text:
Back to top
Expert reviewer, Mr Stephen Pollard, Consultant Surgeon
Next review due May 2020
An oesophagogastrectomy is an operation to remove the upper part of your stomach and the lower part of your oesophagus. Your oesophagus is the pipe that goes from your mouth to your stomach. You might need this operation if you have cancer at the junction between your stomach and oesophagus.
You'll meet the surgeon who's going to do your procedure to discuss your care. It may be different from we've described here as it will be designed to meet your individual needs.
Here we explain about what happens before surgery, what the operation involves, recovering afterwards, and some frequently asked questions.
Tests to see if you need surgery
Before you have an oesophagogastrectomy, your specialist doctor will need to do some tests to make sure the procedure is right for you.
- Endoscopy. In this procedure, your doctor will look inside your oesophagus, stomach and the first part of your small bowel (duodenum). They may also take a small sample of cells, called a biopsy, which will be tested for cancer.
- CT or MRI scan. These are used to find out the size of a tumour and if the cancer has spread.
- Chest X-ray, which also looks to see if the cancer has spread.
- Barium swallow and meal. This test allows X-ray images of your tummy to show the inside of your oesophagus and stomach more clearly.
Checking you're fit for surgery
An oesophagogastrectomy is a major operation. To make sure you're well enough to have it, your doctor will do some more tests. These may include those listed below.
- Blood tests to check your general health.
- Tests to check your breathing (called lung function tests).
- An exercise test to see how fit you are. This might involve climbing a couple of flights of stairs, for example. Your fitness can affect your chances of getting complications after surgery.
- A cardiopulmonary exercise test, which may involve running on a treadmill or using a stationary bike to see how well your heart and lungs work.
- An electrocardiogram. This records the rhythm and electrical activity of your heart.
- An echocardiogram. This uses ultrasound to produce moving images of your heart to see how well it's working.
- A chest X-ray to check the health of your heart and lungs, and to make sure you don't have an infection.
Preparing for an oesophagogastrectomy
Depending on what type of cancer you have, you may be given a course of chemotherapy or radiotherapy (or both) before your operation. Your doctor will have a chat with you about your treatment options once your diagnosis has been confirmed.
Your surgeon will explain how to prepare for your procedure. For example, if you smoke, it's best to quit. Smoking can affect the success of your operation, and also increase your risk of getting a chest and wound infection, which can slow your recovery.
You might need to take a laxative to help clear your digestive system before your operation. Your hospital will give you some advice about this.
An oesophagogastrectomy is done under general anaesthesia. This means you'll be asleep during the procedure. An anaesthetic can make you sick, so it's important you don't eat or drink anything for six hours before your oesophagogastrectomy. Follow your anaesthetist's and surgeon's advice and if you have any questions, just ask.
Your surgeon will already have gone through everything in detail before you go to hospital for your oesophagogastrectomy. They'll also have given you the opportunity to ask questions about the risks, benefits and alternatives to the operation. Once you get to hospital, they'll go over what will happen before, during and after your operation, and any pain you might have. By this stage, you will have all the information you need to give your consent for the oesophagogastrectomy to go ahead. You'll be asked to sign a consent form.
You might need to wear compression stockings to help prevent blood clots forming in the veins in your legs. Your surgeon may also give you an injection of an anti-clotting medicine such as tinzaparin or dalteparin.
What happens during an oesophagogastrectomy?
How long your procedure takes can vary – it depends on exactly which type of operation you have.
Your surgeon can use either open or keyhole surgery.
- In open surgery, your surgeon will make two large cuts into the top part of your tummy and chest. Sometimes they might need to get to the upper part of your oesophagus during the operation. If so, they'll need to make a cut in your neck, but this isn't common.
- In keyhole surgery, your surgeon will make several small cuts instead.
Your surgeon will explain your procedure and whether they'll do open or keyhole surgery.
During the operation, your surgeon will remove the diseased part of your oesophagus and stomach. The amount they remove will depend on things like the type of tumour you have, and where it is. They might then join the remaining part of your oesophagus to the healthy part of your stomach.
Your surgeon might attach your oesophagus to your small bowel if they need to remove your whole stomach. They'll also remove any nearby lymph nodes to check for cancer cells. This will help to find out if you need any additional treatment after surgery.
Your surgeon may put a feeding tube called a jejunostomy into your small bowel, and bring this to the surface of your skin. You'll be able to have food in the form of liquid through this tube for a while after your operation until you recover.
What to expect afterwards
You'll be transferred to the intensive care or high dependency ward at first. You might have some discomfort as the anaesthetic wears off. But you'll be offered pain relief as you need it. You might also have the option of patient controlled analgesia. This is a pump connected to a drip in your arm that allows you to control how much pain medicine you have.
When you wake up after the surgery, you'll notice some tubes.
- You may have a catheter (tube) to drain urine from your bladder into a bag.
- You might have fine tubes running out from the wound. These will drain fluid into another bag while your wound heals.
- You'll have a drip in a vein in your hand or arm, or into the side of your neck to give you fluids. When you feel well enough, you can start to drink a little water.
- You'll probably have a fine tube in one nostril, called a nasogastric tube. This will go across the area where your oesophagus and stomach have been joined.
- You might have a tube coming out of your stomach from your small bowel. This is called a jejunostomy and will enable you to receive nutrients while you recover.
- You might have an epidural to give you pain relief.
Your nurses will encourage you to get out of bed when you feel ready. A physiotherapist might be on hand to help you. If you move around after your operation, it can help to prevent complications and may help to speed up your recovery. You'll also have injections to help prevent blood clots.
You won't be able to eat anything for several days, while you heal. You'll get the nutrition you need through the jejunostomy tube.
You'll usually be able to go home about a week after your operation. Make sure someone can take you home. And ask them to stay with you for a day or so while you get back on your feet.
Before you leave, your surgeon will come and see you to discuss how the procedure went and any further treatment you might need. Your nurse will give you some advice about caring for your healing wounds and may give you a date for a follow-up appointment.
Recovering from oesophagogastrectomy
The time it takes to make a full recovery from an oesophagogastrectomy varies from person to person. It's important to follow your surgeon's advice. If you had a keyhole procedure, you might recover faster than if you had open surgery.
If you need something to help with the pain, you can take over-the-counter painkillers such as paracetamol. Or your surgeon might prescribe some painkillers for you to take home. Always read the patient information that comes with your medicine and if you have any questions, ask your surgeon or pharmacist for advice.
You'll need to make some changes to your diet after your operation. At first, you'll only be able to eat small amounts of food in one sitting. Your hospital will give you some instructions about how to eat well while you recover. To begin with, you'll need to eat only soft foods. Your dietitian or surgeon will explain how to start eating solid foods again. You might need to take vitamin and mineral supplements to help you recover. See our FAQ: Diet after surgery, for more information about what to eat after your operation.
If you have a feeding tube, which is called a jejunostomy, you can have this removed once you're eating enough. This is usually after about two to three months.
Side-effects of oesophagogastrectomy
As with every procedure, there are some risks associated with oesophagogastrectomy. We haven't included the chance of these happening as they differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You might have some pain afterwards. You may also have diarrhoea for the first few weeks, and a dry cough for a while – sometimes up to a year.
Depending on where your surgeon made the cuts, you will have a scar on your chest, abdomen (tummy) or rarely, on your neck. Although your scar may be slightly raised and swollen at first, this should gradually settle over time.
Complications of oesophagogastrectomy
Complications are when problems occur during or after the procedure. Complications of oesophagogastrectomy can include the following.
- The join between your oesophagus and stomach leaking. This is one of the most serious complications, and you may need another operation to repair it.
- An infection called mediastinitis, which can cause severe chest pains and fever. This can happen if your oesophagus is torn during the operation. Mediastinitis can be treated with antibiotics or you can have an operation to repair the tear.
- Narrowing of the new join. The join may need gentle stretching to reopen it using an endoscope (a flexible tube-like camera).
- Heartburn (acid reflux). An oesophagogastrectomy involves removing the valve at the lower end of your oesophagus. So this means you won't have a barrier to stop the acidic contents of your stomach pushing up into your oesophagus.
When this happens, it causes heartburn. See our topic on indigestion for some self-help tips on how to prevent heartburn: the advice is the same in both cases.
Frequently asked questions
Will I need to change my diet after my operation? Will I need to change my diet after my operation?
Yes, you'll need to take things slowly at first. You'll have some swelling after the operation and to begin with, the join between your oesophagus and stomach will be quite narrow. This means that only fluids and soft food will go through it.
You can start with small sips of water and then gradually have things like fruit squash, tea and coffee, milk and soup. You can then progress to eating soft foods for two or three weeks after your procedure. This will help the new join between your stomach and oesophagus to heal. You might need to follow a diet that's high in protein and take vitamin supplements to help your recovery too.
It can take a few weeks or even months for your stomach to recover before you can eat a normal diet. Your stomach will be smaller after the operation so you'll feel full much quicker than before. It's usually best to have small portions regularly throughout the day, rather than three big meals a day. These will be easier for your stomach to manage.
You'll usually see a dietitian after your procedure who will give you some more advice about how to eat well while you recover.
When can I exercise after an oesophagogastrectomy? When can I exercise after an oesophagogastrectomy?
Oesophagogastrectomy is a major operation and you'll need to take it easy for a while. Take things slowly for the first few weeks and then gradually build up the amount of physical activity you do.
Immediately after your procedure, you'll need to rest in bed. On the second day, try to get up and sit in a chair (unless you have an epidural). Over the next few days, your physiotherapist will show you some exercises to do that will help your recovery and improve your strength.
Once you get home, you can begin to do some walking. Start by walking just around the house and then gradually increase the distance. But it's important not to push yourself. Build up your activities gradually and do a bit more each day. There aren't any types of exercise that you won't be able to do eventually. But wait until you're back to full fitness before you do any strenuous activities, such as lifting weights.
When can I return to work? When can I return to work?
The exact amount of time you'll need to have off work will be specific to you. This is because it not only depends on how well you recover from the procedure, but also on the type of work you do. Other things to consider include your age, general health, and whether you're having any more treatment, such as chemotherapy or radiotherapy.
It's likely that you'll need to be off work for about two to four months, although it might be longer. Make sure you get the go-ahead from your surgeon or doctor before you go back. When you do go back to work, you'll probably find it really tiring to begin with, so it's important to take regular breaks. It's a good idea to ask your employer if you can go back part-time at first. Keep them up-to-date about your treatment, as you may need to arrange some time off for further treatments or check-ups.
About our health information
At Bupa we produce a wealth of free health information for you and your family. This is because we believe that trustworthy information is essential in helping you make better decisions about your health and wellbeing.
Our information is guided by the principles of The Information Standard and complies with the HONcode standard for trustworthy health information. We are also a proud member of the Patient Information Forum.
Related information
Oesophageal cancer
Oesophageal cancer is a cancer of the pipe that carries food and drink from your mouth to your stomach.
Stomach cancer
Stomach cancer, also known as gastric cancer, is a tumour (lump) that's created when cells in your stomach grow in an abnormal and uncontrolled way.
Indigestion medicines can be used to relieve pain or discomfort in your upper abdomen (tummy) or chest that may occur soon after meals.
Healthy eating
Other helpful websites Other helpful websites
- Oesophageal Patients Association
0121 704 9860
- Macmillan Cancer Support
0808 808 00 00
- Cancer Research UK
0808 800 4040
- Oesophageal Patients Association
Sources Sources
- Nursing patients with nutritional and gastrointestinal problems. Oxford handbook of adult nursing (online). Oxford Medicine Online. oxfordmedicine.com, published August 2010
- Upper GI tract anatomy. Medscape. emedicine.medscape.com, updated 28 June 2016
- Gastric cancer. Medscape. emedicine.medscape.com, updated 4 January 2017
- Oesophageal cancer. British Society of Gastroenterology. www.bsg.org.uk, accessed 12 April 2017
- Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut 2011; 60:1449–72. doi:10.1136/gut.2010.228254
- Esophagogastroduodenoscopy. Medscape. emedicine.medscape.com, updated 22 February 2017
- Oesophageal cancer. PatientPlus. patient.info/patientplus, last checked 24 November 2014
- Upper gastrointestinal surgery. OSH operative surgery (online). Oxford Medicine Online. oxfordmedicine.com, published October 2011
- Electrocardiography. Medscape. emedicine.medscape.com, updated 12 April 2017
- Echocardiography. Medscape. emedicine.medscape.com, updated 30 January 2014
- Pre-operative chest radiographs (CXR) for elective surgery. Royal College of Radiologists. www.rcr.ac.uk, last reviewed 20 October 2016
- Map of medicine. Upper gastrointestinal (GI) cancer. International view. London: Map of medicine; 2015 (Issue 4)
- Get well soon: helping you to make a speedy recovery after surgery to remove a cancer of the gullet or upper stomach. Royal College of Surgeons. www.rcseng.ac.uk, accessed 12 April 2017
- Personal communication, Mr Stephen Pollard, Consultant Surgeon, 26 April 2017
- Venous thromboembolism: reducing the risk for patients in hospital. National Institute for Health and Care Excellence (NICE), 27 January 2010. www.nice.org.uk
- Low molecular weight heparins. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed April 2017
- Map of medicine. Barrett's oesophagus. International view. London: Map of medicine; 2015 (Issue 1)
- A guide to life after oesophageal/gastric surgery – oesophagectomy and gastrectomy. The Oesophageal Patients Association. www.opa.org.uk, revised September 2013
- Yuan Y, Zeng X, Hu Y, et al. Omentoplasty for oesophagogastrostomy after oesophagectomy. Cochrane Database of Systematic Reviews 2014, Issue 10. doi:10.1002/14651858.CD008446.pub3
- Surgery for cancer of the esophagus. American Cancer Society. www.cancer.org, last revised 4 February 2016
- Mediastinitis. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2014
- Lifestyle changes after cancer of the esophagus. American Cancer Society. www.cancer.org, last revised 4 February 2016
- After surgery. Cancer Research UK. www.cancerresearchuk.org, last reviewed 5 July 2016
Author information Author information
Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, May 2017
Expert reviewer, Mr Stephen Pollard, Consultant Surgeon
Next review due May 2020
Did our information help you?
We'd love to hear what you think. Our short survey takes just a few minutes to complete and helps us to keep improving our health information.
Legal disclaimer
This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
Any information about a treatment or procedure is generic, and does not necessarily describe that treatment or procedure as delivered by Bupa or its associated providers.
The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.
For more details on how we produce our content and its sources, visit the 'About our health information' section.
^We may record or monitor our calls


text:
Taneisha Lee, Ph.D.Chief Executive Officer and Co-founder
Taneisha Lee, Ph.D. serves as Chief Executive Officer and Co-founder of Transformative Research & Evaluation with over 15 years of experience as a director, educational program developer, grant writer and manager, and program evaluator. Dr. Lee is a Program Evaluator with expertise in qualitative and quantitative methodologies and has evaluated programs funded by the National Science Foundation, US Department of Education, and US Department of Health and Human Services. These programs included professional development for PK-12 teachers and education leaders, computer science education, college and career readiness programs, behavioral and mental health interventions, and summer learning loss. Dr. Lee's professional experience includes work as a Project Coordinator for a multi-site evaluation and longitudinal research study of an early childhood literacy intervention, Director of an academic mentoring program that impacted over 700 students annually, and leader of several domestic and international study abroad and service learning trips. Dr. Lee received a Bachelor's of Science in International Affairs from Georgia Institute of Technology, a Master's of Public Administration with a concentration in Nonprofit Management from Georgia State University, and a Ph.D. in Educational Policy Studies Program with a concentration in Research, Measurement, and Statistics from Georgia State University. Her current research projects focus on trauma-informed interventions for urban youth, utilization-focused evaluation and transformative praxis, identity and persistence amongst STEM undergraduate students at HBCUs, innovative practices in computer science at the secondary and undergraduate levels, and the impact of pre-college and career readiness programs.
Shadonna Davis, LCSW, Ph.D.Chief Strategy Officer and Co-founder
Shadonna Davis, LCSW, Ph.D. serves as Chief Strategy Officer and Co-founder of Transformative Research & Evaluation with over 15 years of experience in social service interventions, child welfare, and youth and community development. Dr. Davis is a Researcher, Program Developer, and Qualitative Methodologist. She has designed and implemented multiple programs for school districts, government agencies, and nonprofit organizations. Dr. Davis' professional experience includes serving as a Program Officer for a large scale human development program, Early Intervention Director for an dropout prevention program, School-based Social Worker, Manager of a city-wide truancy intervention program, and Lead Researcher for a juvenile diversion program. Her research expertise in human service focuses on outreach and engagement efforts, employment and workforce development, youth services, behavioral and mental health services, case management, and community partnerships. Dr. Davis received a Ph.D. in Educational Policy Studies with a concentration in Social Foundations of Education at Georgia State University and an Advanced Qualitative Research Certificate. She received her Bachelor's in Business Administration and a Master of Social Work Degree from Georgia State University. She is also a Licensed Clinical Social Worker. Her current research projects focus on the interaction and association between individual, socioeconomic, and political determinants on youth development, participatory action research and evaluation, and transformative praxis.
Carrie Oliver, MPH, CHESGrant Writing & Research Consultant
Carrie Oliver serves as a Grant Writing and Research Consultant with over 8 years of experience in youth development, health education, curriculum development, grant writing, and program development. Carrie's professional experience includes serving as a Health Promotion Specialist overseeing onsite health promotion for employees in over 80 counties in Southern Georgia, Special Projects Coordinator for a nonprofit organization that served the residents of 38 counties of Southwest Georgia, and a Counselor and Researcher for a HIV research project in the Emergency Care Center at Grady Memorial Hospital. Carrie received her Bachelor's in Science in Biomedical Engineering from Georgia Institute of Technology and Master's in Public Health from Emory University with a Certificate in Socio-Contextual Determinants of Health. She is a Certified Health Education Specialist and a Certified Youth Mental Health First Aid Instructor. Her professional interests are corporate wellness, youth development, and serving the educational and community needs of those in marginalized and underrepresented populations.
Amber Mason, Ph.D.Program Evaluation & Research Consultant
Amber Mason, Ph.D. serves as a Research and Program Evaluation Consultant with over 10 years of experience as an educator and program evaluator. Dr. Mason is a former mathematics educator and taught high school students for 7 years in the Chicago area prior to beginning her doctoral studies. Her work has involved research and evaluation studies of language and literacy development, school readiness outcomes, instructional practices, professional development, and family engagement for one of the largest early learning providers in the Atlanta Metropolitan area. Dr. Mason also works as a Graduate Researcher in The Urban Child Study Center at Georgia State University, and has previously worked on several research projects in The Alonzo A. Crim Center for Urban Educational Excellence. Her work has led to the preliminary development of a psychometric instrument that seeks to more adequately measure family engagement in urban educational settings. Dr. Mason also serves as a Data Strategist for a research alliance between Atlanta-area schools, Georgia State University, center-based early learning providers, and several community organizations focused on Atlanta's preschool to 3rd grade (P3) early childhood system. Dr. Mason received a Ph.D. in Educational Policy Studies with a concentration in Research, Measurement, and Statistics from Georgia State University. She received a Bachelor's of Arts in Economics from Spelman College and a Master's of Science in Education from Quincy University. Dr. Mason's research interests lie in the area of mixed methods culturally responsive educational program evaluation.
Tamiera BarlowCopy Editor
Kelli Bacote
TRE played an instrumental role in the inception and development of Better Outcomes for Our Kids, Inc. We needed research and evidence to educate parents on school options and choice. TRE provided the research, talking points, and informational material needed for us to raise awareness and engage parents, community members, politicians, educators, and other key stakeholders.
Deborah Stone, LMSW
Working with TRE Consulting has catapulted our organization in identifying and capitalizing on efficacious practices that empower vulnerable children to be successful. Their tenacious attention to detail and subject matter expertise have guided the development and implementation of our comprehensive community-wide trauma informed and violence prevention interventions. They are a valuable asset to the children and families we serve!
Anonymous Parent
TRE helped me work through some personal issues that were preventing me from being the best person that I can be. Now, I have a job and a safe place for me and my daughter to stay. I am also working to enroll in school.
Anonymous Parent
I needed a family observation for a custody dispute that was pending out of state. TRE provided my family a social worker who was responsive to my family schedule and availability. This was important considering my daughter was only in my custody for short periods because she lives out of state. TRE's responsiveness and professionalism helped me to fulfil a vital court obligation in a timely manner.
Kenita Sullivan
We were recently awarded a service-learning grant that was authored by TRE. Having their assistance ultimately allowed us to work with a well deserving community of youth in Atlanta that would have otherwise continued to not have access to vital resources and opportunities. For that we are forever grateful and will continue to work with TRE in the future.
Melissa Hawkins
TRE designed and assisted with implementation of a one-year youth development model that we use to provide after school programming at high schools. With the support of TRE, our afterschool program has created youth-led projects that received national attention and the youth we served have gained invaluable skills. The services TRE provided exceeded our expectations. In addition to receiving programmatic direction, TRE provided us with research, statistical analysis, and informational documents needed for us to scale up our program.

subset: commoncrawl


text:
I don't know a lot about computers especially when they have a mind of their own. But I do know excellence when I see it. After months of trouble I called mobilepcdoctor as I wanted to sort out my home pc problems before the xmas break. The excellence started when an appointment was confirmed the same day for the early evening. Technician arrived and set about clearing up my pc problems in a totally friendly, professional and expert way. I was even more pleasantly surprised at the very reasonable cost to do what he did. It is not often you come across such outstanding service. From now on if I have issues in the future the solution is easy. Call technician for outstanding service and support.
I thought you were brilliant! Can't believe how quickly and smoothly everything went and I am delighted all my data was retrieved! Also thank you for the helpful advice on upgrading my laptop, would recommend mobile pc doctors in a second!
A big thank you for your help in changing our old Windows XP programme to our new Windows 8. There have been a couple of things we have not understood and thanks to your prompt service, they have been ironed out and we now have a better appreciation of what our computer can do for us. It is nice to know that you are only an email away and will deal with our queries quickly and efficiently. Thanks a lot.
I called for help with my daughters laptop and my own pc – Technician was here the next evening and quickly fixed the laptop. He took my pc away and did some kind of magic on it so that when he returned it it works just like it did when I first bought it. He did all this within the price and time frame he said. I would not hesitate to recommend technician and will keep his number handy for future computer issues. Thanks.
Excellent service. When our company computer 'died' Technician was able to recover all our data and have us back up and running quick smart. Excellent one stop shop for all your computing needs.


text:
Our growth actually endangered our guaranteed stock position and fast deliveries. But it was too risky to simply place an extra layer on existing foundations.
"Our people consulted with the supplier, but it was not easy to find a solution," Bertus Heuver continues.
Negotiations are underway with potential anchor tenants for the site.
Besides those sites, the company also has land in the Queensland centres of Gladstone and Wandoan – both with development approvals.
"And, thanks to our strong brands, we grew strongly last year in Europe (Aeolus and Barkley) as well as the Benelux (Alliance).
As a result, we ended up being restricted a little by our own warehouse.
In NSW the company bought a development site covering 10 hectares that already has development approval for a 240-room village.According to the wholesaler, capacity issues "endangered the delivery times promised to customers." In response, Heuver Tyrewholesale examined the layout of its warehouse, and has installed a tailor-made storage rack that increases warehouse capacity by 3,000 square metres.This extra capacity has enabled the wholesaler to increase its stock levels and, more importantly, it has provided Heuver a means of effectively managing its orders so it can "continue offering the fastest possible deliveries" to its customers."We established a few ambitious objectives a few years ago.However, things advanced faster than we had expected," comments Bertus Heuver, director at Heuver Tyrewholesale.
Why don't they take their kids would have to testify about them. Sent the day after the city happens on the global market as compared to the impact of adolescent life into something.
Sex love tips casual encounters calamus clinton iowa. Free dating sites for singles marietta marina trailer park washington county.
SSMS is an integrated environment for managing any SQL infrastructure, from SQL Server to SQL Database.
NET Framework 3.0 ) to successfully able to run LINQ To SQL examples.
It was all going so well that he had high hopes that she could be the one he'd settle down with. In her dating profile, she'd said she was eight stone and a size 8.
You can meet Sri Lankans living around all over the world and have a conversation with them.


text:
Student Behavior
We are committed to a safe and civil educational environment for all students, employees, parents/legal guardians, volunteers, and patrons that is free from harassment, intimidation or bullying.
We set high standards for student behavior and have a variety of systems in place to support students and families including the following programs and practices.
- Positive Behavior Interventions & Supports
- Restorative Practices
- In-School Suspension Programs
Positive Behavior Interventions & Supports
Positive Behavior Interventions & Supports (PBIS) is a school-wide approach to creating and sustaining positive and effective teaching and learning environments for everyone. In PBIS schools:
- Staff teach, model, and acknowledge positive behavior
- The behavior expectations are taught clearly to students
- Students who have difficulty learning behavior expectations are provided additional support in small groups or on an individual basis
The goal of PBIS is to establish a positive community and culture within a school that has effective systems in place to help ALL students be successful.
Why PBIS?
Research has shown that punishing problem behavior without positive supports is ineffective and may increase aggression, truancy, and dropping out.
Highline has made the bold goal of eliminating out-of-school suspensions except when critical for student and staff safety. In order to give our students the best education in a safe and positive atmosphere, PBIS is being implemented across the district to create systems to support and prevent problem behavior from occurring.
PBIS strives to provide consistent, fair, equitable, and research-based interventions for all students to learn how to manage their own behavior and build social skills to be successful. Physically and emotionally safe environments will increase instructional opportunities and lead to academically skilled students who graduate ready for college, career, and citizenship.
Cardinal Rule of PBIS: Consistency, Consistency, Consistency!
PBIS/Social Emotional Learning Specialists
Christin Lindner
Greg Perkins
Useful Links
Restorative Practices
Restorative Justice is a practice for addressing student behavior through a process that involves the offending student, the offended student, the parent, and community. It encourages accountability, healing and repair.
- Restorative practices use a peace-making circle where students involved in the conflict are able to express the harm that was done and how it impacted them.
- Restorative practices are inclusive of the larger community (in and out of the classroom/school). They build relationships between students, staff and community and provide a process for the offending student to make up for the harm they have caused and make changes to their behavior.
- Several schools have already implemented restorative practices, and more will be implementing this year.
In-School Suspension Programs
Every middle and high school has an in-school suspension program staffed with a certificated teacher in the role of re-engagement specialist.
- Re-engagement specialists have co-designed an alternative-to-suspension handbook that all re-engagement specialists use in their programs.
- Re-engagement specialists use restorative practices to help students understand how their behavior impacts their peers, teachers, and other adults and to problem-solve how they can make better choices in the future.
- Re-engagement specialists connect with classroom teachers to support students on in-school suspension so students stay caught up on course work.
- Re-engagement specialists meet with one another throughout the year with the support of the Chief Engagement and Partnership Officer and the PBIS team to share what is working, what is not working, and how to improve their programs.
RULER is a researched-based approach from our educational partners at Yale University that helps students develop their social-emotional literacy skills.
Through the consistent use of four anchor tools (Charter, Mood Meter, Meta Moment, and Blue Print), RULER supports students in recognizing, understanding, labeling, expressing and regulating their emotions.
After the first year of implementation, RULER strategies are also embedded into reading and writing, helping students develop sophisticated strategies for brainstorming, critically analyzing, debating, perspective-taking, and understanding character development.
RULER is a component of a comprehensive approach in Highline for supporting students emotional development and nurturing behavior expectations across the elementary schools, and compliments the district-wide implementation of PBIS and Trauma Informed Practices. RULER is currently implemented in 2/3 of the elementary schools in Highline.
Learn more about the RULER approach.


text: Why??? I don't get why difficult child 1 had to tell a lie...one that wasn't necessary. He and his friends stayed over Sunday night. They had said something about going to school on Monday. Then when I got home at 4pm last night, he and his friends come running out to tell me how they had to miss school because they were looking for Grandma's dog. (I'm dog-sitting this week) Something about how they left the back gate open the night before and how it was all my fault because they didn't know that I had Grandma's dog. 1) I don't care if he goes to school or not so he didn't have to tell me whether he went or not. 2) It was 4pm, the school doesn't call me and notify me about his going or not going...hasn't since his 18th b-day. So he could have said nothing and I wouldn't of asked. 3) I know the gate was locked because I always check it. 4) If the gate was open, my three runners would of had a hey-day checking out the neighborhood. So why tell a lie??? I don't get it. Are difficult children compelled to lie? Or was it just that I had bragged here about a few steps forward so he had to take one backwards?


text:
Tooth Wu's painting in 3D
Featured on the frontpage of Polycount, for monthly recap news.
Featured in Artstation's staff picks.
Featured on Marmoset Toolbag's website.
This project was done first as a sculpting practice and later turned into texturing practice as well.
Mesh for the low poly version was just quickly generated with Zremesher, since the texturing was the main focus with this.
If you have trouble viewing the marmoset 2 viewer below, try Artstation version.


text:
In the wake of the Equifax breach earlier this year-which compromised the personal information of half of all Americans-identity theft has become a growing concern. "Identity theft" refers to the crime of fraudulently taking and using of someone's personal data for personal gain. Today we examine the federal legislation surrounding this crime:
Tough, Principled Criminal DefenseOffering an honest, no-nonsense, assessment of your legal issue.


text:
In my old location velvetleaf was a very effective trap crop for leaf miners. But (so far?) I don't have any in my yard here.
But I have started noticing leaf miner trails in my nasturtium leaves and nowhere else. Velvetleaf, columbine, and lamb's quarters are the ones listed as leaf miner trap crops. But nasturtium is listed as one of the preferred host plants for them, which should make it a good trap crop too. Anyway, so far it seems to be working like that! Good to know. I'm happy to sacrifice some of the nasturtium leaves to keep the miners out of my veggies. Another reason for planting the nasturtium in my veggie beds!


text:
Scales the color of emeralds armor this ferocious dragon. A single sharp horn protrudes from the end of its toothy snout.
Very Old Green Dragon CR 16
LE Gargantuan dragon (air)
Init -1; Senses dragon senses; Perception +32
Aura frightful presence (270 ft., DC 24)
AC 33, touch 5, flat-footed 33 (-1 Dex, +28 natural, -4 size)
hp 262 (21d12+126)
Fort +18, Ref +11, Will +18
DR 15/magic; Immune acid, paralysis, sleep, SR 27
Speed 40 ft., fly 250 ft. (clumsy), swim 40 ft.
Melee bite +28 (4d6+16/19-20), 2 claws +28 (2d8+11/19-20), 2 wings +26 (2d6+5), tail slap +26 (2d8+16)
Space 20 ft.; Reach 15 ft. (20 ft. with bite)
Special Attacks breath weapon (60-ft. cone, DC 26, 18d6 acid), crush (Medium creatures, DC 26, 4d6+16), tail sweep (Small creatures, DC 26, 2d8+16)
Spell-Like Abilities (CL 21st; concentration +25)
Spells Known (CL 11th; concentration +15)
4th (7/day)— dimension door, ice storm, stoneskin
3rd (7/day)— dispel magic, displacement, fireball (DC 17), haste
2nd (7/day)— alter self, detect thoughts (DC 16), locate object, mirror image, see invisibility
1st (7/day)— magic missile, shield, silent image (DC 15), summon monster I, ventriloquism (DC 15)
0 (at will)— acid splash, bleed, dancing lights, detect magic, ghost sound, mage hand, message, resistance, prestidigitation
Str 33, Dex 8, Con 23, Int 18, Wis 19, Cha 18
Base Atk +21; CMB +36 (+38 on sunder); CMD 45 (47 vs. sunder, 49 vs. trip)
Feats Alertness, Cleave, Critical Focus, Flyby Attack, Great Cleave, Improved Critical (bite), Improved Critical (claws), Improved Sunder, Iron Will, Multiattack, Power Attack
Skills Fly +9, Knowledge (arcane) +28, Knowledge (local) +28, Knowledge (nature) +28, Perception +32, Spellcraft +28, Stealth +11, Survival +28, Swim +43, Use Magic Device +28; Racial Modifiers +8 Swim
Languages Common, Draconic, Elven, Giant, Sylvan
SQ camouflage, trackless step, water breathing, woodland stride
Camouflage (Ex)
An old or older green dragon can use Stealth to hide in any sort of natural terrain, even if the terrain does not grant cover or concealment.
Trackless Step (Ex)
An adult or older green dragon does not leave a trail in natural surroundings and cannot be tracked. A green dragon can choose to leave a trail, if it so desires.
Water Breathing (Ex)
A green dragon can breathe underwater indefinitely and can freely use its breath weapon, spells, and other abilities while submerged.
Woodland Stride (Ex)
A very young or older green dragon can move through any sort of foliage at full speed without taking damage or suffering impairment. Areas of foliage that have been magically manipulated affect it normally.
Environment temperate forests
Organization solitary
Treasure triple
Green dragons dwell in the ancient forests of the world, prowling under towering canopies in search of prey. Of all the chromatic dragons, green dragons are perhaps the easiest to deal with diplomatically.


text:
Posted: Feb 09, 2019
Spartanburg, S.C. -- The Youngstown State softball team started the 2019 campaign with a pair of losses to at the USC-Upstate Spartan Classic on Friday afternoon. The Penguins lost to East Carolina, 11-4, and Towson, 8-0 in six innings.
In the opener against East Carolina, freeshman Grace Cea went 2-for-3 and scored a run while sophomore Nikki Saibene was 2-for-4 with a run scoring single. Junior Elizabeth Birkbeck drove in two runs with a double in the bottom of the first inning.
Against Towson, the Penguins managed just three hits in the 8-0 shutout. Sophomore Yazmine Romero, senior Lexi Zappitelli and Cea collected the Penguins' hits.
Youngstown State faces Miami (Ohio) and USC-Upstate, Saturday, at 11 a.m. and 1 p.m., respectively.


text: Share: Comments Print April 24, 2008 at 2:11 PM Live from training camp: Agler gets defensive Posted by Jayda Evans Players were in a huddle wrapping up practice by the time media was let in today. Heard from the public relations staff that a little snafu happened on when we were supposed to be let in and that it wasn't coach Brian Agler's request to keep us out. Plenty could be heard behind the closed doors, however. Agler was stressing his defense and dishing out the commentary like Sonics broadcaster Kevin Calabro. At one point Agler said, "I'm going to be on you like white on rice." A humorous old ditty that I guess was directed toward G/F Katie Gearlds, but Agler wouldn't share the context and Gearlds wasn't available to ask. Agler has said that he wants to focus on Gearlds' defense, so it could just be that. Vets Yolanda Griffith and Sheryl Swoopes didn't practice because "we're looking at the bigger picture with them," Agler said. "Making sure they're ready and fresh. We would defeat the purpose if we came in and practiced them six straight days." Instead the legends did cardio and they'll practice the next two days then be off with the rest of the team on Sunday. The team will be without rookie G Daphanie Kennedy this weekend. She requested permission to return to California to walk with her graduating class at Pepperdine. Kennedy, who continues to make strides in camp, is the first of her family to attend college and earn a degree. She's also the only rookie to request to leave camp for graduation, but Agler said he'd allow any to leave and wouldn't hold it against any player in terms of his staff's evaluations. "I think that's really important that they get a chance to do that," Agler said. "She [Kennedy] reminded me again today that she's going to go after tomorrow's practice. It's a big day in their life — not only for them, but their families. It gives them a chance to get back and go through that with their friends and family. She'll come back in here on Sunday and be ready to go on Monday." Comments


text:
ITIL® 2011 Practitioner is an accredited course, which extends and deepens the knowledge gained in the course ITIL® 2011 Foundation. In this course you will learn how to practically grasp the individual processes, how to implement the and eventually optimize them. The course does not focus only on the technical or procedural point of view, but also the view of organizational changes, which is in such cases often a critical implementation success factor.
Accredited ITIL® 2011 Practitioner training is provided by ict-123.com or ociris accredited by PeopleCert Examination Institute.
The course is designed for all those, who are to some extent responsible for
the use, creation and optimization of IT processes. The minimum requirement is
completion of the course ITIL Foundation.
The course objectives are:
Course Benefits include:
Printed presentation of the course and the official manual ITIL
IT services Providing
Constant improvement
Metrics and Measurement
Effective communication
Organizational change
ITIL® is a registered trade mark of AXELOS Limited, used under permission of
AXELOS Limited.
Copyright © 2019 GOPAS a.s., All rights reserved.


text:
Liverpool fly to Munich to face Bayern Munich to decide who will advance to the quarterfinals
Date: 14/03/2019
Kick-off:1:30 AM IST
Aggregate: 0 - 0
Bayern Munich are scheduled to host the second leg of the Round of 16 of the UEFA Champions League match against LIverpool at home. The first game ended in a goalless stalemate. Both sides had some chances but neither were able to capitalize. Bayern Munich failed to have a single shot on target. This was the first time this happened for the Bavarians since 2015 in the UCL.
Liverpool is sitting 2nd in the EPL while Bayern Munich tops the Bundesliga. Both sides have players in the leaderboards of their respective leagues. Both Salah and Mane' are among the top goal-scorers in the Premier League while Lewandowski sits on top in the Bundesliga. As is evident from the stats, most players from both teams are in monstrous form.
History is not fully on Bayern's side as they only won one of their eight matches against the Reds in European competitions, way back in 1971. On the glass half full side for Bayern, they have reached the quarterfinals in the UCL for the last seven years and will be looking to up that tally. Meanwhile, Liverpool, so close to lifting the Championship last season will be looking to go for gold again.
Bayern Munich:
Manuel Neuer is set to be the sixth goalkeeper to reach 100 UCL games, joining the likes of Casillas, Buffon, Cech, Valdes and Kahn. Bayern are in a bit of a bind with a few usuals set to miss the game. Thomas Muller and Joshua Kimmich, their key playmaker and assist-leader, are suspended. Robben and Tolisso are out on injury. Niko Kovac is almost certain to let Rafinha fill the Joshua Kimmich-shaped void for Bayern. Mats Hummels might start after his return at the weekend.
The jury is cautiously optimistic on the returns of James Milner and Trent Alexander-Arnold as both are recovering from muscle issues. Lovren has a chance of starting, being benched on the Burnley game. Van Dijk will look to make his mark after missing the first leg on suspension. Adam Lallana could start the game because of a recent spike in form. Some central midfield changes are possible. Fabinho could be moved up the field after filling in at centre-back till now. On the bright side, Liverpool do not have any suspension woes.
Bayern Munich(4-2-3-1):
Neuer; Rafinha, Sule, Sule, Hummels, Alaba; Thiago, Martinez; Gnarby, Rogriguez, Ribery; Lewandowski
Alisson; Alexander-Arnold, Matip, Van Dijk, Robertson; Wijnaldum, Fabinho, Henderson; Salah, Firmino, Mane
Bayern Munich: W-D-W-W-W
Liverpool: D-D-W-D-W
SCORE PREDICTION: Bayern Munich 1 - 2 Liverpool
Both are undefeated in the last 5 games but the Bayern suspensions and Liverpool's brilliant individual player forms give the Reds the slight edge going into the game.


text:
Oyster populations, worldwide, are at record lows. Despite some recovery in recent years, in North Carolina it is estimated that oysters are at about 15-20% of historic harvest levels. Oyster harvest is currently the best measure of the oyster population.
Oysters are vital to North Carolina's coastal ecology and economy. They filter water, provide food for humans and create reefs that build homes for more fish. These environmental functions, in turn, support jobs and provide economic opportunities for coastal communities.
The North Carolina Coastal Federation and its partners are restoring oyster populations by executing the Oyster Restoration and Protection Plan: A Blueprint for Action 2015-2020, which contains goals and provides a framework for oyster restoration and the advancement of oyster mariculture. We are working closely with and helping to coordinate the efforts of all stakeholders to build a statewide network of oyster sanctuaries, enhance shellfish management areas, improve and protect water quality and implement other priority actions. We also engage and educate the public to build political support for oyster restoration.
The federation and its partners will promote oyster restoration and mariculture by working on the following:
- Provide leadership for statewide coordination of oyster restoration and protection efforts
- The federation coordinates a statewide oyster steering committee comprised of researchers, commercial fishers and growers, state and federal agency personnel, non-profit organizations and educators.
- This committee guides the implementation of the current Blueprint and oversees updates to the plan.
- Build New Oyster Sanctuaries
- Construct 50 new acres of oyster reef between 2017-2020 as part of the 50 Million Oyster Initiative, to date 25 acres have been constructed at Swan Island Oyster Sanctuary in 2017-2018 and ten more are planned for 2019.
- Promote a statewide cultch planting strategy
- Partner with the Division of Marine Fisheries to evaluate cost-effective methods for deploying and building harvestable reefs throughout the state
- Grow Shellfish Farming
- Promote key strategies and recommendations provided in the 2018 Strategic Mariculture Plan
- Recycle Oyster Shells
- Expand and promote the Restaurant to Reef Shell Recycling Program
- Establish drop off points for shells coastwide
- Collaborate with other entities such as the Division of Marine Fisheries to determine shell placement
- Clean up Growing Areas
- Align our watershed restoration efforts to protect and restore water quality in high priority shellfish growing waters
- Promote efforts to minimize debris from oyster farms
- Continue to engage fishermen, legislators, researchers, students, agencies and the public in the development and execution of these efforts.
Support the federations efforts to build new oyster reefs throughout the state
The North Carolina Coastal Federation has developed a working map of sites along the North Carolina coast where oyster restoration projects have been built. This map features descriptions, photos, funding agencies and more. Click on the various sites below and check back for new additions.
Check out these resources for all things oysters:
- NCOysters.org, all things North Carolina oysters
- Oyster Restoration and Protection: A Blueprint for Action 2015-2020, the current edition of the oyster Blueprint
- Launching a North Carolina Shellfish Initiative
- NC Strategic Plan for Shellfish Mariculture 2018
- Rural Development Annual Report 2017-2018
- 2018 Swan Island Oyster Sanctuary Handout
- Listen: Podcast about conserving oyster reefs


text:
Thursday Dreaming
I love this dress, it makes me feel like I might be on a beach somewhere lovely!
- Cardigan: Kate Spade
- Dress: Kate Spade
- Belt: Kate Spade
- Shoes: Christian Louboutin
Tomorrow I will be up in Barstow at the Kate Spade outlet for their one year anniversary! In fact, I am bringing these:
Strawberry and Raspberry-Pomegranite! Mmmmm. Come up, have a French Macaron, and shop!!
Until next time,


text:
Submit a Correction I work for this organization
Harry's Cafe
(802) 259-2996
3621 VT Route 103 S
Mount Holly, VT 05758
Retail Food Outlets
- Restaurant / café
Related Goals
- Goal 1: Consumption of Vermont-produced food by Vermonters and regional consumers will measurably increase.
- Goal 2: Consumers in institutional settings (e.g., K-12 schools, colleges, state agency cafeterias, hospitals, prisons) will consume more locally produced food.
- Goal 13: Local food will be available at all Vermont market outlets and increasingly available at regional, national, and international market outlets.
- Goal 15: All Vermonters will have access to fresh, nutritionally balanced food that they can afford.


text:
samples of basic resumes
If folks scan search outcome, they begin looking for your keywords they have input. Let us decide to try to create a great model. Word choice can be a far greater way to get dialogue to truly have an accent. A lot of people may possibly even think about using shock collars because sort of pain-inflicting discipline. When you're experienced, begin hunting for companies and professionals with the ability to cover you specifically what you're really worth. The solution is dependent upon many facets. This really is you make certain your title fits with the articles of one's article and your post delivers crystal clear, relevant advice that your readers want to get. Because questions are often such effective openers, " I wish to share 3 question-crafting formulas that may easily be flexible to lots of various types of businesses. The key is to make it a very excellent issue. The composition of an image produces a tremendous difference in either the visual allure of the picture together with all the message that will be being hauled. The key to good architecture is superb planning. The section of intrigue is vitally essential. Most men and women commit a significant portion of these internet time watching videos. To get a viewer, it's most likely the only of use region of the advertising. Your advertisement is simply going to demonstrate when the hunt is right to your precise keyword phrase you've included over the mounts. The ad will not show for searches that include other important phrases. Not only will it be powerful than some marketing approaches, but it is less costly. On line marketing is continuously changing. Content promotion is the only weapon on your advertising arsenal that can help customers locate your business enterprise to get started with, and establish the value of one's merchandise at just the very same time. You devote a lot on promoting your business on line. As it's to perform your organization, you have to become somewhat selective about what you talk about social media. Regardless of what type of business you have, you will benefit should people might uncover your company on Google. Understand just how videos could be an affordable and effective process to promote your business. Your matter paragraph is the own first impression and also you would like to create it a very good one thus be certain it calms your reader instantly so that they are quite interested in that which you are likely to let them know as you're in what you have got to state. Form easy actuality that, in case of my own lesson for you here, your topic sentence isn't your thesis announcement, it's likewise crucial to comprehend the exact keywords your crowd will read really are some of one of the most crucial to creating an outstanding essay. Just about every paragraph is going to have a topic sentence that is one of the reasons why believe the thesis. You are not going to pass whether your sentences are not functioning. Utilizing special scenes can help encourage your announcement, but it's not your sole recourse. Listed here are a couple of examples. Below are quite a couple of of the most useful instances that you can utilize to start off with. Controlling your societal networking websites can quickly take up a substantial part of your daily life. Developing a web site for your company is confusing, even although you are employing the work-out.


text:
A senior trade union official has hit out at her own organization over the limited number of women in leadership positions, saying it was just one example of women being held back by the proverbial glass ceiling.
Assistant General Secretary of the Barbados Workers' Union (BWU) Wilma Clement yesterday argued that while the union was headed by a woman – General Secretary Toni Moore – and while women constituted the majority of its membership, most of its leaders were male.
"About three years ago our committee looked at the number [of men] who were attending our annual delegates conference and it was like 42 per cent, yet when it was time to vote the women voted unanimously for the men," Clement said, holding females partially responsible for maintaining the status quo.
"Not even a quarter of the composition of the executive council were women, and we have not seen eight women on the executive council for the Barbados Workers' Union for years. Women think that is natural because we believe that men are supposed to lead and women are supposed to support them," she told the media on the sidelines of a leadership seminar hosted by the BWU at its Solidarity House headquarters this morning ahead of International Women's Day on Thursday.
Clement, the gender affairs coordinator at the BWU, also complained about the scheduled time for union meetings, saying it was not convenient for the women, many of whom have "nurturing responsibilities" at home.
"We have to look at the fact that most BWU meetings usually start at 5p.m. Now when you start at that time and you have those caring and nurturing responsibilities, are you going to stay for another two hours at the union, or are you going to go home and take care of your family? So do we need to talk to the unions about when we have meetings, and if the late start is unavoidable could there be childcare facilities?" she questioned.
The union official said the country had made strides towards shattering the glass ceiling over the past two decades, but argued there was still a long way to go.
She said the public service was ahead of the private sector in this regard, pointing to the number of women who head ministries, compared to those in executive positions in the private sector.
She also complained about the number of men who attended Tuesday's event, suggesting it was all part of the problem in a male dominated business environment.
"When you look in the public sector most the permanent secretaries are women, but this is only the public sector where there has been a serious effort to change the culture. The private sector is a different story. Today we should have had at least 30 per cent men, but their employers told them that because it was International Women's Day they couldn't go. The same gentlemen would get permission to come here on Thursday evenings for meetings but can't get permission to come to a women's day activity," Clement complained.


text:
Strong Differences for Harrisburg-York-Lebanon metro area: For every county graded, ozone smog worsens, but fine particle pollution measures are best ever, finds 2018 State of the Air report
Editors Note: Updated Trend Charts and rankings for metropolitan areas and county grades are available at Lung.org/sota on April 18, 2018 at 12:01 a.m. EDT.
(April 18, 2018) - Harrisburg, PA
The American Lung Association's 2018 "State of the Air" report found that ozone air pollution in the six-county Harrisburg-York-Lebanon metro area and throughout much of the Mid-Atlantic worsened when compared with last year's report. Even as fine particle pollution levels continued their steady improvement, the metro area ranked among the "Worst 25 Cities" in the United States for both measures of this pollutant. The "State of the Air" report gives results for three measures of air pollution—days with elevated ozone, and daily and annual values for fine particle pollution.
The Harrisburg-York-Lebanon metro area again met the current national standard for year-round particle pollution, according to the 19th annual "State of the Air" report. It also marked a report in which the average year-round level of fine particle pollution for each county improved to its best ever value. However, Lebanon County, rejoining the grading after a one-year hiatus because of incomplete data, and despite posting its first passing grade, had a value that was worse than the metro area's previous best-ever performance in last year's report. As a result, the metro area's rank worsened from 22nd worst in the nation in last year's report to 15th worst rank of 187 across the country in the current report.
For the five counties monitored for the daily measure of fine particle pollution, all posted the fewest number of days of unhealthful air quality, but the worst performances continued to earn "F's," with the result that the metro area's rank improved only slightly, from 21st worst last year to 22nd worst of 201 metro areas in the current report.
For ozone, the four counties with monitored data for this pollutant all worsened from their previous year's performance. In the metro area, Lebanon County had the highest number of days with unhealthful levels of ozone pollution, and picked up its fourth consecutive "F." York County worsened and received the same grade. Nevertheless, as other areas have also struggled with the same situation, the metro area's rank actually improved somewhat, from 41st worst last year to 45th worst of 227 in the current report.
Compared to the 2017 report, the Harrisburg-York-Lebanon metro area has seen a distinct increase in unhealthy days for ozone and a continuing gradual improvement in both measures of particle pollution. This is in keeping with trends seen across the nation for both higher ozone and lower particle pollution levels than in last year's report. In the case of the daily measure of particle pollution, the metro area recorded its second consecutive year of improvement in its worst county's number of days with unhealthful air quality.
"The 2018 'State of the Air' report finds that unhealthful levels of ozone in the Harrisburg-York-Lebanon metro area put our citizens at risk for premature death and other serious health effects such as asthma attacks and greater difficulty breathing for those living with a lung disease such as COPD. As long as there are many days with high ozone levels, people with lung diseases such as asthma will continue to need medical attention," said Kevin Stewart, Director of Environmental Health, American Lung Association of the Mid-Atlantic. "Across the nation, the report found continued improvement in air quality, but still, more than four in 10 Americans – 133.9 million – live in counties that have unhealthful levels of either ozone or particle pollution, where their health is at risk."
The trends in this year's report, which covers data collected by states, cities, counties, tribes and federal agencies in 2014-2016, confirm the ongoing challenges to reduce each pollutant in the changing political and outdoor climate.
"We can and should do more to save lives," Stewart said. "The American Lung Association in Pennsylvania calls on our members of Congress to defend the Clean Air Act, currently under threat from those who want to weaken this effective public health law. We also call on the U.S. Environmental Protection Agency to implement and enforce the law instead of trying to roll back major safeguards such as the Clean Power Plan and cleaner cars, both steps that help us fight climate change and reduce air pollution."
For 19 years, "State of the Air" has provided a report card on the two most widespread outdoor air pollutants, ozone pollution, also known as smog, and particle pollution, also called soot. The report analyzes particle pollution in two ways: through average annual particle pollution levels and short-term spikes in particle pollution. Both ozone and particle pollution are dangerous to public health and can increase the risk of premature death and other serious health effects such as lung cancer, asthma attacks, cardiovascular damage, and developmental and reproductive harm.
Ozone Pollution in the Harrisburg-York-Lebanon metro area
Compared to the 2017 report, the Harrisburg-York-Lebanon metro area experienced more unhealthy days of high ozone in this year's report. Three counties earned worse grades than they had in last year's report, with Adams and Dauphin Counties dropping from "C's" to "D's," and York County from "D" to "F." Lebanon County's performance was worst in the metro area, and grade of "F" was unchanged.
"Ozone especially harms children, older adults and those with asthma and other lung diseases," said Stewart. "When older adults or children with asthma breathe ozone-polluted air, too often they end up in the doctor's office, the hospital or the emergency room. Ozone can even shorten life itself."
This report documents how warmer temperatures brought by climate change make ozone more likely to form and harder to clean up. This year's report also revealed that ozone levels increased in most cities nationwide, in large part due to warmer temperatures in 2016, the second hottest year on record in the U.S. Over the past decades, ozone pollution has decreased nationwide because the nation has cleaned up major sources of the emissions that create ozone, especially coal-fired power plants and vehicles.
Particle Pollution in the Harrisburg-York-Lebanon metro area
Where they could be compared, the 2018 report also found year-round particle pollution levels were distinctly lower than in the 2017 report, all were much better than the national air quality standard, and all represented each county's best performance ever. Even the metro area's worst value (posted in Lebanon County) resulted in that county's first passing grade. Nationwide, the best progress in this year's report came in reducing year-round levels of particle pollution.
"Particle pollution is made of soot, chemicals, and tiny particles that come from coal-fired power plants, diesel emissions, wildfires and wood-burning devices. These particles are so small that they can lodge deep in the lungs and trigger asthma attacks, heart attacks and strokes, and can even be lethal," said Stewart. "Year-round particle pollution levels have dropped thanks to the cleanup of coal-fired power plants and the retirement of old, dirty diesel engines."
"State of the Air" 2018 also tracked short-term spikes in particle pollution, as these can be extremely dangerous and even lethal. According to the 2018 report, all five counties monitored for this measure recorded their best performance ever, some for more than just one year's improvement. Three counties earned improved grades, with Adams and York going from "C's" to "B's," and Cumberland jumping from "F" to "C." Dauphin and Lebanon Counties continued with "F" grades for the fourth consecutive year. The noted improvements continue a general trend toward fewer short-term spikes in particle pollution in the Harrisburg-York-Lebanon metro area.
In other areas of the country, many of the daily spikes of fine particle pollution were directly linked to weather patterns such as drought or to events such as wildfires, which are likely to increase because of climate change. In some localities, high emissions from wood-burning devices have also been a factor.
While the report examined data from 2014-2016, this 19th annual report provides online information on air pollution trends back to the first report covering 1996-1998. Learn more about Pennsylvania's rankings, as well as air quality in the Harrisburg-York-Lebanon metro area and across the nation in the "State of the Air" report at Lung.org/sota. For media interested in speaking with an expert about lung health and healthy air, contact the American Lung Association in Pennsylvania Communications Director Ewa Dworakowski by calling 717-971-1123 or 717-503-3903 (cell) or emailing [email protected] .
About the American Lung Association in Pennsylvania
The American Lung Association in Pennsylvania is the leading organization working to save lives by improving lung health and preventing lung disease, through research, education and advocacy. The work of the American Lung Association in Pennsylvania is focused on four strategic imperatives: to defeat lung cancer; to improve the air we breathe; to reduce the burden of lung disease on individuals and their families; and to eliminate tobacco use and tobacco-related diseases. For more information about the American Lung Association in Pennsylvania, a holder of the Better Business Bureau Wise Giving Guide Seal, or to support the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit: Lung.org.
American Lung Association in Pennsylvania
3001 Gettysburg Road • Camp Hill, PA 17011
717-541-5864 Lung.org
Sign up for the latest lung health news sent right to your inbox.
Join more than 500,000 people who receive research updates, inspiring stories, health information and more.


text:
387% SATISFACTION GUARANTEED (Yep, no typo. We mean it)
(Yep, no typo. We mean it)
5 Things You Never Knew Your Rainbow Vacuum Could Do.
Be the envy of the neighborhood without feeling robbed! This Rainbow will have your home looking like you don't have kids... Just saying, it will pick up more dirt than you knew was possible.
Rainbow E Series - 1 speed bagless Rainbow canister vacuum reconditioned to like new condition loaded with a tools to clean everything in your home, including the dog... (seriously use the upholstery tool with the bristles on).
Warranty - Of course, 5 whole years!
Tools - Loaded with tools (comes with everything you see in the picture) for a complete list of tools and attachments see "SPECS" section below.
Guarantee - 60 day money back, no questions asked.
100% Rebuilt! - Our experts here at GreatVacs have rebuilt over 100,000 vacuums. Each vacuum has been rebuilt with new bearings, seals, motor parts, attachments, belts, brush roll and too many other parts to mention. So you can buy in confidence, knowing your rebuilt vacuum will have the same longevity and performance as a brand new unit.
Worry Free - Few days over on your warranty? No worries contact us anyway, we will work with you.
Mini Turbo Upholstery nozzle - with its spinning brushroll its Pet hairs worst nightmare and perfect for stairs and upholstery.
Basic Maintenance - WE have you covered, with a NEW HEPA filter (installed) and 3 extra belts (1 installed) included.
Genuine Rainbow - Tried and true hoses and power nozzle that excel on any carpet type.
Filtration - Rainbow has you covered, water and HEPA Filtration. Dust is staying IN this vacuum.
Wet Pick Up - You will never cry over spilled milk again! And you can use your Rainbow to deep clean and shampoo your carpet to. (Carpet Shampooer sold separately - check out the "add-ons" section above!)
- Electric Power Nozzle - Spinning brush roll pulls all the dust and debris from your carpet. Hose handle trigger to control brush roll.
- Attachments - 2 Hoses. Electric main hose for the power head and tool hose for all your wet pickup needs, floor tool, duster brush, crevice tool (great for finding lost change beside your car seat), and upholstery tool (with removable slider brush). All these tools fit in the included tool caddie.
- Filters with the power of water (never use bags again) so of course it comes with the included Squeegee tool and 2 extra plastic wands. Kids spill something wet on your floor or counter top? No worries just put on this attachment and suck it right into your Rainbow.
- Also comes with the mini head with spinning brush roll (great for upholstery, stairs and pet hair), the extra long crevice tool (great for Fridge coils and window tracks), Hand Held Sprayer/Upholstery Shampooer, 2 spare belts, 2 fragrance bottles (just add a few drops to your water when your cleaning and your house smells amazing) AND the Aerofresh Bag to clean cushions and pillows. Hey we told you it came with a tool for every job imaginable!
- Knock out your cleaning with standard house hold tool kit, convenient wet pick up squeegee and the pet hair annihilating GV Mini turbo.
- Deep Cleaning Motor - deliver's an amazing 80 CFM of power!
- Quiet but powerful motor pulls 80 CFM.
- Tools hoses and wand extensions for walls and reaching ceilings.
- Dual filtration technology uses water and HEPA filters to keep dust out of your air.
- Handle trigger controls the genuine Rainbow power nozzles brushroll so it can easily be used on any floor surface.
- Ranked #1 most dependable canister vacuum in the world by Consumer Reports.
- Made in the USA!
The warranty is the best part of buying this vacuum. This is how it works. We love our vacuums but once its yours we never want to see it again. When we rebuild a Rainbow vacuum we NEVER take any shortcuts.
- 5 Year Bumper to Bumper warranty through GreatVacs that covers ALL moving parts.
- 60 day Money Back Guarantee......We are so confident you will LOVE it that you can send it back for any reason within 60 days of purchase (plenty of time to deep clean and shampoo your home).
- We don't sweat the small stuff - Why is it when you go to use your warranty you notice it expired the day before?! Its like they have a button they push the day after your warranty expires! !@#$% Not here at GreatVacs! Go over your Warranty by a few days? No problem we still have you covered.
- We only buy good running Rainbow's- Even though this Rainbow ran great, so it would qualify for our 5 year warranty and 60 day Money Back Guarantee we have totally rebuilt to like new condition.
- New Parts Include - All new bearings, seals, motor parts, attachments, belts, brush roll, and too many other parts to mention.
- GreatVacs Cost for parts - Sometimes a small thing breaks on your vacuum. Its not worth sending your vacuum back for repair. For example lets say years go by and your brush roll wears out. Instead of sending your whole vacuum back to get it fixed we will just sell you a new brush roll at cost!
Customer Reviews
I was a bit skeptical when I came across GreatVacs reconditioned Rainbows and bought the E model. Everything came as promised and we've used the unit a couple of times now and all is good. With a 5 year warranty, it is an excellent price for a great product. I can comfortably recommend GreatVacs Rainbow deal.
The vacuum itself is great, a few of the attachments don't fit. The small circle brush will not stay on the pole. other than that all is good.
I was amazed at how much dirt and dog hair was still in my carpet after I vacuumed with my old vac. My carpet looked new again and was soo soft. The air in my house even smells cleaner. I don't have that "dog" smell anymore. Best decision I have made.
I was shipped the wrong items and they made sure I got the right ones and that I was happy. I got a rainbow and I love it. The price was also good.
Love the Rainbow vacuum. I was a distributor in 97 and bought one for myself. I have used the same machine until this year, the motor burned out. It lasted 21 years so I knew I had to have another one. Thank you Great Vacs for the great deal!


text:
Destination of the Month!
With over 400,000 lakes, rivers and streams and a history spanning thousands of years, Ontario is the perfect destination for your canoeing or kayaking holiday. A total paddler's paradise, enjoy a variety of experiences from fully guided, self guided, voyageur canoeing, rafting, kayaking and more. Come and explore Ontario!


text:
Director: Jay Oliva
Genre: Cartoon, Struggle, Adventures
Year: 2015
Runtime: 80 min.
Country: United States
Actors: Troy Baker, Kevin Conroy, Robin Atkin Downes, Griffin Gluck, Sean Maher, David McCallum, Jason O'Mara
On cinema screens there was a new project, which will delight all fans of comics and superhero stories, the more that the plot cartoon strikes their uniqueness, though its essence and clear from the title. It is regrettable, but even in the case of disagreement the team of superheroes. Most recently, Betsy has found its main partner, the person to whom you can trust - his son Damian, acting in the fight against evil along with his father. Username guy known to fans of the series - Robin. The boy had barely begun to be considered as a teenager but already has a great martial arts and several types of weapons. His skills and proximity to the dark knight does the boy coveted prey for all kinds of villains, but his father is cut easily with them. But one day, even my father's protection does not save boy from bad influences - enigmatic member of the council of the Soviet plays the teenage feelings. He knows that a man-bat is not all trust your little son and promised to provide all the necessary data. Now Damien is a difficult choice, whether it is to go to war against his own father? With SarMovie.com you can download Batman vs. Robin free movie in HD.


text:
Iwen Acreage
42291 210th Ave, Havelock, IA
Approximately 2.91 acres m/l, 2 story home with approx. 1776 sq ft living.
Main level, Open kitchen, living room and master bedroom, main floor laundry, beautiful cupboards with island, upper level 5 bedrooms and 1 bath, attached oversized 2 car garage. Move in Ready Home! Outbuildings, small barn - flat 31 x 52, 2 car unattached garage, 20 x 24, and lean-to 11 x 24.
Plenty of space for animals, or enjoyment. This is a must see!


text:
Today's video contains a DPOW goldmine, along with lots of other dermatological goodness! For those of you who aren't familiar with the term, DPOW is short for "dilated pore of Winer". It's basically a large, solitary blackhead filled with dead skin cells. Thanks for watching, but viewer discretion is advised (as always).
Thank you for joining our cyst loving community.
Insomnia Cures Click Here
Blackhead Removal Tools Click Here
Popping Blackheads Click Here
Education: Please wear gloves and wash before practicing any home medicine.
Social Media
Facebook: https://www.facebook.com/freakymedical
Twitter: http://www.twitter.com/asboxoffice
Support us by supporting our sponsors.
Please support this page by bookmarking and using our Amazon link. It won't cost you a penny! http://www.amazon.com/?tag=wrestling911c-20
This page contains no medical advice. Please consult a doctor as our information may not be medically accurate. This is for entertainment.
Favorite Channels
Incredible Animals: https://www.youtube.com/mrmonkeyzits?sub_confirmation=1
World's Greatest Medical: https://www.youtube.com/c/worldsgreatestmedical?sub_confirmation=1


text:
AgSync, Inc.
AgSync`s concept and continued development is a combined effort of air applicators, ag retailers, hardware manufacturers, growers, and crop consultants. The goal is to make AgSync a logistics management tool for the crop production industry. AgSync provides tools for you to break through the barriers in communication, limited resources, management, and integration in the precision ag industry.
Company details
Find locations served, office locations, manufacturers and our distributors.
- Business Type:
- Software vendor
- Industry Type:
- Crop Cultivation
- Market Focus:
- Nationally (across the country)
It's Not Just About Maps Anymore.
It's Not Just About Maps Anymore.
Our products range from a simple map to work order in seconds to a real-time system that synchronizes the relationship between growers, retailers, consultants, and applicators. Your customers can request applications at their convenience regardless the time of day with the satisfaction of knowing real-time status of their application from their computer or cell phone without having to call. You can manage the workflow in planning, ordering, scheduling, and record keeping as well as flow of information to and from assets and pilots. Automated processes and integration reduce data entry requirements and eliminate redundant paperwork. Regardless of size, locations, or experience, AgSync has a solution for you!


text:
HD Angle Mounted Crown™
The Pipe & Base 2.0™ Angle Mounted Crown™ has proven to be one of the most versatile tools in our product line. Delivered with pre-drilled holes for attachment, the Angle Mounted Crown™ gives users many options when setting up drape.
Please contact your distributor for pricing information
What's Included:
One Each Machine Aluminum Angle Bracket with Swivel Crown


text:
Skip to content
Learn how
Quick Shipping - Same Day Delivery Available!
Satisfaction Guaranteed!
My Cart
Search our store.
Submit Search
Custom Signs
Deliver Today
Balloon Bouquets
Flowers Today
Fruit + Gourmet Baskets
Gift Baskets
Baby Baskets + Parent Gifts
Birthday Gift Baskets
Candy Bouquets
Care Packages
Cheese + Meat Gift Baskets
Children's Gift Baskets
Chocolate Gift Baskets
Coffee + Tea Baskets
Cookies + Bakery Gifts
Corporate Baskets
Custom Gift Baskets
Deluxe Gift Baskets
Fruit Baskets + Nut Trays
Get Well Gift Baskets
Gift Towers
Healthy Gift Baskets
Her + Mom Gift Baskets
His + Dad Gift Baskets
Holiday Gift Baskets
House Warming Gift Baskets
International Delivery
Pet Gift Baskets
Same Day Gift Delivery
Sexy Gift Baskets
Spa Baskets
Specialty + Theme Baskets
Sports Gift Baskets
Sympathy Gift Baskets
Thank You Gift Baskets
Wedding Baskets
Wine Baskets
Personalized Gifts
Personalized Bottle Capcatcher
Personalized Boxes + Trays
Personalized Cabin Gifts
Personalized Chests + Toyboxes
Personalized Kids Growth Charts
Personalized College Gifts
Personalized Crosses
Personalized Family Tree
Personalized Flasks
Personalized Gifts for Her
Personalized Gifts for Him
Personalized Golf Gifts
Personalized Holiday Gifts
Personalized iPhone Cases
Personalized Jewelry
Personalized Kitchenware
Personalized Money Clips
Personalized Name Art
Personalized Picture Frames
Personalized Pillow Cases
Personalized Preserved Roses
Personalized Signs
Personalized Smoke Shop
Personalized State Themed Gifts
Personalized Tools Keychains
Personalized Totes
Personalized Water Bottles
Personalized Wine Gifts
Sign Shop
Baby + Children's Signs
Bar + Pub + Tavern Signs
Cabin Lake + Vacation Signs
Canvas Prints + Signs
Coffee + Bar + Chocolate Signs
Country Signs + Plaques
Create Your Own Sign
Dog + Cats + Pet Animal Signs
Family + Friends Signs
Family Name Signs
Funny + Wizard of Oz Signs
Golf Signs + Plaques
Hunting + Fishing + Sports Signs
Initial + Monogram Signs
Inspirational Signs
Kitchen + Bath + Household Signs
Mother Signs + Grandma Plaques
Real Estate Mortgage Closing Signs
Romantic + Love Signs
Spiritual + Faith Signs
Team Prints + Fan Signs
State Wall Signs
Welcome Signs for Homes
Wood Signs Made in USA
All Sign Quotes Available
Wine Gifts
Champagne Gifts
Luxury Wine Gifts
All Wine Baskets
Wine Accessories + Tools
Custom Wood Sign
Family Signs
24K Gold Dipped Roses
Medallion Barware
NFL Gear
Toy Boxes
Christmas Shop
Christmas Baskets and Towers
Christmas Cookies and Baked Goods
Christmas Picture Frames
Christmas Stocking Stuffers
Christmas Wine Gifts
New Year Day Gifts
Holiday Shipping Schedule
BBQ Gift Baskets & Grill Tools
Bar + Wine + Cigars
Business Gifts
Cabin Decor
Children's Gift Shop
Chocolate and Cookie Lovers
Coffee Lovers
Heart Shop
Inspirational Gifts
Irish Gifts
Family Vacation Gifts
Man Cave Gifts and Gear
Military Gifts
Pet Gifts + Charms
Picture Frames
Romantic Gifts
Religious Gifts
Signs for the Home
Sports Shop
Tools Gadgets
Wedding Shop
Shop by Occasion
Anniversary Gifts
Birthday Gifts
Executive Gifts
Farewell Gifts
Get Well Gifts
Graduation Gifts
House Warming Gifts
New Baby Gifts
New Job Gifts
Retirement Gifts
Romantic Gifts
Sympathy Gifts
Thank You Gifts
Thinking of You Gifts
Valentines Gifts
Wedding Gifts
Shop by Price
$0 - $ 50
$50 - $100
$100 - $250
$250 - $500
$500 - $1000
$1000 - $5000
$5000 plus
Shop by Recipient
Baby Gifts
Bridesmaid Gifts
Children's Gifts
Clients + Colleagues
Dad Gifts
Gifts for Her
Gifts for Him
Graduate Gifts
Groomsmen Gifts
Host + Hostess
Mom Gifts
Pet Gifts
Secretary Gifts
Teachers Gifts
By Personality
Shop by Brand
Design A Wood Sign
Gift Basket Drop Shipping
JDS Personalized Gifts
Lady Fortunes Bakery
Gift Certificates
Deal of the Day
Coupons Codes
Free Shipping
New Arrivals
On Sale Today
Become Affiliate
Visit Us On Facebook
Join Us On Pinterest
Follow Us On Twitter
Read Our Blog
See Reviews
Angels Over Sandpoint
Admin Prof Day
Boss's Day
Breast Cancer Awareness
Easter Gifts
Fathers Day Gifts
Fourth of July Gifts
Friendship Day
Grandparents Day
Halloween Gifts
Independence Day
Labor Day
Memorial Day
Mothers Day Gifts
New Years Gifts
Saint Patrick's Day
Sweetest Day Gifts
Thanksgiving Gifts
Valentines Day
Women's Friendship Day
Gift Baskets
Specialty + Theme Baskets
Spring Gift Baskets
Sunflowers For You Gift Basket
Sunflowers For You Gift Basket
Alternative Views:
Clay pot, birdhouse and miniature tools
The Sunflowers for You gift basket will make her smile with thoughts of whimsical summertime. This 7 inch clay pot brings a wooden bird house, miniature garden tools, and treats of great summertime taste! Send the sights, scents and taste of summer - send her the Sunflowers for You gift basket. A great gift basket for her. A unique mothers day gift. A great birthday gift for a woman. A Mothers day gift basket.
Gift Basket Contents
7 inch clay pot
Sweet and Crunchy Trail Mix Box 2 oz.
Dessert Ice Tea mix
Sherwood Vanilla Cream filled wafer cookies
GW Caramels
Wildflower Honey
2 Miniature tools
1 Wooden Bird house
Reg Price
Earliest Date:
Expedited Ship Today place before 2 pm EST Mon – Fri
Item #
Do you have a large list?
Use our handy
Gift Basket Order Form
Shipping Selection*
Choose Shipping Time Frame
Ground 3 - 5 Days - Mon thru Fri [Add $13.95]
2nd Day Air - Mon thru Fri [Add $27.95]
Next Day Air - Mon thru Fri [Add $45.95]
Sat Delivery - Order before Fri Deadline [Add $75.99]
Canada - 5 to 10 Day Express - Mon thru Fri [Add $34.95]
You must select Canada shipping method for Canada addresses.
If no Canada in dropdown Canada delivery is NOT available.
Sat Del not Avail to all Zip Codes
PO Boxes, APO, FPO, Alaska & Hawaii Addresses
Additional Delivery Charges & Info?:
Normal Address
AA - Armed Forces America [Add $10.00]
AE - Armed Forces Europe [Add $10.00]
AP - Armed Forces Pacific [Add $10.00]
P O BOX [Add $10.00]
Alaska or Hawaii Additional Ground Charge [Add $15.50]
Alaska or Hawaii NEXT Day Charge [Add $25.50]
More Details
Clay pot, birdhouse and minature tools
You might also like ...
The Weekend Gardener Tote Gift Basket
Reg Price
Average Rating:
of 5
Total Reviews:
Write a review »
0 of 0 people found the following review helpful:
Sunflowers For You Gift Basket
October 25, 2012
Reviewer: Adriane C. Stasurak from Macungie, PA United States
Sunflowers For You Gift Basket
Was this review helpful to you?
Back to top