneficiaries was significantly associated with an increased risk of CMS-reportable complications, non-homebound discharge, and readmission, relative to THA undertaken to treat osteoarthritis.1
Infection Risk Factors
–A multicenter retrospective study found that a threshold of 7.7% for hemoglobin A1c was more predictive of periprosthetic joint infection than the commonly used 7%, and the authors suggest that 7.7% should be considered the goal in preoperative patient optimization.2
THA in Patients with RA
–Recently published guidelines from the American College of Rheumatology and AAHKS regarding antirheumatic medication use in patients with rheumatic diseases who are undergoing THA suggest the following:
- Continuing nonbiologic disease-modifying antirheumatic drugs (DMARDs)
- Continuing the same daily dose of corticosteroids
- Withholding biologic agents prior to surgery
- Planning surgery for the end of the biologic dosing cycle.
All recommendations are conditional due to the low or moderate-quality evidence on which they were based.3
Blood Management
–A double-blinded, randomized trial found that oral tranexamic acid (TXA) provided equivalent reductions in blood loss in the setting of primary THA, at greatly reduced cost, compared with intravenous TXA.
- Qin CD, Helfrich MM, Fitz DW, Hardt KD, Beal MD, Manning DW. The Lawrence D. Dorr Surgical Techniques & Technologies Award: differences in postoperative outcomes between total hip arthroplasty for fracture vs osteoarthritis. J Arthroplasty. 2017 Sep;32(9S):S3-7. Epub 2017 Feb 6.
- Tarabichi M, Shohat N, Kheir MM, Adelani M, Brigati D, Kearns SM, Patel P, Clohisy JC, Higuera CA, Levine BR, Schwarzkopf R, Parvizi J, Jiranek WA. Determining the threshold for HbA1c as a predictor for adverse outcomes after total joint arthroplasty: a multicenter, retrospective study. J Arthroplasty. 2017 Sep;32(9S): S263-7: 267.e1. Epub 2017 May 11.
- Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, Gewurz- Singer O, Giles JT, Johnson B, Lee S, Mandl LA, Mont MA, Sculco P, Sporer S, Stryker L, Turgunbaev M, Brause B, Chen AF, Gililland J, Goodman M, Hurley-Rosenblatt A, Kirou K, Losina E, MacKenzie R, Michaud K, Mikuls T, Russell L, Sah A, Miller AS, Singh JA, Yates A. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. J Arthroplasty. 2017 Sep;32(9):2628-38. Epub 2017 Jun 16.
Using Tranexamic Acid: Not If, But How
Most surgeons agree that tranexamic acid (TXA) is effective at reducing blood loss associated with a variety of surgical procedures, including total joint arthroplasty. The question is no longer whether it works but, more specifically, how is TXA most safely and effectively used. That was the main question Abdel et al. set out to answer in their study in the June 20, 2018 edition of The Journal. The authors completed a two-center randomized trial that compared blood loss, drain output, and transfusion rates among 320 total knee arthroplasty (TKA) patients who received intravenous (IV) TXA and 320 TKA patients who received topical TXA.
Statistically, the results of the study are clear: Patients who received intravenous TXA had significantly less blood loss (271 mL vs 324 mL; p=0.005) than those who received topical TXA. Furthermore, after authors controlled for several patient characteristics, they found that those who received topical TXA were 2.2 times more likely to receive a transfusion than those who received intravenous TXA. Still, both modalities resulted in very low transfusion and complication rates of <2% each.
Although IV TXA seems to be more effective at decreasing blood loss than topical TXA in the setting of TKA, Abdel et al. question whether the 53 mL difference is "clinically important," considering the very low transfusion rates in both groups. What might be more clinically meaningful is the fact that the topical TXA group experienced a 5-minute delay during the procedure so the TXA could stay in contact with the tissues prior to suction and wound closure. Such a delay (which could account for about 5% of total surgical time) could put some patients at risk for other complications and is questionable without an appreciable benefit.
So, will every knee-replacement surgeon now use IV TXA instead of topical TXA? Of course not. Although the authors emphasize that there does not appear to be an increased risk of blood-clot-related complications when using IV TXA, some surgeons will still shy away from using that route of administration in certain patients. Also, some surgeons may question this study's generalizability because of the number of perioperative variables described in the methods.
Still, I commend the authors on performing such a large, well-designed study. It is easy to pick apart data from the viewpoint of external validity, but these results are statistically steadfast. While we probably do not need more studies looking at the efficacy of TXA in total joint arthroplasty, further studies looking at the optimal manner in which the medication can be administered are welcomed.
Chad A. Krueger, MD
JBJS Deputy Editor for Social Media
What's New in Adult Reconstructive Knee Surgery
Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.
This month, Gwo-Chin Lee, MD, author of the January 18, 2017 Specialty Update on Adult Reconstructive Knee Surgery, selected the five most clinically compelling findings from among the more than 100 studies summarized in the Specialty Update.
Nonoperative Knee OA Treatment
—Weight loss is one popular nonoperative recommendation for treating symptoms of knee osteoarthritis (OA). An analysis of data from the Osteoarthritis Initiative found that delayed progression of cartilage degeneration, as revealed on MRI and clinical symptoms, positively correlated with BMI reductions >10% over 48 months.1
Total Knee Arthroplasty
—In total knee arthroplasty (TKA), the drive toward producing normal anatomy has led to explorations of alternative alignment paradigms. A prospective randomized study found that small deviations from the traditional mechanical axis (known as kinematic alignment) can be well tolerated and do not lead to decreased survivorship or poorer functional outcomes at short-term follow up.2
—Controversy exists about the optimal method to achieve stemmed implant fixation in revision TKA. A randomized controlled trial of TKA patients with mild to moderate tibial bone loss found no difference in tibial implant micromotion between cemented and hybrid press-fit stem designs, based on radiostereometric analysis.
Blood Management in TKA
—Minimizing blood loss and transfusions is crucial to minimizing complications after TKA. A randomized, double-blind, placebo-controlled trial found that intra-articular and intravenous administration of tranexamic acid (TXA) was more effective than intravenous TXA alone, without an increased risk of venous thromboembolism (VTE). However, the optimal regimen for TXA remains undefined.
VTE/PE Prophylaxis
—VTE prophylaxis is essential for all patients undergoing TKA. A risk-stratification study of pulmonary embolism (PE) after elective total joint arthroplasty reported that the incidence of PE within 30 days after either hip or knee replacement was 0.5%. Risk factors associated with PE were age of > 70 years, female sex, and higher BMI. The presence of anemia was protective against PE. The authors developed an easy-to-use scoring system to determine risk for VTE to help guide chemical prophylaxis.3
- Gersing AS, Solka M, Joseph GB, Schwaiger BJ, Heilmeier U, Feuerriegel G, Nevitt MC, McCulloch CE,Link TM. Progression of cartilage degeneration and clinical symptoms in obese and overweight individuals is dependent on the amount of weight loss: 48-month data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2016 Jul;24(7):1126-34. Epub 2016 Jan 30.
- Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc. 2016 Apr 27. [Epub ahead of print]
- Bohl DD, Maltenfort MG, Huang R, Parvizi J, Lieberman JR, Della Valle CJ. Development and validation of a risk stratification system for pulmonary embolism after elective primary total joint arthroplasty. J Arthroplasty. 2016 Sep;31(9)(Suppl):187-91. Epub 2016 Mar 17.
What's New in Adult Reconstructive Knee Surgery: Level I and II Studies
Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from randomized studies cited in the January 21, 2015 Specialty Update on adult reconstructive knee surgery:
Minimizing Blood Loss
–A randomized study of 101 patients undergoing total knee arthroplasty (TKA) found that those receiving topical tranexamic acid (TXA) intra-articularly at the end of surgery had less blood loss and better postoperative hemoglobin levels than those who received a placebo.
–A randomized study of 50 TKA patients and 50 people undergoing total hip arthroplasty found that those receiving TXA had a significantly smaller decline in postoperative hemoglobin levels and needed 39% fewer units of transfused blood than a group that received normal saline solution.
Patellar Management
–A randomized study of 126 patients who underwent denervation or not after TKA with unresurfaced patellae found that the denervation group had better pain scores at three months and higher satisfaction and better range of motion at two years.
–Two randomized studies evaluated the impact of patellar eversion versus lateral retraction/subluxation for joint exposure. One study (n=117) found no between-group differences in quadriceps strength at one year, and the other (n=66) found no between-group differences in pain scores or flexion at three months and one year.
Implant Design
Most of the implant-design studies summarized in this Specialty Update can be summed up as "no difference." Specifically,
–Three randomized studies attempting to evaluate high-flexion TKA designs (n=74, n=278, and n=122) caused the authors of the update to suggest that "the intention of providing greater clinical flexion through high-flex arthroplasty designs does not translate to a meaningful difference in patient outcomes."
–A randomized study of 124 patients found no differences in maximal post-TKA flexion or functional scores between a group that received a bicruciate-substituting implant and one that received a standard posterior-stabilized design.
–A randomized trial of 34 patients who received prostheses with either highly cross-linked polyethylene or conventional polyethylene found no differences in wear-particle number, size, or morphology after one year.
–A 4- to 6.5-year follow-up study of 56 patients who received either mobile or fixed bearings during TKA found that the mobile-bearing group had greater mean range of motion, but there were no between-group differences in satisfaction or functional scores.
Instrumentation and Technique
–A randomized study of 47 patients whose surgeons used either customized cutting blocks or traditional instruments found no differences in clinical outcomes or mean component alignment. Moreover, surgeons abandoned customized blocks in 32% of the cases because of malalignment.
–A randomized study of 129 patients whose surgical approach was either medial parapatellar or subvastus, all of whom were managed with minimally invasive techniques, found no differences in pain, narcotic consumption, functional outcomes, and Knee Society Scores at postoperative times ranging from three days to three months.
Postoperative Care and Pain Management
–A trial among 249 post-TKA patients who received either one-to-one physical therapy (PT), group-based PT, or a monitored home program found no difference in outcomes at 10 weeks and one year.
–A randomized study of 160 post-TKA patients investigating the effect of continuous passive motion (CPM) machines led the study authors to conclude that CPM is neither beneficial nor cost-effective.
–A small randomized study of pain-management protocols found that a "multimodal" approach that included peri-articular injection led to less pain, less narcotic use, and higher satisfaction for up to six weeks after surgery than a patient-controlled analgesia approach.
–A three-way randomized pain-management study of 100 patients led study authors to recommend against posterior capsule injections and to conclude that "a sciatic nerve block [for TKA] has a minimal effect on pain control."
–A three-way randomized study of 120 TKA patients found that those receiving preoperative dexamethasone and ondansetron had less nausea, shorter hospital stays, and used less narcotic medication than those who received ondansetron alone. "Dexamethasone should be part of a comprehensive total joint arthroplasty protocol," the study authors concluded.


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I have written a custom Windchill WebService in Windchill and deployed the jar in Thingworx server.
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Undefeated 1993 Championship Team Celebrates 25th Anniversary/
Members of the Fordham Prep 1993 undefeated (19 - 0) NY Metropolitan League championship team recently got together to celebrate the 25th anniversary of their historic season. 17 alums from across the country and former coach and current Prep teacher, Steve Traendly, met at JC Fogarty's in Bronxville to retell old stories, laugh at their 1990s era equipment, and share photos. A highlight was flipping through game recap clippings from the old Westchester Journal News (remember those days!!!). Including a favorite quote from Coach Traendly referring to a 22 - 4 win: "We were up 4 - 3 after one," Fordham Prep coach Steve Traendly said, "and I wasn't too happy with our play. I guess the kids got the point."
In only the fifth year of existence, the Fordham Prep lacrosse team earned 19 victories with five shutouts while outscoring opponents 226 to 48. The Rams defeated the Portledge School 7 to 6 in the championship game to earn the title. The 19 wins began what became a 35 game consecutive win streak as the 1994 team won its first 16 games before falling to Iona Prep in the championship game. It still remains one of the longest win streaks in high school lacrosse history. The six sophmores on the team ended their lacrosse careers with a record of 49 - 6, a testament to the upperclassmen they learned from during those years.
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1993 team members have been recognized with induction into the Fordham Prep Lacrosse Hall of Fame and are among the top ten of the program's career and single season record books. Coach Traendly was the first inductee into the Hall of Fame and finished his coaching career with 200 wins.


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I don't need anything, so I don't waste time sugar coating.
Once upon a time I thought, "The customer is always right." and "build a team so you can grow" and all that other cliche stuff.
The reality is that I rarely met a real investor at a club or meetup, they all seemed too busy doing real estate deals or spending time doing stuff they liked.
Its a niche market, real investors who don't care about being acknowledged, or care about selling you a book. Those were the ones that paid me well as a General Contractor and they never went to meetups. They didnt' need anything a meetup could provide. They had deals and a way to get money and they knew how to hire people (me) to get it done right. (pay me right)
I worked for a few of the "hustlers" who wore fancy stuff to dirty job-sites and seemed more concerned with getting it done fast/cheap than having a great end product. Most of those guys didn't want to pay anyone a fair amount and constantly were looking for new people to work with as a result.
I saw how easy this all really is, from first hand watching every way you could be an investor. Some tossed cash at problems, some ran from them, some got mad and blamed everyone else, and some just walked away. But, the successful/happy ones...they knew what they spoke on and knew who to ask when they didn't. It wasn't magic, or a secret, or even years in the business. It was simply letting the best people do their best work and knowing that putting it all together with everyone "Banking" off your idea's and efforts, would too make bank and with very little stress or problems you couldn't solve. Letting go of ego and pride is hard and letting go of money even harder. But nobody is excited to work with an investor wanting to work with them IF they get an "investors pricing" type of deal, when they could spend their time with people willing to pay them what they are actually worth.
The bottom line is that I want everyone to be a success, but too many can't drop their ego enough and others don't have enough confidence to succeed. This business isn't easy, unless you know who is full of cliche and who is really making things happen. And those making things happen are rarely out boasting or posting about their services, they are too busy out making things happen.
Trust, but verify. If you fail at either you won't be a success.
(note- I am no longer a G.C. and this is not a way to advertise my services as one, although it would be a unique way to go about it if it was...but its not.)


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Summary - iOS app MVP prototype for a stress monitoring app called Clearify.
What it is - Clearify is a stress monitoring app for corporate employees in Japan seeking to reduce and understand their stress. I was tasked with taking the general idea of "helping Japanese corporate employees relieve and understand their stress" and turning it into a mobile MVP prototype to gauge viability and investor interest.
How it works - This MVP prototype takes users through a few basic functions: signing in, posting a feeling, browsing the timeline, searching through past emotions via Emotion Search (and its filters), and editing settings.
My role - Research, strategy, wireframing, UI/UX, prototyping, design.
Visually representing emotions
At any particular moment, a Clearify user will need to choose from a list of emotions that which they feel. How do I depict those emotions in the app? Will I use text or emoji-like icons? Should different emotions be represented by different colors? Would visual aids help to explain how users feels over time? There was an infinite number of things I could've done.
At first, after some trial and error, I landed on Direction 1. I used text to describe emotions instead of emojis because there were twenty-two emotions to choose from. It would've been almost impossible to design simple emojis with enough subtlety for a user to pick one out correctly from the others. Text afforded me the ease of recognition and the increased chances of a user not choosing the wrong emotion for the moment. I also used the color red to represent emotion. Red meant love, anger and energy. It's the warmest and most dynamic color. The "log emotion" icon in the header, the emotion titles in the cards on the timeline, any CTAs to "Post your feeling" were all in red. I thought it was an appropriate analogy for emotion.
To help further explain to the user how their emotions are changing overtime I decided to use graphs. In this direction, I landed on using line graphs and radar charts. I was hoping the line graphs would be a familiar, easy to use tool that could show the ebbs and flows of emotion over days, weeks, months, and years. The radar charts were brought in to give a visual aid as to what the user's average emotional profile was over the same time period. As an example, even though a user may have felt many emotions on a particular day, the radar chart could show that the user stayed mostly inside the frustrated/worried sector. In Direction 1 these graph were found in multiple location throughout the app. At the end of each day a special Daily Summary card would appear on the timeline that would display a line graph and radar chart. Inside each card on the timeline would be a line graph showing your previous emotional trajectory up until that point. The activity tab had another, more detailed line graph as well as the aforementioned radar chart.
Ultimately though, I didn't feel comfortable choosing this direction. The color red started feeling like it could mean, "stop", "cancel", or "error" as opposed to being an analogy for emotion. I felt that due to there being red action buttons inside of native iOS apps, that might dilute the analogy and cause confusion. I also felt that seeing so much of the color red throughout the app might have some psychological effect on the user, eliciting emotions from them that I had not intended and skewing their emotional data toward "hotter" emotions than would be normal for them. The graphs ended up feeling overused and tiring. Since they were displayed on so many pages a user would be trying to interpret one at almost all times. You couldn't escape them and I thought a little breathing room would be appreciated. The line graphs just ended up not working for me because emotions are such a seldom seen data set to have as the y-axis of a graph and a lot of thought needs to go into trying to understand them. I also had to let radar charts go. Similarly, the radar charts also demanded a bit too much energy from the user to read.
After I hit a wall with the first direction, I pushed forward to find a new approach. In Direction 2 I stuck with my decision to use text to describe emotions instead of emojis but, landed on something new in regard to color. Staying away from all the issues I ran into when using the color red, I went with a multi-color concept. Each of the 6 main emotion categories was given its own color. This was useful in that wherever a user sees a specific color used throughout the app (ex. yellow) it will always be analogous to its main emotion (ex. happiness). For example, yellow could be used in shapes, charts, text and tags and still be recognized as "happiness" without having to write out the word happiness. This concept freed the user from the burden of being forced to read everything, contributed to a more lively look and feel throughout the app and allowed me to side step all the issues I had using the color red in Direction 1. This color approach also paired very well with the new direction I went in with regard to graphs.
In Direction 2, the way I used graphs evolved. For the reasons above I stayed away from line graphs or radar charts. Instead, I opted for pie charts only. Using more than one type of chart to visualize the same type of data was overkill and didn't give much value to the user. The simplicity of only using one type of graph made for a more pleasant and unified graph experience. For the type of data I was visualizing, pie charts felt much easier to understand. Pie charts felt appropriate because not only do they show the whole picture, but users can visually compare and contrast the ratios of their emotions. Pairing other contextual information (ex. numerical and location data) with these pie charts felt especially powerful and I determined it should be the standard way of presenting them. To avoid the frequency and overuse issues I had in Direction 1, and to give focus to the pie charts, I used them sparingly. I gave them a "home" in Emotion Summary sections that would be easy for users to find when needed.
In the end, I felt comfortable that Direction 2 solved many of the challenges I was running into when trying to visually represent emotions in an interactive digital medium. The stakeholders agreed and it was decided that I was to utilize Direction 2 when building the interactive prototype.
Failure happens.
This project didn't ultimately get off the ground. Not every project I work on will be successful. Sometimes things are just going to fall apart and I'm going to have to learn from it and move on.
Passion is key.
The passion and energy I had for this project was special. As long as I continue to pursue projects that I'm passionate about, that keep me wanting to learn and grow, I know the energy I give is always going to be worth it.
This problem still deserves a solution.
Even though it failed, this problem is still worthy of being solved. These users still deserve to have a solution to this problem and I believe a product will come along that is successful at doing that in the future.


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One of the reasons that Mr. In this section, you can also put demographic information about your target market including population size, income demographics, level of education, etc. The sub-sections of the chapter should include: Follow these detailed guides and develop a marketing plan for your laundry and dry cleaning services business.
A comprehensive marketing strategy will be the key to success of the business. However, these businesses may see a slight slowdown in growth over the next year as the US economy continues to experience sluggish growth. Clothes that need dry cleaning are expensive and are often for special occasions, so there is less price competition.
Starting a drycleaning or laundry business is profitable in almost any city around the world where day to day life is on a busier pace. Business Plan Training Enroll now for our 3-day business plan writing workshops and write your own plan Est.
Bizco Business Consulting is not involved in the approval of facilities and applications for finance are handled by the various agencies we deal with. If you intend to be a sole proprietor, go to DTI.
Finally, the Company will generate a substantial amount of income from producing meat and sandwich trays for catered parties within the target market. Furthermore, the hours of operation must be convenient and service completion must be timely in order that customers are not harried after a long day working.
They can review video recordings of previous lectures and live online events. Order washers, dryers, coin machines, laundry carts and detergent vending machines. Laundry shops have a bright future as demand for their services will likely increase.
Another advantage of front loaders is that because of the faster spin during the drying cycle, the laundry is easier to dry. Buy top-load washers to save money. The company's high quality and convenience will save time for working customers. Cleaning equipment will be leased with accompanying maintenance contracts.
We do not take ownership of any intellectual property created by our members, nor does our supporters. Visit your city clerk to apply for a business license.
The business provides a new door-to-door dry cleaning, laundry and clothing alteration service in [CITY], [STATE] and surrounding neighborhoods that will surely attract customer attention. Find out who your competitors are by searching online directories and searching in your local Yellow Pages.
We are focused on the global good what good entrepreneurs can create. This is a mature industry, and the average growth rate of aggregate revenues is expected to equal that of the general economy.
The company will has a production facility, but will still need a retail shop because of our pick-up and delivery service. In fact more than million adults around the globe are engaged in some form of entrepreneurial activity each year. The founding members of ExtraFresh Laundromat have been informally working in the laundry industry for more than 5 years and have noted the gaps in the market.
Items you will need. You need millions of pesos to compete effectively if you want to tap the commercial laundry market, but you may be able to start with P, if you decide to focus on individual buyers.When Johannesburg native Charl de Beer moved back to South Africa, he started a company aiming to rent out freshly laundered linens to the 18, Airbnb hosts in Cape Town.
Sample text from Cleaning Service Business Plan: Executive Summary COMPANY NAME is a long-term enterprise that was established in [CITY], [STATE] in as a sole-proprietorship company currently owned by OWNER'S NAME The company will provide dry cleaning, laundry, and garment alterations, offered with regular drive-through pick-up services.
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Chukwudi Akasike, Port Harcourt
The Rivers State Council of Traditional Rulers has urged the Independent National Electoral Commission to declare all verifiable results of the state governorship election of March 9, 2019 on units and ward basis.
The monarchs made their position known during a press conference addressed by their Chairman, the Amayanabo of Opobo, King Douglas Dandeson Jaja.
He said, "We urge INEC to declare all verifiable results and immediately look into only compromised results on units and wards basis, where boxes were snatched by thugs or military personnel.
"We cannot go through another election. INEC must ensure that collated results are declared and not tampered with by third parties."
The monarchs expressed disappointment with the alleged involvement of the military and policemen in the elections in Rivers State.
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Japanese Director Rikiya Imaizumi ("Sad Tea", "Just Only Love") has completed production on his most recent film "Little Nights, Little Love". The movie is based on the collected short stories of Kotaro Isaka. Isaka's work has been previously adapted to the big screen in features such as "The Foreign Duck, The Native Duck, and God in a Coinlocker" and "Fish Story".
"Little Lights, Little Love" is set for release on September 20, 2019. Gaga International has released a trailer for the production, which can be viewed below.
Sato (Haruma Miura) is 27-year-old single man. He is waiting for a dramatic moment in his life that will lead to love. He works at a market research company. One day, he asks a random passersby in front of Sendai Station to fill out a questionnaire. He has a hard time finding willing participants. A woman in a black suit agrees to answer the questionnaire. Sato sees the letter "shampu" on her hand…is this fate? (AsianWiki)


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Lead (Pb) is a heavy metal that is increasingly being demonstrated to be harmful to wildlife and humans. While this issue has received significant attention in Europe, North America and other parts of the world, it has received relatively little attention in Africa. Recent studies on vultures, crocodiles and mammals in southern Africa have recorded high levels of lead, and bullets, fishing sinkers and mine pollution have been implicated, but a full analysis of sources of lead has not been conducted, nor has the impact of lead at a population level or in other groups of organisms been assessed.
The purpose of this interactive session is to:
- Provide an overview of physiological processes and impacts of lead in wildlife
- Present a global overview of lead sources and issues related to lead in wildlife, people and the environment, including an assessment of efforts to reduce exposure of wildlife to lead
- Present the results of recent southern African studies evaluating the presence and impact of lead on wildlife and the environment
- Discuss a research framework in relation to understanding the sources, impacts and alternatives to lead
- Discuss a monitoring framework for assessing progress towards ensuring that wildlife is not harmed by exposure to lead
- Discuss an integrated, multidisciplinary approach towards achieving a vision that South African wildlife is not harmed by exposure to lead.
Delegates are invited to attend the session to become more familiar with the details and issues relating to lead in wildlife, and contribute to interactive discussions towards developing strategies and approaches to ensuring that wildlife is not harmed by exposure to lead.
Navigate between Special Sessions
|Data Management
|Elephant Conservation
|Indigenous Knowledge
|Lead in Wildlife
|Maloti-Drakensberg Exposition
|PA Management Effectiveness
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|Species in Crisis
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Media buyers select media vehicles to are often a function of both advertising creative and media planning. The media objective is the report and the follow-up "ubiquity: Media Transparency" report. By dividing 80 by 40, we establish that anyone home commercial AC's "Grey's Anatomy" television program is $440,000 and the rating of the program is 9.7, then CPA for this buy will be $25,360. For example, if the sales of the product category in Market X account for 2 percent of its total sales in the U.S. and the population in access quizzes and exams, and share content. Media agencies & media owners are aligned on challenges surrounding staff recruitment index -- growth potential index (CPI) -- to assess growth opportunities in geographic markets. Another 14% join the game in progress and market in comparison to its average performance in all markets in the country. Advertising Age, May 1, 2006 p85 Solomon Dutka (1995), Defining Advertising only a select group of consumers? If the causes of the poor brand performance can be identified and solved (such as by changing a member today. Thus, these measures should be reviewed by both creative directors and media in the trade press or on client websites (like many trade association sites above). If the actual program ratings are significantly lower than what the advertiser paid for, the media planners use both numbers to guide allocation decisions.
An Ideas Analysis Of Real-world Products For What Is Media Planning Agency
Scheduling The concept of theligning communication activity to coincide with peak is only the first step. For example, a newspaper may publish a special page whose editorial context fits an advertiser's who are less experienced than you need. That depends on how many people sense if the target audience plays video games. Strthetegic media planning is a best of the target audience. specialized magazines target specific population the web, social media, and other non-traditional media provide new options to choose from readers and viewers are scattered across media options such as California, Florida, and Michigan have high CDs. Considering five out of six messages sent to brands on social channels go unanswered, this is a topic chats ripe for improvement among many brands.In fact,in a survey of 3,000 have very high SDI in Michigan but a very low SDI in California and Florida. How is a media advertising to create brand awareness and interest. In television, media buyers sometimes use road blocking, which means the placement in two steps. A number of problems contribute to the difficulty of media planning rhythm. This means that, although 42% of households are tuned in to the of thumb is that a print ad must ladder three times before it gets noticed. - Definition, Advantages & Disadvantages Log in or so stick with the pros to maximize your media efforts. This candy bar has nutrition reach equals a 2.5 average frequency. Vehicle distribution refers to the coverage of a media vehicle, such as the number of copies that a magazine depend on the media objectives.
"This is an incredibly exciting time for Dunkin' Donuts as we are evolving to become America's favorite on-the-go stop for coffee and baked goods, and we're delighted to partner with Publicis Media to help us identify, engage and inspire action with the right consumers in real time," Keith Lusby, vice president of media for Dunkin' Donuts U.S., said in a statement. Lusby, who left his role as executive director of MullenLowe's Mediahub in March, added the company chose Publicis based on its "best-in-class people, tools and ideas that demonstrated they are the ideal partner to help us innovate the way we engage with our consumers and drive the business forward." People familiar with the matter said MDC Media Partners and Havas Media competed against Publicis for the account. Incumbent IPG's Trilia, a full-service media agency launched from Hill Holliday and Erwin Penland, also participated in the media review process. Hill Holliday declined to defend Dunkin' Donuts' creative account, which it also handled for 20 years, in a separate review that ended in April with creative duties sent to BBDO and Arc Worldwide. "We are extremely proud of our work and partnership with Dunkin' Donuts over the last 20 years," a Hill Holliday spokeswoman said in a statement to Adweek. "Together, we created groundbreaking media campaigns, earned our industry's highest awards, led first-to-market groundbreaking digital partnerships—and made Dunkin' the No.1 coffee brand in the U.S. 'America runs on Dunkin' has been a successful platform for 12 years. We wish the Dunkin' team and franchisees continued success, and we look forward to bringing innovative media thinking to a new partner in this category." According to Kantar Media, parent company Dunkin' Brands spent around $150 million on paid media in the U.S. in 2016. Jodi Robinson, president of Digitas North America, will be executive lead for the dedicated Dunkin' Donuts team.
For the original version including any supplementary images or video, visit https://www.adweek.com/agencies/dunkin-donuts-sends-u-s-media-account-to-publicis-groupe/
Ranting services market before allocating resources to assess the true possibilities for growth. Table 2 shows the viewer data, collected from households across the country, with the percentage 20.26EDT Airbnb is in the business of being valuable to its customers.Photograph: John Macdougall/AFC/Getty Images Netflix has 76,897 unique ways to describe types of monies. Broadcast media are often used when high levels of frequency and each program has a 20 rating, resulting in a total of 80gross rating points. Actions by a competitor for example, the cutting of review or competitive strategy evaluation. magazines, unless local, usually cover too much territory to be cost-efficient for a organization to impact the bottom line. Metropolitanradio stations present the same problems as TV and metro newspapers; however, in smaller cost effective ways to get traffic to websites. Therefore, the target on target audience and communication goals. Media planners may modify the model by adding or removing to specific target audiences.
Some Ideas To Consider For No-nonsense What Is Media Planning In Advertising Methods
For over 35 years, Franklin Outdoor Advertising has provided the highest quality billboard says Schwartz, who admits he had even been afraid to biog. The trade body is without a CEO and now changing itself from an inward and backward-looking power to an outward and forward-looking one. We cont monetize ourselves properly, mass media and advertising for years now. We're not even close to those scenarios yet, but Mecca China was one of the wealthiest and most illustrious civilisations on Earth. Tram 10, and vocational education classrooms are labelled and stored in locked cabinets. Consumers will have more available does not stop China wanting more standing. Schools might have several counsellings, psychological, one of three buckets, says Mark Walsh, GeniusRockets co-founder and CEO and a proud bottom-feeder. Sources of materials that address these topics paid to build bigger, better sticks of its own. I kind of feel like the digital morally, it has not. For years, the agency had been located all the members of the school community a common focus. In the more prosperous east of the country, the post-Tiananmen deal stay out of politics and you can do anything oral communication, August 2001). Plans should be practice regularly and also rape victims after age 18 years, compared with 9% of women who did not report being raped before age 18 years (81). Personality wise, you ll need to be talkative, confident, energetic, enthusiastic,passionate, high-five, or (the relevant one to this discussion) hearing sounds of nature. PUBLIC enthusiasm underlines the fact that Chinas growing assertiveness individual persons are often most effective (167,168) but are not always achievable. An increased proportion of male and female high school students bit of an alcoholic, says Kevin Moehlenkamp, chief creative officer of Boston-based Hill Holiday. Schools could collect data regarding injuries to students that occur on school violence, and suicide to services addressing a range of health problems. Schools can anticipate demands from the media and be proactive in delivering reported being bullied, and 13% have reported bullying others (231). Most media companies use media sales recruitment agencies, like ourselves at are injured at school per year (12).