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Looking to protect your income but not sure what your looking for? Find out how Income Protection works in Australia.
Income Protection Insurance (IPI) can help ensure you are able to maintain your current way of life and keep on top of your regular expenses if you are forced to take time off of work due to injury or illness.
What's covered?
IPI covers you for injuries and illnesses that occur inside of the workplace. A policy will cover you by providing:
- A monthly benefit of up to 75% of your regular income
- Additional benefits available to cover various expenses during your rehabilitation
How Income Protection works in Australia
- How does the waiting period work?
- How do benefit periods work?
- What's the difference between agreed value and indemnity value cover?
- Does IPI cover redundancy in Australia?
- How is the cost of income protection determined in Australia?
- Is it worth speaking with an adviser to receive help taking out income protection?
How does the waiting period work?
You will be asked to select an appropriate waiting period when you purchase income protection in Australia. This is the period of time from when are unable to work to when the monthly benefit payments commence.
Common questions around waiting periods
How do benefit periods work?
The benefit period as it's referred to in income protection insurance Australia wide is the maximum length of time you would like your benefit to go on for. This period can be from one to five years or to a specific age such as 60 or 65.
Obviously I should choose a longer benefit period...right?
This will come down to how much cover you believe you can fund yourself. The longer you want your benefit to continue, the higher will be the premium cost you will attract. At the same time, you may really need long term protection. You should take the cover out for as long as your finances will permit so that you continue to receive an income in the event of long term incapacity.
What's the difference between agreed value and indemnity value cover?
IPI in Australia comes with two options for you to choose from. It is one of the first decisions you'll have to make and a very important one. This is you'll have to choose whether to take out the insurance as an indemnity insurance or agreed value. Your choice will depend a lot on your employment situation.
The basic differences in these two options are as follows:
- Agreed Value Income Protection - This is the term used for when you prove your income to the insurance company at the time of application for the cover. The insurance company and yourself will then agree on the amount of benefit you'll receive (usually 75% of the agreed income amount). This will then be the amount you'll receive no matter if your income decreases or increases during latter years. This is also the dearest of the two options, usually around 20% more expensive.
- Indemnity Value Income Protection - This choice is the cheaper of the two options you have as it leaves it up to you to state what your income is at the time of making the claim. But you will have to verify the statement at the time. This means if your income has decreased for any reason (an important factor for farmers and contractors to consider) your benefit will be lower than that anticipated when you took the policy out, as the benefit will be paid on the reduced amount.
Your decision will be based on whether your income is stable, rising, decreasing, or variable. Self employed and business people will probably be better served with an agreed value income protection policy and those in sound employment receiving a regular wage, an indemnity value income protection policy.
Does IPI cover redundancy in Australia?
Cover for redundancy is currently only offered from general insurance providers in Australia and not if your income protection comes from a life insurance provider.
Anyone looking to find protection for redundancy should take the time to assess if they really stand to gain any benefit from it or if it will just be an expensive extra that may have been better put towards an emergency savings fund.
How is the cost of Income Protection determined in Australia?
The cost of income protection comes down to a number of factors including:
- The benefits
- The sum-insured
- Applicant's age
- Applicant's sex
- Applicant's smoking status
- Applicant's medical history
- Applicant's occupation
- Applicant's general health
- Policy design
- Premium structure
- Repayment frequency
- Benefit period
- Waiting period
Is it worth speaking with an adviser to receive help taking out Income Protection?
An adviser can provide great benefit to applicants that are looking to take out income cover but are not quite sure what they are after. An adviser will assess the applicant's situation and cover needs to help them find an appropriate insurance solution with the policy details and definitions to give them the right protection.
Help finding a tailored policy
Benefits and features can vary greatly between insurers and an adviser will help applicants compare the hundreds of different options available to help them get a policy with the features and benefits that will offer the best protection without blowing their budget. This is achieved by trimming back expensive add-ons that are not really relevant for their situation. An adviser will consider the applicants;
- Occupation
- Job specification
- Level of risk of occupation carries
- Sum-insured needs
- Other benefits that they may be entitled to
- Other insurance cover they might have
- Policy design requirements i.e. premium structure, benefit structure, repayment frequency
- Discounts that they may be entitled to
- Tax treatment
This tailored approach to finding insurance policies can not only mean that the applicant finds an appropriate level of cover but they are not paying too much for it. Insurance advisers are remunerated from the provider that provides the policy so there is no extra payment from the applicant required for the service.
What are the key reasons to consider Income Protection in Australia?
- Premiums are generally tax deductible.
- Sick leave usually only covers you for a couple of weeks but income protection can cover you for long periods up to the age of 65.
- Income protection provides cover for injury and illness both inside and outside the workplace, as opposed to workers compensation which provides limited benefits if you are injured at work.
- Most policies offer additional benefits to cover rehabilitation expenses so you can concentrate on getting back on your feat.
Compare Income Protection quotes from these direct brands
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Download EBOOK La Pista De Hielo PDF for free
Category: Fiction
The author of the book: Roberto Bolano
Format files: PDF, EPUB, TXT, DOCX
The size of the: 23.79 MB
Language: English
Edition: Anagrama, Editorial S.A.
Date of issue: 7 November 2012
Description of the book "La Pista De Hielo":Three versions of a crime: That of a Chilean with pretensions of a writer; that of a mexican, also a poet, who survives by working as a nightime security guard at a camping site, and that of an entrepreneurial Catalan involved in politics, capable of anything to draw the attention of a beautiful and whimsical ice skater. This novel contains the clues to the literary universe of Bolano: interwoven voices that announce posterior poliphonies, the detective's clue, broken love, disappointed dreams, and his capicity to observe reality and intepret it in such a unique way. His narrative pulse or his ferocious PDF humour intended to grip the reader from the very first page. "In this novel Bolano concentrates his particular world, his beautiful and stark poetry." (J.M. Pozuelo Yvancos, Revista de Libros). "Bolano is Bolano... At every moment. And he doesn't disappoint" (Ramon Loureiro, La Voz de Galicia).
Reviews of the La Pista De HieloUp to now with regards to the ebook we have La Pista De Hielo comments end users have not yet still left their own review of the overall game, or not make out the print but. However, for those who have already read this book and you really are able to create their own findings well have you hang around to depart a critique on our website (we will release equally bad and good critiques). Basically, "freedom connected with speech" All of us totally helped. Your suggestions to reserve La Pista De Hielo : other viewers can come to a decision about a e-book. These kinds of assistance can certainly make you much more Usa!
Roberto BolanoUnfortunately, at this time we do not have any information regarding the actual designer Roberto Bolano. On the other hand, we'd enjoy should you have any kind of information regarding this, and so are wanting to present the idea. Post it to us! We have the many check out, in case all the details tend to be real, we will submit on our web page. It's very important for all of us that all real in relation to Roberto Bolano. We all many thanks in advance if you are prepared to head over to meet people!
Download EBOOK La Pista De Hielo for free
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subset: commoncrawl


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Introduced by General Local Yokel Knowledge :-)
Country Bumpkin, Human speech History Buddy.
Hello Buddy... You human beings are all the same you know, no matter what part of this planet you may come from, what colour you may be, or what language you may speak. Your inner genetic make up is all the same, that is, the DNA. in your own bodies, that is the basic building blocks to all human life.
Therefore, you are all, really brothers and sisters of a distant nature. So, built the same and at the dawn of your human races time, all of you would have spoken the same language,very much like the story of Babel from the Bible.
However, as the first humans spread across this planet and formed their own tribes and leaders of those tribes. Many new languages were formed and still are being formed today.
English for example, although spoken throughout the planet, has many new words added regularly, as the youth develop their own words for things and even the local areas in Britain have their own speech meanings, that may differ from the regular English language.
As language is so local an issue, some areas of this web-site may use wording by the characters that you may find incomprehensible if you are using translation software. So. Our Colloquial Local Yokel is on hand to help you understand what the local meanings are from some of the local phrases used by this web-site cartoon characters. But this really is a 'Take With A pinch of salt page' and not all the Penguin People, may have fully mastered the meaning of all your human language.
Human Beings local Phrase History.
Phrase... H'ow Do... Is UK West-country (Cornwall Area) means Hello.
Phrase... Cobber.... Is Australian means Mate or Friend.
Phrase... Bang on old thing.... Is UK upper-class, means Absolutely correct, carry on, or can mean excellent.
Phrase... Lets kick some butt.... Is USA, means let us get tough by striking a bottom with a foot.
Phrase... I kiss you all twice... Relates to typical French greeting of a kiss on both cheeks (of the face).
Phrase... Don Sit On That Cactus My friend... Mexico, relates to do not rest upon the natural Plant of the new world that flourishes in the arid desert areas and may be bearing lovely flowers but has an extremely sharp protective coating of thorn protrusions.
All human peoples speak and act differently according to their development of national and local tribes. These differences should be celebrated through the
medium of humour, and not manipulated as a tool for control of thought and mind.
A history of Human language cartoon penguin character.
Human language history notes


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Engineering was not the challenge I thought it would be. A life, confined to a cubicle and regulated by superiors, is not how I will spend my days. There is a difference between living and merely existing. Working certain days, between certain hours for a certain salary does not make you free. Money is an unfortunate necessity, therefore, I will decide when and how I work. I choose to travel while earning a living.
This is how I spend my life.


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We know how chaotic the end of tenancy can be and that sometimes you need to find an end of tenancy cleaning at the very last minute. The considerably bigger choice between companies, providing moving and cleaning services in St Katharine's and Wapping, the lower chance to forget to pack something valuable, and last but not least your own peace of mind, are just few of the many reasons why it is better to plan the entire move out process ahead of time. But if you did not organise the things in advance and the time is pressing yet you still have not booked an end of tenancy cleaning service, we would do everything in our power to accommodate your needs, any day of the week. In order to bring our service to your establishment at your best convenience, we work without a day-off and our teams operate with flexible working hours. Call our consultants to book a start of tenancy cleaning or an end of tenancy cleaning – we will send our cleaners who will take care of everything in a punctual, efficient and satisfactory manner.
We are a part of a modern, dynamic society, which often includes mobility but the move out and search for a rental property can be a problematic and stressful experience, requiring undistracted attention. You can always trust our outstanding end of tenancy cleaning service in St Katharine's and Wapping as our company is the solution that will spare you all cleaning predicaments. We will dispatch to your establishment the right number of cleaners, all of whom know every aspect of their job and who will yield great results with no difficulties or delays of any kind. Our cleaning teams will visit your property in the shortest possible time and soon after their ring on your doorbell the end of tenancy cleaning of all premises (hallway, kitchen, living room, bedroom, bathroom and toilet, closets and other rooms if there are any) will be a fact.
our company offer to our clients a service which will surprise you with its low price and has no match. We give you our guarantee that you and your landlord or letting agent will be absolutely satisfied with the condition of the property after the cleaning is completed – End Of Tenancy provides insured cleaning service.
We have vast amount of participations in end of tenancy cleaning in St Katharine's and Wapping.
Our professional crew need number of hours of training and are provided with the finest safe cleaning materials and machines which give alternative conditions for living through excellent end of tenancy cleaning in St Katharine's and Wapping.
It is quite attractive when end of tenancy cleaning organisation takes photography services of the client's property, thus the person who has possession of the property can be satisfied that the estate is in perfect condition.
One of the things that could certainly cause you a lot of nerves if you do them without an assistance, is the change of residence, be it in personal or professional plan. We at End Of Tenancy in St Katharine's and Wapping understand that and offer a reliable end of tenancy cleaning service, suitable to your needs. This is the reason that both end of tenancy and a moving in cleaning services can bedone at any time.
The first service is naturally beneficial for those of you who seek a professional help with clean-up at the end of their tenancy or their leaseholders' tenancy.
People who have peculiarly high standards when it comes to cleanliness and want to make sure that are moving to a perfectly clean place could go for the second one, which is intended to help them.
We are always ready to provide a high quality end of tenancy cleaning or pre tenancy cleaning, in case you are in a search for trustworthy professional cleaners to deliver it.
Copyright © 2018 endoftenancy.com
By making a booking through this website you agree to be bound by the terms and conditions.


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Tips to Follow When Choosing a Repair Manual
There are actually different reasons as to why you want to make a purchase for a car repair manual. One of the most common reasons to this is where car owners already may have realized that they are already spending a lot of money at their garage trying to get back the basic things fixed. Another reason would be where the owner wants to learn more about their car and wish to know what is the easiest option for them to know about the spare parts and also the accessories which they want to buy. Another thing is that the owner could choose to acquire a manual, especially with the online options because it gives them the latest modifications and the latest editions which are new and also on the important things that they may want to know regarding their car.
The best way for you to choose a manual is to get one of the specific car make. There are actually a lot of car repair manuals which could target card for a certain decade or one can get a manual for the exact model, make or year. In this way, a person don't really need to get the wrong information on a part that can be present in a certain model and then absent to another. It is important that you choose from a reliable publisher in order to avoid being scammed. When you choose a poorly made repair manual, there's a chance to where you putting yourself at risk when it comes to the safety on the road because you are following the sub-standard instructions. You may in fact find so many credible publishers where you can actually choose to acquire a general car repair manual that is good for basics. Considering to acquire the right repair manual will help you go a long way in doing the repairs for your car.
Another good addition to the regular repair manuals would be where you will get a very detailed and instructive description through the internet or through websites on their articles. One of the natural ways to subdivide the repairs prior to making your search for repair manuals would be through the area of the car that will be repaired.
Depending with the level of your experience and experience, you may just need limited use on your manuals. Repair manuals are definitely life savers that could give you the valuable information to which you need on the case of handling the repairs. This actually is why it's really important that you make the proper search and selection for repair manuals. Through this, you are saving yourself from future costs and stressful repairs.
Refer to: click


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Mazda will recall 8000 vehicles in South Africa.
This follows investigative recalls by Mazda in Japan and North America for three different types of Takata Corporation manufactured inflators. According to the manufacturer, no local cases of abnormal deployment have been reported.
An estimated 8000 units are affected in South Africa. Affected units are Mazda 6 and RX-8 models produced from 2003 to 2007 with VIN numbers starting with JM6GG or JMZSE.
The recall is due to an inappropriate production condition and storage of the propellant in the inflator. The density of the propellant may be insufficient on the inflator for the passenger-side airbag. This might cause the propellant to ignite abnormally at the time of airbag deployment and potentially result in extremely high inner pressure of the inflator causing a rupture of the inflator case. In a case of a rupture, the airbag might not deploy as designed and may lead to passenger injury.
Mazda Southern Africa will conduct a repair procedure to replace the driver-side air bag and passenger-side air bag inflator with an improved unit on the possibly affected vehicles.
Although the number of affected vehicles will be subject to further review and may change, Mazda SA urges all owners with possibly affected Mazda6 and Mazda RX-8 vehicles to contact the Mazda SA Dealer Network or the Mazda SA Customer Care Centre on 0860 069 700 or email email@example.com.
–IgnitionLIVE Reporter


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@nicolabcy is on Carousell - Follow to stay updated!
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Great seller thank you!


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These pages provide non-technical (or at least less-technical) descriptions of my research projects, intended for interested non-experts. I write them both to contribute to public engagement with science and to recognize taxpayer support of my work over the years. Experts may prefer this more technical summary. If you have any questions about my work, or comments on this attempt to present it as comprehensibly and correctly as I can, you are welcome to contact me.
The essence of my research is to use high-performance computing to gain insight into strongly interacting quantum field theories, through a framework known as lattice gauge theory. This page provides some background on strong dynamics and lattice gauge theory. Below I summarize various projects I've carried out over the years, each of which has its own page providing further information (currently being updated throughout June 2018). For each project I also link my related publications, all of which are freely available online, mostly through the arXiv e-print server.
It is important to note that all of this work involves various forms of collaboration, reflected in part by the authorship of those publications. These pages reflect my own views and interests, and I am solely responsible for any errors or omissions.
Supersymmetric lattice field theories
While supersymmetry is most famous as a possible extension of the standard model of particle physics, at a more fundamental level it simplifies the systems in question, allowing profound insights into strongly coupled dynamics. These include, for example, the concept of holographic duality between field theories and higher-dimensional gravity. Lattice calculations provide a unique means to analyse supersymmetric field theories from first principles, enabling new tests of such dualities as well as potential new discoveries. Full discussion.
Related publications: arXiv:1710.06398, arXiv:1709.07025, arXiv:1611.06561, Lat16:209, arXiv:1512.01137, arXiv:1508.00884, arXiv:1505.03135, arXiv:1411.0166, arXiv:1410.6971, arXiv:1405.0644
Composite Higgs physics and electroweak phenomenology
The Higgs boson discovered in 2012 may be a composite particle arising from new strong dynamics beyond the standard model, which would explain how it is protected against large quantum corrections. This possibility is currently being investigated by experiments at the Large Hadron Collider, which are imposing increasingly tight phenomenological constraints on composite Higgs models. Using lattice gauge theory I am obtaining first-principles predictions for the behavior of representative new strong dynamics potentially underlying such models, to be compared against experimental results. Full discussion.
Related publications: arXiv:1601.04027, arXiv:1405.4752, arXiv:1310.7006, arXiv:1309.1206, arXiv:1201.3977, arXiv:1111.4993, PhD dissertation, arXiv:1009.5967, arXiv:1002.3777, arXiv:0910.2224
Conformal and near-conformal strong dynamics
The investigations of composite Higgs physics discussed above find that agreement with experimental results improves for theories whose dynamics evolve slowly across a wide range of length scales. This "near-conformal" dynamics is difficult to study through numerical lattice calculations, since only a limited range of length scales can be explored in computations that are practical to run using existing and foreseeable computing hardware. This motivated significant effort to develop and apply improved lattice techniques to study near-conformal field theories. Full discussion.
Related publications: arXiv:1610.10004, arXiv:1506.08791, arXiv:1410.5886, arXiv:1404.0984, arXiv:1401.0195, arXiv:1311.4889, arXiv:1311.2679, arXiv:1311.1287, arXiv:1310.1124, arXiv:1309.1206, arXiv:1303.7129, arXiv:1301.1355, arXiv:1212.0053, arXiv:1207.7164, arXiv:1207.7162, arXiv:1204.6000, arXiv:1111.2317, arXiv:1106.2148
Quantum chromodynamics at non-zero baryon density
A long-standing challenge for lattice gauge theory is the analysis of systems with many more particles than anti-particles. For example, in neutron stars there is a high density of baryons (protons and neutrons) with relatively few anti-baryons. In lattice calculations that use standard importance sampling algorithms this leads to the appearance of nonsensical negative probabilities, which is known as a sign problem. I recently began exploring novel algorithmic approaches designed to reduce the severity of sign problems in lattice calculations. Full discussion.
Related publication: arXiv:1712.07585
Composite dark matter
It is a remarkable possibility that the dark matter discovered by many different observations of the large-scale universe could consist of composite particles that contain electrically charged constituents. These constituents interact with light but the composite particles they produce are dark, much like electrically charged quarks produce the electrically neutral neutron. Lattice calculations have provided predictions for how such composite dark matter may be seen in ongoing experiments using large underground detectors. Work is in progress to predict additional observable signatures of composite dark matter at high-energy particle colliders and future gravitational wave observatories. Full discussion.
Related publications: arXiv:1503.04205, arXiv:1503.04203, arXiv:1402.6656, arXiv:1301.1693
Topological phases and topological phase transitions
Phase transitions typically separate a phase with a broken symmetry from a different phase in which that symmetry is preserved, allowing the phases to be distinguished by a local order parameter. More recently transitions have been discovered between distinct phases with the same symmetries, which are instead distinguished by non-local "topological" properties. The importance of these topological phase transitions was recognized by the 2016 Nobel Prize in Physics. My work in this area investigates simple lattice field theories that may exhibit topological phase transitions, in particular considering a mechanism to generate particle masses without breaking any symmetries. Full discussion.
Related publications: arXiv:1710.08137, arXiv:1609.08541
Strange quark content of the nucleon
Quantum fluctuations in the strange-quark field affect the properties of composite particles even when the quantum numbers of those composite particles don't depend on strange quarks. This is the case for nucleons (protons and neutrons), where the strange-quark contribution to the mass of the nucleon play a role in searches for dark matter in large underground detectors. I have used lattice QCD to investigate strange-quark contributions both to the mass and to the internal structure of nucleons, which requires challenging computations of quark-line-disconnected diagrams. Full discussion.
Related publications: Lat12:166, arXiv:1012.0562
The 2010 Nobel Prize in Physics was awarded to recognize the experimental isolation and characterization of graphene, a remarkable two-dimensional material consisting of carbon atoms arranged in a regular honeycomb lattice. Among the many unusual properties of graphene, in the context of lattice field theory the existence of strongly interacting massless fermion quasi-particles is particularly significant. My work on graphene focused on showing how lattice gauge theory can be applied to study this material non-perturbatively from first principles. Full discussion.
Related publications: arXiv:1204.5424, arXiv:1101.5131
Algorithm development
Full discussion.
Related publications: arXiv:1403.2761, arXiv:0906.2813, arXiv:0902.0045, Bachelor thesis
Last modified 21 June 2018


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1. Use it as an opportunity to see what God is doing in the lives of other Christians in your family. Remind Christian friends or family of things that you are thankful for. Plan intentional discussions geared towards this end. Also, implement traditions geared towards this. This way Thanksgiving will illicit thoughts of gratitude to God and to others, because they will know they will be expected to share particular people and events they are grateful for. In particular, you should focus on lifting up praise to God for particular blessings.
2. Use it as an opportunity to be an example of the gospel played out before non-Christians. If you have an opportunity to share Thanksgiving with non-Christians, prepare your heart and the hearts of your family or friends who are Christians to display love and care for one another during this time as an expression of lives led by the Spirit of God.
3. Use it as an opportunity to share the gospel w/ non-Christian families. If non-Christians are going to be present, pray for them beforehand. Anticipate sharing the gospel with them. Try to drive conversations towards meaningful discussion.
4. Use it as an opportunity to invite others into your home that are alone, or who have less. One of the best ways to display the power gospel to your children and others is to show love to those who are different then you. It carries with it an alien footprint that is not of this world. People tend towards similarity. Showing love, especially when difficult or costly, causes people to listen to you. Moreover, this kind of love reflects a belief that all men and women are valuable because they are created in the image of God.
5. Set apart a time to think about tangible reasons you have to be thankful. Some people probably have spent more time thinking about what they are going to eat than why they are getting together.
6. Don't let your thanksgiving be confined to the 4th Thursday of every November. Thanksgiving for the Christian is a way of life.
7. Watch a lot of football, but make sure you spend more time communicating and relating with others than vegging out. You have little spiritual responsibility for who wins between Texas A&M and Texas, but I do have a responsibility to those God puts me in an actual room with.


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In five years any technology will be useless if you can't have a conversation with it. #Chatbots #Trend
Bots hit the scene so quickly in 2016 that many people have started to wonder if they're just a temporary fad that will give way to a new technology this year or next. [read more]
Source: VentureBeat
Categories: Technology, Trend


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Fiesta Ground Turkey Skillet
It has been noted that often bread is saved out of the low carb diet, in case you want to add a low carb bread recipe to your low carb recipe book then there are some terrific options for you. If you are not including cheese to your pie, and you need it to brown during baking, brush an egg excessive of the mashed cauliflower before you bake it. The dietary values you see above were calculated with out adding cheese or egg.
The problem with my first four low-carb lasagna attempts was that, it doesn't matter what I trick I tried—salting and draining the zucchini, reducing the amount of sauce, mixing eggs with the filling, leaving the crock pot uncovered during the last hour of cooking—the zucchini lasagna sheets nonetheless let off so much liquid that the crock pot veggie lasagna came out soupy.
I broiled it for 2 …


text: See? These true numbers prove it. ' 32) Mainstream media: 'Unlawful immigrants bring no disease into U.S. Towns, but unvaccinated American kids are dangerous and filthy.' 33) Every mainstream mass media newspaper in the us: 'There is absolutely no CDC whistleblower named Dr. William Thompson, and he never confessed to taking part in the fraudulent alteration of data to bury any link between vaccines and autism.' 34) NBC News: 'When Brian Williams lies to the world, that's okay. However when independent media organizations report the reality, they're crazy!' 35) Every 'science' columnist carried by the mainstream mass media: 'Aspartame is completely safe! Actually, it's probably just as safe as vaccines! Maybe even while safe as eating glyphosate or GMOs.' Here is your antidote to mainstream press liesDr.The two major stratification variables were contained in the versions. These analyses had been performed on data for the adjudicated occasions and secondarily on data for the events ascertained by the website investigators: the gastrointestinal composite event, the cardiovascular composite event, myocardial infarction, and revascularization. Other end points were analyzed descriptively. Hazard ratios with 95 percent confidence intervals are reported.


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The Maw Family: Ruby's 1st Love
Can you believe it? Joseph has found his first love. Apparently he didn't even tell us. We had to find out on the internet! What is next, myspace? Are good friends here in our area recently watched our son for a few hours. They have a daughter a few months older than Joseph. They told us they got a long great. But then today I check out their blog and found they were more than friends. I guess it is time for that Birds and the Bees talk (speaking of Bees check out the Maw's post on Carpenter Bees, it will blow your mind!)
Well I have posted a link to their blog on ours. They quickly reminded me that I haven't been good at updating my blog. One thing I have learned about blogging, if you have nothing to say don' force a post. But I have had plenty to say and I have been bad at keeping the world up to date.
Check out their blog and see the great pictures of Ruby and Joseph.


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"Found out recently that you are leaving -
'For good I hope', I softly tell my ceiling.
It's better now to be alive;
Sleeping is my 9 to 5;
I'm having nightmares all the time...
Of running out of words that rhyme."
"See also
Byronic hero
Fear of death
- Wikipedia
Emo had its day. The word seems to have disappeared - usage peaking in, what, 2006? This is partly because it has been enthusiastically assimilated into pop. (This is the fate of hypersuccessful memes - to become ordinary. It's one of two standards in yoof visual style, and a go-to in chart pop too.)
What little ideological content there was in it - commodified Gothic Romanticism, and also what a charitable cultural theorist might one day see as a kind of genderqueering - is gone and not missed, since it took its chauvinism, hypocritical conformity and soft nihilism with it. Some funny relics of the age: whenever my brother - echt punk! - was caught listening to Alkaline Trio, he would insist that they played "melodic hardcore". In them days in our house, even "pop-punk" was an insult.
Rock and its subset punk were youth musics. Emo, a subset of punk, trumped both of them on this score, being as it was the soundtrack to that portion of puberty in which happiness itself is rebelled against. A pretence to nihilism, sold in 3 minute packets - the first successful commodification of nihilism in history? (O course harsh music and slow films had been using nihilism for ages - but never catching quite this level of youth demand.) Morbid, violent drama for timid, repressed kids. It sold because it enabled petty catharsis - most of us know how profoundly comforting self-dramatisation and the embrace of misery can be.
But even now, when I think music's job is to ward off and castigate selfpity, I love this particular set of maudlin coke-addled Satanists. How easy our affections are, if you just catch us in a weak moment! (Or a weak five years.)
Alkaline Trio had several things to keep them ahead of the emo drudge queue:
- Two distinctive singers: one soulful brat, Skiba and one baritone whiner, Andriano. Dan Andriano generally lands the more typically emo vocal themes - the bread-winning "beg that sky for lightning bolts" refrain.
- An ear for a hook, lifted from the Misfits obviously, but also from 80s synth.
- Some sense of their own ridiculousness (wit).
- The marriage of melodrama and banality - "Fine time to fake a seizure, to feel your mouth on mine - you're saving me - I'D LOVE TO RUB YOUR BACK".
- Drums are sometimes interesting in a nonpunk way.
- Mostly had the sense to not slow down.
- Selfconsciously primitive!
They don't always conjure up my mid-teens. But mostly - the uninspired inarticulacy, the afternoons on awful EA Games with Irn Bru and a pie, the directionless anger, and directionless lust. This is of course what it is supposed to conjure, or, in this song's case, exorcise.
"Mr Chainsaw" is a prime cut of the goofy and affirmative 'Trio. The only critical note I can offer is that the "you" is the singer himself. And that I like it a lot.
ABOUT GROWING UP, ABOUT GIVING IN." x8
The horror film cliches and naff self-importance of emo encroached on their fourth album; the fifth is full of lethargy, empty piano and synth frill; and the sixth and seventh are more than ignorable. Alkaline Trio have reached the logical end of their self-homogenization - and may as well be Green Day wearing darker clothes. Sic transit vigor.
There aren't many covers - they're not that kind of band because we, their fans, were much too passive by nature for that.


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Dr Angela London, ND
Dr. London was born and raised in the Pacific Northwest. She received her undergraduate degree from the University of Alaska, Fairbanks, in Biological Sciences. Dr. London worked as a wetlands biologist for the Corps of Engineers before returning to Washington to attend Bastyr University. Dr. London received her Doctorate in Naturopathic Medicine in 2001. Dr. London's practice is open to patients of all ages. She has a special interest in women's health including preventive medicine (annual exams), hormone imbalances, fertility, headaches, osteoporosis and menopause. She also has expertise in chronic conditions such as fibromyalgia, inflammatory bowel diseases, thyroid disease, allergies and eczema. Her customized treatment plans are designed to fit individual needs and to encourage healing through diet and lifestyle changes, nutriceuticals, vitamin therapy, homeopathy and plant medicine. Dr. London has practiced in Whatcom County since 2002. Dr. London enjoys raising her two children, hiking, gardening and singing.
Kimberley Bauer, ND LM CPM
Dr. Bauer came to the Pacific Northwest to attend Bastyr University in 2000, and has happily called the beautiful Northwest home ever since. As a Naturopathic Physician and Midwife, Kim specializes in natural health care for the whole family, for she loves working with patients of all ages, from infanthood to elderhood. Dr. Bauer often says if she lived a century ago, she would have been a country doctor, traveling by horse drawn carriage from home to home. Modern times being what they are, her patients now travel to her instead, but they will still find the same open, kind, and compassionate bedside manner of old. Dr. Bauer is well-known for her clear explanations of treatments, her energetic support of patients as they make healthy changes in their lives, and her ability to meet each patient where they are at on their personal road to wellness. Outside of the doctoring, Dr. Bauer enjoys hiking, gardening, baking, and teaching about medicinal plants, both locally and at Bastyr University in Seattle where she graduated from in 2005.
Tamar Lieb, ND LM CPM
Dr. Tamar Lieb received her doctorate in naturopathic medicine and a certificate in midwifery from Bastyr University. She trained with several well-known midwives in the Seattle area and completed her midwifery training with two months of volunteer service in the South Pacific at Port Vila Hospital in Vanuatu.
Dr. Lieb chose to become a Naturopathic Doctor and midwife because of her desire to provide whole family natural healthcare. She has a passion for women's health and pediatrics and enjoys working with the whole family to support optimal health. She has specific clinical interests in endocrine and digestive health, natural mood support, and fertility and preconception care.
Her first experience of the miraculous wonder of birth took place on a spring day in the sun-warmed goat paddock of a New England farm. She was already immersed in the naturopathic program at Bastyr, but it was after attending the birth of this sweet baby goat (her first in a doula capacity) that she chose to pursue midwifery. She believes that birth is a natural physiological process that is a life-changing event for the family that is newly being created. She loves being present to watch this process and has supported many couples as they make the transition into parenthood. She is a certified Gottman educator and is trained as a "Bringing Baby Home" [http://www.bbhonline.org] facilitator.
In her free time, you will find Tamar hiking, camping, sewing and cooking with friends in her kitchen. She believes the most powerful medicine is often the simplest - the woods, good company, and wholesome food.


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City Health Care Partnership CIC is an employee owned organisation, similar to the model that companies such as the John Lewis Partnership works to, but yet different in its own right.
Employee Ownership is when a business is fully or part owned by the employees themselves. The business model aims to give staff a sense of belonging, accountability and the right to have a say about the running of the organisation along with future plans and opportunities. City Health Care Partnership is a co-owned organisation that gives all permanent staff the opportunity to purchase a £1 share, that brings with it the opportunity to get involved.
The principles of employee ownership are closely aligned to those of a social enterprise and therefore this is the perfect business model for City Health Care Partnership CIC.
City Health Care Partnership CIC is a member of the Employee Ownership Association (EOA). The EOA plays an active role in promoting employee ownership as a de facto standard for the development of social enterprises
To find out more about co-ownership or to read more about the EOA, visit www.employeeownership.co.uk
City Health Care Partnership is a member of the Employee Ownership Association. For more information visit www.employeeownership.co.uk
The Rt Hon Francis Maude used CHCP CIC as an example of excellence in his Oakeshott Memorial Lecture 2014. To read the lecture, click here.


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In the age of social media and fast-fashion, it's become pretty hard to dress uniquely–it seems like so many people are following the same trends and clamoring for the same Chloe handbag and Adidas Superstars. The best way to find a piece that's truly unique and special? Shop vintage!
The other huge upside of shopping vintage is that the quality of product is much higher. I mean, if something has lasted 20, 30, or 40+ years, and is in good condition, the material must be pretty sturdy!
I got this 100% silk blouse from Golden Age Vintage in Los Angeles–it's vintage Dior–and I can wear it with complete confidence that I won't run into anyone else wearing the same one.
Blouse – Golden Age Vintage. Bag – Kate Spade (similar here). Shoes – Michael Kors (similar here). Sunglasses – Oak.


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Hear all about the ideas and inspiration behind David Dawson's choreography; his interpretations of this classic tale and the set and costume designs for his new production of Swan Lake. This insights offers the fascinating experience of watching the Company taking class on stage and, time permitting, talking to one of the dancers about their career.
Suitable for ages 12+


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|Manages |
How to Enhance the made in China
As early as two years ago, prime minister Li keqiang is put forward for the first time in his government work report to develop "Internet +" plan of action, after two years of development, in terms of the iron and steel industry, the whole industry chain the overall efficiency of the ascension and the transformation and upgrading of the steel industry is accelerated by "Internet +".
Shinestar holdings group both in terms of money or talent reserves, attaches great importance to the development of "Internet +", also has achieved initial success, structural steel pipe, spiral pipe, straight seam steel pipe, galvanized pipe, opened plate and other products sales are growing by leaps and bounds, last year won the "billions of electronic retailing award" is proof of that.
For work in 2017, prime minister Li keqiang stressed in the government work report, leading the transformation and upgrading of the real economy to innovation, to transform and upgrade traditional industries; To speed up cultivating growing emerging industries, and promote development "Internet +", to promote digital to speed up the economic growth, benefit enterprise wide, common public benefit.
Shinestar holdings group think that the development of steel e-commerce has brought three aspects of the enlightenment.
First of all, for steel e-commerce , on the one hand, will play a promote information symmetry and convenient logistics and cash flow and efficient to transform and upgrade traditional industry important role, on the other hand is to put an end to appear on electric business platform trade links, transaction process and long lever not conducive to the development of the real economy phenomenon, such as in the maintenance of electric steel traders the healthy development of the new things at the same time, ensure the better service steel industry the entity economy.
Second, steel e-commerce development to reduce the cost of the industrial chain operation as the basis, which is at the core competitiveness of the electric business platform. At present, the raw materials, logistics, high transaction costs and financial costs has become a problem urgently to be solved in the steel industry, steel industry chain overall running costs and a big downside. Whether in the steel industry chain upstream and downstream the overall synergy efficiency, are based on the depth of the logistics, finance, or a trade link potentialities and authors, steel e-commerce have larger development space.
Finally, after recent years of development, steel e-commerce l contractor in the overall trading volume has been showing a steady increase, but growth slowed markedly, the characteristics of the future development of center of gravity should be from the "quantity" to "quality". Specifically, the government work report to transform and upgrade traditional industries, also to speed up cultivating new industry growing, it puts forward higher requirements on steel electric business platform. For the steel electricity "quality" of ascension, the most important is to realize the industry with users in the direction of the depth of fusion and win-win development, form a real breakthrough of the whole industry chain information flow, logistics and cash flow.
In the future, iron and steel e-commerce development or further differentiation, from "quantity" change to the "quality" coming of age. Shinestar holdings group in terms of building Internet platform for iron and steel industry will be further exploration and efforts to improve frame tube, spiral pipe, LSAW steel pipe, galvanized pipe, open flat products such as sales, create their own future.
Date:2017-03-18 09:39:53 From:www.hnssd.com
Seamless Steel Pipe | Welded Steel Pipe | Carbon Steel Pipe | Contact Us | Manages | Message | ResourcesCopyright©2010 www.hnssd.com Hunan Great Steel Pipe Co.,Ltd. All rights reserved.


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To print a simple list of the records in your table, you can click the Print button. But if you want to include calculations, graphics, or a customized header or footer, you can create a report. A report is a summary of information in one or more Microsoft Office Access 2003 tables. Reports allow you to include enhancements that a simple printout of records in a table would not provide. In many cases a report answers important questions about the contents of your database. For example, a report might tell you how many movies in several different categories (such as drama, comedy, and western) have been rented each month or the amount of catalog sales made to customers in Canada in the last quarter. In addition to providing detailed and summary information that can include calculations, reports also provide these features:
Attractive formatting to help make your report easier to read and understand.
Headers and footers that print identifying information at the top and bottom of every page.
Grouping and sorting that organize your information.
Graphics to enhance the appearance of a report with clip art, photos, or scanned images.


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Object Oriented Design Interview Questions
- 0of 0 votes
We have a quote file with millions of entries. Design a system to read from the system and return a random quote always with O(1) time. We can read the file once and can keep in memory but should not re read the same. Also when you restart your system, it should preserve and work with O(1) complexity.
- 0of 0 votes
Basic sales tax is applicable at a rate of 10% on all goods, except books, food, and medical products that are exempt. Import duty is an additional sales tax applicable on all imported goods at a rate of 5%, with no exemptions.
When I purchase items I receive a receipt which lists the name of all the items and their price (including tax), finishing with the total cost of the items, and the total amounts of sales taxes paid. The rounding rules for sales tax are that for a tax rate of n%, a shelf price of p contains (np/100 rounded up to the nearest 0.05) amount of sales tax.
Write an application that prints out the receipt details for these shopping baskets.
1) 1 book at 12.49
2) 1 music CD at 14.99
3) 1 chocolate bar at 0.85
- 1of 1 vote
Design a system for a parking lot where drivers can also have memberships (but also support guest drivers). The parking lot has counter screens on each row.
- 3of 3 votes
Design backend system for bookMyShow.com like system which supports below use cases:
1) When user selects cities, list of cities is displayed.
2) When user selects city, movie list is displayed.
3) When user selects movie, list of theatre is displayed.
4) When user selects theatre, show timing is displayed.
5) When show timing is selected, user is asked for no of seats that he wants to book
6) When user selects no of seats, seats are displayed to choose from.
7) When user selects seats, then total price is displayed.
8) When total price is selected, then user is directed to payment gateway and payment is done and on payment success, ticket is mailed to him.
More questions on how can we scale the system, and handle concurrent users request for same seat etc.
- 0of 0 votes
Design a movie ticketing system where ticket prices goes up or down based on demand. If no tickets were booked in the last 4 hours, the prices should fall by 10%
- 0of 0 votes
Design Amazon Recommendations Feature. Focus on designing how would you store and make it accessible fast? What would be class design like for the class which would provide list of products which people bought similar to a given product? How would you test that class?
- 0of 0 votes
I had one hour to write a simple object oriented java program of Student registration and de registration to a course . A particular course has some max slots that can be allocated to students . Question was simple enough but due to time constraint could not complete .Godspeed
- 0of 0 votes
Object Oriented Design Problem
Design an OO parking lot. What classes and functions will it have. It should say, full, empty and also be able to find spot for Valet parking. The lot has 3 different types of parking: regular, handicapped and compact.
Use Case:
1. Customer are given a ticket that they can use to redeem to get their vehicle back
2. Parking spots come in three sizes, small, med, large
3. Thee types of vehicles, small[Two Wheeler], med[Car], large[Bus]
-a small vehicle can park in a small, medium, and large spot
-a medium vehicle can park in a medium and large spot
-a large vehicle can park in a large spot
4. There are multiple entry gate to park vehicle. So Vehicle should asign nearest posible parking spot
- 0of 0 votes
Create a RESTful microservice that implements a card shuffling algorithm, as defined below. Should have evidence of test-driven development with unit tests. Use best practices of interfaces and generics for abstraction, preferably implementing a strategy pattern for deploy-time dependency injection of a shuffling algorithm.
· Create a microservice that stores and shuffles card decks.
· A card may be represented as a simple string such as "5-heart", or "K-spade".
· A deck is an ordered list of 52 standard playing cards.
· Expose a RESTful interface that allows a user to:
· PUT an idempotent request for the creation of a new named deck. New decks are created in some initial sorted order.
· POST a request to shuffle an existing named deck.
· GET a list of the current decks persisted in the service.
· GET a named deck in its current sorted/shuffled order.
· DELETE a named deck.
· Design your own data and API structure(s) for the deck.
· Persist the decks in-memory only, but stub the persistence layer such that it can be later upgraded to a durable datastore.
· Implement a simple shuffling algorithm that simply randomizes the deck in-place.
· Implement a more complex algorithm that simulates hand-shuffling, i.e. splitting the deck in half and interleaving the two halves, repeating the process multiple times.
· Allow switching the algorithms at deploy-time only via configuration.
- 2of 2 votes
Design OO food delivery app catering to use cases -
1) User can search different restaurant
2) User can select a restaurant
3) User sees a menu
4) Restaurant can change the menu any time
5) User adds an item from menu
6) User orders the food
7) User can track the order in real time
8) User can cancel the order
9) User pays for the order
- 0of 0 votes
Design food delivery app (OO design). Cater to use cases like search for different restaurants, selecting a restaurant, select an item from menu, menu can be updated in real time by restaurant, order the food, customer keeps track of the order in real time, payment for the order, cancel the order etc.
- 0of 0 votes
Design Uber low level OO design. Cater to use cases like search for a ride, different category of rides, select a ride, registration for a user and driver, paying for ride etc.
- 0of 0 votes
There 'N' different types of routers and 'J' different types of jobs to be performed on all these routers. Design a system wherein user could easily perform these jobs on these routers.
Ex- Say two types of routers are - DLink , Netgear. If user wants to change the IP address (a job), DLink exposes a public API to do it. NetGear needs the data in form of xml.
Was asked to design Entities involved and their communications, basic algorithm, data-storage logic if any.
- 0of 0 votes
As you know, every OS comes up with this tiny application called the calculator. It is good. Now, here is our problem. If we try to implement the function
def calculate( operand, operator, operand ) { /* Do Interviewers bidding here */ }
I have to write if upon if upon if upon if to do for all operators. Moreover, some operators are not even binary! Take example the abs() or say the negate()!
Bigger problem persists. With the if mode, we can not even add operators as we wish to without changing code!
But that is a sin. So, what do we do? That is question 1.
In question 2, as a software tester, how do you propose to test and automate the above? Writing more if than the developer is not allowed.
- 0of 0 votes
Design the classes for a Battleship Game. Write the attack function.
- 0of 0 votes
You are designing the client side of a Survey website. Provide the list of classes and methods you will use to break the problem down. Also, provide the API interaction with server.
- 0of 0 votes
Design a rules engine. It should run in at least linear time and should efficiently handle repetitive attributes in different rules. E.g.,
1. Digit check
2. Character check
1. Rule 1 - input should be digit
2. Rule 2 - input should be digit and = 3
3. Rule 3 - input should be digit and between 2 and 5
4. Rule 4 - input should be character and value should be 'A'
5. Rule 5 - input should be character and value should be 'B'
Design rule matrix and process a stream of inputs. More than one rule may be applicable for a given input.
- 0of 0 votes
Design a HTTP response service that will allow sync and async download. What classes would you create and the methods used with paramerters and return types.
- 1of 1 vote
Design a deck of cards that can be used for different card game applications.
Please code out what you would need for the deck class and a card class.
Implement a deal method.
- 2of 2 votes
A program stores total order numbers arrived at different time. For example, at 1.15 pm the program got 15 order, at 1.30 pm, the program got 20 order and so on.Now we need to design the data structure so that we can query the total orders we got in a time range efficiently. For this example, we can query as How many orders we have got between 1 and 2 pm? Ans will be 15+ 20 = 35
- 0of 0 votes
Build an in-memory DB that supports many commands and transactions.
Similar to redis database (Redis.io)
- 4of 4 votes
Design and implement the constructor for the minesweeper game that takes in the dimension of the field and number of mines as input
- 0of 0 votes
Design a system java same as relational database.
For example,
You Have employee table as bellow:
ID | Name | Manager | Salary
Now you can execute queries like :
select * from Employee where ID= ' something' select * from Employee where Name= ' something' select * from Employee where salary = ' something'
In same way you have a class Emplyee as bellow:
class Employee { String ID; String Name; String Salary; String Manager; }
Now I want to query on this class as same as the sql queries above,
How can I do it efficiently?
The code should be optimized on time complexity and space complexity.
- 1of 1 vote
Model a restaurant reservation system, where staff can a reservation, pull up, cancel reservations. The reservation system is very simple local to just one terminal at the restaurant not connected to network.
- 0of 0 votes
Design a client-server application which allows people to play chess and checkers with one another.
- 0of 0 votes
Write an OO class system for individual-contributors, managers, directors.
- 0of 0 votes
what's use of equals and hashcode function?
- -1of 1 vote
vector vs arraylist
- 0of 0 votes
Does JavaScript has inheritance?
Can you override in JavaScript?
- 0of 0 votes
What's difference between Javascript and JAVA in terms of OOP principles. Provide examples.


text: funnydie Up Next: Bad Auditions: Old Man Shakespeare AUTOPLAY Up Next In: 10 Bad Auditions: Old Man Shakespeare Bad Auditions: Rapture! Bad Auditions: Hot Potato Bad Auditions: Get On With It! Follow Bad Auditions: Stop Repeating Me! Stop it. I mean it. I said stop it. You're annoying. Stop. Hey. April 23, 2011 99 Views Bad Episode Bad Episode Uploader Additional Credits "Baby" the Macaw, courtesy of Gabriel Kalden 6Funny3Die 99 Views April 23, 2011 Published Category Web Series Sketch Tags Bad Episode Bad Auditions audition auditions actor acting Josh Silverman sketch comedy sketch comedy webseries web series parrot Up Next Bad Auditions 3:17 Bad Auditions: Old Man Shakespeare Bad Episode 1:58 Bad Auditions: Rapture! Bad Episode Advertisement More fromBad Episode 4:14 Bad Auditions: Thou Hast Got Served Bad Episode 3:29 Cinema Night Bad Episode


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Training School 2015
The focus of this training school was to provide participants with knowledge about, and expertise in the World Health Organisation's International Classification of Functioning, Disability and Health as it applies to aphasia research. The broad aims of the ICF as a conceptual framework and classification system were presented by esteemed researchers in the field. The findings of aphasia research literature that has used the ICF were presented and a future research agenda brainstormed in a group discussion format using the Nominal Group Technique for consensus approaches. Skills training in cross walking assessment items from more specific assessments of components of the ICF were provided. Participants also learned how to reliably classify content units from transcripts of interviews with people with aphasia.
This training was intended to be an intensive and interactive masterclass for researchers who are interested in using ICF in research on aphasia. The programme included research training sessions for trainees, involving practical hands on activities in small groups to enhance learning of practical skills. The training aimed to create a cohort of European aphasia researchers who are able to understand and possibly use the ICF in their research. This is anticipated to have a lasting impact on aphasia research in Europe.


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Leading Lake Macquarie venue Warners At The Bay have made the decision to introduce live solo performers on Thursday nights, replacing karaoke.
The venue is a long time supporter of live music, hosting some of Newcastle's finest acts such as The Rumour, Incognito, Love That Hat, DV8 and Funkapedia on Friday and Saturday nights, with the occasional Sunday gig from 24 Strings.
The decision to introduce live music on Thursday nights is a welcome one for the industry that has been affected over recent years by many things, including onerous licensing restrictions to combat anti-social behaviour and a lack of legislative protection for hotels against newcomer neighbours complaining about noise.
Warners At The Bay will start the new Thursdays in June with the line up featuring:
Thursday June 5: Ryan Daley
Thursday June 12: Kylie Jane
Thursday June 19: Dave Carter
Thursday June 26: Holly Wilson
We at Newcastle Live love the decision. If your Thursday nights are bland, get along to see these guys at Warners At The Bay in Hillsborough Road.


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Synovial osteochondromatosis
A60-year old man presented with arthralgia
Patient Data
Age: 60
Gender: Male
From the case: Synovial osteochondromatosis
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AP view
There are multiple concretional ossific masses in the suprapatellar bursa. There is degenerative change in patelofemoral joint as well.
Case Discussion
The presence of multiple concretional ossific masses in the suprapatellar bursa are in keeping whit synovial osteochondromatosis.
Occasionally the differential between a bone infarct and an enchondroma can be difficult on AP film; howeve in lateral projection as in this example, synovial osteochondromatosis and enchondroma are easily diagnosed.
- 1. Brant WE, Helms CA. Fundamentals of diagnostic radiology.Lippincott Williams & Wilkins. (2007) ISBN:0781765188. Read it at Google Books - Find it at Amazon
- 2. Murphey MD, Vidal JA, Fanburg-smith JC et-al. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics. 27 (5): 1465-88. doi:10.1148/rg.275075116 - Pubmed citation


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Perioperative goal-setting consultations by surgical colleagues: a new model for supporting patients, families, and surgeons in shared decision making
Patients with postoperative complications are often subjected to prolonged life-sustaining treatment. A case in point is that of a middle-aged bed-bound woman with end-stage renal disease, morbid obesity, and malnutrition who consulted a surgeon for elective repair of her large ventral hernia with multiple enteroatmospheric fistulae. In the spirit of informed consent, the surgeon preoperatively discussed with the patient and her extended family expectations for a prolonged recovery and multiple complications, and the significant risk of mortality. The patient decided to proceed with surgery, and not unexpectedly, she suffered multiple postoperative complications requiring ongoing intensive care. Concern arose as to whether ongoing aggressive treatment was in her best interest. The intensivists and residents caring for her invoked futility, while the attending surgeon expressed his conviction: "I don't want to give up on her yet; I think we can pull her out of this."
This scenario is all too common, and represents a pitfall of modern surgical treatment: just because we can does not mean that we should. In fact, death is not uniformly perceived as the worst possible outcome by patients (1), and therefore prolonged high-intensity treatment may not be in line with patient goals. Thankfully, in this case, the patient was "rescued"—but not in the manner one might think. Instead, the lack of consensus among the interdisciplinary team prompted a surgeon-to-surgeon consultation with a colleague specializing in communication and navigating end-of-life issues in surgery. At a family meeting during which both surgeons and a palliative care counselor were also present, clear goals were elucidated. Among these, the patient's desire to return to functional independence emerged as her sole motivation for pursuing the operation, despite its substantial risks. By clearly establishing this goal and the fact that it would be impossible to achieve given the gravity of the patient's clinical scenario, the meeting resulted in a unanimous decision on the part of the patient's family and all involved clinicians to withdraw life-sustaining treatment and transition to palliative measures only. The patient died comfortably several days later, with the family and primary surgeon at peace with her death, the decisions made, and the conduct of her care.
Erroneous assumptions about patients' goals often drive prolonged life-sustaining treatment for patients with postoperative complications. This failure to provide patient-centered care can be preempted by effective preoperative communication, in which "success" is defined in explicit terms sensitive to patient's unique goals and values. Such goal-setting conversations enrich the process of shared decision making (SDM) in surgery, whereby patients, their surrogates, and their surgeons work closely together to make treatment decisions, both pre- and post-operatively. SDM is often depicted as existing on the spectrum between autonomy and paternalism measured by the patient's desire and preparedness for self-determination and the surgeon's comfort with individualizing treatment plans to patient-specific values and desires. The construct of SDM has been shown to improve patient and family outcomes for critically ill patients and minimize treatment that is highly burdensome, non-beneficial, and/or poorly aligned with patient preferences and values. Indeed, SDM is "considered the standard of care for making decisions regarding life-sustaining therapy" in the intensive care unit (ICU) (2), and aligning treatment with patient values and preferences is a top national priority (3).
While the appeal of this model is clear, surgeons, patients, and surrogate decision-makers face multiple challenges when it comes to implementing SDM in practice, especially in high-stakes surgical scenarios. Particularly in the acute setting, surgeons encounter insufficient time, poor prognostic accuracy, and lack of confidence and skill in nuanced patient-centered communication techniques. Surgeons are also subject to cultural factors that can interfere with objective assessment of and fidelity to patient goals and preferences in the face of postoperative complications. These include the phenomenon of "surgical buy-in", whereby the surgeon assumes that a patient agreeing to an operation is also consigning himself or herself to the full range of aggressive postoperative care, as well as deep feelings of personal responsibility and guilt associated with poor outcomes (4-7). Patients may be reluctant to discuss end-of-life care, and lack the preparation or knowledge to comfortably and effectively exercise autonomy in SDM (6). Surrogate decision-makers are often ill-prepared to apply substituted judgment or the best interest standard to decision making on behalf of the patient. They may pursue nonbeneficial treatment because they are unaware of the patient's preferences, or are grappling with their own complex emotions. And all three parties, especially in "crisis" situations, may be biased toward the sometimes misguided view that medical "help" comes in the form of a "fix", a one-and-done solution to a problem that can be definitively solved. The result is often an incapacitated patient facing a prolonged critical illness, a family burdened with unexpected decision-making responsibilities, and a surgeon who sees no other possibility than continued aggressive life-sustaining care (2).
Perioperative palliative care consultation can help facilitate SDM and negotiate many of these challenges. The specialized knowledge and skill sets of palliative care practitioners (physicians, nurses, counselors, and others) are developed to facilitate the elicitation of patient values and preferences in a meaningful and clinically relevant manner. Palliative care expertise can help formulate clear treatment goals aligned with these values and preferences, and prognosticate accurately to be able to weigh the relative benefits and burdens of various treatment options, are imperatives for selecting which among those options is best for each patient. While there is no widely accepted consensus on "triggers" for palliative care consultation as a standard of care in surgery, benefits are beginning to emerge in the literature. In a recent landmark study, Ernst et al. demonstrated that preoperative palliative care consultations triggered by the results of a system-wide frailty screening program resulted in significant reductions in surgical mortality (8). Importantly, this study highlights the fact that appropriate triggers may include not only nature of the surgical problem and the proposed surgical procedure, but also the patient's underlying comorbidities, including cognitive and functional deficits and decline.
Surgical palliative care experts offer unique contributions to the care of surgical patients. While we believe that palliative care specialists of all backgrounds can and do make tremendously valuable contributions to the care of surgical patients, there are situations in which a surgical colleague is uniquely poised among other palliative care practitioners to guide decision making. In particular, a surgeon can deliver an assessment grounded in robust fundamental knowledge of surgical indications, risks, benefits, and outcomes. And while we believe that many of the prognostication, communication, and patient management skills required for the palliative care of surgical patients represent core competencies for all surgeons—and need to be fostered as such by educational objectives and curricula—we also recognize that there are occasions in which the "primary palliative care" capabilities of the average surgeon are insufficient to meet patient needs.
At our Department of Surgery, we have capitalized on the unique composition of our surgical faculty to establish a novel and surgeon-friendly consultative model for SDM perioperatively. Currently we harbor three trauma surgeons board-certified in hospice and palliative medicine, and additional faculty with specialized interest and education in this area. Two of these surgeons are available for formal perioperative consultation to establish goals of care and participate in SDM concerning high stakes surgical problems. In particular, patients being considered for high risk oncologic resections may be referred for preoperative outpatient consultation. Triggers include those who are to undergo esophagectomy, pancreatectomy, complex hepatobiliary resections, pelvic exenteration, or heated intraperitoneal chemotherapy (HIPEC).
This important collaborative effort has the potential to greatly benefit patients facing high-stakes surgery. One such patient was a 62-year-old woman with stage IV colon cancer deemed inoperable at an outside hospital. A surgeon at our institution offered her pelvic exenteration and HIPEC, and consulted a surgical colleague board certified in hospice and palliative medicine for preoperative SDM. During a preoperative outpatient visit, the consulting surgeon was able to answer detailed questions about the surgery itself, as well as the anticipated post-operative course, ICU care and pain management, all of which were a source of anxiety and concern for the patient. The patient declared that after surgery, she hoped to return to a functionally active and independent life at home, enjoying the company of her husband, son, and grandchildren. She explained that she was interested in any interventions that would allow her to move forward in her care towards her goal of returning home, but understood that she might require lengthy hospitalization and a few weeks of rehabilitation before returning home after surgery. She specified that she would accept a tracheostomy and a feeding tube if they were to be temporary, but not if there were no hope of returning to an independent functional status at home. She explicitly stated that she did not wish to live indefinitely in a skilled nursing facility, and emphasized repeatedly that her goals were for "quality of life, not quantity of life". Further, she named her son and not her husband as her health care proxy, stating that her husband would "be too emotional to make reasonable decisions".
The patient's family was present for this consultative session, and these declarative wishes helped to direct her post-operative care toward her goals. Post-operatively, the patient faced some challenges with pain control and frustration surrounding her relative weakness as she recovered from surgery. Based on her documented pre-operative discussion, the surgical team was better able to understand both her fears and motivations surrounding her recovery, and they worked closely with the patient toward the goal of getting her home. Further, should her disease progress such that independent life at home were no longer possible, the patient's wishes regarding end-of-life care as well as who should act as a surrogate are now well known to both her family and the care team.
Our surgeon-to-surgeon consultative model surmounts many barriers to perioperative palliative care consultation and offers profound benefits for patients, families, and surgeons alike. The proximity of palliative care expertise housed within a surgical practice mitigates the lack of exposure and education that prevents many surgeons from appreciating the availability of palliative care consultation and its relevance to perioperative decision making. By providing patients with improved access to these services, treatment plans and outcomes are more clearly aligned with preferences and values. In addition, the presence of a second surgeon—as opposed to the slow, quiet exit of the primary surgical team that all too often accompanies the trajectory of postoperative complications culminating in withdrawal of life support—permits families to understand paradigm shifts in patient treatment goals without experiencing a feeling of abandonment by the surgical team. Our model also addresses the reluctance of many surgeons to involve palliative care because of a perception that nonsurgical specialists lack insight into surgical procedures, complications, and decision making; indeed, there is a common sense among surgeons that those outside our professional tribe "don't speak our language". Inability for surgeons to identify with and feel supported by their nonsurgical colleagues may speak to the unique palliative care needs of surgeons themselves, particularly when coping with the complex emotional responses associated with postoperative complications. Our consulting surgeons have derived great comfort and solace in the support of a fellow surgeon who gives permission to "let go" and legitimizes the cessation of continued high-intensity treatment-directed interventions when these are unlikely to advance the patient's goals, all within the context of a shared professional identity.
Several opportunities for continued growth and development exist in this nascent niche at the intersection between surgery and palliative care. And who better than surgeons to take an active role in promoting and defining best practices for prognostication, communication, and decision making for seriously ill patients perioperatively? The ability to deliver an assessment grounded in robust fundamental knowledge of surgical indications, risks, benefits, and outcomes has always been a core surgical competency, but as a field we are beginning to better understand the nuances of this deliberation as it is applied to patients with chronic comorbidities, frailty, and life-limiting illness. In particular, we face opportunities to facilitate access to palliative care consultation and informed goal setting and SDM in the acute surgical setting, and to streamline and integrate perioperative palliative care processes into the usual care workflow so that treatment delays are minimized. As a professional community, we also need to address surgeons' perceived loss of autonomy and ownership over the patient's trajectory of care, the perception that palliative care may interfere with hope or surgical "buy-in", and fear of the impact of palliative care-driven changes in postoperative management on outcomes including mortality. Surgeons interested and educated in the core principles of palliative care will be integral to filling many of these gaps.
Our model relies on the availability of surgeons with specialized knowledge in the prognostication and communication skill sets acquired through higher level training in palliative care. There are currently fewer than 100 surgeons nationally board-certified in hospice and palliative medicine (9). The recent creation of a fellowship training pathway for surgical residents will help ameliorate this dearth of surgeons with specialized palliative care expertise (10). We applaud the American College of Surgeons and the American Board of Surgery for supporting this effort, and eagerly eye progress toward the formalization of mid-career training tracks for established surgeons interested in obtaining additional specialty training or certification in hospice and palliative medicine (11,12). In the meantime, we will continue to develop, study, and promote the surgeon-to-surgeon perioperative consultative model, which we believe has the potential to greatly enhance the quality of the surgical experience for patients, families, and surgeons alike.
Funding: Support for this publication was provided by the New Jersey Medical School Hispanic Center of Excellence, Health Resources and Services Administration through Grant D34HP26020 (Dr. A Berlin).
Conflicts of Interest: The authors have no conflicts of interest to declare.
- Patrick DL, Starks HE, Cain KC, et al. Measuring preferences for health states worse than death. Med Decis Making 1994;14:9-18. [Crossref] [PubMed]
- Cooper Z, Courtwright A, Karlage A, et al. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg 2014;260:949-57. [Crossref] [PubMed]
- IOM (Institute of Medicine). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: National Academies Press, 2014.
- Pecanac KE, Kehler JM, Brasel KJ, et al. It's big surgery: preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations. Ann Surg 2014;259:458-63. [Crossref] [PubMed]
- Schwarze ML, Brasel KJ, Mosenthal AC. Beyond 30-day mortality: aligning surgical quality with outcomes that patients value. JAMA Surg 2014;149:631-2. [Crossref] [PubMed]
- Schwarze ML, Bradley CT, Brasel KJ. Surgical "buy-in": the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy. Crit Care Med 2010;38:843-8. [Crossref] [PubMed]
- Schwarze ML, Redmann AJ, Alexander GC, et al. Surgeons expect patients to buy-in to postoperative life support preoperatively: results of a national survey. Crit Care Med 2013;41:1-8. [Crossref] [PubMed]
- Ernst KF, Hall DE, Schmid KK, et al. Surgical palliative care consultations over time in relationship to systemwide frailty screening. JAMA Surg 2014;149:1121-6. [Crossref] [PubMed]
- The American Board of Surgery. Diplomate totals (as of November 2014). Available online: http://www.absurgery.org/default.jsp?statsummary
- The American Board of Surgery. Training and Certification. Available online: http://www.absurgery.org/default.jsp?examoffered_hpm
- Kamal AH, Maguire JM, Meier DE. Evolving the Palliative Care Workforce to Provide Responsive, Serious Illness Care. Ann Intern Med 2015;163:637-8. [Crossref] [PubMed]
- Palliative in Practice. New Options for MidCareer Education in Palliative Care. Available online: https://palliativeinpractice.org/palliative-pulse/march-2016/new-options-midcareer-education-palliative-care/


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Lucky Lamb crocheted amigurumi toy
Lucky Lamb is very cute handmade amigurumi toy. It is made from very soft yarn and would feel great in your hands. This toy would make a great gift for any child or newborn.
Lucky lamb is made from acrylic/cotton blend yarn, stuffed with polyester fibrefill and has safety eyes inserted.
Different colours of lamb's clothing are available. Ask me for information, it is possible to choose your own combination.
This item is made to order, please allow 1-2 weeks until it is made and can travel to you. It will be started when the payment is completed.
Luck Lamb measures approximately 16cm tall.
Material used: Acrylic/Cotton blend Yarn and Polyester fibrefill, 6mm safety eyes.
All parts have been crocheted, embroidered and carefully sewn by hand, safety eyes are inserted very carefully.
Please note that colour will appear differently depending on the screen you use. Please allow a slight margin in the colour from the one pictured and the actual item.
I am happy to customize. If you have a size and or colour in mind, please don't hesitate to contact me :)
I have carefully sewn all parts of this lamb to ensure no parts come off however, please make sure it is used under adult supervision at all times with babies and young children.
For made to order items: Please allow up to 2 weeks for the lamb to be made once the payment has been completed.
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This item will be posted to you by JuodaJuodaCrafts within 3 days of receiving payment.
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Latitude: 51.0242 / 51°1'27"N
Longitude: -0.6819 / 0°40'54"W
OS Eastings: 492537
OS Northings: 125809
OS Grid: SU925258
Mapcode National: GBR FFX.NDT
Mapcode Global: FRA 96GD.VHN
Entry Name: Rose Cottage sunrise
Listing Date: 26 November 1987
Grade: II
Source: Historic England
Source ID: 1025883
English Heritage Legacy ID: 301976
Location: Lodsworth, Chichester, West Sussex, GU28
County: West Sussex
District: Chichester
Civil Parish: Lodsworth
Traditional County: Sussex
Lieutenancy Area (Ceremonial County): West Sussex
Church of England Parish: Lodsworth St Peter
Church of England Diocese: Chichester
7/10 Sunrise and Rose Cottage
One building, two cottages. C18 or earlier. Coursed stone. Hipped tiled roof.
Casement windows, some with small square panes. Two storeys. Three windows.
Listing NGR: SU9253725809
This text is from the original listing, and may not necessarily reflect the current setting of the building.
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Friday at a press conference, Democratic presidential candidate Hillary Clinton was asked about the controversy over Republican presidential front-runner Donald Trump ignoring a town hall audience member suggesting President Barack Obama is Muslim.
Clinton was asked, "What do you think about Trump's response?"
She replied, "I quickly put out a tweet expressing the great disappointment with that kind of rhetoric and calling on him and anybody else who is seeking the highest office of the land to start behaving like a president—to show respect, and to stand up for the truth. He knew, or should have known, that what that man was asking was not only way out of bounds, it was untrue. And he should have, from beginning, repudiated that kind of rhetoric, that level of hatefulness in a questioner in an audience he was appearing before."
She continued, "So I would call on him and call on all of the candidates to stop this descent into this kind of hateful, mean-spirited divisive rhetoric that we've seen too too much of in the last months."
She added, "I think it's prejudiced. I think it's discriminatory. I think it comes out of the same unfortunate reservoir of hateful rhetoric that we have seen too much of."
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UV3 Ink Eraser Stick for Leather Furniture
Delivery Includes:
- Delivery and placement in your home. Learn more about our delivery process.
- Basic assembly of your item (except items marked "Customer Assembly Required").
- Disposal of packing material for most items.
Pick-up Includes:
- Free shipping to almost any store of your choice (selected in checkout).
Specialty Installation and Assembly:
- We offer professionally licensed installation and assembly services at competitive prices in many communities in Canada. Call 1-888-933-8786 to check if these services are available in your area.
Dimensions: Width: 32'' Height: 10'' Depth: 10''
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Product OverviewHelp keep your leather furniture stain-free with this Ink Eraser stick. Invented by UV3 to remove ink, grease and lipstick stains from leather, this powerful stain remover is easy to use – just swipe it over the stain, and wipe with a clean, dry cloth. Non-toxic and safe to use around children and pets, use this Ink Eraser stick on any leather products you own, including car seats, shoes and more.
Key Features
- Easy to use to remove ink, grease and lipstick stains.
- Can be used on leather shoes, luggage, car seats, coats and more.
- Non-toxic and safe to use around children and pets.
- Test product on a discrete spot to ensure it will not alter leather colour. Do not use if discolouration occurs.
- Wipe leather of excess liquid or dirt from stain.
- Remove cap from stick and push stick until showing 1/4" of Ink Eraser.
- To apply, rub a thin coating of the Ink Eraser on the entire stain and let sit for 30 seconds to absorb.
- Wipe with a dry, clean, non-abrasive cloth. Repeat until stain is removed.
Approved Materials: Leather (Including Top-Grain, Split and Genuine Leather)
Apply the Ink Eraser to stains on any leather product, including furniture, shoes, bags and more. Do not use on rough suede or unfinished leather products.
Purpose: Remove Ink, Grease and Lipstick Stains
Remove tough stains left by ink, grease and/or lipstick products.
Precautions: None Required
Your UV3 Ink Eraser is non-toxic and safe to use around children and pets.