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I'm raising a glass to the town that has an event called San Francisco Cocktail Week - "a weeklong celebration of all things cocktilian."
It means the relentless inspiration to push the boundaries of what makes a great drink is alive and well, which in turn means we'll always have libation worthy of the awesome food they dish out here.
Now that's something to celebrate AND another great use for that bottle of Fernet-Branca I bought.
This is the 2012 Official Cocktail of SF Cocktail Week - Black Lily, and here's the story behind the name and the recipe is below.
Fernet has a very distinct flavor and that part I like, but overall I found this combination a tad too sour so I made a few adjustments. 2 oz Cointreau instead of 1.5 and a teaspoon or so of simple syrup - you can make your own or try this one.
Black Lily
1.5 oz. Cointreau
1 oz. Fernet Branca
.75 oz. Fresh Lime Juice
Shaken, strained over ice in a rocks glass. Garnished with an orange twist


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CERTIFIED SC RECIPE OF THE WEEK: Butternut Squash Gnocchi
October 30, 2018
- 1 small Certified SC butternut squash, about 1 pound
- ½ cup Parmesan cheese
- ¾ teaspoon nutmeg, cinnamon, or ginger
- 1 teaspoon salt
- Pepper to taste
- 2 large Certified SC eggs
- 2+ cups flour
- 3 tablespoons butter
- 2 shallots, finely diced
- 4 cloves garlic, minced
- 2 cups chicken stock
- 1 cup bourbon
- 1/3 cup Certified SC heavy cream
- Salt and pepper
- Fresh thyme leaves for garnish
- Preheat the oven to 450 degrees F. Cut the squash in half. Remove the seeds and lay on an oiled, rimmed baking sheets. Roast the squash until soft, 30-40 minutes. Scoop the flesh of the squash out and place it in the food processor. Puree until completely smooth.
- Mix the pureed squash with parmesan cheese, nutmeg, salt, pepper and eggs. Then add the flour into the mixture and work together by hand. It will be very sticky.
- Once smooth, flour a work surface and a large piece of parchment paper. Flour your hands and grab a handful of dough. Roll into a long rope, about ½ inch wide. Cut the rope into ½ inch pieces.
- Place each piece in the palm of your floured hand (or on the cutting board) and gently roll with a fork to create ridges. Place each piece on the floured parchment paper and repeat with the rest of the dough.
- Bring a large pot of salted water to boil. Boil half the gnocchi, then remove and repeat. With each batch, boil until all the gnocchi floats, about 5 minutes.
- Meanwhile, heat another large skillet over medium heat. Add the butter and 2 tablespoons flour, whisk until smooth. Then add the shallots and garlic. Saute for 3 minutes. Then add the bourbon and chicken stock.
- Whisk and raise heat. Bring the sauce to a boil. Allow the sauce to reduce down to a thin gravy-like consistency. Then lower the heat to medium-low and add the cream. Salt and pepper to taste—usually about 1 teaspoon of salt.
- Once the gnocchi are finished cooking, remove them with a skimmer and place them directly into the cream sauce. Stir to coat. Serve the gnocchi warm and garnish with fresh thyme leaves.

subset: commoncrawl


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There is one main driving force that any business or individual must take on when considering Business Improvement strategy (using Lean Six Sigma) and that is a POSITIVE change in CULTURE in the way that we think, we act and we work by.
It is easy to change a particular component or item from a task or remove or add tasks in a process but it is sometimes very difficult to change the culture of how people act and think towards it. Any improvement transition requires a particular culture to keep it moving on.
In business today the problem lies in the perception or misconception of what a culture change actually entails
Culture change is not a program with a completion date, nor is it a quick fix.
It is an ongoing journey – a journey that requires leaders to understand the current state of the organization, establish a clear vision, align behaviours and instill accountability.
This journey can take up to 5 year so strong leadership is required as well as total commitment by the staff.
Managing change during a process improvement effort, such as a Lean Six Sigma intervention, is essential. Not only is it essential for the team working on the intervention, but for the organisation as a whole in understanding what the Lean Six Sigma team is doing and accomplishing.
It has to be remembered even at this early stage of change that our customers will also see the effect so the change must be in a positive wave to the business and the customer.
Creating a culture change will include:
- Understanding the basics of Lean Six Sigma
- Opening people's minds to improvement and change
- Sharing examples, case studies and research
- Bench marking your organization to best-in-class competitors
- Providing proper Lean Six Sigma techniques for the job, so employees don't feel helpless in their journey
- Modifying management policies, including metrics, governance, and rewards and recognition
- Establishing timely and routine reviews and accountability
- Improving communication within the organization
In Lean Six Sigma methods and techniques can be learned and practiced but Culture Change will be bespoke to the business and can only be delivered buy a strong leadership and willing committed staff.


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- Average
- Main course: £13
- Food spend: £30
- Opening hours
- Monday to Saturday: 10:00 - 23:00 Sunday: 10:00 - 22:00
Lovely meal and excellent service. Thoroughly enjoyable!
11 January 2018
from Bristol
Once a part of the Bristol Museum & Art Gallery, the building housing Browns Brasserie & Bar Bristol is modelled on the Doge's palace in Venice, and is situated just next to the prestigious University of Bristol. Part of the landscape of this vibrant city, the brasserie serves a menu of British and European-inspired cuisine in a lively, friendly environment.
Spanning from breakfast through to lunch and dinner, the Browns menu offers all-day brasserie dining. Indulgent plats du jour and Sunday roasts are staple favourites, while sumptuous flavours include roasted lamb with potatoes & minted peas, Browns' signature fish pie, and decadent salted caramel profiteroles. A sophisticated children's menu at Browns offers tempting favourites with a grown-up twist.
Showcasing a penchant for cocktails, the Browns bar offers an array of classic mixes, signature concoctions and thirst-quenching mocktails, as well as fine world wines, and smoothies. Enjoy Browns' afternoon tea and cake accompanied freshly-roasted coffee from an independent supplier, or a warming pot of loose leaf tea.
Browns Brasserie & Bar Bristol is just a 15-minute walk from Clifton Down Rail Station.
Browns Brasserie & Bar - Bristol
38 Queens Road, Clifton, Bristol, BS8 1RE
See all Browns Restaurants
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Customer reviews for Browns Brasserie & Bar - Bristol
- Food
- Value
- Ambience
- Location
- Service
- Drinks
((((( 11 January 2018 by Kate from Bristol
Lovely meal and excellent service. Thoroughly enjoyable!
((((( 30 October 2017 by Sandra from Weston-super-Mare
Enjoyed very much the breakfast menu, staff were excellent and booking service was easy to follow.
((((( 2 September 2017 by Teresa from Bristol
Had an absolutely amazing time last night, service, staff & food amazing
((((( 14 June 2017 by Sue from Bristol
Excellent food. Lovely atmosphere. Service was exceptional.
((*** 9 June 2017 by Julie from Bristol
Our waitress through the evening was fantastic and the environment was lovely - however foodwise, the chicken added to our salads was really tough, rubbery and poorly cooked. The tuna in the salad nicoise was extremely salty too. I was glad of the 25%discount I'd found on bookatable before I booked.
((((( 7 June 2017 by Andrew from Bristol
We enjoyed the various dishes that we had which were all good quality from a wide variety of choices. The restaurant staff were friendly and efficient and we had a good evening
((((( 7 June 2017 by Karen from Bristol
Very impressed with service and menu.
Food was piping hot.
Great atmosphere
(((** 22 April 2017 by Ronald from Exeter
Arrived at 7pm for our booking, were greeted politely and shown to a table. We were given 5 different menus and waitress was unclear which menu corresponded with the deal we had booked (£19.95 for 2 courses + 1 drink). We waited over half an hour, in a restaurant which was very quiet, for our order to be taken. We were not offered anything to drink or eat prior to our order. We were almost at the point of leaving. We asked for some water when we finally ordered, but had to ask again after another 15 minutes, as nothing was forthcoming. When our meal finally came, at least 50 minutes after we arrived, even though the main wasn't what we had ordered, we accepted it and it was wonderful!
The waitress was polite and very pleasant, but we were disappointed in the length of time of service and felt initially ignored.
The food was excellent, but we felt the establishment was let down by the poor initial service.
((((( 20 March 2017 by Susan from Bristol
We visited Browns in Bristol for Sunday lunch in March The service and meal were excellent and the venue was attractive and clean. We would definitely visit again
(((** 11 February 2017 by Julie from Bristol
Food was nice service good although rushed at end because kitchen was closing (10.45?)
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This is the Largest, most complete& comprehensive service manual for the 2N 8N 9N! Ford 8N Tractor. This manual has it all! Disassembly of Tractor. Related products for New Holland Ford 6610 Tractor Repair Manual PDF: Ford USA Microcat Parts Catalog 2018. Ford USA Microcat 2018 is a spare parts catalog for all models of cars and vans Ford of USA market.
100 [ Ford Europe Microcat 2018 Parts Catalog. Buy Ford New Holland 6410 (10 Series) Parts and a massive range of tractor replacement spare parts& accessories. Fast UK and worldwide delivery.
Fits: 5110 Tractor 5610 Tractor 5900 Tractor 6410 Tractor 6610 Tractor 6710 Tractor 7610 Tractor 7710 Tractor The Jensales Team is excited to bring you this Parts Manual for the Ford 5610 Tractor. A historically accurate parts manual is essential when ordering parts and doing repairs.
Our Ford 6610 Service Manual (OEM) is an original OEM tractor manual from the original equipment manufacturer. Note that the image provided is for reference only. Tractor service manuals (tractor shop manual repair manual) provide detailed service and repair information for your tractor, with stepbystep instructions on how to repair your 6010, 6110, 6210, 6310 and 6410 tractors( ) copyright 2001 (c) deere& company. this data is the property of deere& company.
all use andor reproduction not specifically authorized by deere& company is prohibited. Operators Manual for the Ford 5610 6610 7610 tractors. PDF format for download. Ford 6410 Mark III tractor engine. TractorData. Notice: Every attempt is made to ensure the data listed is accurate. Some of the parts available for your Ford New Holland 6610 include Air Conditioning, Clutch, Transmission, PTO, Electrical& Gauges, Engine and Overhaul Kits, Filters, Front Axle and Steering, Hitch Drawbar, Hydraulic System, Lights and Related, M Ford 6410 Mark III tractor overview.
TractorData. Notice: Every attempt is made to ensure the data listed is accurate. Feb 19, 2010 It may be difficult to get a workshop manual specifically for the 6410, as that model and the 6810 were built towards the end of 10 series production, and AFAIK Ford didnt print specific manuals for them, just supplied a 6610 manual with a few added pages outlining the differences.
ABOUT THIS PAGE: You are viewing our category listing of Ford 6410 tractor parts and engine parts. As one of the largest suppliers of new and rebuilt parts for these tractors, you can count on our large inventory and discount prices.
Phone: (730) 893-2597 x 5157
Email: [email protected]


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* Being in Singapore I know I haven't been gone for too long, but I've gotten use to and already started romanticizing of constantly being in transit and living out of my suitcase [as frustrating as that can be sometimes] so being in a place that I'm familiar with almost makes me claustrophobic. I suppose my love for travelling has extended to a desire to leave the country I was born in, and create something somewhere else.
* Hydrangeas A bouquet of hydrangeas [only my favourite flowers! reminds me of my summer in New York!] arrived for me this morning when I woke up, together with a note from someone I met in the US. Funny how a lot of fleeting meetings become interesting, long-time encounters.
* Film cameras I have a love-hate relationship with film cameras. While I love the fact that for once, in our tech-obsessed lives that we cannot get something in an instant; the menial task of having to bring it to the photo shop, and buzz of hearing the perforation tear from the slip about to be handed to you. All a lot of fun. But what isn't fun is my inability to use up film just because I have to. My mother likes to save things, and I got this from her - I cannot justify using up the film I have in my fabulous pink Fish Eye on any random day, and God dammit, I want to see the pictures I took!
* Wonderwooled The lovely folks at WonderWool featured me as their first Style Spy. It's so sweet that I got a whole post to myself off their very stylish blog - thank you again, and I must make a trip to your physical store soon! Pinky promise!
* Spruce Up I got bored of my old header, so with the help of a friend, I thought I'd replace it with a self-portrait of myself on my first trip to Madrid. A little change in colour here and there. What do you think? I even have a stiletto as a favicon - clear your cache to see it! I wish I had a personal photographer follow me around so I can post photos of my outfits more often [I know a few of you have been hounding me for this! Sorry!] - but I'll try! Let me know what else you want to see on this blog - more fashion? More personal drama [haha!]? More advice? More shopping? Let me know!
* Random Love Shower Receiving postcards; making friends, keeping friends, reading comments on blogs about you from people you've met only for awhile, but already love; getting an iPhone soon!; hot hot tea with honey; my Mom; writing; getting out of my comfort zone, meeting new people, having Xiao in town, hanging with friends I haven't seen in ages, having a crush on someone; trying to stop thinking about that someone; thinking about that someone whilst in line for coffee and making yourself grin randomly into the air like an idiot and have the guy facing you think you fancy him; reminiscing the trip... and making plans for the next one!
What's on Your Love List this Week? Let me know!
Loving you, and leaving you as always!


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The type of treatment you receive will depend on the type of cancer you have. The highly skilled physicians at Antelope Valley Hospital use the latest treatment options, including surgery, radiation therapy and chemotherapy, among others. State‑of‑the‑art treatment options include:
Laparoscopic and Robotic Surgery
Minimally invasive laparoscopic procedures and robotic surgery allow the surgeon to use innovative scopes and other imaging tools to view and operate through much smaller incisions. As a result, most patients experience shorter hospital stays, less post‑operative pain, and faster recovery times than traditional surgeries.
Radiofrequency Ablation
Radiofrequency ablation is a minimally invasive procedure that uses electrical energy and heat to destroy cancer cells. With this treatment, high‑frequency energy is delivered through a thin needle, causing the surrounding tissue to heat up and kill nearby cancer cells.
Chemoembolization delivers chemotherapy drugs directly to a tumor, while minimizing exposure to healthy tissues. Chemoembolization may be used as a standalone treatment or in combination with surgery, chemotherapy, radiation therapy or radiofrequency ablation.


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Earful: July
This post is long overdue. However, I didn't realize how overdue it was until recently when I received a question on Instagram about how I plan my outfits. The truth is I don't plan my outfits but I do rely heavily on accessories to transform my looks into the outfits you all have come to know and love. That brings me to today's subject: earrrrrrrrrrings! The transformative power of earrings is unmatched. They can sculpt a face or break an outfit and because they are being released in so many different contours, materials, and lusters earrings are able to make a dull outfit playful. Below, I've compiled a list of my favorite earrings for the month of July. Each adornment is so different from the next they are apt for any disposition I might be feeling on any particular day.
I present my faves:
I wore these on an extremely warm day this year and convinced people that the sun was causing my earrings to melt (lol @ the gullible). I thrifted these from my job and they caught my eye because of their simplistic curves. They look great with prints and lend an air of excitement to monochromatic looks.
The marbled accessory trend is everywhere right now. I love them because of the nod to the retro. I wear these earrings with everything. EVERYTHING! Technically, they are a print, however, the complexity they provide to a print is second to none. I don't like my outfits to be easily replicated so the more (good) complexity, the better.
What is more ladylike than pearls? The July baby in me can never pass up on a good pearl no matter how dated they can appear at times. This earring encompasses the best of my worlds: modern and distinctive. The gold hoop allows me to still remain this is decade while the pearls are a personal preference I can't seem to relinquish. I wear these all the time with slip dresses and to add a lil' joie de vivre to the austerity.
I got these beauties when I collabed with Lou & Grey and I haven't been able to put them down since. They look good with so many pieces I own and I really appreciate that in an accessorial piece. I like when the pieces I own are multifaceted and Machete is a great retailer if that is what you are looking for. The shape looks different enough to extract compliments from strangers and color doesn't hurt either. The dark green color will be perfect this fall but I'm making sure to get great use out of them in the meantime.


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The Art of Giving & Receiving
Yes, there is an art to giving and receiving.
It's more than just physical gifts—it's a form of energy. We all give and receive subconsciously every day—whether we realize it or not! We give and receive subconsciously through breathing. We must exhale to inhale, and inhale to exhale. We sleep and we wake. We talk and we listen. It's about exchanging energy—which takes form in many different ways.
Consciously taking hold of that energy however, takes practice. It is an art form of sorts, because it requires a conscious understanding of where we exist within the spectrum of those energies throughout the different parts of our lives. Giving and receiving is a part of every day life. When we practice it consciously (and understand how it works energetically), we are able to live more deeply and improve how we exchange energy with others.
It's as Simple as Yin and Yang
Giving and receiving is better understood as Yin (female—receptive) and Yang (male—expressive) energy. According to the Encyclopedia Britannica, Yin-Yang philosophy is as follows:
Yin is a symbol of earth, femaleness, darkness, passivity, and absorption. It is present in even numbers, in valleys and streams, and is represented by the tiger, the color orange, and a broken line. Yang is conceived of as heaven, maleness, light, activity, and penetration. It is present in odd numbers, in mountains, and is represented by the dragon, the color azure, and an unbroken line. The two are both said to proceed from the Great Ultimate (taiji), their interplay on one another (as one increases the other decreases) being a description of the actual process of the universe and all that is in it. In harmony, the two are depicted as the light and dark halves of a circle.
There is both Yin and Yang energy in everything that exists. We all contain both Yin and Yang elements within us mentally, physically, emotionally and spiritually. No on is 100% "masculine" or "feminine". The better we understand these energies, the better we can be at putting balance in our lives and becoming more harmonious.
Examples of Yin and Yang in our Lives
We have all experienced Yin and Yang energies in different ways in our lives. Yin and Yang elements exist even in our bodies! When you're shy or introvert, you're mentally in a Yin state. When you're expressing yourself, you're in a Yang state. The left side of our bodies is the receiving side—the Yin side—and the right side is the giving side—the Yang side (part of the reason we shake and eat with our right hands!). When you inhale, you are receiving (Yin) and when you exhale, you are giving (Yang). These two sides can't exist without each other, just as we can't live without both inhaling and exhaling. That's why it's important to keep both elements in our lives balanced.
Why it's Important
Like I said previously, it's about balance. When we are imbalanced or feel stuck in our lives, we are often times missing Yin or Yang elements to our energies.
Imbalances often manifest as feelings of stagnation or lack of flow. Imbalances can manifest in your love life, friendships, finances, health, and life path.
The reason we become stuck sometimes is the same reason we cannot exponentially exhale or inhale. Life has a rhythm, so we must let go in order to receive, and receive in order to give. So if you're having trouble moving forward in a part of your life, such as making friends, increasing your finances, going through a transition or anything else—ask yourself this question: What do I need to release?
98% of the Time Just Let Go
Around 98% of the time it's just about letting go. With most of my clients who feel "stuck" it's almost always about letting go of something. On the rare occasion, it's about being humble enough to receive help, but again, that's rarely the case. Often times I have a client who is trying to move forward in some way, but they aren't making progress (or finding it difficult to do so). This is because they have elements of their lives that need to be released and cannot be carried with them into their next chapter—these elements in their lives no longer serves their highest good. The things that need releasing can take the form of old friends you've grown apart from, a bad relationship, too much stuff you don't need and even negative elements of your personality that you need to release.
Personal Experiences
I personally had a lesson or two to learn when it comes to balance the Yin and Yang energies in my own life and business. For some time, I had this increasing feeling of restriction in the energies surrounding my business. I felt limited, and I knew something was out of balance—I just wasn't quite sure what.
Slowly, it dawned on me (and Spirit of course gave me some clear signs). It was my prices. My prices were too low, and the restriction was a result of my growth as a psychic, ironically. Initially, the prices I had set were fine when I started out. But I had grown as a psychic since then and they no longer reflected the quality of my readings.
In turn, the readings I gave began to feel restricted. The best way I can describe it is like being a deep sea free diver. I knew I could dive deeper into the reading, but something took the air out of my lungs before I could reach that energetic destination with my clients.
After much contemplation, I not only increased my prices, but stopped doing readings at psychic fairs altogether. I knew I needed to not only be willing to receive more compensation for my readings, but also be willing to give quality readings (readings that weren't just 20 minutes long). Once I took the brave step of increasing my prices, it felt like a weight had lifted. The readings I gave afterwards were even better in quality, and now I am able to help my clients on an even deeper level than before.
Another instance involves our move to Atlanta. Often times in a large move that involves big life changes, like moving from one state to another, we experience a lot of sacrifices in the process. I not only had an experience that helped reshape my identity right before the move, but my husband and I had to sell and throw away a lot of our stuff (we were downsizing).
Many transitions require a form of sacrifice, or letting go, so we can fully receive. After all, how can we take a present if our hands are full?
How to Better Give & Receive
Like I said in the beginning, the art of giving and receiving is about learning where your life is out of balance, and being willing to let go or ask for help in order to re-establish that balance.
If You're Needing to Receive Something...
Let go, simply put.
If you want to receive, you need to let go of something. If it's an emotional thing you need help with, release your worries to God and put your faith in Him. This means letting go again every time you think about it. Make it a habit to put your faith in Him and surrender. Make it a habit to release. This isn't as easy as it sounds, because it requires persistence—and faith. You'll be surprised at how much that indraws positivity in your life.
If it's physical (money, health, job, etc...) let go of physical things. Donate to an ethical charitable organization. When is the last time you've donated old clothes you haven't used in years? What about children's toys from years ago? Does your house need cleaning? Have a yard sale—or donate unused things to Goodwill. All of these actions create a vacuum—a space that allows you to indraw the energy you're looking for.
Other things to consider releasing are friends that no longer serve your highest good. There are countless times I have done readings for clients with abundance hanging over their heads, but the Universe restricts that because they have friends in their lives that are parasites. God/The Universe/Spirit has a tendency to refrain from giving abundance to people with energy vampires, because the abundance is a divine blessing—and not meant for people who would warp or taint it.
So if you're looking to move your life to the next level, inflect. What people do you need to release from your life? Who do you need to set better boundaries with? Limit phone calls and spending time with people who drain you. You have the right to be picky.
If You're Needing to be Better at Giving...
Humble yourself and receive.
I see empaths and moms especially can have a hard time with this. They're so used to giving, and then when they're drained they get frustrated, depressed, anxious and upset with themselves and others because they ran out of gas. Don't be afraid to ask for help. Take a salt bath, or a walk in nature. Ground yourself. Take a nap. Do something for yourself. If someone offers to help you, take them up on it. It's a sign from the Universe that it's time to receive.
This is especially true for empaths—the gentle warriors. They need to stay recharged and fill their own cup if they wish to truly help the world.
In Conclusion
Learn to balance how you give and receive—your Yin and Yang. Paying attention to how you are addressing these energies in your life will allow you to live more deeply, and have a balance on all levels. Understanding these energies takes time, but practice and patience will allow you to move freely between the Yin and Yang in your life—just like breathing.


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Sofia Dress Suit In Navyhttps://www.tmlewin.co.uk/clearance/womens-tailoring/sofia-dress-suit-in-navy-61641B.html
Sofia Dress in Navy
Sofia Jacket in Navy
Additional Information
Product Details
The Sofia dress suit is a modern and feminine approach to formal tailoring. The fitted dress and short jacket are crafted in smart navy for an elegantly understated aesthetic.
The dress is sleek and simple, with a flattering V-neckline and band detailing around the waist. The classic sleeveless design works well as a stand-alone piece for warmer days. With its clean lines and no lapel or buttons, the jacket completes the sophisticated look with a dressy touch.
Both the dress and jacket are made from a blend of polyester, viscose and elastane. Polyester is easy to care for, while viscose is soft and breathable to help keep you cool on busy days. There is a hint of stretch in the fabric for an individual fit.
- 66% Polyester, 28% Viscose, 6% Elastane
- Navy blue
- Buttonless jacket
- Sleeveless dress
Delivery Options
Free Click & Collect - Collect from a T.M. Lewin store in just 3-5 working days and receive £5 to spend in-store. £5 voucher to be redeemed in-store on any purchase over £10 on the day of collection.
Next Day Click & Collect - £4.95 - Order by 12.30pm for delivery to store next day (excludes weekends and orders including an alteration)
Standard UK Delivery £4.95 - Delivery in 3-5 days
Guaranteed Next Day - Order by 4pm - £8.95
International - from £8.00
We hope your purchases meet your discerning standards, but if you wish to return an item and live in the UK, you can send it to us completely free of charge using the free returns label. We recommend you get a Proof of Delivery from the Post Office.
All items must be returned with a receipt or delivery note, in saleable condition, in the original packaging and with all labels attached. Returns exclude altered shirts, underwear, footwear, gift voucher purchases and delivery charges. Faulty items that include altered items, may be returned within six months of purchase.
Please note that hemmed trousers cannot be returned for a refund or exchange unless faulty. If you are unsure of your sizing, we recommend choosing unfinished (36") and visit your local TM Lewin store for your adjustments with proof of purchase. The standard charge for alterations will be £9.75.


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Amber Gamma — It's Time
It's time to open up,
to become limitless.
Broken barriers,
erased erections
of societal perceptions.
Let's get up to 5D,
make ourselves free,
open our eyes so we can see
the fortitude in fragility,
the value in vulnerability,
the angelic in ability,
the erotic in eccentricity.
It's time to propel ourselves
to outer space,
lose all face,
become beings time will never erase.
It's time to grace
the world with our love
that heavenly manna from above
that star stuff
that good stuff
that melt-in-your-mouth tasty stuff.
It's time to upload
your weight load
so you can freeload
off the download
of this exquisite energy,
this sumptuous synergy,
before you spew your elegy
to your past neurology.
It's time to become all that can be,
joining together as a we,
making a strong, solid one,
before our time on this earth is done
It's time to rise,
time to shine,
time to be all and none in kind,
it's time.
Tick tock.
It's time.


text:
Map of Union Missouri MO
Union Missouri MO Map professionally designed by GreatCitees.com. Feel free to remix and share.
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text:
Get creative with balloons and decorate them with ribbon to mimic the look of whimsical hot air balloons.
Read more
While you as well as your bridal party are shooting photos (in between the ceremony and reception), why don't you entertain guests with an array of lawn games for example bowling?
Personalize your outdoor service with aisle runners that have phrases that are dreamy.
Personalize your outdoor space with wreaths that are monogrammed.


text: I've seen a few posts about difficulties compiling/running pvrxxx on 7.0. Are there any instructions out there to do this succesfully? I've seen both that I need the i2c bus patch, and I don't need the i2c bus patch, for example. Is there anything more recent than the content in the ports tree I should download for this port? Thanks, -Jim Stapleton


text: A NEW SPIN ON OLD FAMILY TRADITIONS D ECEMBER 2014 HOLIDAY E DITION HOLIDAY EVENTS Rastelli spreads holiday cheer TAQUERIA & HOT WOK A tale of two lunches HOLIDAY CATERING #LookGoodEatGood ALSO INSIDE featured recipes, champagne pairings, holiday entertaining tips & more! Facebook.com/rastellimarketfresh 856-334-8074 @rastellimarket 710 NEW JERSEY ROUTE 73 SOUTH Mon. - Sat. 7am - 10pm Sunday 7am - 9pm A NOTE FROM RAY & TONY The holidays are a time for family and friends to gather around the table with delicious food, flowing wine and great conversation. While we can't cover all three of those elements, we can provide you with all of the delicious holiday items you need to make the season merry amd bright! Catering. Our fully scalable gourmet catering service is the perfect option for your holiday meal. A house-made menu filled with rustic, festive and budget-friendly options is perfect for hosting your whole extended family. Our chefs and catering team work tirelessly to create a stunning holiday meal, tailored to your needs, with a classic homemade feel. One Stop Holiday Shopping. With everything else you have on your holiday to-do list, food shopping should be easy to check off. Along with our classic roasts and staple groceries, we are featuring some amazing limited edition holiday ingredients that will set your meal apart. Check out our Holiday Shopping List and Featured Seasonal Recipes throughout the store Community Events. Our guests are incredibly savvy and often ask our chefs for tips and tricks to create great meals at home. It is never more important to have an easy, yet crowd pleasing meal than around the holidays. We are featuring some great tastings and events throughout December to help guide you through holiday entertaining from how to season and cook the perfect roast to involving the kids in holiday treat-making. Be sure to take a look at our calendar for a full list of holiday themed events. As always, thank you for joining us at Rastelli Market Fresh. Our goal this season is to do the work for you, so that you can focus on being with your loved ones. We hope to see you soon and throughout the holidays! Ray and Tony Rastelli 2 NEW PRODUCT SPOTLIGHT Talluto's Authentic Italian Food A chef by profession, Joe Talluto enjoyed sharing his passion for Italian Cuisine. Joe's knowledge and appreciation of simple Italian cooking encouraged his hope of opening his own ravioli store. In 1967, Joe sold his family's home in Southwest Philadelphia for $7,500 to purchase a $7,400 ravioli machine, and moved his family of six into a building he owned "around the corner." Just a few of the products in store... •Talluto's Large Round Cheese Ravioli Joe Talluto was 60 years old, and at a •Talluto's Large Round Grilled time when most men his age were pre- Vegetable Ravioli paring for retirement, he was commit- •Talluto's Rainbow Tortellini ted, both personally and financially, to •Talluto's Chicken, Spinach, Feta Cannelloni pursuing his longtime dream. Today, 2nd and 3rd generations of the Talluto •Talluto's Pumpkin Tortelloni •Talluto's Crepe Manicotti family produce over 100 varieties of fresh pasta and sauce with the same •Talluto's Tonnarelli - Pasta alla passion, values, and authenticity that Chittara made the Talluto's brand synonymous •Talluto's Large Round Spinach, with quality and value. Sundried Tomato, Goat Cheese Ravioli 100% extra fancy durum flour, fresh •Talluto's Large Round Ricotta and whole eggs, and a unique process of Broccoli Rabe Ravioli laminated pasta dough make Talluto's •Talluto's Spinach Cream Sauce pasta the lightest, most refined egg •Talluto's Rosé Sauce pasta available. Combining pure, all natural ingredients like whole milk ri- •Talluto's Vodka Sauce cotta and premium product packaging, •Talluto's Arrabbiata Sauce Talluto's promises unmatched quality, •Talluto's Alfredo Sauce •Talluto's Shallot Cream Sauce taste and value. PPG G 3 FEATURED RECIPE Roast: Frenched 4-Bone Pork Roast 2 tsp Salt ½ tsp Fresh Ground Black Pepper 1 tsp Cumin 1 tsp Chili Powder 1 tsp Cinnamon 2 Tbsp Olive Oil Sugar Glazed Pork Roast with Apple Compote Glaze: 1 1/2 cups Light Brown Sugar, packed 2 Tbsp Flour 2 tsp Dijon Mustard 3 Tbsp Cider Vinegar Combine all compote ingredients in a saucepan and bring to a simmer. Cover and cook for at least 60 minutes. Remove thyme sprigs. Preheat oven to 350. Stir together the Salt, Pepper, Cumin, Chili Powder and Cinnamon. Coat Roast generously with spice rub. Heat an oven safe cast iron skillet over medium-high heat and add oil. Place Roast in pan and sear on all sides; turning until each side reaches golden brown (about 4 minutes total). Stir together the Brown Sugar, Flour, Mustard and Vinegar until smooth. Brush evenly over Roast and place skillet on the middle rack of preheated oven. Roast in the middle of the oven until a thermometer in center of the roast reaches 145 degrees (about 30 minutes). Rest 10 minutes. WAKE UP WITH RASTELLI Join us for Breakfast Now you can have every meal with us! Rastelli Market Fresh is open for breakfast daily from 7 a.m.-10 a.m. Get your fill of savory breakfast staples including french toast, eggs, bacon, sausage, potatoes and more. Create your own breakfast sampler and change it up daily. Top it off with a coffee, tea latte or juice from our Java and Juice bar for everything you need to get the day started off right! PG 4 Compote: 3 Apples (Honeycrisp or Fuji), quartered and cored ½ Cup Brown Sugar 1 Cup Sherry 1 Tbsp Fresh Ginger Root 1 Lime, zest and juice 3 Sprigs Fresh Thyme WINE & SPIRITS PAIRING Champagne tasting can be conducted just like a wine tasting. Take a deep breath in to inhale the champagne's aroma. Take a small sip and hold before swallowing to observe flavors. Next, use a cocktail fork (classic) or your finger (fun) to gently release the oyster from its shell. Tilt back and sip the liquor surrounding the oyster. Finally, chew the oyster for maximum flavor and texture experience. The longer you chew, the more sweetness and flavors you'll discover. Before swallowing the oyster, take another small sip of champagne. Swirl the bubbles around; allowing the flavors to work with each other. Suggested Champagne: Zardetto Prosecco Conegliano Valdobbiadene Made from 100% Glera grapes, this Zardetto exhibits true varietal character. The first fermentation takes place after a brief maceration period; enhancing the typically tropical aromas of the fruit. These intensely fruity aromas continue to develop during secondary fermentation, carried out in large stainless steel containers. Crystal clear with a hearty white foam and fine perlage, it delivers fresh fragrant aromas and a delicately soft and harmonious taste; the hallmarks of this quintessential aperitif wine. An ideal pairing with shellfish, white meats and fresh cheeses. Suggested Oyster Variety: Betsy's Cape May Salt Oysters Betsy Haskins of Betsy's Cape Shore Salts has been dedicated to premium quality oysters and sustainable fishery for more than 50 years. Ring in the new year with these locally sourced gourmet oysters. Mangia Bene and Happy New Year! HOLIDAY EVENTS The Nog Off & More Do you have the best recipe for homemade Eggnog? Join us for the first annual Nog Off with Rastelli Market Fresh owner, Ray Rastelli. Judges, including cheesesteak legend and eggnog aficionado Tony Luke Jr., will taste and compare our guests' original recipes with Ray Rastelli's traditional family Eggnog. Stop by to see the competition unfold, taste the best recipes and take an Eggnog Kit home for the holidays. Enter to be in the Nog Off at guest services today! Spread Holiday Cheer all December long with events to make the season bright. From cookie decorating and pictures with Santa (12/20) to Holiday Catering Events as well as Holiday Happy Hour tastings (every Friday from 4-7pm), Rastelli Market Fresh has all of your holiday needs covered! 5 TAQUERIA & HOT WOK Breakfast may be the most important meal of the day, but when it comes to getting you through those last crucial hours at the office, it's lunch that really matters. Rastelli Market Fresh offers a myriad of made-to-order lunch choices from Salads to Sushi, but perhaps our most unique are the Taqueria and Hot Wok. Featuring authentic ethnic flavors from South of the Border to the Far East, both the Taqueria and Hot Wok use time-honored recipes and traditional ingredients that truly represent their heritage. Taqueria Say "Hola" to crisp chopped vegetables, slow roasted salsas and handmade tortillas. These are the zestiest, freshest tacos and burritos north of Mexico. Choose from juicy adobo seasoned Chicken, Pork and Beef or try our Vegetarian and Fish Taco options. Top it your way with an array of salsas from smoky to spicy, store-made guacamole and flavorful veggie slaw or keep it simple with a little queso blanco and sour cream! Plus, enjoy our storemade corn tortilla chips! However you take your tacos, you can be sure that you haven't had one this fresh since your last vacation. Hot Wok Watch as our chefs expertly combine flavors from all over Asia. Get whisked away to Bangkok for classic Pad Thai or visit Hong Kong for traditional Lo Mein...all on your lunch hour! Mix and match your favorite flavors for a unique fusion dish. Sweet and savory are one in the same at the Hot Wok, where pineapple and mandarin orange meet bok choy and baby corn. Add some depth with your favorite meats or tofu and finish over your choice of noodles in a signature sauce. If you weren't hungry for our favorite lunch spots, you should be now. Stop by the Taqueria or Hot Wok to get your midday fix! PG 6 CATERING Our Holiday 2014 Catering Menu is available now in store and online. Choose a few dishes a la carte or let us cater your entire Holiday Feast for an unforgettable holiday meal that allows you to focus on being with friends and family. HOLIDAY CATERING #LookGoodEatGood A recent survey revealed that 66% of families would approve of banning cell phones during meals over the holidays. This means the focus is back on spending quality time together. So, why are you going to waste all of those precious moments in the kitchen? Here's a flashback to last year: Flour on your face. Sauce on your clothes. Aching feet from a full day (or two!) of cooking. The holidays ended and you had no idea where the time went! Who needs it? At Rastelli Market Fresh, our gourmet catering team wants to let you in on a little secret. You don't have to do all of the cooking to have a great holiday meal. Save yourself some prep time with catered options. Our holiday catering catalog allows you to pick and choose dishes that will complete your meal or select an entire menu that your guests will love. What will you do with all of that spare time? Actually take a minute to catch up with friends and family (earning instant brownie points with the in-laws), play with the kids (vying for the title of favorite aunt or uncle) or spend a little extra time perfecting your holiday look (without worrying that you'll burn the ham!) We look forward to catering to all of your holiday needs and helping you #LookGoodEatGood! Happy Holidays! Brittany Rastelli Catering Director 7 DECEMBER 2014 SUNDAY 7 12-5 p.m. Sample our holiday meat & seafood 12 p.m. Café Spice Demo 14 11 a.m. Deli Demo: 1732 Meats 1 p.m. Meet Big Ang, VH1's Mob Wives 21 28 1 8 MONDAY 4 p.m. Taqueria Tasting 15 4:30 p.m. Hot Wok Tasting 22 11:30 a.m. Chef's Corner Demo 2 TUESDAY 3 10 16 17 11:30 a.m. Catering Demo: Holiday Appretizers Happy Hanukkah! 23 THURSDAY 4 5 FRIDAY 6 SATURDAY 12-5 p.m. Sample our holiday 11:30 a.m. 11:30 a.m. 11:30 a.m. meat & seafood Catering Demo: Catering Demo: Catering Demo: Holiday Holiday Holiday 6-10 p.m. Appetizers Appetizers Breakfast Join us at the Med- 9 11:30 a.m. Catering Demo: Latkes & Roasted Cauliflower 11:30 a.m. Catering Demo: Grilled Italian Asparagus & Lobster Mac & Cheese 24 ford Dickens Festival 13 11 4 p.m. 12 12 p.m. 18 19 20 25 26 27 11 a.m. Sweet Noodle KuCatering Demo: Grilled Cheese Oven Roasted Demo featuring gel & Traditional Tzimmes Potatoes & Andrew & Brussel Sprouts Everett Cheese 1-3 p.m. with Bacon & & Vermont The Nog Off Garlic Bread 11:30 a.m. Catering Demo: Scalloped Potatoes & Green Beans with Caramelized Shallots 4:30 p.m. Catering Demo: Stuffed Shells 12-4 p.m. FREE photo with Santa & Mrs. Claus Christmas Merry Eve! Christmas! 30 29 WEDNESDAY 31 We have Did you everything pick up for your NYE your NYE party! champagne? Meet Big Ang, star of VH1's Mob Wives Join us on December 14th at 1 p.m. for a meet and greet with Big Ang! After finding instant fame as the voice of reason with a huge personality on Mob Wives, Big Ang has become the face of the glamorous Italian-American family lifestyle. In October 2013, she launched Big Ang Wines with her Chardonnay, Cabernet and Prosecco quickly gaining notoriety across the country. 1st Annual Nog Off, December 13th Mr. & Mrs. Claus visit Rastelli Market Fresh Bring the kids to the North Pole at Rastelli Market Fresh on December 20th for a photo and holiday treat-making with the real Mr. and Mrs. Claus. Get Social with #rastellimarket & Do you have the best recipe for homemade Eggnog? #LookGoodEatGood this holiday season! Join us for a showdown with Rastelli Market Fresh owner, Ray Rastelli. Judges, including Tony Luke Jr., will taste and compare our guests' original recipes with Ray Rastelli's traditional family Eggnog. Stop facebook.com/rastellimarketfresh by to see the competition unfold, taste the best recipes and take an Eggnog Kit home for the holidays. Instagram.com/rastellimarket Twitter: @rastellimarket 856-334-8074 710 NEW JERSEY ROUTE 73 SOUTH Mon. - Sat. 7am - 10pm Sunday 7am - 9pm


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Nvidia (NVDA) stock skyrocketed from the summer of 2015 until it dropped quickly in the fall of 2018 as investors grew more concerned about the company and the larger semiconductor industry. Now, the chip firm looks to be headed in the wrong direction for its upcoming fourth-quarter and the following fiscal year.
Recent News
News spread quickly Wednesday that SoftBank's (SFTBY) roughly $100 billion Vision Fund sold all of its NVDA shares. The Japanese firm locked in returns of $3.3 billion on its nearly 5% stake in Nvidia. The announcement highlighted Nvidia's precarious position as the broader chip market suffers from US-China trade war worries.
The company has been a leader in gaming-focused graphics chips. Nvidia has in recent years expanded into data centers, cloud computing, artificial intelligence, and machine learning. Nvidia also last year launched new GPUs based on its much-anticipated Turing architecture.
Nvidia said that Turing had received the fastest adoption of any server GPU in history, including from the Google Cloud Platform (GOOGL). But none of this has seemed to matter for Nvidia lately because, like Advanced Micro Devices (AMD) and other chipmakers, it has taken a hit from the downturn in cryptocurrency-related demand. Plus, the chip industry is historically cyclical.
More importantly, Nvidia on January 28 added to the list of Wall Street standouts that dramatically lowed their holiday quarter guidance, along with the likes of Apple (AAPL). The company dropped its Q4 revenue projection by roughly 19% from $2.70 billion to $2.20 billion and said it expects its gaming and datacenter revenues to come in below its previous expectations.
Stock Price Movement
Shares of the graphics chip designer have lost nearly half their value since their October 2018 peak. This massive downturn to close the year hasn't been followed by a post-Christmas rally like other big names such as Facebook (FB). NVDA stock has now plummeted 33% over the last year and hovered at around $153 share Wednesday.
Nvidia's 12-month performance is actually slightly better than its peer group's average decline, which includes Texas Instruments (TXN) and industry powerhouse Intel (INTC). We can also see that NVDA stock has destroyed its industry over the last 25 years, which makes it plausible that this downturn ends up looking more like a small drop in the long-run.
Outlook & Earnings Trends
Moving on, our current Zacks Consensus Estimate calls for NVDA's fourth-quarter fiscal 2019 revenues to fall 18.6% from the year-ago period to hit $2.36 billion. This would mark Nvidia's first revenue decline in more than five years and stand in stark contrast to Q3's 21% top-line expansion, Q2's 40% climb, and Q1 66% jump.
Meanwhile, Nvidia is expected to see its adjusted quarterly earnings plummet over 56% to touch $0.75 a share. Peaking a bit further ahead, Nvidia's fiscal 2020 EPS figure is projected to come in 20% below our 2019 estimate. The big downturn comes on the back of Nvidia's subdued guidance, which sparked a ton of downward earnings estimates revisions from analysts.
The chart below shows investors just how much NVDA's bottom-line outlook has deteriorated over the last 30 days, which is rarely a sign of good things to come.
Bottom Line
Nvidia is currently a Zacks Rank #5 (Strong Sell) based in large part on its negative earnings estimate revision activity. The company is scheduled to release its Q4 fiscal 2019 financial results on Thursday, February 14.
In the end, investors interested in Nvidia might want to wait on the company's Q1 guidance because as CEO Jensen Huang said in a recent statement "Q4 was an extraordinary, unusually turbulent, and disappointing quarter."
Will You Make a Fortune on the Shift to Electric Cars?
Here's another stock idea to consider. Much like petroleum 150 years ago, lithium power may soon shake the world, creating millionaires and reshaping geo-politics. Soon electric vehicles (EVs) may be cheaper than gas guzzlers. Some are already reaching 265 miles on a single charge.
With battery prices plummeting and charging stations set to multiply, one company stands out as the #1 stock to buy according to Zacks research.
It's not the one you think.
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To read this article on Zacks.com click here.


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Novartis is hosting a one day thought-leadership forum on Potentially Preventable Hospitalisation on the 9th October, the day before the formal commencement of the World Hospital Congress.
This session is free to attend by registrants of the 2018 World Hospital Congress.*
Potentially preventable hospitalisations is a critical whole-of-health issue and addressing this problem requires dedicated commitment by stakeholders across the health system.
This thought-leadership forum brings together a diverse group of leaders to engage with attending participants in a facilitated discussion, create connections, spark new ideas and contribute to solving this critical issue.
The day is anchored over four main themes:
1. Models of care and preventable hospitalisations:
This discussion explores the impact of how different models of care across the patient journey could potentially reduce preventable hospitalisations for long term conditions. Examples of key themes will include:
- Role of primary and community care, hospital care and the patient
- The importance in the flow of patient information, such as meds, discharges, referrals, reports
- The role of care models such as the "Health Care Home" (Australia) and "the House of Care" (UK NHS)
2. Patient experience, activation and engagement, and health literacy:
This discussion explores the patient's experiences and their role in engagement and participation from the perspective of preventing hospitalisation. Further, the topic explores patient knowledge, ability, and confidence in self-management.
3. Quality, safety and measureable outcomes:
This topic discusses the importance of quality and patient safety in preventable hospitalisation, along with different approaches in measuring preventable hospitalisation and health outcomes across primary and secondary care. It further discusses the merits and pitfalls of potential measures on cost, benefits, quality, safety and patient reported experience.
4. Interventions, innovations, and strategies (relation to preventable hospitalisation):
This discussion explores the role of innovative technologies in preventing hospitalisation, as well as different strategies (thinking outside the box) that could be considered or have been trialled in different health systems.
You will have the opportunity to exchange ideas and stimulate meaningful debate with some of the country's leading thought leaders in this space.
A provisional detailed agenda and list of speakers are available here.
The "Potentially Preventable Hospitalisations" thought-leadership forum has limited places available and attendance is via an Expression of Interest process. To express your interest, email with your name, title, contact details and a short, one paragraph outline of insights and experiences you wish to share to the day.


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Sociologist Mark Regnerus explored the topic of conflicting values in an opinion piece for the Washington Post titled, "Say Yes. What Are You Waiting For?" Based on sociological research he had conducted on young evangelical Christians, he discovered a tension between the sub-cultural expectation of no sex before marriage versus the normative practice of delayed marriage. He writes:
Sara, a 19-year-old college student from Dallas, equated thinking about marrying her boyfriend with staging a rebellion. Her parents "want my full attention on grades and school because they want me to get a good job," she told me. Understandable. But our children now sense that marrying young may be not simply foolish but also wrong and socially harmful. And yet today, as ever, marriage wisely entered into remains good for the economy and the community, good for one's personal well-being, good for wealth creation and, yes, good for the environment, too. We are sending mixed messages.
According to this article on Regnerus, the argument has generated more than a little controversy. Regnerus is a sociologist at the University of Texas and is the author of Forbidden Fruit: Sex and Religion in the Lives of American Teenagers.
Though this particular conflict is more specific to this group of religious believers, it might make for an interesting class discussion about how values can conflict, especially values that come out of different institutional spheres of our lives. In this case it sounds like there might be tension between basic economic expectations (e.g. get an education, establish yourself in a career, then get married) versus the religious expectations for this group of believers (e.g. abstinence only).
In other words, this conflict might be distantly related to tensions people feel due to the normative expectations between work and home. For example, I feel a constant struggle between my desire to be a good father (e.g. to be involved in my daughter's lives, to attend school events, to know what's happening in their classes, to drive them to and fro, simply to talk with them, etc.) and at the same time to be a responsible professor (e.g. to prepare for class, to grade exams, to provide useful feedback on papers, to be on top of committee work, to continue to write and research, to post on my blog, etc.). Part of the beauty of sociology is that it can help us to open our eyes to possible conflicting patterns and practices.


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Come Grow with Us & Be Part of Our Story
Elder Network is growing throughout Southeastern Minnesota. We serve individuals impacted by the limiting effects of aging, so they have an optimal quality of life. We are talking about all those who surround, support, and love older individuals that are experiencing the limiting effects from aging. We know that these effects not only impact the individual, but their families, friends and neighbors. We want to help everyone have an optimal life as they journey through this aging process. If you think this sounds revolutionary, you're right. If you think it's a little bit radical, we're OK with that. But if you're intrigued by our mission and the possibility of becoming part of it, we invite you to learn more about a career at Elder Network.
What Employees Say:
"Elder Network provides me the flexibility to be a caregiver for my Mom while working. They understand the issues I face."
"I feel like I make a difference every day."
"I love working with older adults, they have the best stories! I always feel that I get as much out of the relationship as I give."
Job Openings
Executive Director, Full Time
Do you have a passion for the elderly? The Executive Director (ED) serves as the chief paid staff employee for Elder Network, a multi-county non-profit organization based in Rochester, Minnesota, whose mission is to serve individuals impacted by the limiting effects of aging to have an optimal quality of life. The ED is accountable to the Board of Directors and is responsible for implementing the organization's programs, day-to-day oversight of staff and volunteers, and managing the organization's finances. A fuil job description is available online at indeed.com
The Board of Directors is responsible for hiring the Executive Director. Please do not contact the Elder Network staff or Interim Executive Director regarding this opening. Applications can be made online at indeed.com We will not review any applications until the application period ends on June 28, 2019. At that time, we expect it will take 3-4 weeks to review applications and conduct initial interviews.
Companions: Part-time
We are looking for Companions, a part-time paid position to support individuals experiencing the limiting effects of aging to have an optimal quality of life.
Responsibilities: Support individuals through going for walks, making meals, going shopping, and other tasks that will optimize the individual's life and support the caregiver in knowing that their loved one has that special attention. The companion is not a health care worker nor a housekeeper instead their role is supportive task accomplishment.
Please contact Holly Brown 507-285-5272 for more information.
Volunteer Positions Available
Male respite visitor/volunteer
Position would support a caregiver to be able to complete some daily living duties like shopping, cleaning, personal appointments or just an opportunity to rest themselves. These companions help the care receiver be comfortable with the caregiver gone or otherwise engaged through active conversation, playing games, making a favorite treat or even going for a ride.
At the moment we have a waiting list of male care receivers and their caregivers that would like to be matched with a male respite companion. Please call Holly at 507-285-5272.
Elder Network Visitors
Elder Network also has waiting lists for friendly visitors in a variety of areas in greater Rochester. The responsibilities for a friendly visitor are mainly social interaction and engagement. Many elders are lonely - their support network may be gone during the day or perhaps they have outlived their friends and their family is not close by.
Men and women are needed for this volunteer position. Please call Debbie at 507-285-5272 for Olmsted County and Barb at 507-452-0580 for Wabasha and Winona Counties.
Peer Support Volunteers
Elder Network also has openings for Peer Support volunteers who are of similar age with perhaps similar aging issues who meet with individuals and support them through this aging journey. Men and women are needed for this volunteer position.
Please call Debbie at 507-258-5272.
Transportation Drivers
Elder Network has openings for volunteers willing to take seniors to their crucial medical appointments. This is particularly important in the winter as other transportation options are reduced.
Please call Beth at 507-285-5272.


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House Flipping Is at a 6-Year High
This piece originally appeared on Money.com.
House flipping. the practice where the same home is sold twice in a 12-month period, is at a six-year high, according to data from RealtyTrac.
Over 51,000 single family homes and condos were flipped in the second quarter of 2016, 14% more than in the first quarter and 3% higher than a year ago and the most overall since 2010. Almost 40,000 investors flipped a house in Q2, also a six-year high.
Why is house flipping back in vogue? "Home flipping is becoming more accessible for smaller operators thanks to an increasingly competitive lending environment with more loan options for real estate investors, who are also benefitting from the historically low mortgage interest rates," said Daren Blomquist, senior vice president at ATTOM Data Solutions.
It's also a sign of an improving housing market. New home sales are at their highest since 2008, aided by low mortgage rates and an improving job market.
Read more from Fortune: It Only Seems Like the Economy Is a Disaster
Not that you should jump on the home-flipping bandwagon. As MONEY has written, the practice was one of the "most notorious drivers of the financial crisis." And while more and more flippers may be financing their purchases, more than two-thirds are using cash.
A recent analysis RealtyTrac ran for MONEY showed that "12% of flips sold at break-even or at a loss before all expenses. In 28% of flips, the gross profit was less than 20% of the purchase price." Not exactly sterling figures.
"As the economy has come back, the [opportunities] to make huge profits have become fewer and further between," Michael Banovac, managing partner of RMB Luxury Real Estate in Phoenix, told MONEY.


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It scans and analyzes entire computers in as little as one second, and cleans computer by several aspects, including junk data on disk, registry, and more unneeded Windows files. Cloud System Booster`s engine is fast and powerful, and it scans deeply and thoroughly than traditional system cleaner and optimization tool. It has two optimization mode, which are one-click mode solution for PC novice and expert mode for PC specialist.


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Travelers could spend their whole time in Dublin wandering around 18th century Georgian houses with brightly-painted doors, strolling through tranquil parks, viewing all the statues lining O'Connell Street and taking in all the new buildings around the Financial Centre beside the River Liffey and still take in the culture and beauty of the city.
Travelers wanting to visit a variety of attractions turn to CIE for an interesting travel experience. CIE tour directors are well trained in the background information of Ireland and enjoy giving their travelers a fun and informative narrative of their destination.
Our experts put together a list of the best things to do in Dublin with CIE.
Trinity College
The Book of Kells is one of Ireland's greatest treasures and is also a European cultural icon. It was created by Celtic monks around the year 800, but was never finished for unknown reasons. The book contains manuscripts of the four Gospels of the New Testament (Matthew, Mark, Luke and John) in Latin, along with other various texts and illuminations.
It's been in the Trinity College Library in Dublin for safe keeping since 1653, and went on permanent display in the mid-19th century.
EPIC: The Museum of Irish Emigration
The world's only fully digital museum, EPIC Ireland uncovers hundreds of stories of adventure, adversity, and triumph of the 10 million people who emigrated from Ireland over the centuries and how they shaped and influenced the world. Travelers will discover family friendly exhibits full of education and entertainment, high tech galleries complete with touchscreens, motion-sensor games and audio and videos to bring these stories to life.
Guinness Factory
More than a million travelers a year tour this famous factory to learn how to pour the perfect pint of this Irish beer. (Hint: It involves holding the glass at a 45-degree angle!) Not only is this the place to learn about the 'black stuff' brewing process, but the top floor Gravity Bar is arguably the best view of the city. During your tour, sniff the raw ingredients, learn about the history of Guinness advertising and, of course, sample some of their beer. Pro-tip: the storehouse is 7 floors and they suggests at least an hour and half to explore the whole facility.
Related: Guaranteed Lowest Prices On CIE Tours.
Dublin Castle
During its lifetime since the early thirteenth century, Dublin Castle has not only been the seat of power and government for the English Administration in Ireland for more than 700 years, it has also been used as a military fortress, a prison, treasury, and courts of law. In 1922, following Ireland's independence, Dublin Castle was handed over to the new Irish government. Today it plays a leading role in Presidential Inaugurations, State Functions and Ireland's Presidencies of the European Union.
As an integral part of Ireland's history, the complex represents some of the oldest surviving architecture in the city. With CIE, you will take a guided tour inside parts of the Dublin Castle.
Temple Bar
For travelers looking for Dublin's nightlife district, this area of town will have all the "craic". They have tourist-focused nightclubs, bars and restaurants. During the day, there are art galleries, theaters and museums for you to explore. This popular area is a great place to soak up local culture in a fun atmosphere.
Don't miss out on hearing some live performances of 'The Fields of Athenry' and 'It's a Long Way to Tipperary' played by high quality traditional Irish musicians. Ask your travel director what pub the locals like to frequent.
Related: Explore Ireland With CIE. View Discounted Itineraries!
General Post Office Museum
The General Post Office or GPO on O'Connell Street is one of the oldest, actual working post office in the world and has grown to one of the top unforgettable Irish attractions. Most famously known as the location of the short-lived Irish Republic as proclaimed by Patrick Pearse, it was left in ruins during the week-long Easter Rising of 1916. It was renovated and restored to the impressive traditional interior it was known for.
If collecting stamps is your passion, the GPO is home to the Irish Philately (stamp collecting) community so, check out the separate side room full of interesting stamps.
St. Stephen's Green
St. Stephen's Green is a historical, 22 acre park in the heart of the city, once owned by the Guinness family. It is a charming green, full of lakes with swans, bridges, a waterfall and lots of places to relax or eat a picnic. Stroll through the sculptures, gardens and trees located throughout the green. This is also a favorite place for locals to go for a jog. Pro tip: The park is closed and locked and dusk, so be sure to be out in time.
Ha'penny Bridge
Built in May of 1816 and spanning the width of the River Liffey over which it crosses, it was an expensive replacement from the ferry service that operated across the river previously. The costs were recuperated through the half penny toll, which gave the bridge its popular name, Ha'penny Bridge.
In 1916, the bridge was handed over to the Dublin Corporation and three years later, the tolls were abolished. For over 180 years, the bridge remained the city's only pedestrian bridge over the Liffey the Millennium Bridge was constructed in 1999. Today, 30,000 people a day walk across the famous bridge.
Visit Ireland with CIE for balanced and varied days of sightseeing with plenty of stops for taking photos, shopping, and eating. View all tours here.


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Oh the weather outside is frightful, (frightfully hot)But the fire is so delightful, (on the screen*)
And since we've no place to go, (cuz of security threats)
Let It Snow! Let It Snow! Let It Snow!
It doesn't show signs of stopping, (the heat is neverending)
And I've bought some corn for popping, (that we do have!)
The lights are turned way down low, (cuz of power outages)
Let It Snow! Let It Snow! Let It Snow!
When we finally kiss goodnight, (but not in public!)
How I'll hate going out in the storm! (it's sunny here)
But if you'll really hold me tight, (but not in public!)
All the way home I'll be warm. (no kidding)
The fire is slowly dying, (on the screen)
And, my dear, we're still good-bying, (we're alone for Christmas!)
But as long as you love me so, (I know you all do)
Let It Snow! Let It Snow! Let It Snow!
*I have a picture of the yule log on my computer screen to give the illusion of a fireplace! It doesn't really work.


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Draft Animal Power – Draft animals and sustainable land stewardship › Forums › Market Place › Buy/Sell Livestock › Team for free lease
This topic contains 0 replies, has 1 voice, and was last updated by jen judkins 5 years, 7 months ago.
- AuthorPosts
- January 1, 2014 at 8:16 pm #81975
jen judkinsParticipant
Once again I find myself in the position to place two really nice horses. I love this team. As many of you know, I take on horses in need of rehab from injuries and such. I always fall in love with these big lugs and hate the day I need to move them on to working situations, but that's part of the deal. So I have a nice percheron team available for work this spring. JD and Ripple. Both have recovered from injuries and will never be suitable for the show ring, but are totally suitable for farm work.
Both horses are 8 or 9. Beginner safe as a team, though would need careful conditioning for full time work. JD works well as a single or as a team. Ripple is rock solid as a team…unconfident as a single (though manageable by someone with experience).
I am looking for a free lease situation. I am not 100% sure this team will hold up to regular work (but am pretty sure they will), so I would send them out to the right situation for the season and make it a permanent situation if it works out.
The perfect situation would be a new market farm where the horses are gradually introduced to more work. These two work well together and are unflappable.
JD is probably the nicest horse I have ever worked with. Rides and drives as a single or team. He came off a farm in NY where Tim Biello worked him on a diversified farm. Shoulder injury. Still walks with a limp but sound at the trot and ready for work.
Ripple came off an Amish farm through the New Holland auction. He is a sweetheart and mischievous by nature. Rides and drives. OCD in the stifles brought him to me. He needs some conditioning, but is a solid working horse.
Please email me or message me if interested. Jennifer. firstname.lastname@example.com
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Over the course of the twenty years that the adidas Predator range existed, the Predator Mania, in the champagne colorway that David Beckham wore in the 2002 World Cup is an absolute standout. This was Becks' redemption after the catastrophe that he experienced in the 1998 World Cup. And he did it in a champagne colored pair of the beautiful Predator Manias.
Fast forward 15 years and we see a super limited edition return of the champagne Predator Manias hit the market again. And this release is an incredible remake of the original.
If footwear has taught us anything it is that limited releases of classic silhouettes that have unique stories associated with them always make a big impact. This particular pair of soccer boots might be the first real example of a brand bringing back a retro performance product that has a real story that ties into the product and the sport at large. And the market went nuts for it (eBay has bids for these between $600-$1000 as of now). We have seen this on countless occasions with Retro Jordan re-releases, but I don't think we have really seen something like this in the soccer world. Until now.
Mark our word, this is going to be something that we start seeing much more in the soccer world.


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Ubukata's hair was grayish in the manga. In the anime it's a shade of pink. Hayase, a brunette in the manga, became a redhead in the anime. Adaptation Expansion: The anime gives several Seiseki regulars small speaking appearances before their former introductions where they were just there in the manga, most prominently Kimishita and Ooshiba picking a fight while watching the first years play and later practicing one on one and fighting over who gets the ball after Kimishita scores a goal.
Celine Outlet When Cream were recording most of their material he was by far the best known member of the band, and he was also their lead vocalist as well as by far the largest contributor in terms of original songs. Also somewhat averted, though, as Clapton's fame has obviously overshadowed his these days, and Ginger Baker has gotten quite a lot of exposure since the band's break up as well. Then again, in a power trio as influential as Cream and consisting of three virtuosos, they're all going to https://www.smilehandbag.com attract quite a lot of attention. Celine Outlet
Celine Cheap Flannery O'Connor lived in rural Georgia in the middle of the 20th century and wrote two collections of extraordinarily realistic short stories and two novels in the course of her very short life (she died in 1964 at the age of 39). From the mindset of her deep Catholic faith; her intimate and perceptive knowledge of the culture, mores, and personalities of the Deep South; and shaded by her long battle with lupus (which eventually killed her), she wove tales replete with deeply dysfunctional, highly flawed, and bizarre characters, many adhering to an unconventional or twisted form of fundamentalist Christianity. And many who died realistic deaths. Celine Cheap
Celine Luggage Tote Replica He names it "Kettle Junior" and he ends up keeping it around for several months. Why a penguin? Because of this trope, essentially. Evil Albino: Cerastes. Extranet Counterattack: Taken to an extreme with Operation Down With Discord. Discori made some postings offering to sell slaves. An army of mercenaries launched a coordinated attack on his base. Oh fuck, the extranet is here Executive Meddling: Temporarily happened in universe to The Life Egregious. Eye Scream: Considering the average forum goer's occupation, bullets and knives to the squishy bits are a distressingly common occurrence. Celine Luggage Tote Replica
Celine Bags Replica Cassandra Truth: The local cops don't listen to anything Ace says and dismiss and ridicule him as just a kooky animal lover. Justified with Lt. Einhorn, because she is the Big Bad. Catch Phrase: "Allllllllrighty then!" To the point that "Allrighty then" is made into his meditation mantra in the second movie. "Llllliiiike a glove!" "Unfortunately, in every contest, there must be. a loser. Lu hoo. zu her." "Ree hee hee hee HEEEEAAAAALLY." Caught on the Jumbotron: Ace beats the crap out of a bird suited mascot on a Jumbotron at the end of the first movie. The reason? He shooed away a runaway pigeon that had a cool reward of on its head. Good news is, it was the away team's mascot, and the Dolphins were yukking it up, along with Melissa. Gets coupled with Description Cut since the announcer introduced him as a lover of all life's creatures just before he got caught. Chuck Cunningham Replica Celine Syndrome: The unexplained disappearance of Melissa Robinson between films. Justified since Ace was in self exile in Tibet for the second film and then went straight to Africa. One would simply assume none of the former cast decided to shell out the cash to leave the country just to join in on the antics. Melissa does appear in Ace Ventura Jr. (played by a different actress), having married Ace at one point and had a son with him. Closer Than They Appear: When Ace sees an angry, baseball bat wielding maniac in his rear view mirror:Ace: Warning! Assholes are closer than they appear! Celine Bags Replica
Celine Replica Death Is A Slap Onthe Wrist: Depending on your timing, you can completely negate the side effects of the above Crisis. Crosshair Aware: The picture for Hunted By The Crime Syndicate (Crisis 3) has this, since this card repeats the current Super Villain's attack on anyone other than the turn player each time a Villain is defeated. Crossover: Enforced. The original box reads: "Compatible with other Cerberus Engine: Heroes games, a common card back means you can shuffle your whole collection together for the ultimate throwdown!" The small expansions are titled "Crossover Packs." Massive Multiplayer Crossover: If you feel like buying all the cards, this is easily possible (though not necessarily very fluid) Celine Replica.


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This blog will talk about scripture, share songs about Christ, and discuss being a lesbian in the Church of Christ. Feel free to walk with, leave comments, and be part of the journey!
Thursday, September 22, 2016
Facebook Church of Christ Group
If you are in the Church of Christ and you want to be part of a group for LGBT because you are or because you support...go to:The LGBT Church of Christ Facebook Group
I will not let in haters, this will be a safe place. So welcome and come on in!
Posted by Unknown at 2:36:00 PM
Labels: Christian, Church of Christ, Lesbian
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I saw this news story today:
NASHVILLE, Tenn., 4/23/08 -- The number of people baptized in Southern Baptist churches fell for the third straight year in 2007 to the denomination's lowest level since 1987. Although the SBC added 473 new churches and gave more than $1.3 billion to support mission activities around the world, there's no escaping the disappointing fact that Southern Baptists are not reaching as many people for Christ as they once did, according to Thom S. Rainer, president and CEO of LifeWay Christian Resources, which gathered the information on the denomination's behalf…Read the rest of this press release here.
I don't know if I have anything interesting to say on this subject and I'm sure I have nothing new to say. But I do want to get some thoughts out there. And thank you for reading.
I love the Southern Baptist Convention. I love my church. And when I see news like this I want to cry.
I know that the SBC is not equal to the church. And I know that Jesus didn't say, "Upon this rock I will build my denomination." I also know that there are many good churches of other stripes, but this feels like a kick in the teeth. I'll restate it. The churches of the SBC baptized fewer people for the third straight year.
Without getting into why I am a Southern Baptist or analyzing lots of potential problems (others will do a great job of that), here is what I see. The tragedy is that we are officially now losing the war for souls. More church members are reaching less people. Which means, simply put, more people will die and spend forever in hell.
I also know that the problem cannot be fixed on a national level or with better leaders. Nobody could do a better job calling for revival in evangelism than Frank Page or Bobby Welch. It must be fixed by individual Christians. Take this test.
- Do I know somebody who doesn't know Jesus?
- Do I know somebody who doesn't know Jesus that I haven't witnessed to?
- Do I love this person?
If you answered yes to these questions, you are officially part of the reason for this news story. I have been deeply convicted lately that I don't witness enough. And I wanted to share.
BTW: If you are reading this and don't know Jesus please read here or here
Feel free to comment.


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Photographic restoration has been done for many years. In the past all work was hand done on the original image, now the work has been moved to the computer. Images are scanned and loaded into the computer, that way the original photo cannot be damaged while it is being worked on. Restoration can help take out dust, dirt, stains, repair rips and creases, and fix faded or discolored images. All work is done with many different tools using Photoshop. Depending on how damaged the original image is, the amount of time (and price) will be different for each item.
Below are samples of finished images I have worked on.
If you or your company has a project that you need work done on, I would be happy to help you. Feel free to click the contact button below for more information.
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Brandon Moore (guard)
Brandon Lamont Moore (born June 3, 1980) is a former American football guard who spent his 10-year career playing for the New York Jets of the National Football League (NFL). He was signed by the Jets as an undrafted free agent in 2002 after playing college football at the University of Illinois. Moore was to sign with the Dallas Cowboys during the 2013 season but opted to retire.
Moore in 2011.
|No. 65
|Offensive guard
|Personal information
|June 3, 1980
Gary, Indiana
|6 ft 3 in (1.91 m)
|305 lb (138 kg)
|Career information
|High school:
|Gary (IN) West Side
|Career history
|* Offseason and/or practice squad member only
|Career highlights and awards
|Career NFL statistics
|Career Arena statistics
|Player stats at ArenaFan.com
College careerEdit
Moore attended the University of Illinois at Urbana–Champaign, where he played defensive tackle. Moore was a starter for the Fighting Illini for three seasons, and was named All-Big Ten in his senior season. Moore graduated from Illinois with a bachelor's degree in English.
Professional careerEdit
New York JetsEdit
Moore signed with the New York Jets as an undrafted free agent on April 26, 2002. After spending time with the practice squad and with the Scottish Claymores, as well as with the Carolina Cobras of the Arena Football League, Moore first saw action in 2003, appearing in three games and starting one. Moore started 13 games in 2004, helping running back Curtis Martin lead the NFL in rushing yards. The Jets released Moore on February 26, 2009; however, he was re-signed the next day.
After being considered one of the top guards in the NFL for several years, Moore was finally selected to his first Pro Bowl after the 2011–2012 season.[1]
Moore is probably most known for his role in the infamous "Butt fumble" against the New England Patriots on Thanksgiving Day 2012. On the play, New York quarterback Mark Sanchez face planted into Moore's rear-end and fumbled the ball, and it was returned for a touchdown by Steve Gregory.
Dallas CowboysEdit
On August 7, 2013, Moore signed a one-year deal with the Dallas Cowboys. Shortly after, he announced his retirement saying that he "could not bring himself to get on a plane and leave his family".[2]
Personal lifeEdit
His brother Julian played football at Central State University in Wilberforce, Ohio.
- ^ "Jets guard Brandon Moore earns trip to Pro Bowl". nj.com. Retrieved 23 January 2012.
- ^ Brandon Moore agrees to terms with the Cowboys, then announces retirement.


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Connected Health Today and in the Future
Vice President of Marketing
The healthcare industry's version of the Internet of Things (IOT) is very often referred to as the Internet of Health Things or, more commonly, connected health. When most people talk about connected health, they're referring to the devices, wearables, apps, and other tools that track an individual's activity or aspects of their health. However, connected health is much more than just a set of devices. As connected health becomes a reality in today's world, a new model of healthcare delivery is evolving with innovative strategies to move care from the hospital or doctor's office into the day-to-day lives of people.
In a recent Datica Healthcare Innovators Podcast, Datica interviewed Joe Kvedar, MD, Vice President, Connected Health with Partners HealthCare. Last year, he wrote "The Internet of Healthy Things," which is packed with real-world information that will help entrepreneurs, innovators, and investors drive the disruption of healthcare delivery. Dr. Kvedar has long been a proponent of personalization in healthcare and is known as one of the greatest HIT influencers in our generation.
"There are still some technology problems to be solved. Chief among them is the ability to normalize the data from all of these wearable sensors so that it makes sense." -Joe Kvedar, MD
The connected health journey
Some aspects of connected health are in play already today and we're only likely a few years away from reaping the full benefits of this connected health journey. Dr. Kvedar described that journey unfolding in three major phases:
- The future is here today in terms of technology. The majority of the technology is ready for this connected, internet of healthy things world, but some roadblocks prevent clinical providers from leveraging some of this new information. Dr. Kvedar offers, "There are still some technology problems to be solved. Chief among them is the ability to normalize the data from all of these wearable sensors so that it makes sense." With wearable technology such as a Fitbit, for example, we can already measure steps and calories, but does that tell us a useful story? Dr. Kvedar explains, "They don't tell a story because no one has been able to translate that data into something that is normalized. So that's a gap."
- Data analysis will become more personal. The second step in the connected health journey involves the ability to take all those data feeds and analyze them effectively. "One thing that is most exciting about those data feeds is that they do represent a unique digital fingerprint for each of us, because we do those things all uniquely, whether it is the way we travel with our phones, or our step counts." Dr. Kvedar says. "The next technical challenge is to be able to harness all of that data and create a unique profile."
- Business engagement. The final part of the connected health journey is the engagement with the consumer to propel action, for example, motivating them to make a healthier choice. This third level is just starting to happen today despite both technical and business model hurdles, although Dr. Kvedar says the business model hurdles are starting to break down. "For instance, United Health Group now offers 100,000 insured people a smart wearable device. If they achieve three kinds of fitness goals during a day, as measured by that wearable device, they get $4.00 added into their health savings account."
Some parts of the healthcare industry seem to embrace the connected health journey faster than others. "Companies like Walgreens are embracing this idea of taking in wearables' data and giving consumers something back in return. They are all seeing improved outcomes as a result," comments Dr. Kvedar. On the other end of the adoption scale are doctors and hospitals. "Docs and hospitals are used to making a living by taking care of sick people and we haven't quite figured out how to reward clinicians for keeping people well or how to reward hospitals for keeping people out of hospitals." Those business model challenges are happily being worked on," Kvedar explains.
Roadblocks to interoperability
Even though the technology is just about there to enable connected health for consumers, there are still major industry changes that need to occur in the area of interoperability. Dr. Kvedar described these biggest impediments to interoperability:
- Proprietary technology. Interoperability doesn't seem to be in anybody's financial best interests. Take a look at technology vendors, for example. "If you are an IT vendor, almost all of them, up and down the stack, whether it's telecom all the way down to database, or even hardware, all of them want to bring you in and upsell you new things. They can only upsell you if they build barriers to others entering their space, and that means that they are doing something proprietary to keep you as a customer," explains Dr. Kvedar.
- Fear of losing patients. On the hospital side of things, resistance to interoperability is primarily driven by the fear of losing patients to competitive hospitals. Dr. Kvedar comments, "From a pure business perspective, why would my hospital want to make it easy for patients to take their data to another hospital and get their care done there? To implement interoperability costs a lot of money. If there's no revenue reward or efficiency award on the business side, why would you do it?" Dr. Kvedar sees one possible way hospitals might get on board with interoperability. "The only way I could conceive of having interoperability become the norm is to have a demand from government purchasers that if you are going to be a government contract, you have to have a certain set of open standards. I don't know if that will happen under a Trump administration, but they certainly are signaling that they wouldn't view the world that way. So, I don't see it happening soon, unfortunately."
Wearables and chronic illness management prevention
With the data available to consumers wearing health technology devices, the potential exists for not only managing chronic illnesses but also helping to prevent them. Dr. Kvedar cites two important considerations:
- Wearables provide a feedback loop. "I like to talk about conditions that don't result in symptoms, like high blood pressure, high blood sugar, high cholesterol, visceral fat — all of those which portend bad outcomes down the line and don't really, on a day-to-day basis, make you feel particularly poorly. In that context, you can think about connected health as feedback loops and motivation." Wearables provide feedback loops since they are giving you data about your life. With a Fitbit, for example, if you haven't hit your step goal for the day, you may be motivated to walk on a treadmill in the evening.
- Raw numbers don't always motivate a lifestyle change. The other part of making feedback useable is motivation. "It turns out there's a bit of paradox at play. A big part of our population doesn't care about numbers. They care about other things. So if you are not a quantitative person, or you are not particularly motivated to change whatever the feedback loop is sending your way, it quickly becomes background noise," Dr. Kvedar explains. That could be why the market for wearables is seeing a decline in activity.
He continues, "The good news is that there's a crop of devices coming out now in the wearables space that give insights rather than just numbers. One of them is the Spire device that tracks respiration but doesn't tell you your respiratory rate; it tells you whether you've been focused or stressed because we breathe differently under different conditions." We may see a rebound in the wearables market as data becomes more meaningful to people with insights rather than just numbers.
How does all this data into a clinician's workflow?
Clinicians today are inundated with data, most of it today within the EHR. Clinicians spend too much time clicking, finding, charting, and checking boxes to document the in-person encounters or manage a workflow. It's hard to imagine connected health data fitting within the clinician's already data-heavy process. Dr. Kvedar suggests this particular journey will unfold in two steps:
- The current state: Innovation practices exist but are not mainstream. Dr. Kvedar sees connected health in play today, but primarily in medical homes. "We have quite a few examples of that in our system, where we are heavily at risk and a lot of our primary care practices are patient centers or medical homes as part of our population health management structure. In those practices, there is someone whose responsibility is the burden of hypertension, just for instance. We will provide that person with a home monitoring for hypertension toolset for the patients that are either difficult to control or newly diagnosed. In any given practice it is not enough of a burden if this one person, typically a nurse and sometimes a pharmacist, is assigned the burden of data. It isn't high enough that they can't afford to get their work done. They check in a couple of times a week and the software flags the patients that are out of parameter and makes it a little bit easier to sort through. Then they involve a doctor if it is a medication change or something that really needs a doctor's input."
- The future state commands an AI layer. Most industries today are already using intelligent analysis software and data science that creates meaning and actionable information from a vast state of data. Dr. Kvedar describes how this might take shape in healthcare. "We are really at the beginning of a new era. Let's say someone has high blood pressure and you've been tracking their blood pressure for the last two months. We should be able to give you a dashboard view that shows what blood pressures are normal when they go up, why they go up. Do they go up at night? Do they go up during the day? Do they go up after a meal? That would give you some real insight into how to care for that patient."
Dr. Kvedar cautions that seeing this all become a reality with physicians is dependent on solving more than just the problems of data overload and dashboards. Here are two other important dependencies to be aware of.
"If you call it decision support, maybe you can sell it. Artificial Intelligence sounds scary." - Dr. Kvedar
- The timing of value-based reimbursement. "We sort of had a rhythm going under the Obama Administration. Will that change? Not sure. Medicare has produced a plan that 50% of payments by two years from now will be value-based. So they seem to be on that curve. Many plans are now doing this but the rate is to be determined. As that happens, the reason we did medical home across our system is because of value-based payments and it makes much more sense in that context."
- Physician resistance to the idea of AI. "On the one hand, we do this in the EMR with decision support. So if you call it decision support, maybe you can sell it. Artificial Intelligence sounds scary. It sounds like you are trying to take my job away from me, so I think it is how you frame it. And, of course, there's the liability issue that goes along with that and how you convince docs into a state where they are not afraid they are going to get sued because there was a data point that they didn't see that didn't go right in the algorithm."
How far off is the future?
Dr. Kvedar concludes, "The pieces of connected health are here today, but we still have to put them together. Some of that will be technical. A lot of it will be business model. Some of it is even societal."
Make sure to listen to the complete podcast interview with Dr. Kvedar for many more insights about connected health, including a look at telemedicine and artificial intelligence.