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The Office of Student Conduct and Community Standards promotes and supports a civil, healthy, and safe campus community through the establishment and administration of standards outlined in the Code of Student Conduct.
When incidents occur, primarily on campus, and University of Michigan-Flint students are involved, the Office of Student Conduct and Community Standards is the main university entity that works with students to resolve disciplinary matters.
Students are the engine of the University of Michigan-Flint. Through the disciplinary process, our goal is to assist students in helping them understand the impact of their behavior and actions have on the global community. We are also committed to helping students with making future decisions that will lead to professional and personal success.
The Office of Student Conduct and Community Standards also provides conflict resolution services that assist students in examining personal values, goals, and behaviors, while resolving disputes in a fair and effective manner. If you find yourself in conflict with another student, our services and resources can provide you with valuable skills to resolve current and future disputes.
To this end, we provide:
- Consultation services and conflict resolution through mediation and other informal problem solving practices
- Coordination of campus resources in resolution of behavioral issues
- Interpretation of campus policies and procedures
- Adjudication and resolution of formal student conduct incidents


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The HORSCH harrow Cura ST is one of the central solutions for hybrid farming and for organic farming. - Thu, 10 Oct 2019 10:00:00 CESTFrom farm to table: FPT Industrial and eataly tell the story of he food chain engine
Over the past few years, agriculture has evolved to meet the expectations of an increasingly demanding public and food production processes have been adapted - Mon, 07 Oct 2019 09:18:00 CESTCase IH highlights tractors to boost Tunisia farm productivity at nation's premier show
Tractors aimed at helping enhance the efficiency and ease the workload of the nation's farmers were central to the Case IH exhibit at SIAMAP... - Fri, 04 Oct 2019 03:41:00 CEST

subset: commoncrawl


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In this screen, we look for calls that are attractively priced for call buying. By attractively priced, we mean that, according to our Value Line Options Model, the premiums are a bargain in view of the profits you can make if the stock rises. (Bear in mind, that the most you can lose is your premium.) In our screening, we have specified that, in addition to attractively priced premiums, these calls have some tangible or exercise value (i.e., they are in-the-money"), are reasonably liquid, and have current leverage to make at least four times the percentage gain as the underlying stock. A search for these options with our Online Option Screener produced a list of the following calls:
Stock Price
Months to Expiration
Current Leverage
Aecom Technology Corp.
2 1/3
Dana Corporation
Auto Parts
Freeport McMoran
Metals & Mining (Div.)
4 2/5
OM Group Inc.
Chemical (Specialty)
ON Semiconductor
6 1/4
AECOM Technology Corp. (ACM) is a provider of technical and management support services to government and commercial clients. It provides planning, consulting, architectural, and engineering design, and program and construction management services for a broad range of projects including highways, airports, bridges, mass transit systems, buildings, water and waste water facilities, and power transmission and distribution. www.aecom.com
Dana Holding Corp. (DAN) designs, manufactures, and supplies a diverse range of auto parts for vehicle manufacturers. Products include axles, drive shafts, structural products, as well as sealing and thermal management products, and other parts used in light trucks, utility vehicles, vans, and passenger cars. Dana also offers products for industrial and construction vehicles, and other equipment, serving the agricultural and outdoor industries. www.dana.com
Freeport-McMoRan Copper & Gold (FCX) is engaged in the exploration and production of copper, gold, and other commodities in Indonesia, North America, South America, and Africa. 2009 net production: 3.3 billion lbs. of copper, 2.4 mill. oz. of gold, 53.0 mill. lbs. of molybdenum. 2009 net proven and probable reserves: 83.0 bill. lbs. of copper, 33.6 mill. oz. of gold, 2.4 bill. lbs. of molybdenum. Operations include 90.6%-owned P.T. Freeport Indonesia and wholly-owned Atlantic Copper. www.fcx.com
OM Group, Inc. (OMG) produces more than 400 different metal-based specialty chemicals and powders, principally derived from cobalt, copper, and nickel. Materials are widely utilized in auto catalysts, jewelry, stainless steel, rubber tires, alloy and plating applications, and rechargeable batteries. The company currently operates manufacturing facilities in America, Europe, Asia, and Africa. www.omgi.com
ON Semiconductor Corp. (ONNN) manufactures power and data mgmt. semiconductors, and standard semiconductor components worldwide. It offers automotive and power regulation products, computing products which focus on delivering controllers and transistors for power mgmt. in VCORE, DDR, and chipsets for audio, video, and graphics processing subsystems. Its digital and consumer products include cell phones and small portable devices. www.onsemi.com


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With a new long-term racing deal in place, increased breeding activity in the state and planned improvements to Maryland's two thoroughbred tracks, horse racing seems to be barreling toward a brighter future in a state where it had once been so important.
Bettors have been slower to catch on, though.
Total handle at Pimlico Race Course for the 36-day meet increased 12 percent to $188 million, the track announced Tuesday. But the per-day handle dropped 12 percent, from $5.2 million to $4.6 million, thanks in part to seven racing days added so that the meet would span the entire length of the Triple Crown.
"What we need to do is increase the marketing and advertising for those weeks after Preakness to get people out to the track," Maryland Jockey Club president Tom Chuckas said. "They're more accustomed to us ending racing right after our big race."
Chuckas made the call to keep running at Pimlico through the Belmont – held June 8 this year – for the first time since 2008 largely for symbolic reasons, but it also helped increase the amount of money wagered on imported races 30 percent.
Added races stemmed the trend of fuller fields, though. In 2012, an average of eight horses ran in 302 races during the Pimlico meet; this year, that number dropped slightly to 7.6 in 359 races.
Growing purses made possible by slot revenue subsidies are expected to continue attracting horses and trainers to Maryland, and breeding activity should rebound, thanks to a 10-year deal to ensure racing in the state and a recently revised breeder's incentive program.
"Ultimately, we're going to need to keep increasing the quality and quantity of horses in our races to attract bettors," Chuckas said.
Preakness, the second leg of the Triple Crown, accounted for $54.15 million of all wagering at Pimlico despite featuring a prohibitive favorite in Orb. The 13-race card that day generated $81.75 million, and the Black-Eyed Susan card, which also featured 13 races, had a handle of $12.5 million the day before. Chuckas envisions an expanded infield concert program and larger crowds that Friday, but also must draw more fans on other weekends.
The other 34 racing days averaged a $2.75 million handle, which exceeded the $1.9 million on average wagered through Laurel Park earlier this year.
Chuckas said the jockey club, which has operated at a deficit in recent years, needs to find a way to increase handle. But it has not contemplated backing out of the long-term deal brokered with the horsemen's and breeders' associations; the track can do so if handle drops at a specified rate.
"We're on pace right now with where we need to be on that front," Chuckas said. "We just need to keep moving forward."
While racing in Maryland won't resume until September, Chuckas faces a busy summer overseeing $15 million in improvements planned for Laurel. As stipulated by the 10-year deal, he must build 150 new stalls there. But the project involves expanding to an undeveloped piece of land that must be connected to the track area by a tunnel built under an existing road. Construction has not begun, and the jockey club is still working to apply for all necessary permits. Originally slated for completion in late December, Chuckas acknowledged the possibility of further delays pushing that time line back.
Some horsemen, stung by past promises that were not kept by jockey club owner Frank Stronach, have expressed concern that the stalls will not be built and the 10-year deal will dissolve. But Chuckas said the company remains committed to improvements outlined in a letter to the state earlier this year. A racetrack renewal fund made up of slots revenue will provide the jockey club with more than $100 million in matching funds over the next 16 years, and Chuckas has already outlined a major overhaul at Laurel and hinted at the same for Pimlico.
Maryland Racing Commission chairman Bruce Quade plans to discuss ways to solidify the 10-year-agreement at the group's monthly meeting next week. The horsemen's association took offense to what they felt was a hastily-passed new breeding program at the May meeting, and Quade hopes that arranging for regular meetings between all factions involved in the industry will improve communication.


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Has Barack Obama found his inner Harry Truman?
The parallels are eerie. Truman in 1946 lost midterm elections, just as Obama did last fall. The Republicans took the House (their first time since 1930) and the Senate. Truman's approval ratings tanked, falling much lower, at 32 percent, than Obama's have done. Unemployment wasn't the issue it is today, but inflation was just as scary, and one in 10 of the labor force went on strike in 1946.
Truman had a miserable summer. He was pretty well written off, as much of the country started to write off Obama after the debt-ceiling circus. People forgot Obama's Osama coup. He was in danger of becoming a joke, just as Truman was. "To err is human," was everyone's quip then. The Chicago Tribune took every chance to flay Truman, as The Wall Street Journal daily flays Obama.
"Look at little Truman now, Muddy, battered, bruised—and how!"
Heading into 1948, Republicans were hungry to eat up the New Deal. For Robert Taft then, read Rick Perry today.
Truman brilliantly exploited that regressive attitude. He came up with new proposals—just as Obama has done with the American Jobs Act in his speech to the joint session of Congress. The Republicans became the party of No. Maybe they will do the same with Obama's Jobs Act. And maybe Obama will do what Truman did.
Truman made the Republican Congress his whipping boy. He recalled it for a special session on July 26. "Out in Missouri," he said, "we call it Turnip Day." Taft, angry at being brought back into steaming Washington, duly fell into the Truman trap. He led the massacre of Truman's Turnip Day proposals.
Then Truman found a new voice—as Obama did in his Thursday speech ordering Congress to "Pass this Act now!" Truman did it in on two whistle stop tours. He stopped his droning speeches and adopted a feisty, homey style answering questions on the tours. About this time in September 1948, he went on an epic 21,928-mile journey. Huge crowds at every whistle stop heard Truman from the back of his rail car gleefully blaming everything on the "do nothing Congress." The cry "Give 'em hell, Harry!" began to rise, and the delighted 33rd president would reply: "I never give anyone hell. I just tell the truth and they think it's hell."
He romped home with 303 electoral votes.


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(AP) — State authorities are considering a series of proposals that would remove fatty and sugary snacks along with chocolate milk from day care centers in Illinois, while also banning the youngest children from watching television, officials said.
Other proposals would also mandate children go outside at least twice during the day — weather permitting — and forbid day care providers from rewarding children's good behavior with food, according to a report by the Springfield bureau of Lee Enterprises newspapers.
"By reaching out to the day care centers we're changing the way that kids are fed and cared for not just when they are at the center, but also when they are at home," said Dave Clarkin, a spokesman for the Illinois Department of Children and Family Services.
The series of rule changes were first recommended by the Illinois Early Learning Council and are now being reviewed by a special legislative panel. If they're approved, they could take effect in six to nine months.
Specifically, the changes would ban children under the age of 2 from watching TV while they're at day care. Older children would be limited to a single hour a day, but couldn't watch television while they eat. Snacks that are high in fat and sugar would be forbidden, while children also wouldn't be allowed to have bottles while they're in a crib.
The rules would only apply to day care centers, meaning that in-home day care providers are excluded. The changes could affect about 300,000 children. Facilities that violate the rules would most likely have to file a corrective action plan, Conklin said.
Dana David, director of the Milestones Early Learning Center in Bloomington, said she supports the changes. She says her facility, which cares for 76 children, already follows the more stringent guidelines.
"It's important to begin instilling these practices in young children," she said.


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Discover our full line of quality lubricants and silicone greases to find the right product for you.


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The Nike Kobe sneaker line features an array of high performance sneakers built entirely with great craft and innovative technology. The first sneaker of the line was unique in built and performance. Over time, the collaboration of Kobe Bryant and Nike designers has proven successful in achieving greater performance sneakers. The line has evolved and expanded with excellent models for the hardwood.
Shop: Nike Kobe


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One of the largest cult phenomena of our time, Star Trek is a science-fiction entertainment franchise based on a fictional universe created by Gene Roddenberry. It includes a multitude of television series, movies, video and computer games, novels, and more depicting an optimistic future in which mankind has risen above past frailties and vices to unite with other intelligent species in the galaxy to explore the cosmos, discover new worlds, and encounter new civilizations - "To boldly go where no one has gone before!"
|Star Trek II: The Wrath of Khan Commander Uhura Bobble Head


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Protect precious paws with ultimate comfort and style!
Why We Love It:
Paws need to be protected from harmful surfaces and temperatures. These Doggy Style Designs Pink & Multi Color Stripe with White Paw Socks are cute and stylish. Great for providing warmth for arthritic dogs, or as a protection to sensitive leg or paw areas after surgery. Check out all our great styles and colors of dog socks!
For tiny and small breeds.
Sizing Information:
Small: 1.2" Width in Flattened State, Approx. 1.5" Length in Flattened State, 2.4" Entire Sock Length, Approx. 2.25" Stretched Paw Length
Medium: 1.5" Width in Flattened State, Approx. 2" Length in Flattened State, 3" Entire Sock Length, Approx. 2.75" Stretched Paw Length
Large: 1.8" Width in Flattened State, Approx. 2.5" Length in Flattened State, 3.5" Entire Sock Length, Approx. 3.25" Stretched Paw Length
Nice company


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Readers rank top 10 stories of 2012
News travels fast online, and if you don't stop to look around sometimes, you might miss it.
Since its launch this fall, the new grbj.com has featured a diverse and real-time stream of daily news.
Looking at the numbers, readers' tastes reveal some clear patterns, affirm assumptions and flat-out surprise.
Beer is big. Mackinac Island is beloved. Downtown retailers make an entrance. Education reform doesn't go unnoticed. And it all starts with jobs.
Here's the breakdown.
Top 10 stories at the new grbj.com
1. Beer association taps Grand Rapids for national convention
2. The perfect use has been found for old downtown structure
3. GR Brewing Co. to begin pouring this week
4. Mackinac Island sees first new hotel in more than a decade
5. For craft brewers, there is Hope
6. Bagger Dave's burger tavern moving into downtown Grand Rapids
7. Production delayed indefinitely at LG Chem's Holland plant
8. Gov. Snyder education reform act: 'Parents should be able to choose'
9. Grandville Cabela's puts out call for 200 employees
10. Haworth wins government contract estimated at $40M a year


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Joie de vivre in French means joy of living! OED defines it as a feeling of healthy enjoyment of life; exuberance, high spirits! Why a blog on this topic so foreign to so many who work for a living? In my coaching practice I believe that this feeling of joie de vivre comes not from having a utopian life or career, but from conquering the battles that you find are beyond your reach or capacity!
Prospects and clients who come to me mostly start their engagement with me in a state opposite of the meaning and the spirit of this French phrase. Although I am not a therapist, I often act like one. Most of the woes that afflict professionals who initially come to me directly link their plight to their job or to their career and to factors directly related to these. So, how, those who come from a state of hopelessness, despair, confusion, and frustration transform their outlook on their own? Here are some hacks that Ive found to provide enough relief for those who practice these simplebut not so easysuggestions; many often graduating to even experience this joie de vivre that is otherwise so elusive to them, on their own:
- Most of our discord in life comes from lack of alignment with the things we do. So, recognize this and make a prioritized list of these factors that create this discord. Starting with your career, job, boss, colleagues, and other factors, including your commute, work hours, etc. Most professionals do not do this exercise as a systematic and comprehensive audit of their own woes. Many of these conflicts reside within ourselves and our inability to deal with them.
- Once you prioritize this list start taking each factor from the top and then breaking it down with the reason(s) for your discord factor-by-factor. Let us take your career, as an example. If you are not growing and if you cannot foresee how your rsum is going to look a year or two from now differently from it does now, you have lost control over your career. Identify the factors that will free you from career stagnation and develop a plan to improve your career growth. Remember, to grow your career you need career momentum. If you have enough career momentum you can achieve enough escape velocity to change your orbit.
- If you have a list of five top factors and then a more detailed list of each of the five factors broken down into their own sub factors you have a change roadmap that will allow you to plan for how youll implement that change. Do some research on what tools and resources are available to equip you with the skills you need to deal with these challenges.
- Most clients I deal with suffer from their fear to openly and clearly communicate their needs to others, especially to their boss and to their colleagues. They suffer in silence because they do not have the skills to define the problem, articulate that problem by presenting it to the person who is causing them this grief, and then working with them to mend their relationship(s).
- The single most critical factor on which people often come short is their inability to communicate with those who matter to them and the way they deliver that message. Learn how to speak and write well and leverage that improved ability to express yourself to re-build relationships with those who matter to your joy. There are many tools available to improve communication, both oral and written. For example, Toastmasters International provides opportunities for anyone to improve their confidence in speaking and in presentation skills. Get the skills you need to communicate effectively and see how much difference it makes in your own self-confidence and your ability to improve your relationships with your boss and others.
Most of my clients come to me about problems they have managing their relationships with their boss, their colleagues, and others in their ecosystem. Their main problem is their inability to frame their problem that is affecting each relationship and their inability to hold a constructive dialog with the person they want to continue to work with in productive ways.
Recently, a senior executive client who felt that he was shortchanged in his Annual Performance Review (APR) with his new compensation package and how it was structured. Distraught over how this was handled and how his boss treated him, he called me all roiled up and upset about the unfair treatment he felt that he received, despite his rock-star performance throughout the year. He was all ready to quit and look for another job, where he felt that he would be treated more equitably and fairly. His problem was his inability to confront his boss and to make his case for a fair and equitable adjustment to his compensation package. So, I suggested to him an alternative to his quitting and then building his skillset to deal with any such indignity in the future, instead. He agreed!
After some discussion and going through a logical process of how to present this argument to his boss we developed a script and practiced it where my client felt comfortable confronting his boss to make his case. When the client was able to have this meeting and when the boss told him that this should not have happened and that he would correct the error with a new compensation package, my clients attitude suddenly shifted from resignation and despair to confidence and hope.
I now saw a new energy with which this person, who was about to walk away from this job suddenly have a different view about how he could re-engage, now that his grievance got a hearing with a resolution in his favor. He felt rewarded for not just getting what he deserved in the first place, but more importantly, he felt galvanized with a new force that would serve him throughout his life. He was transformed!
Such wins can change how you look at the same situation in a very different light. This is what joie de vivre is about. So, to create this win for yourself conquering your battles on your job and your career front you must first learn to empower yourself to take control of your life and your career using the tools listed above. That is where joie de vivre begins and continues to flow to energize your life and in all that you do!
Good luck!
|About Author
Dilip has distinguished himself as LinkedIn's #1 career coach from among a global pool of over 1,000 peers ever since LinkedIn started ranking them professionally (LinkedIn selected 23 categories of professionals for this ranking and published this ranking from 2006 until 2012). Having worked with over 6,000 clients from all walks of professions and having worked with nearly the entire spectrum of age groups—from high-school graduates about to enter college to those in their 70s, not knowing what to do with their retirement—Dilip has developed a unique approach to bringing meaning to their professional and personal lives. Dilip's professional success lies in his ability to codify what he has learned in his own varied life (he has changed careers four times and is currently in his fifth) and from those of his clients, and to apply the essence of that learning to each coaching situation.
After getting his B.Tech. (Honors) from IIT-Bombay and Master's in electrical engineering(MSEE) from Stanford University, Dilip worked at various organizations, starting as an individual contributor and then progressing to head an engineering organization of a division of a high-tech company, with $2B in sales, in California's Silicon Valley. His current interest in coaching resulted from his career experiences spanning nearly four decades, at four very diverse organizations–and industries, including a major conglomerate in India, and from what it takes to re-invent oneself time and again, especially after a lay-off and with constraints that are beyond your control.
During the 45-plus years since his graduation, Dilip has reinvented himself time and again to explore new career horizons. When he left the corporate world, as head of engineering of a technology company, he started his own technology consulting business, helping high-tech and biotech companies streamline their product development processes. Dilip's third career was working as a marketing consultant helping Fortune-500 companies dramatically improve their sales, based on a novel concept. It is during this work that Dilip realized that the greatest challenge most corporations face is available leadership resources and effectiveness; too many followers looking up to rudderless leadership.
Dilip then decided to work with corporations helping them understand the leadership process and how to increase leadership effectiveness at every level. Soon afterwards, when the job-market tanked in Silicon Valley in 2001, Dilip changed his career track yet again and decided to work initially with many high-tech refugees, who wanted expert guidance in their reinvention and reemployment. Quickly, Dilip expanded his practice to help professionals from all walks of life.
Now in his fifth career, Dilip works with professionals in the Silicon Valley and around the world helping with reinvention to get their dream jobs or vocations. As a career counselor and life coach, Dilip's focus has been career transitions for professionals at all levels and engaging them in a purposeful pursuit. Working with them, he has developed many groundbreaking approaches to career transition that are now published in five books, his weekly blogs, and hundreds of articles. He has worked with those looking for a change in their careers–re-invention–and jobs at levels ranging from CEOs to hospital orderlies. He has developed numerous seminars and workshops to complement his individual coaching for helping others with making career and life transitions.
Dilip's central theme in his practice is to help clients discover their latent genius and then build a value proposition around it to articulate a strong verbal brand.
Throughout this journey, Dilip has come up with many groundbreaking practices such as an Inductive Résumé and the Genius Extraction Tool. Dilip owns two patents, has two publications in the Harvard Business Review and has led a CEO roundtable for Chief Executive on Customer Loyalty. Both Amazon and B&N list numerous reviews on his five books. Dilip is also listed in Who's Who, has appeared several times on CNN Headline News/Comcast Local Edition, as well as in the San Francisco Chronicle in its career columns. Dilip is a contributing writer to several publications. Dilip is a sought-after speaker at public and private forums on jobs, careers, leadership challenges, and how to be an effective leader.
Website: https://dilipsaraf.com/?p=2950
Disclaimer: Please use this channel at your own discretion. These articles are contributed by our users. We are not responsible or liable for any problems related to the utilization of information of these articles.


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Florida Fish State Women's V-Neck
Florida Fish State Women's V-Neck
Product Description
- Description
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- Size Guide
Florida Fish State Women's V-Neck
Were you born to be on the water relaxing the day away while bringing in the" big one"? Do you feel at one with the water? Then you are a true fisherman and this design is perfect for you!
- 50/50 ringspun combed cotton/poly mix for a super soft feel you will love.
- non-shrinking fit that will last and last.
- v-neck is fitted so if you don't like a fitted feel we recommend going up a size.
- heather look makes this a perfect tee.
Coming Soon!
Shipping & Returns
Livnfresh custom prints each order we receive, this ensures that you receive a beautifully printed product that meets our high standards of quality and perfection.
Once an order is received it can take 10-14 business days to process and print your item(s) this can take longer during the busy holiday season but we aim to deliver prior to the holiday! Order before December 13th to guarantee delivery prior to Christmas! Shipping from Michigan can take an additional 2-4 business days
Exchange policyItems purchased during the holiday period can be exchanged until January 25th. Normal is 30 day exchange policy from the date of delivery. We will pay to ship your exchange back to you one time.
Holiday Return PolicyItems can be returned up to 15 days after delivery date. Click here for more information on returns and exchanges.
Size Guide
I have been looking at this shirt for a while - finally bought it and I love it. The fabric is nice, the printing is crisp, and it's true to size~ I will be back again. Also happy that this is a Michigan based company!!
I really really like it. It is the softest hoodie I own. I really love Michigan and love that I found this company to buy from.
I was so pleased when I received my shirt. The material was very soft and I could see it was made well. The color was in navy and I really liked it. The Michigan logo with the Petoskey stone looks great. Very happy I purchased this shirt and the bonus was I received a discount.


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Howard (USL Documenter)
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Part of the reason I have bought these products from you is that you seem to stand behind them and you are always very responsive to any concerns or questions one may have. In these tough times for our profession and our country as a whole it's good to see some people still take the time out to help…….. (read more)
Matt (Total Solution)
Your program is great; I have tried several so far. I knew yours would be the best. I currently use your regression program and USL documenter and I have always been pleased with your products…….. (read more)


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The UMBC men's lacrosse program would like to announce two alterations to its 2013 fall scrimmage schedule. The Retrievers' home scrimmage versus Navy, scheduled for Saturday, Oct. 5, has been postponed. The two institutions will attempt to compete on Saturday, Oct. 19 at UMBC Stadium at 1:00 p.m.
In addition, The Mario St. George Boiardi Foundation is pleased to announce that UMBC will be competing in the Second Annual Capital Lacrosse Invitational on Sunday, Oct. 13th, 2013. The Retrievers round out a field of four elite Division I lacrosse programs which also includes Bucknell University, Lehigh University, and Penn State University. The free youth lacrosse clinic and games take place at the Landon School in Bethesda.
Head Coach Don Zimmerman leads a UMBC squad that reached the America East conference championship game in the spring of 2013 and features 26 returning players.
"UMBC is excited to participate in the Second Annual Capital Fall Invitational," said UMBC Head Coach Don Zimmerman. "It is an honor to play the game of lacrosse in memory of Mario St. George Boiardi, a young man who embodied those selfless character traits that will forever serve as an example to all us fortunate enough to be associated with the great game of lacrosse - coaches, players, officials, parents and fans. We look forward to joining our brothers at Bucknell, Lehigh and Penn State - "Four Teams, One Cause"- and thank the Foundation for this wonderful opportunity."
The event schedule for the day is as follows:
8:30 a.m.-10 a.m. - Free Lacrosse Clinic
10:30 a.m.- 12 p.m.- UMBC vs. Bucknell; Penn State vs. Lehigh
12:30 p.m. - 2 p.m.- UMBC vs. Lehigh; Bucknell vs. Penn State
The Boiardi Foundation is excited to have a fourth great program participating in the 2013 Capital Lacrosse Invitational, and is thrilled to have been able to add a local team to the round robin.In addition to the participating teams, the Boiardi Foundation would like to thank Under Armour and Trilogy Lacrosse, who will assist with the free youth lacrosse clinic, and sponsors Brown Advisory, Marymount University, The Shooshan Company, Sport Automotive, The View Apartments, and Volunteers of America.
For more information or to purchase tickets: www.capitallacrosseinvitational.org
About The Mario St. George Boiardi Foundation:
The Mario St. George Boiardi Foundation is a 501(c)3 organization honoring the memory of George Boiardi, who lost his life while playing lacrosse at Cornell University in 2004. George excelled both as a student and as an athlete, and was a young man who was always engaged with his community as he sought to help others and better his surroundings. The Foundation's mission is to carry on George's legacy by empowering the next generation through academics and athletics.
For more information, please visit www.boiardifoundation.org or contact Tim Kirchner at email@example.com


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Finding the Right Weight Loss Plan
I used to be more (much more) than 100 lbs overweight. 2 years ago I decided "This is it." and I went on a serious diet. Lost about 50 lbs (the "right" way, i.e, slowly, over about 40 weeks, by going to a low fat, calorie controlled diet and by gradually increasing my exercise). Then I got "stuck" there. I suppose I should be glad I didn`t gain it back over the last year or so, but I haven`t lost any more since then either. My BMI is still about 32, so I am still clinically obese, and my health risks are just as bad as they ever were.
Meanwhile, I`ve read everything I can get my hands on about weight management, and the problem is, for every piece of advice (or research) that says one thing, there`s another piece of advice (or research) that says exactly the opposite. Even measures that the "mainstream" used to consider to be kooky, wacky or radical are now becoming very mainstream recommendations. But they weren`t always. So how do I know that the *current* "mainstream" recommendations aren`t as much "behind the times" as they were back when (eg) they used to call lo fat vegetarian diets "fads" or "kook" diets, and when VLCD "medically supervised" near-starvation programs were considered "mainstream" and complaints by the obese that "starvation dieting slowed down our metabolism & made us feel sluggish" were dismissed as being "whiny excuses" and "not true." (now they are considered true) I`ve been struggling with my weight for long enough to have seen even the mainstream experts to an about face on just about every conceivable issue at one time or another. I`ve even read a fairly convincing article that claimed that dieting is the cause of obesity.
I am so confused on what to do, it seems like no matter what I do, there will be somebody or some article or some research somewhere that will be "warning" me that I`m going about it all wrong, and citing 2 bazillion studies that "prove" that I`m doing it all wrong and risking my health. This is so frustrating! I think one of the reasons I`m not losing any more weight is that I can never stick to any one program or plan for very long, and part of the reason for that is because almost as soon as I get started, I read or hear something that "warns" that the very plan I`m attempting to follow "has been shown" to not work, or to have bad consequences years later, or something.
The plan I lost the first 50 lbs on was very simple: 2x as many grams of carbohydrates as protein, no more than 20% of total calories from fat, and just keep adjusting the exact numbers (but keep the ratios the same) as necessary in order to keep losing about a lb per week.
But now I`m almost afraid to follow that, as I`ve heard and read all kinds of claims about how "wrong" that kind of a diet is. Besides that, by the time I`d lost 50 lbs I was down to about 900 calories/day and still not losing any more weight, and not only was it hard to keep eating that little food, but I also have heard and read that it is dangerous to eat less than 1200 calories/day for an extended period.
Since then I started exercising, and now with about an hour/day of walking I am actually UP to being able to eat 1200 calories/day without Gaining. But I`m sure not Losing either. And my BMI is still over 32, so I still obviously need to lose more.
Congratulations on losing 50 lbs. the "right way" and maintaining that weight loss. With so many weight loss methods to choose from, doing it the "right way" is no easy task. The questions you have asked are shared by many; so are the frustrations.
First, you asked how to know whether or not diet information can be trusted or believed. Keep in mind that the science of nutrition is relatively new (compared to a science such as astronomy or geology) and it is constantly evolving. Scientists continually challenge and revise their "facts" as new information is uncovered (and proven to be scientifically valid by duplicating the studies). Sometimes the media reports these new findings before tests are completed and confirmed. It may be a "big scoop" for them, but results in confusion and distrust of nutrition scientists by the general population. The best advice I can give you is to take the information you read or hear and critically evaluate it. Learn all you can about the diet advice before taking action. When new diet information comes on the market, be cautious. "Red flags" to signal trouble include: (1) promise of quick, dramatic weight loss, (2) easy to do, (3)costly, (4) severely limits or restricts food choices, (5) restricts or eliminates 1 or more major nutrients or food groups, (6) is inadequate in vitamins and minerals, (7) does not include exercise, (8) cites testimonials, (9) doesn't recommend variety and moderation, and (10) is only to be used for a set period of time. This will help safeguard you from misinformation and possible harm.
Your second question involved two parts: (1) why you are not losing any more weight and (2) why can't you stick to any ONE program for very long? In the first part of your question, you are describing a plateau. This may result from any of the factors that contribute to obesity (genetic, metabolic, biochemical, psychological, and physiological), the effect of yo-yo dieting, societal influences, overabundance of food choices, or the many other factors still being explored. For example, a plateau may occur because you are building muscle (by exercising) which is heavier than the fat you are losing. The scale does not tell the entire story and the numbers on it are "arbitrary" in thoroughly describing the positive effects your lifestyle changes are making. Another possibility is that if you are limiting your calories so severely (less than 1200 per day), your body interprets this as a state of starvation and actually slows down your metabolism to conserve nutrients and energy (thus slowing down your weight loss).
The second part of your question involves how to follow a program and which ONE. All diets "work" temporarily, but none have been proven to work long term (if one did, the other diets would disappear from the market forever!). The goal of any GOOD diet is to lose body fat, preserve and/or increase muscle tone, and change your poor eating and exercise habits to good ones that you can live with for a lifetime. Therefore, you do not go "on a diet" (so that you can go off one). Instead, you adopt a new value system and focus on a better lifestyle. This helps avoid the feelings of disappointment, frustration, etc. from lapse and relapses. In other words, the emphasis is not to follow a specific diet, but to follow the "nondiet approach" which focuses on wellness rather than weight loss.
According to the Healthy Weight Journal publication "Health Risks of Weight Loss," most treatment programs that use the nondiet approach focus on three factors: feeling good about oneself, eating well in a natural, relaxed way, and being comfortably active. The nondiet advocates helping people learn hunger awareness, how to respond to internal signals, self-discovery (not willpower), self esteem, diversity and accepting people as they are (not judging), and getting on with one's life, not waiting to be thin. In the book "You Count, Calories Don't" by Linda Omichinski, RD, key differences between diet and nondiet thinking are described. For example: a dieter's goal is weight loss, a nondieter's goal is to develop confidence in his/her ability to make choices for better health.
For more information on the nondiet, you may enjoy reading Omichinski's book or "Intuitive Eating" by Evelyn Tribole, MS, RD and Elyse Resch, MS, RD. A Registered Dietitian can help too. To find a Dietitian in your area, try the American Dietetic Association's Nationwide Nutrition Network at the link listed below.
I hope this has helped put things into perspective and alleviates your frustration. Have a happy and healthy New Year!
For more information:
Go to the Healthy Weight Center health topic.


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A cheap set and it shows, but not nearly so glaringly as you might think.
The build quality might be a little ropey and the remote diabolical, but on paper (and bar the odd fancy image 'engine') there is little to choose between the Finlux and other, more prestigious brands, and the performance doesn't lag too far behind, either.
In fact, the Freeview pictures are the equal of, if not superior to, the Samsung LE26R87BDX's and this set's DVD and high-definition performances are also pretty watchable.
Purists might find the picture a little crude in some ways (movement can be pretty jerky and blacks lack presence), but generally speaking, this is a competent set for a reasonable price.


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Don't worry…I haven't become a nudist. But I did fertilize with all those wonderful organic fertilizers that my garden loves: alfalfa pellets, bone meal, blood meal, cottonseed meal, and milorganite. That along with the horse poopy I put down a couple of weeks ago and the rain we've been getting lately means the garden should start looking much healthier and happier soon. I cut way, way back on the fertilizing earlier in the season cause of the drought and high temps cause I didn't want to force new growth that was just gonna get fried and stress the plants out. So my fertilizing schedule is totally off this year. But having to deal with what Mother Nature sends us is just a part of gardening.
So, you ask, what exactly does all that organic fertilizer stuff do? Good question! Organics provide nutrients to the plants along with improving the viability of the soil as they break down. Most of the organics I use are slow release except for blood meal which is considered a fast release organic. Here's what I use and what they do:
- Alfalfa Pellets: Gives the plants slow-release nitrogen and trace minerals. It also contains a naturally occurring plant hormone called triaconatol that stimulates growth by improving photosynthesis and cell division.You can use either alfalfa meal or alfalfa pellets. If you use pellets be sure to get the pellets used for horse food and not for rabbit food. The rabbit food pellets have salt added to it and salt build-up in the soil is not a good thing. I use 1 – 2 cups per bush depending on the size of the bush. 3-0-2
- Blood Meal: Gives quick-release of nitrogen. Yes, it is exactly what the name says: made from blood, usually from cows. It's awesome in its ability to green plants up quickly that need a nitrogen fix. This stuff is very potent so be sure to use it as recommended on the bag! Mine's from Hi-Yield and 1/4 of a cup (yes, only 1/4) is enough for a 3'x3′ area. That's a big area for only 1/4 of a cup. Lessen the amount for smaller bushes and plants in containers. For large climbing roses or trees the amount can be increased. It's water soluble so it can be mixed in a water can and used that way. I've never used it in a sprayer so I don't know if that'll work. 12-0-0
- Bone Meal: This is basically ground up bones. It proves a very slow-release of phosphorous and calcium. It doesn't travel easily through the soil so be sure to either work it into the soil or add it to the hole when planting. I use 1/4 – 1 cup per bush. 4-12-0
- Cottonseed Meal: Provides a slow-release of nitrogen, phosphorus, potash, and minor elements. It also loosens heavy soils and helps sandy soils hold water and nutrients. 1 – 4 cups per bush depending on the size. 6.5-2.5-1.5
- Milorganite: Slow-release of nitrogen and phosphorus and iron. 1 – 2 cups per bush depending on size. 5-2-0
Organics are awesome cause they increase the biological activity of the soil structure as they break down. Simply put, all the little microscopic and not so microscopic critters that make your soil healthier like to hang around where organics are. The microorganisms break the organics down and release the nutrients for the plants to use. As the breaking down happens other critters, such as earthworms, show up to either munch on the organic goodies or use them in building their tunnels. And we all know how incredibly cool and helpful earthworms are to our gardens! So by using organics you not only fertilize your plants you also increase your soil which in turn helps your garden to be healthier and happier.
The three numbers at the end of each organic description, i.e., 5-2-0 for Milorganite, represent the macronutrient analysis of Nitrogen-Phosphorus-Potassium of each fertilizer. All of my organics are from Hi-Yield except for the Milorganite. The numbers can be different if your organics are from a different distributor.
There are differing opinions of whether organics should be worked into the soil of existing beds or just used as top dressing (meaning just thrown on top of the soil). I personally agree with the opines that as organics decompose (or "cure") they generate heat. And that heat has the possibility of damaging the tender feeder roots of plants if the organics are worked into the soil. So I pull back the mulch, toss the organics around the drip line, and put the mulch back in place over the organics. (The "drip line" is the area below the canopy of the plant's leaves. Keep in mind that roots rarely grow past the plant's drip line.) Please, please, please do not pile the organics up against the trunk or stems or base of the plant! That same curing heat that damages the feeder roots means the organics are too hot to be placed up against the plant.
I've got the perfect example of an organic that was too hot and damaged the plants it was on. Remember my post on getting two loads of horse poopy? Well, one load was aged and one load was fresh. Usually I unload stuff like that onto the driveway by the double gates but I knew the heat from the horse poop along with the heat from the driveway along with the fact that it was August in Florida would probably kill me if I put it on the driveway. So I put both loads in separate piles on the grass. In the pic below, the pile in front is the aged one and I was just starting to unload the fresh one. The aged pile actually sat on the grass for about twelve hours longer than the fresh one did.
The next two pics were taken about a week after I'd put the poop into the beds. This is the grass that had the aged poop on it. You can see that some of the grass was killed, but definitely not all of it.
And this is the area where the fresh pile was. Pretty much all the grass and weeds were killed cause the heat coming from the pile as it decomposed was extremely high.


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We mentioned it on Friday but we thought it important enough to mention again (and to give it its own post) - Ring of Bone - The Collected Poems of Lew Welch, (an expanded edition of the old Grey Fox Press book) was published last month by City Lights (with an introduction by Gary Snyder - that introduction may be read in its entirety here). This new edition includes "photos, a biographic time-line and a statement of poetics gleaned from Welch's own writings".
As we noted on Friday, a gathering for the book took place recently at the San Francisco Public Library featuring Gary Snyder, Joanne Kyger & others.
Jonah Raskin's review in the San Francisco Chronicle may be read here, Jeff Baker's in The Oregonian here. Andrew Burke, on his blog, Hi Spirits, here, and Jessica Cornola on htmlGiant here
Meantime, for links to original audio sources, we'd draw your attention here, to our earlier post, Lew Welch Speaks From Beyond The Grave
(not, of course, that there ever was a grave!)


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The One23 MT-F8 8-in-1 Mini Tool is a decent companion when you're stranded by the roadside.
When it comes to selecting the right multi-tool there are many decisions to be factored in. Do you want to carry out repairs on the fly or have a mobile workshop?
The answer is generally the former. Roadside repairs will normally be enough to get you home and within the remit of most riders, perhaps with a bit of practice. That still leaves a decision on what multi-tool will do.
I have to confess to not having come across one quite as compact as the One23 MT-F8 8-in-1 Mini Tool, nor one with quite a geeky sounding name either. The 8 relates to the fact it has 8 functions in one unit. It has 2/4/5/6mm hex key attachments, a cross head PH1 driver, a straight head driver and a torx T25. What does that mean in plain speak?
In short most of the attachments you might need in a simple emergency but the downside of such a small and compact unit is you might not have have the length of lever to use it properly.
The individual heads are quite small but given you have four on each side of the MT-F8 it makes for a wide unit. Yes it is well made and will take up very little room wherever you stash it and there is a but - I wouldn't want it to be my go to tool. The hinge is a little stiff to open completely - although well made and solid. The saying goes that size isn't everything and in the case of the MT-F8 it is small and perfectly formed but not really man enough for every job.
Small and perfectly formed but not quite man enough for all uses.
If you're thinking of buying this product using a cashback deal why not use the road.cc Top Cashback page and get some top cashback while helping to support your favourite independent cycling website
road.cc test report
Make and model: One23 MT-F8 8-in-1 Mini Tool
Size tested: One
Tell us what the product is for, and who it's aimed at. What do the manufacturers say about it? How does that compare to your own feelings about it?
An ideal accompaniment for the weight conscious rider.
Tell us some more about the technical aspects of the product?
Eight options give you probably enough cover for basic jobs out on a ride and get you home.
Well made but the hinge proved a little in-flexible.
The MT-F8 has a slightly peculiar name but is well made. Providing a solid if slightly small feel in hand.
It feels as if it's built to endure.
Given its size you'd be surprised if it was anything other than lightweight. It is exactly that.
A decent price for a lightweight multi-tool.
Tell us how the product performed overall when used for its designed purpose
It can cope with the basic, easy to reach tasks but could do with a little more leverage.
Tell us what you particularly liked about the product
Compact and lightweight.
Tell us what you particularly disliked about the product
The wider head and lack of leverage makes some tasks tricky.
Did you enjoy using the product? On the whole, yes.
Would you consider buying the product? Not really given its limitations.
Would you recommend the product to a friend? Yes although I would be clear it wouldn't suit everyone.
About the tester
Age: 44 Height: 178cm Weight: 80kg
I usually ride: Currently riding a Pinnacle Evaporite Three My best bike is: As above
I've been riding for: 5-10 years I ride: Every day I would class myself as: Experienced
I regularly do the following types of riding: road racing, commuting, sportives, mtb, Not yet but looking to dip my toe in the world of TT


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156 Shady Oak Circle, Richmond Hill, GA 31324 (MLS # 216122)
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The broker providing these data believes them to be correct, but advises interested parties to confirm them before relying on them in a purchase decision.
The listing data was last updated 12/14/19 6:30 PM PST.
Copyright 2019 Savannah Multi-List Corporation. All rights reserved.


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This unit enforces the regulations associated with the operation of all licensed food service facilities. This includes routine and complaint investigations, food-borne disease outbreak investigations (with the Disease Control Office), plan review for public pools and food service facilities, and emergency response at licensed facilities. Staff conduct educational seminars for licensees and issue periodic newsletters. This unit also enforces Montgomery County's smoking, trans fat and menu labeling laws, as well as regulations related to the control of rats.
This unit consists of Environmental Health Specialists who perform complex inspections and investigations of public facilities to enforce the regulatory standards associated with the operation of all licensed facilities. The investigators work in assigned areas of the county and schedule and conduct on-site inspections and investigations of construction and operating standards in facilities and institutions, such as restaurants; markets: bakeries; nursing homes; group residential homes; public and private schools; tanning salons; and public swimming pools, for the purpose of identifying public health and safety hazards.
The investigator's duties include:


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- 1/2 cup whole almonds
- 1/2 cup pecan halves
- 1/2 cup walnut halves
- 1 teaspoon canola oil
- 1/2 teaspoon cumin
- 1/2 teaspoon curry powder
- 1/8 teaspoon cayenne pepper
- Dash of white pepper
Preheat oven to 350°F. Toss the nuts with oil in a large bowl. In a small bowl, combine the spices. Add spices to the nuts, stirring until the nuts are covered evenly. Spread the nuts on a baking tray in a single layer. Bake the nuts for 10 to 12 minutes. Remove from oven and cool before serving.
Yield: 1 1/2 cups.
Serving size: 1/4 cup.
Nutrition Facts Per Serving:
Calories: 96 calories, Carbohydrates: 3 g, Protein: 2 g, Fat: 9 g, Saturated Fat: <1 g, Sodium: 1 mg, Fiber: 1 g
Exchanges per serving: 2 fat.
This recipe was developed by Angie Sharp, a Diabetes Nutrition Specialist at the International Diabetes Center in Minneapolis, Minnesota.


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Sky-high condo in Kakaako
If you like a bird's eye view of the world, this one-bedroom condo in the west tower of the Moana Pacific will give you that and more, since it's far above where most birds fly.
Perched on the 46th floor, the 701-square-foot penthouse unit offers panoramic city and harbor views, and its location puts you right in the middle of the action of Kakaako with all of its hip events and restaurants, including Pow Wow Hawaii, Eat the Street and Honolulu Night Market.
"The owners love the view and the location," says realtor Liza P. Erickson of Coldwell Banker Pacific Properties. "They are so sad about selling it."
Due to a growing family, though, they need someplace larger. Since they only used the condo as a vacation getaway, it's like a model home. Lined with walnut hardwood floors in the living room, the well-appointed home is being sold fully furnished.
The maintenance fee ($460 a month) includes the basics: water, sewer and cable TV, along with broadband Internet service. You can even set up your iPad while relaxing by the pool; Wi-Fi is available in many of the common areas, including the recreation deck.
Other amenities on the recreation deck include two tennis courts, a putting green, six golf driving cages, a whirlpool and swimming pool, and a playground. Each tower has its own fitness center, party room and a 21-seat movie theater with stadium-style seating.
Fuzz factor: You can have two small dogs, but you need to hand carry them when you're riding in the elevator or in the lobby.
The condo comes with one covered parking space that's conveniently near the entrance to the elevator. Guest parking is available, along with ample street parking.
If you'd like to see it for yourself, the condo will be open this Sunday from 2 to 5 p.m. Click here for details.
Money talk: $528,000 fee simple
Contact: Liza P. Erickson, Coldwell Banker Pacific Properties, 808-348-9745, email@example.com


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Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
There are major changes in health care that will impact all areas of medicine, including sleep medicine. Given the growing cost of health care and the current fiscal state of the United States, there is no doubt that more changes are coming. Added to these general changes, there are specific issues facing sleep medicine. The major financial base of sleep medicine is reimbursement for in-laboratory polysomnography. The recent change in moving to home-based sleep studies is a disruptive innovation.
Many aspects of our economy are facing change due to new technology and other factors. This includes bookstores, companies renting home movies, newspapers, etc. The challenge is to recognize the need for change and implement change strategies before it is too late. That sleep medicine has recognized the need for change is indisputable as the excellent commentary by Dr. Patrick Strollo, then President of the American Academy of Sleep Medicine, wrote last year in this journal.1 What is unclear is whether, as a field, we have a strategy to address change. Change is hard and the natural tendency is to try to maintain the status quo. However, given the forces currently at play, maintaining the status quo is a high risk strategy, and if pursued for too long could have a devastating outcome on our field and the patients we serve.
There are common aspects of strategies for change in any endeavor. These have been described by John Kotter in the Harvard Business Review.2 They are outlined in Figure 1. Currently it is unclear whether nationally in sleep medicine we are on this ladder, and hence there is much work ahead of us.
Steps in transformation
(more ...)
An early step in a transformation strategy is creating a sense of urgency. This is essential to unite all constituencies behind the need for change. Some constituencies will simply hope that the current situation continues and hence will hold out to the end (if not beyond). Anybody following recent events in Massachusetts will appreciate the sense of urgency for sleep medicine and the need to take a proactive leadership role in working with payors to design and implement a strategy for responsible change. In brief, a relatively small, central Massachusetts-based insurance company, Fallon Community Health Plan (FCHP), initially made the change in 2010 and was swiftly followed by Tufts Health Plan (THP) in January of 2011. Each signed a contract with Sleep Management Solutions (SMS) and CareCore National (a national benefits management company) to manage sleep studies and associated DME needs of their non-Medicare/Medicaid HMO and PPO subscribers. CareCore National acts as gatekeeper, through a prior authorization process, and directs patients requiring sleep studies to specific modalities (HST vs. in-lab) based on CareCore National criteria. SMS is the exclusive provider of HST and the corresponding PAP therapy for the Fallon Plan. SMS is the exclusive provider of HST for the Tufts plan, and existing, qualified network providers may provide PAP therapy regardless of whether the study was requested by a sleep physician at a sleep center.
The stated goals from insurers are to ensure the appropriate sleep diagnostic setting and manage the delivery of therapy services while improving outcomes. The majority of patients are being directed to HST rather than in-laboratory polysomnography. It should be noted that there has been very limited success in challenging diagnostic testing determinations by CareCore National. It is still unclear what percentage of those directed to HST actually receive studies and treatment.
Recently, August 1, 2011, Massachusetts-based Harvard Pilgrim HealthCare (HPHC) instituted a similar program through CareCore National. The triage of sleep study requests to HST or in-lab polysomnography is identical to the other carriers. However, HPHC is using select qualified providers from their existing network to deliver HST, in-lab polysomnography, and PAP therapy to their subscribers versus any exclusive provider relationship with Sleep Management Solutions.
This transformation came rapidly in Massachusetts over a period of 18 months. Sleep centers were initially caught off guard. It has resulted in a number of sleep centers in Massachusetts closing. Currently Sleep HealthCenters, that services some of the Harvard hospitals, has seen 10% to 20% of its activity overall switched from in-laboratory to in-home sleep studies, though the percentages are up to 60% for the previously specified healthcare plans. They anticipate that once the largest plan—Blue Cross—goes in this direction as well, that 50% to 60% of their sleep study activity will be home studies (personal communication—Dr. L. Epstein, Chief Medical Officer, Sleep HealthCenters).
While one could argue that this is simply a Massachusetts phenomenon given that state's need to control health care costs following the health care plan introduced by then Governor Romney, this is not a powerful argument. We have already seen United Health Care indicating that they will move in this direction, and by November they will have a company in place managing their sleep studies nationally with a major shift to home studies. Thus, while the speed of this transformation may vary across the country, it is safe to argue that this change will take place in almost all, if not all, areas.
The argument of course is that these companies mandating how studies are done with a focus on home studies may control costs of diagnosis but they will not deliver good outcomes of care. This is a valid argument, but unfortunately we are, as a field, in a weak position to mount this argument, since we do not track the outcomes of our accredited centers. As indicated in the 2006 Institute of Medicine Report, "Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem,"3 sleep medicine is a chronic disease management knowledge-based discipline, not a diagnostic discipline. The report recommended that accreditation standards should focus primarily on outcomes of care. It is unfortunate that much of our focus has been on the diagnostic aspects of the polysomnogram, not on quality outcomes. That sleep medicine should focus on outcomes of care rather than the diagnosis was also proposed in 20064 by one of the pioneers of our field—Dr. Peretz Lavie—who is now President of the Technicon University in Israel.
This argument leads to a clear vision (a subsequent necessary step in the transformation process), i.e., that sleep medicine should be a field with a focus on quality outcomes of care. This should not just be for sleep apnea, but for all sleep disorders. We need to avoid patient experiences such as those documented in the book by Patricia Morrisroe5 of a patient with insomnia.
The notion of focusing on quality outcomes is very much in line with the vision of an integrated sleep center that the American Academy of Sleep Medicine is discussing with Medicare as a demonstration project. While this is a move in the right direction, it is concerning whether the current speed of change will result in this effort being too little too late.
The American Academy of Sleep Medicine has the ability to move our field to a new, patient-centered and outcomes-based delivery model. This would require an adjustment of the current accreditation standards. It would mean establishing metrics that consist of quantifiable standards and work with centers to achieve these metrics as part of the accreditation process and site visit. It is of course unrealistic that this will occur overnight. However, the American Academy of Sleep Medicine could indicate that change is coming and give a period of 12-18 months to allow centers to tool up to accommodate this new direction. Some centers may choose to give up their accreditation, thereby electing to be a casualty of positive change. The group that will transform will be focused on quality outcomes and place our field in the very best position to deal with the major market and political forces that are now in play.
At the University of Pennsylvania (Penn) Sleep Center, we are aggressively pursuing development of an outcomes-based approach to chronic care. The fundamental principles of this approach are: a) focus on outcomes of care and b) provide for diagnosis and treatment for all sleep disorders. The latter needs to include a well-functioning behavioral sleep medicine program.
Building this model requires a focus on the following aspects of care. First, one needs to build capability not only for in-laboratory sleep studies but also for in-home studies. Outcomes need to be defined and the relevant tools put in place to capture data. For sleep apnea a starting set of outcomes would be the following: sleep apnea symptoms, Epworth Sleepiness Score, Functional Outcomes of Sleepiness Questionnaire, PAP compliance, blood pressure, HbA1C (for diabetics), and medication use. The concept of an integrated center envisages that the center would provide alternative therapies for sleep apnea such as intra-oral devices. It further envisages that the center itself would provide CPAP therapy, thereby facilitating the tracking of CPAP compliance. For insomnia, outcomes would include an insomnia symptom questionnaire, sleep diary (could be web-based), medication use, etc. For other sleep disorders, there would also be specific outcomes. There need to be processes put in place to establish national guidelines for outcomes to be assessed for each sleep specific disorder.
While initially tracking outcomes will involve currently available technology, it will be facilitated by use of information technology. Technology could be employed to capture questionnaire information using web-based approaches or touch screens in outpatient offices and sleep laboratories. Information technology could be used to input other relevant clinical data and to track outcomes from devices such as PAP machines. Databases will need to be developed to store, track outcomes, and be the basis of graphical outputs as well as reports to the insurance carriers.
One of the barriers to developing information technology (IT) is that currently IT systems are propriety, with each manufacturer of diagnostic equipment or therapeutic equipment doing "their own thing." Our profession needs to provide guidance about our needs with the hope that all stakeholders will see benefit in collaborating and moving out of their silos.
Cost-effective chronic disease management of large numbers of patients requires the focus and expertise of all professions. Particularly important in this regard are nurse practitioners trained in sleep medicine. The School of Nursing at the University of Pennsylvania has taken the lead in developing a training program in this area. The benefit of a nurse-led treatment program for sleep apnea has already been demonstrated in a randomized trial in Australia.6
This model envisages that chronic management of patients with sleep disorders will be under the guidance of a sleep medicine physician. Some have argued that this should be the purview of the internist or family medicine practitioner.4 While this may be viable in the future, our own experience suggests that this is not something that the internist/family practitioner wants to take on, at least at present. They have difficulty managing the vast array of daily needs presented by their patients, resulting in major time pressures. Currently Penn is experimenting with placing our sleep medicine physicians as "embedded specialists" in the community-based internal medicine practices totally owned by the University of Pennsylvania (Clinical Care Associates). We envisage nurse practitioners trained in sleep medicine also practicing in these locations. Telemedicine/web-based approaches should be developed that assist in patient follow-up and tracking outcomes. This can be conducted in the patient's home, without the need for the patient to travel, park, and wait to see the physician or nurse practitioner.
While currently this brave new world is a dream, it all does not need to be accomplished at once. We do, however, need to take action on initial steps to make our field an outcomes-based field with innovative approaches to tracking outcomes, with currently available technology. We need to start with consensus on best practices, since much of this lacks a formal evidence base. There is, however, a wonderful opportunity to develop research programs in comparative effectiveness research to formally evaluate different strategies. This will require collaboration between academic medical centers, community-based practices and involve all stakeholders including insurance carriers and patients. As results of this research become available, diagnostic and treatment strategies can be modified and upgraded. It is a major opportunity for a partnership between our academic and clinical colleagues.
Thus, the fundamental themes of this commentary are the following: a) change in sleep medicine is essential and the time is now; b) the American Academy of Sleep Medicine needs to take the lead in indicating the urgency of the situation, based on the sub-optimal Massachusetts experience; c) the vision for our field should be a quality outcomes-based chronic disease management discipline for all sleep disorders, not just for sleep apnea; d) the American Academy of Sleep Medicine should lead change and use the power of the accreditation process to move our field to a quality outcomes field. It is time to be proactive, not reactive; and e) there is a need for all stakeholders to work together to develop the information technology we need.
The time is NOW. It is time to act. Groups who act can lead the change in the best interest of the people we serve, i.e., the millions of Americans with chronic sleep disorders.
Dr. Pack has indicated no financial conflicts of interest.
Pack AI. Sleep medicine: strategies for change. J Clin Sleep Med 2011;7(6):577-579.
I am grateful to John Leteria (CEO of Neurocare, Inc.), Dr. Michael Coppola and Dr. Larry Epstein for information about what has happened in Massachusetts and Kim Halscheid, Education Coordinator in the Sleep Division at the University of Pennsylvania for pointing out to me the article on leading change.
Strollo PJ Jr, author. Embracing change, responding to challenge, and looking toward the future. J Clin Sleep Med. 2010;6:312–3. [PubMed Central][PubMed]
Kotter JP, author. Leading change--why transformation efforts fail. Harv Bus Rev. 2007 1;1–9
Colten HR, Altevogt BM, authors. Sleep disorders and sleep deprivation: an unmet public health problem. 2006. Washington, DC: The National Academies Press;
Lavie P, author. Sleep medicine-time for a change. J Clin Sleep Med. 2006;2:207–11. [PubMed]
Morrisroe P, author. Wide awake: what I learned about sleep from doctors, drug companies, dream experts, and a reindeer herder in the Arctic Circle. 2009. Spiegel & Grau;
Antic NA, Buchan C, Esterman A, et al., authors. A randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea. Am J Respir Crit Care Med. 2009;179:501–8. [PubMed]


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Butt-Touch Extraordinaire
Pic by Matt Frank
Well guys, it's officially the anniversary of me becoming a member of TSG!
Dang...6 years went by so fast! D:
Here's to many fun years to come!
(I know I'm like a week late on posting this, I was on vacation last week.)
It's that time of year again, Final Fantasy week long marathon 2009 where a lot of us joined this community. It's hard to believe I've been apart of this community for 5 years already. If not for this community, I probably wouldn't be the person I am today. You guys have been there for me though thick and thin. I remember when I joined this community, I was such a noob back then and I didn't know much about
My TSG care package came in today.
It's the times like this where I realize just how many people I have out there supporting me. I have never met most of you guys in real life, but over the past 5 years of being a part of this community, I have made friends whom I will cherish for a life time. The card was signed by TSGers who were at the Indie Game Marathon two weeks ago. Members like Chase, Britt, Caden, Rob, Squint, JDTwins, Ana, Tyler, Bear, Phil and Toast. The inside said "thank
As some people know, I am on my way to becoming a professional artist. So the people in the chat know right now, I've been working on a sculpture. This is a sculpture for my 3D art class in college. It took roughly 15hours to make it this far. Next up is wrapping it with different duck tape.
Materials Used: 3 rolls of generic plastic wrap, 6 rolls of packaging tape.
So apparently we all got blogs now. So I might aswell rant about stuff.
Being a gamer girl and anime fan can be stressful at times. Especially when you're an art major in college. SO MUCH WORK TO DO SO LITTLE TIME!


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Hunting scenes in Egypt - CABS publishes private hunting video
Film shows shooting of Eagles, Vultures, Pelicans and Storks
Press release dated 12.02.2012
The Committee Against Bird Slaughter (CABS) today severely criticised the unchecked shooting of migrant bird species by Maltese hunters in Egypt. The country on the River Nile opened the hunting season for birds last December for the first time since the so-called avian influenza outbreak in 2008, and again permitted foreign hunters to enter the country. According to reports from local conservationists received by CABS, several groups of Maltese hunters have shot large numbers of birds around Lake Nasser, including protected species.
CABS received support from local conservationists who want an end put to this uncontrolled hunting tourism. "Maltese hunters are crazy fanatics. They have been bird hunting in Egypt for decades, because Egypt has interesting-looking birds compared to its neighbours" complains Sherif Baha el-Din, an Egyptian bird expert, in an interview with the Egypt Independent newspaper on the 4th of February this year. The conservationist has witnessed at first hand the indiscriminate killing of Flamingos and other bird species. He is critical about the almost complete lack of effective controls in Egypt. "You cannot open a hunting season when you don't have a system to monitor this activity" states Baha El-Din.
Because of the numerous reports of massacres of birds by hunting tourists, CABS has announced that it will send a team to Egypt during the next hunting season to monitor important rest areas around Lake Nasser for migrant birds on passage. "As on Malta we will work closely with local ornithologists and law enforcement agencies" promises CABS spokesperson Axel Hirschfeld.
CABS has published sequences from a shocking video on its Youtube channel. These show a group of Maltese hunters hunting protected birds on Lake Nasser, some of which are highly endangered species. The film shows birds, including numerous Pelicans, Spoonbills, Glossy Ibis, Egyptian Vultures as well as an Osprey, a Lanner Falcon and a Bonelli's Eagle being shot - accompanied by cheering and laughter as the birds are hauled into the hunters' boat. According to CABS the original material is over an hour in length and was filmed by the hunters themselves a few years ago. At a later date it was provided anonymously to CABS and its Maltese partner organisation International Animal Rescue Malta. Hirschfeld comments bitterly "This video shows the true face of these so-called hunting trips. We have therefore decided to expose them by publishing extracts from this video".
From today the film can be viewed on Youtube at http://www.youtube.com/watch?v=34GPawd-Hu0. In order to protect the identity of the hunters and their local guides the faces of the hunters have been blurred and their voices edited.


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More than 1540 new forms and templates. 3,500 data+ fields. 1000 elements. FINREP and COREP add complexity to your existing regulatory reporting processes, not to mention time. With the advanced capabilities of CCH Tagetik, combined with pre-packaged COREP and FINREP reports and templates, we take care of the complexity for you so you can meet demands faster.
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Asterix and the gang ventures into 3D animated waters for the first time, and I must say it was quite delightful to watch them breathe alive on the big screen. All those big shiny noses and their clumsy acts look just brilliant in CGI.
Asterix and Obelix: Mansion of the Gods wouldn't disappoint you. It is funny, featuring slapstick comedy, more of a situational provocation brought to you by the Roman invasion and the debatable empty heads of the Gauls. The plot is well written and is taken from the comic The Mansion of the Gods. The relentless Caesar walks in again with a master plan to ingest the Gaulish by building Mansion of the Gods, a new territory near their village for the Romans to populate. The story saunters around to and fro as both parties keep fighting with each other for the land.
A majority of the scenes in the beginning have been stretched, and sometimes the movie topples into the non-funny zone. But still the low comedy manages to beam up the down. Every character in the movie is a hoot. Caesar brings in the grim but the people who surround him wouldn't make him look deadly. Someone or something would do something stupid every now and then and you would end up in fits of laughter.
The fun doesn't stop at any point. A lot of fish slaps, cloud brawls, boar hunting and fake-fighting drive in the hilarious nail. Although you feel the ending dies out pretty quickly, you still get a brilliant feast to devour, as you laugh your way out of the theatre with a contended look.
A really entertaining flick. Kids are going to love it. It would be a great way to tell them the legacy of Asterix if they haven't come across the comic hero hitherto.


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Many people believe canyons take a long time to form. In North America, though, there is a canyon that simply wasn't there 150 years ago.
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Answers in Genesis is an apologetics ministry, dedicated to helping Christians defend their faith and proclaim the gospel of Jesus Christ.


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Dino Mite Plant Food
Short Description
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Full Description
This all natural mineral plant food works wonders on everything with roots-from apples to zucchini. The unique harmonically balanced blend remineralizes and stimulates your soil for super growth of all living plants. Works wonders indoors and outdoors. Even revitalizes tired and underperforming plants, trees and lawns.
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Dino Mite Plant Food is rated out of 5 by 4.
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Date published: 2016-05-28
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Date published: 2015-03-31