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While enhanced recovery after surgery (ERAS) protocols are associated with shorter length of stay and improved outcomes in multiple surgical specialties, its application to spine surgery has been limited. Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with a relative efficacy and safety profile that makes it suitable for the application of ERAS principles. Reviewing our outcomes and practice and incorporating evidence-based clinical studies, we propose the development of an ERAS pathway for ACDF.
This is a retrospective review of ACDF cases performed at a single institution by a single surgeon from 2014 to 2017. Primary outcome measures included length of stay, complications, and 30-day readmission rates. The 1- and 2-level and the 3- and 4-level groups were also each consolidated into a single cohort for comparison. A comprehensive review of evidence-based literature pertaining to ACDF was then performed. Best-practice recommendations derived from the literature were incorporated into the proposed ERAS protocol.
In this series of 75 1-level, 77 2-level, 44 3-level and 20 4-level ACDF procedures, the average surgical time (minutes) was 68, 90, 118 and 141; length of stay (days) was 1, 1, 1.4, and 1.7; drain usage (%) was 1.3, 2.6, 13.6 and 10; and 30-day readmission rates (%) were 2.7, 3.9, 4.5, and 15, respectively. Combining the 1- and 2-level as a single group and 3- and 4-level as another cohort, the 3- and 4-level cohort had a significantly higher rate of drain usage and estimated blood loss (EBL) but there was not a difference in length-of-stay, complications or 30-day readmission rates.
Given the relative equivalent safety profile between 1- and 2-level as compared to 3- and 4-level ACDF, the proposed ERAS pathway can be applied to all patients, and not just restricted to 1-level or 2-level ACDF. Taking into account feasibility parameters as deduced from a review of institutional outcomes, this pathway can streamline same-day discharge and improve the patient experience. Its success will be predicated on an iterative improvement process deriving from optimal prospective outcome measurements.
Enhanced recovery after surgery (ERAS) is a multimodal, evidence-based approach that aims to modulate the surgical stress response to accelerate post-operative recovery and reduce morbidity [1]. Anterior cervical discectomy and fusion (ACDF), with its relative efficacy and low morbidity, is increasingly being performed as an outpatient procedure [2]. However, partly due to concern about the higher complication rates associated with multi-level ACDF, in a recent meta-analysis of outpatient ACDF procedures, it was found that almost two-thirds of the outpatient procedures were a single-level, with virtually none undergoing 3- or 4-level ACDF [3,4]. Consequently, we are interested in describing whether there is a difference in our complication rates between 1- and 2-level compared to 3- and 4-level ACDF as to determine whether it is advisable to include 3- and 4-level ACDF in an ERAS protocol. Reviewing our data and outcomes, while incorporating a comprehensive number of evidence-based clinical studies, we developed an ERAS pathway for ACDF.
Materials & Methods
Retrospective data review
Following institutional review board approval, a retrospective review of clinical data was performed on patients that had undergone 1-, 2-, 3- or 4-level ACDF by a single attending physician from 2014 to 2017 for treatment of degenerative cervical spine disease. Exclusion criteria were: less than 30-day follow-up, corpectomy, and those with indications resulting from trauma, infection, or neoplasm. Primary outcome measurements included length of stay, complications, and 30-day readmission rates. Statistical analysis was performed via GraphPad Prism 7 using unpaired 2-tailed t-tests with unequal variances. A p-value < 0.05 was defined as statistically significant.
ERAS pathway design
In addition to utilizing the data conditions from the retrospective data review, a literature review of established ERAS pathways was conducted using PubMed for English articles published before October 2018. The initial focus was broad, and subsequently narrowed to spinal procedures and ACDF. Since there has not been a published ERAS pathway for ACDF, articles pertaining to trial designs, techniques or recommendations with evidence suggesting improvement in post-operative course were selected. Based on available evidence, recommendations were compiled and, together with our outcome data, an ERAS protocol for ACDF is proposed.
1-level ACDF
For patients who underwent 1-level ACDF, there were 75 patients, 49% were males, with a mean age of 51.8 and a mean BMI of 31.5 (Table 1). On average, surgical time was 68 minutes, with an estimated blood loss (EBL) of 17 ml and hospital length of stay (LOS) of one day. Only one patient (1.3%) had placement of a surgical drain, which was removed on postoperative day (POD) 1. Most patients had an unremarkable post-operative course requiring 1-2 days of admission but three patients (4%) had eventful hospital stays, two of which were directly related to the procedure. One patient had dysphagia immediately post-op that improved with steroid treatment. The second patient developed new onset of upper extremity numbness and weakness that self-resolved after 24 hours. The third patient had urinary retention related to traumatic urinary catheter placement. All three patients were discharged home on POD 2 and seen in follow-up with expected recovery. One patient (1.3%) developed a superficial wound infection that was successfully treated with a 14-day course of oral antibiotics. Two patients (2.7%) were readmitted within 30 days following discharge - one was due to chronic obstructive pulmonary disease (COPD) exacerbation and the other was due to gastroenteritis, both of which were managed medically.
2-level ACDF
For patients who underwent 2-level ACDF, there were 77 patients, 43% were males, with a mean age of 55 and a mean BMI of 29.1 (Table 1). On average, surgical time was 90 minutes, with an EBL of 24.8 ml and LOS of 1 day. Two patients (2.6%) had placement of a drain, both of which were removed on POD 1. Two patients (2.6%) had eventful hospital stays. One was a COPD exacerbation and the other a compressive subplatysmal hematoma, which required takeback to the operating room for evacuation. Both patients were discharged within 72 hours post-operatively. There were no wound infections. Three patients (3.9%) were readmitted within 30 days following discharge for medical reasons: hyponatremia, suicidal ideation and acute bronchitis exacerbation.
3-level ACDF
For patients who underwent 3-level ACDF, there were 44 patients, 50% were males, with a mean age of 57 and a mean BMI of 31 (Table 1). On average, surgical time was 118 minutes, with an EBL of 33 ml and LOS of 1.4 days. Six patients (13.6%) had placement of surgical drain, all of which were removed on POD 1. All patients had uneventful hospital stays. One patient (2.3%) had a superficial wound infection that was treated with a 10-day course of oral antibiotics. Two patients (4.5%) were readmitted within 30 days following discharge for dysphagia, which improved with steroids.
4-level ACDF
For patients who underwent 4-level ACDF, there were 20 patients, 55% were males, with a mean age of 59 and a mean BMI of 30 (Table 1). On average, surgical time was 141 minutes, with an EBL of 47 ml and LOS of 1.7 days. Two patients (10%) had drain placement; one was removed on POD 1 and the other on POD 2. Four patients (20%) had eventful hospital stays consisting of significant dysphagia requiring steroids. Three patients (15%) were readmitted within 30 days following discharge. One patient had a wound infection associated with dehiscence that required returning to the operating room for wound revision, followed by a six-week course of intravenous antibiotics. The second patient had a subcutaneous hematoma and dysphagia that was managed with steroids. The last patient had altered mental status and delirium that were managed medically.
1- and 2-level vs. 3- and 4-level
Data for 1- and 2-level were pooled into a single cohort while data for 3- and 4-level were pooled into a second cohort for comparison (Table 2). Demographic variables including gender and BMI were equivalent, except that the 3- and 4-level group was older. In addition, the 3- and 4-level group had a significantly higher rate of drain usage and EBL but there was not a difference in length-of-stay, eventful hospital course, wound infection or 30-day re-admission rates.
A retrospective review of our clinical data over the last four years demonstrates a pattern of practice that is amenable to implementation of an enhanced recovery protocol. For all levels of ACDF, most of our patients are currently being kept overnight. Nevertheless, we make minimal use of drains and our surgical time for 1- and 2-level procedures is less than two hours while that of our 3- and 4-level procedures is slightly more than two hours. There was also not a significant difference in complication rates between 1- and 2- vs. 3- and 4-level procedures. Considering these findings, we believe that the proposed ERAS pathway can be applied to both single and multi-level ACDF, with the goals of accomplishing same-day discharge and improving patients' outcomes.
The pre-operative component of the ERAS protocol aims to optimize the patient's physical and functional status and educate about the procedure and recovery (Figure 1) [5].
Surgical education
Patient education will include pre-admission testing, medication use, peri-operative eating and drinking, expected post-operative complications and discharge criteria [6]. For patients who have recently undergone epidural steroid injections, surgery will be scheduled at least three months from the date of injection to minimize infection risks. A retrospective database was used to compare postoperative infection rates within 90 days in patients who received a cervical epidural steroid injection (ESI) before undergoing ACDF stratified into three cohorts: ACDF within 3, between 3-6 months, and between 6-12 months following ESI [7]. Compared to controlled cohorts, patients who had an ESI within three months before ACDF had a significantly higher rate of postoperative infection. In addition, patients will be provided with surgical site cleansing education. A chlorhexidine gluconate (CHG) solution will be provided for washing the incision site for three consecutive nights before surgery [5]. The rate of compliance will be monitored by asking the patients about CHG use on day of surgery.
Opioid use
Chronic preoperative opioid use is associated with worse outcomes following ACDF [8]. In a prospectively collected questionnaire of 91 patients who underwent ACDF, the use of narcotics on a daily basis for more than six months before surgery was associated with worse outcomes and continued post-operative narcotics use [9]. In another study of 281 patients who underwent single-level ACDF, patients with pre-operative opioid use were less likely to return to work after one year [10]. Moreover, patients with more neck than arm pain were also less likely to improve in overall disability following surgery. Consequently, patients who use greater than 30 morphine equivalent dose (MED) for more than four weeks will be referred to pain management to address preoperative opioid reduction [5]. As simple opioid reduction or abstinence is not likely to happen without provision of viable alternatives to pain management, a multidisciplinary preoperative optimization program for chronic pain patients is necessary to achieve optimal reduction.
In patients undergoing spine surgery, diabetes, both insulin dependent (IDDM) and non-insulin dependent (NIDDM), is associated with higher infection rates, more complications, and greater medical costs [11]. In a retrospective analysis of 3726 ACDF cases, patients with NIDDM had higher rates of urinary tract infection and return to the operating room, while patients with IDDM had higher rates of reoperations, readmissions and length of stay. IDDM was also an independent predictor of increased 30-day readmissions [12]. Moreover, another study of 29 diabetic patients who underwent a single-level ACDF found them to have lower fusion rates, although there was not a significant difference in functional outcomes or quality of life [13]. As pre-operative Hemoglobin A1C (HbA1c) is a reliable measure of chronic diabetes control, patients with HbA1c > 8% or with random serum glucose > 200 mg/dL should have an endocrinology consult to achieve pre-operative glycemic control [5].
Nutritional optimization is an essential component of preoperative preparation. In a retrospective review of 3671 ACDF cases, of which 37% had preoperative albumin measurements, hypoalbuminemia was associated with major pulmonary and cardiac complications, reoperation and longer hospital stay [14]. On the other hand, obesity has not been found to be associated with less improvements in patient-reported outcomes and even morbidly obese patients showed significant improvements in pain, disability and quality of life [15]. A more recent analysis of 277 patients who underwent 1- and 2-level ACDF also showed that higher BMI patients had comparable outcomes, narcotic use, and hospital costs to those with lower BMI [4]. Therefore, although ACDF procedures should be considered for patients across the BMI spectrum, preoperative nutritional consultation and optimization is important to promote recovery, especially in patients with hypoalbuminemia and high BMI (>25) [7].
Smoking cessation is generally advisable to optimize wound healing and improve outcomes. Nevertheless, in a retrospective review of 573 patients (156 smokers and 417 nonsmokers) with a minimum follow-up period of 24 months who underwent a single level ACDF with allograft and a locked cervical plate, no statistically significant difference in fusion rate was found [16]. Moreover, in a large retrospective review of ACDF patients who were either current smokers or non-current smokers, current smoking status or number of pack-years was not associated with increased risk of complication. However, people who have ever-smoked did have a higher risk of developing complications. Therefore, although the association of smoking and poor outcome in ACDF is not as evident as that found in other surgical procedures, a prior smoking history should be considered a risk factor in patients undergoing ACDF [17]. In active smokers, a mandatory smoking-cessation period of four weeks prior to surgery with appropriate aids and counseling should be considered [5].
Anxiety and depression
Patients with a greater degree of depression pre-operatively may have lower improvements in postoperative quality of life outcomes [18]. In those with depression, pretreatment with antidepressants before surgery can improve perception of pain and functional disability. In patients with anxiety, treatment before surgery results in significant reduction in postoperative neck pain [19]. On the other hand, a more recent study of 52 patients who underwent 1- or 2-level ACDF failed to demonstrate a correlation between preoperative SF-12 Mental Component Summary (MCS) scores and improvement in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), or neck and arm pain [20]. While more research is necessary, for patients with an established psychiatric diagnosis, treatment compliance will be ensured prior to surgery to optimize recovery.
The peri-operative period begins from the day of surgery until transfer to the Post-Anesthesia Care Unit (PACU). The goal here is to optimize anesthetic and surgical interventions to ensure optimal convalescence (Figure 2).
Oral pre-emptive analgesia to improve post-operative nausea will be provided in the pre-op holding area. This will include acetaminophen (1 g), gabapentin (100 mg), tramadol (100 mg) and scopolamine patch (1.5 mg). Total intravenous anesthesia technique will be used preferentially while minimizing intravenous opioid [21]. Antibiotic prophylaxis will be administered. To reduce recurrent laryngeal nerve palsy, the anesthesiologists, following placement of surgical retractors, will deflate the endotracheal cuff and then re-inflate until a seal is obtained and when possible, reduce the endotracheal cuff pressure to below 20 mm Hg [22].
Intravenous dexamethasone (0.2 mg/kg) will be given prior to surgical incision to reduce post-operative dysphagia. While the evidence for steroid use is still limited by risk of bias and a small number of studies, systematic reviews are generally in favor of steroid use. A recent review found that the incidence and severity of dysphagia and pre-vertebral soft-tissue swelling are generally lower in the steroid group, while airway compromise and LOS were inconclusive [23]. Complications related to steroid use were rare and fusion rates were comparable.
Foley use
Patients will be encouraged to void before anesthesia induction and Foley catheter will not be placed in those undergoing 1- or 2-level ACDF as the surgical time is usually less than two hours. For 3- and 4-level ACDF, Foley placement is determined on a case-by-case basis, and will be removed immediately postop, if placed. Avoiding Foley use will encourage early mobilization and reduce the risk of urinary tract infection [24].
Early start time
All cases will be scheduled mornings and early afternoon start to facilitate same-day discharge. A retrospective review of 106 patients undergoing ACDF was stratified into two cohorts based on surgical start time: first of the day before 9 am (early cohort), and later in the day (late cohort) [25]. The late cohort was more likely to stay overnight (45% of the early cohort were discharged on the day of surgery, as compared to only 26% of the late cohort).
Neurological monitoring
Intraoperative neurological monitoring will not be used. In a large retrospective review of a national database of patients who underwent a single-level ACDF, neuromonitoring did not lead to a reduction in neurological complications but was associated with an increase in total payments for the procedure and for hospitalization [26].
Surgical drain
Drains will not routinely be placed, as meticulous attention is paid to hemostasis at the end of the procedure. In a study of 43 patients who underwent one-level ACDF divided into two groups with and without drain placement, CT obtained at POD 1 did not show evidence of postoperative hematoma in any of the patients [27]. The group without drains also reported a milder pain level. In a retrospective study of 321 patients undergoing multi-level ACDF, 58 (18%) patients had subfascial drains placed based on surgeon preference [27]. Drain use in this study cohort was not associated with a decreased incidence of post-operative hematoma or surgical site infections; on the contrary, drain usage was associated with a higher likelihood for a post-operative blood transfusion and an almost two-fold increase in LOS. At the same time, it is important to ensure hemostasis of major vessels such as superior and inferior thyroid arteries, external jugular vein and prevertebral venous plexus during surgery.
Cervical collar
While there is some contention that cervical collar can reduce post-operative pain or rates of non-fusion, we generally have not used cervical collar due to concern for skin breakdown, difficulty swallowing, long-term sensory compromise, and general immobility [28]. In a prospective randomized control trial investigating the use of cervical collars following 1- and 2-level ACDF for six weeks postoperatively, there was not a statistically significant advantage as measured by Neck Disability Index scores at one-year, one-year fusion rates, and six-month subsidence rates. As a result, cervical collar will not be recommended.
The post-operative period includes care in the PACU and follow-up after discharge. Emphasis is also placed on direct patient communication after leaving the hospital to ensure continuity of care (Figure 3) [5].
Pain control
Post-operative pain control will employ preemptive and multimodal analgesia instead of patient-controlled analgesia and avoid the use of intravenous opioid. By inhibiting central autonomic hyperactivity with the use of nonsteroidal anti-inflammatory drugs, anti-convulsants, and acetaminophen, pre-emptive analgesia has shown improvement in immediate post-operative pain, anxiety and self-care. Post-operatively, we will use oral tramadol and acetaminophen until every discharge, unless a patient has known hepatic dysfunction [5]. Oral narcotics will be used on an as-needed basis, while intravenous narcotics will be minimized. Patient-controlled analgesia will not be used as multimodal analgesia has been found to be associated with lower narcotic consumption, shorter inpatient stay and reduction in post-operative nausea.
Laboratory studies
As ACDF is associated with minimal blood loss, unless there is significant intraoperative hemorrhage, or the patient has risk factors for postoperative anemia, routine laboratories will not be obtained. In a retrospective analysis of 332 patients who underwent ACDF, postoperative labs were compared with preoperative values [29]. While there was a significant reduction in the postoperative hemoglobin after 1- or 2-level ACDF, no patients required a blood transfusion or demonstrated hemodynamic imbalance. Therefore, routine postoperative labs are unlikely to alter management.
Imaging studies
Routine post-operative radiographs will not be taken prior to discharge, unless there is significant clinical concern. A study compared two ACDF groups, in which one group (n = 109) received routine post-operative XR imaging and the second group (n = 113) received radiographs only when clinically indicated. Routine post-operative XR did not change clinical management or mandate revision surgery. All cases that required surgery or further imaging were identified based on clinical deterioration. The group without imaging also had a shorter LOS [30]. Thus, refraining from obtaining routine post-operative radiographs can minimize radiation to sensitive neck structures and reduce medical costs.
Discharge criteria
Following surgery, the patient will be observed in the PACU for at least six hours until discharge criteria are met. An observation period of about six hours is generally deemed adequate to detect severe complications that preclude same-day discharge. Discharge criteria will include toleration of oral intake, adequate pain control (numeric rating scale <5), prompt mobilization within two hours of PACU arrival, and demonstration of adequate social support and sufficiency for self-care [5].
Follow-up communication
After discharge from the hospital, a member of the surgical team will call the patient within 48 hours to discuss pain management, diet, mobility, wound care, available triage resources and planned appointments [5]. The patient will follow up with both the primary care physician and surgeon within two weeks and then again at three months. Clinical monitoring and questionnaire regarding outcomes will be administered during these visits.
The primary goal of the proposed ERAS pathway is to achieve same-day discharge while improving outcomes for patients undergoing ACDF. Besides being a patient-centered approach and modulating the stress of the surgical procedure, the ERAS pathway could improve process that allows for prompt modification to each step of the protocol based on outcome data. The success of this protocol will depend on establishing a core team of nurses, surgeons, anesthesiologists and ancillary staff, as well as having a receptive institutional culture and the availability of resources.
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Retrospective Data Analysis and Literature Review for a Development of Enhanced Recovery after Surgery Pathway for Anterior Cervical Discectomy and Fusion
Ethics Statement and Conflict of Interest Disclosures
Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Article Information
Cite this article as:
Mesfin F B, Hoang S, Ortiz Torres M, et al. (February 10, 2020) Retrospective Data Analysis and Literature Review for a Development of Enhanced Recovery after Surgery Pathway for Anterior Cervical Discectomy and Fusion. Cureus 12(2): e6930. doi:10.7759/cureus.6930
Publication history
Received by Cureus: January 31, 2020
Peer review began: February 02, 2020
Peer review concluded: February 04, 2020
Published: February 10, 2020
© Copyright 2020
Mesfin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Retrospective Data Analysis and Literature Review for a Development of Enhanced Recovery after Surgery Pathway for Anterior Cervical Discectomy and Fusion
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John W. Freiderich is an applied technology scientist at the Y-12 National Security Complex. He specializes in the advanced processing of non-radiological and nuclear materials. His scientific areas of expertise include electrochemistry, ionic liquids/molten salts, aqueous solution chemistry, and various spectroscopic methods. Freiderich has developed and patented technologies related to the improvement of consumer-relevant materials and processes during his tenure. These technologies include rare earth extractive metallurgy, mineral electrowinning, high-throughput molten salt reactor material production, advanced sensor development, and electroplating methods. He holds a Ph.D. in radiochemistry from Washington State University and a B.S. in chemistry from Minnesota State University.
Ashley Stowe's technical expertise in novel materials spans from energy storage to ionizing radiation detection. He has numerous publications in development of chemical and metal hydride systems as well as radiation detection materials for handheld and imaging applications. He also has expertise in materials compatibility and aging as well as instrument and method development for the characterization of associated chemistries. He was previously named a Y-12 Technical Fellow and Director of the Nuclear Forensics and Detection Initiative. In that role, he acted as a technical lead, coordinating technology transfer activities and leveraging university partnerships for radiation detection technologies. Stowe holds 15 patents, has authored more than 70 publications, and was recognized with a 2013 R&D 100 award for his pioneering development of the 6LiInSe2 semiconductor radiation detection crystal. He holds a Ph.D. in physical chemistry and an MBA. His research interests include materials development, spectroscopy and materials characterization, crystal growth, radiation detection, and high energy radiation imaging.
Dr. Washington currently serves on multiple committees both at SRNL and in the Aiken community. These include the Conduct of R&D safety council, Diversity Board of Directors for SRNS, and the former Board of Directors Chairman and current member for Habitat for Humanity. He is an also an Adjunct Professor at USC Aiken in the chemistry department.


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BINA Gap Year is a life-changing 10-month experience that combines communal living with Israelis, experiential learning, hands-on volunteering, travel, and leadership training – with tracks in Tel Aviv and Haifa!
Live in Tel Aviv, Israel's most exciting city. Go in-depth with classes from the Jewish bookshelf. Torah, Talmud, philosophy, contemporary Israeli society, Jewish identity and more – with optional college credit! Take trips around Israel and immerse yourself in Hebrew as part of an Israeli Mechina – a leadership program for Israeli peers.
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TEMPO.CO, Jakarta - Facebook Indonesia has sent a clarification through a letter dated April 25, about the demands of the government. The letter is an answer to the second warning letter sent by the government on April 10.
In the letter, Facebook claimed to have restricted the access and ended the third-party applications, such as CubeYou and Aggregate IQ.
"Facebook is currently investigating the third-party application," said the director general for applications and informatics at the Communication and Information Ministry Semuel Abrijani Pangerapan, today, April 26.
Read: Minister Rudiantara No Answer from Facebook
As for the audit process, Facebook stated the process is underway and might take times. The social media platform built by Mark Zuckerberg promised to inform the progress of the investigation to the Indonesian government.
In addition to the letter, Semuel got a report that Facebook official is said to be visiting Indonesia as to explain the development progress face-to-face to the Communication and Information Ministry.
Semuel added the government is struggling to prevent further personal data misuse by holding a socialization to the public. "The government also quicken to final the draft bill (RUU) of Personal Data Protection to be then submitted to the House of Representative (DPR)," he said.


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FSSAI Assistant Mock Test PDF-4: Food Safety and Standards Authority of India (FSSAI), hereinafter referred to as 'Food Authority' is a statutory Body under M/o Health and Family Welfare. FSSAI has been created for laying down science based standards for articles of food and to regulate their manufacture, storage, distribution, sale and import to ensure availability of safe and wholesome food for human consumption to 130 crore citizens of the country. In this post, we are providing you FSSAI Assistant Free Mock Test PDF. You can download PDF from the link given below.
Here are some sample questions. You can download Complete Test Paper from the link given below.
1. What does FSSA stand for?
a) Food Security and Standards Act
b) Food Safety and Standards Act
c) Food Standards and Security Act
d) Food Standards and Safety Act
Ans: b,
2. What does FLRS stands for?
a) Food Licensing and Regulations System
b) Food Licensing and Registration System
c) Food Licensing and Recording System
d) Food Licensing and registration Society
Ans: b,
3. What does FSMS stand for?
a) Food Security Management System
b) Food Safety and Management Scheme
c) Food Safety Management System
d) Food Security and Management Scheme
Ans: c,
4. The officer appointed under section 36 of the Act is called.
a) Food Safety officer
b) Designated Officer
c) None of these
d) Both a & b
Ans: b,
5. The officer appointed under section 37 of the Act is called
a) Food Safety Officer
b) Designated Officer
c) None of these
d) Both a & b
Ans: a,
6. What does CAC in section 11 of FSSA stand for?
a) Codex Administrative Committee
b) Codex Alimentarius Committee
c) Central Advisory Committee
d) Central Administrative Committee
Ans: c,
7. P in HACCP stands for
a) Prevention
b) Pollutants
c) Points
d) Peaks
Ans: c,
8. MFPO stands for
a) Meat Food Products Order
b) Meat Fruits Products Order
c) Meat & Fowl Products Order
d) None of these
Ans: a,
9. EOPO Comes under
a) Essential Commodities Act
b) Meat Food Products Order
c) Fruits Product Order
d) None of these
Ans: a,
10. AGMARK stands for
a) Agricultural Grading and Marketing Act
b) Agro Industry Grading and Marketing Act
c) Agricultural Grading and Management Act
d) None of these
Ans: a,
11. Which is the shortcut key to jump to the first slide of the presentation?
a) Home
b) Alt + Home
c) Ctrl + Home
d) Shift + Home
Ans: c,
12. To select more than one slide in the presentation, ______.
a) Just Click on slide
b) Ctrl + Click on slide
c) Alt + Click on slide
d) Shift + Click on slide
Ans: b,
13. To place something in the same position on every slide of presentation automatically, insert into ______.
a) Slide master
b) Notes master
c) Handout master
d) All
Ans: a,
14. Can edit an already inserted embedded organization chart object by _____.
a) Double Click on the organization chart object.
b) CTRL + Click on the organization chart object
c) SHIFT + Click on the organization chart object
d) Single Click on the organization chart object
Ans: a,
15. Shortcut key to insert a hyperlink in a slide _____.
a) Ctrl + H
b) Ctrl + K
c) Hyperlinks can't be inserted in slides
d) Alt + K
Ans: b,
16. To draw the Square box in the slide by selecting rectangle tool and _____.
a) Holding CTRL & Draw
b) Holding ALT & Draw
c) Holding SHIFT & Draw
d) All of the above
Ans: c,
17. What is the maximum zoom percentage in Microsoft PowerPoint?
a) 100
b) 200
c) 300
d) 400
Ans: d,
18. Microsoft PowerPoint can insert objects from the following add-ins?
a) Equation Editor
b) Organization Chart
c) Photo Album
d) All of these
Ans: d,
19. Which type of template provides a design concept, fonts & color scheme for presentation?
a) Format
b) Design
c) Content
d) Normal
Ans: b,
20. In Normal view, this tab displays the content of each slide.
a) Slides
b) View
c) Sort
d) Outline
Ans: d,


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Smartstream's Consumer Education Program
Smartstream works with Qlicksmart to educate healthcare workers on both the importance of staff and patient safety, and how Qlicksmart products can help institutions to comply with regulatory standards. We are happy to share the resources and information we've collated and produced with Qlicksmart distributors for your sales team's use in the field.
Sharps Injury Statistics
Infographic on sharps injuries around the world.
Video infographic summarising the facts surrounding sharps injuries and their prevention using the latest CDC statistics.
Sharps Injuries: What can you do?
Brochure focusing on the costs or scalpel injuries, and the Qlicksmart solution.
UK version.
USA version.
Staff Safety and Why We Ignore It
This powerpoint describes the reasons behind general negligence among healthcare workers in regards to sharps safety and possible remedies to address this pertinent issue.
Blame-worthy Phenomenon in Sharps Injuries Among Nurses
This poster presents Dr. Michael Sinnott's observation of the "Blame-worthy" phenomenon in sharps injuries among nurses who blame themselves when they are injured.
"Scalpel Safety": Will Surgeons Ever Willingly Comply?
This poster describes the issues and misconceptions about Safety Scalpels and evidences that traditional scalpel handles, which are preferred by 95% of surgeons, is superior and safer than the former.
Sharps Injuries – Why I am to Blame!
This poster illustrates the possible causes of high incidence of sharps injuries in Australian hospitals and a cultural shift by both management and staff is required to change the current practices.
*Presented at the American Psychological Association Conference, Denver, Colorado, August 4-7, 2016
Useful Websites
Qlicksmart's Blog provides pieces on consumer-targeted information, safety updates, and medical news.
Staff and Patient Safety website was developed by Dr Michael Sinnott as the medical, nursing, and allied health professional forum for those dedicated to staff and patient safety.
Standards and Guidelines
Safety legislation and regulations surrounding sharps and needle stick injuries were introduced to protect healthcare professionals from blood borne diseases, and healthcare institutions from injuries' costs.
Qlicksmart products have been designed to help hospitals comply with legislation and regulations from the USA, Europe, and Australia/NZ. See below for a summary of these relevant regulations.
OSHA Regulation 29 CFR 1910.103 mandates each healthcare establishment has to establish an organisational bloodborne pathogen Exposure Control Plan (ECP). An ECP must be designed to eliminate and minimize employee exposure to bloodborne pathogens. The ECP must be reviewed yearly, technology used to minimise exposure to bloodborne pathogen must be documented, and a copy of the ECP should also be available to all employees.
When planning for an ECP, an employer should consult employees responsible for direct patient care, for example nurses, who are potentially exposed to injuries from contaminated sharps.
Furthermore, this regulation provides specific provisions on handling sharps, such as recapping or removal of needle that must be accomplished through a one-handed device, and that re-usable sharps should be placed in puncture-resistant, leak-proof containers.
The cost of violating these requirements can be severe. Currently, OSHA fines hospital and healthcare providers for sharps injury violation at USD12,675 per violation, and USD12,675 per day if the hospital fails to abate the violation. In 2016, 12 UPMC hospital faced $451,000 fine for mishandling untreated medical waste, including body dressing, needle and body fluids. A repeated violation? Get ready to pay 10 times more, at $126,749 per violation. The fine does not include fines from other agencies.
In Europe, Directive 2010/32/EU outlines a framework agreement to prevent sharp injuries in the hospital and healthcare sector. The agreement is signed between European Hospital & Healthcare Employers' Association (HOSPEEM) and the European Public Services Union (EPSU). This agreement is applicable to all workers in the healthcare and medical industry.
This agreement aims to:
- Protect workers at risk,
- Achieve the safest possible working environment for employees in the hospital and healthcare sector,
- Prevent injuries to workers caused by sharp medical objects and instruments
- Set up an integrated approach to assessing and preventing risks
- Training and informing healthcare professionals
Fine enforcement from the Directive varies in individual member states. For example, in Ireland, a person who commits an offence under the Directive can be fined up to €500,000 or imprison for a term not exceeding 3 years, or both. In the UK, Worcestershire Acute Hospital was fined £12,500 plus £9,000 costs after an employee was infected with Hep C from a needle stick injury.


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As you brainstorm just what you would like to convey in your letter, remember ways to structure your ideas depending on the recommendation letter template explained previously. Ideally, a lawyer's letters will provide a detailed picture of the qualities and accomplishments as opposed to replicating precisely the same points repeatedly. If you're writing a letter for 1 applicant for the specific fellowships, take note that committees will look to determine which student seems to be favored.
One, she wishes to understand who the letter is about. A recommendation letter part of the majority of scholarship programs. A letter of recommendation is tailored depending on the job or position involved along with the guy or woman who is being recommended. Therefore a recommendation letter is not too formal. However, it still must be succinct and semi-formal. Apply to Experts abroad it is a formal letter, therefore it is not the type of record to get creative with. A pupil recommendation letter is a substantial document which needs to be treated with worth in order for it to serve its favored purpose effectively.
You can decide to start your letter as visually as you want, but all introductions shouldinclude certain key info, since you'll see within the next segment. A letter of recommendation is very similar to a letter. It is, in essence, a business letter and must be composed using a business format. Writing a recommendation letter for somebody else is a really major responsibility, and receiving everything right has a significant role in that individual's future. In brief, if you prefer your correspondence to endorse a powerful and positive image, make sure it doesn't sound insincere. A correctly written letter may produce the livelihood of someone. Provided that the correspondence contains the candidate's qualifications and individual attributes, it's going to be a persuasive argument in their favor. Permit the person know you've submitted the recommendation letter. While the perfect recommendation letters are unique to each student, they all share certain key characteristics which make them effective.
Supply a pre-addressed, stamped envelope to make it easy for the guy to send the letter once it's written, with no out-of-pocket price. The recommendation letter elucidates strong justification to assist you to get the opportunity. If you must request a individual to write a letter of recommendation for your benefit, it is best to put your request . You're able to save your bills, clients and company setting by making an account. Pick the order that you want to produce an invoice from. An invoice must state it is a statement on the top layer of the bill. Every invoice you send should have a identifying number, and duplicate numbers should be averted. A subcontractor invoice is largely employed by the contractors that are hired to furnish services using a limited company or other builders to work on several distinct tasks. A superb subcontractor invoice must contain a couple of compulsory items to be shown on it can form a nice and reasonable invoice.
You will discover lots of statement generating software online that could automatically generate your invoice slip. Then, the holdback sum is subtracted from the simple statement amount. Invoices aren't the specific same as receipts. Not only can they differ based on the company, but you can also expect differences based on the industry you are in and sometimes even the nation. You will be able to see how the final statement will appear. The last invoice amount is going to be the specific same or close to the sum on the pro forma bill. An Invoice acts as a reception and may function as sole proof of a transaction. Overall the invoice needs to be made in such a manner that even after placing all of the particulars of this transaction, it appears sophisticated. An individual may obtain an assortment of professionally prepared invoices from web.
Together with the bill number, it may be utilized to distinguish invoices. In case you are also searching for some professional designed together with free of cost bill to prepare your own small business invoice, you are able to procure an entirely Free Invoice Template from our site. Invoices are required for the majority of companies. How a Car Dealer Invoice Is Calculated The dealer invoice includes the purchase price of the automobile itself, in addition to any additional option bundles. There are various varieties of bill templates easily available, and they're produced in Microsoft Word so that individuals find them simple to edit and prepare their required invoices by including business information and logo. A blank statement template is merely a template where full information about an item can be filled to change it in an invoice. As with other traditional invoices an online invoice templates include a header section and a diagram in its physique. You will download the on-line invoice templates in a really nominal cost from reputed sites. Over 321 totally free invoice templates that you may download and print. Free bill templates are a fantastic technique to begin, but it requires more to run a business enterprise.
Sending detailed, professional statements for your company is the most straightforward approach to eventually become paid the appropriate manner by your customers. When put to great usage, data from invoices can actually be useful in targeting the proper marketplace or people. You also don't have availability to the complete assortment of styling alternatives offered in Word. It's likely to see whether a client has seen or paid your bill in actual moment. To achieve abiding your invoices accommodate the suitable advice and attending able (and also to conserve time), you need to use a chargeless balance arrangement or internet invoicing software such as Square Invoices. It is essential to make a suitable invoice to earn the trade clear.
All our bills are incredibly professional. So invoices are extremely vital for practically any sort of business. Some statements might be more comprehensive than that and could consist of payment terms or other order-specific particulars. This means you can produce stylish, proper, correct invoice for your business. Fundamentally an invoice contains some info linked to the services provided by your organization. It's possible that you save your invoices, clients and company setting by making an account. A sales statement is an industrial tool that comprises the itemized details of their goods or services a customer must cover. It's possible to easily create your invoices by utilizing invoice template. Invoices are not the same as receipts. So invoices are extremely essential for any sort of business. Creating an expert freelance invoice is crucial to the achievement of your enterprise.
Letters are quite essential for all kinds of communication and everyone really needs the ability of writing it into their native language. Ordinarily, the letter functions as a typical stationery sheet for a company, reflecting the corporation's branding, including and logos or distinctive images. Knowing the right business letter format, the pieces of a company practicing and letter writing is crucial to successful small business correspondence. In many cases, the business letter is the initial impression so that it's important to guarantee the content is accurate and free from errors. Composing a professional small business letter is a vital portion of business communication. A clean, professionally designed letterhead is perfect for smaller companies. No matter what type of business you're running, you desire a well-designed letterhead.
Although you need letterhead that's unforgettable, the most significant consideration to bear in mind is that your name and contact information are easy to find and read on the webpage. Try to bear in mind that the letterhead will ought to be professionally printed. A specialist letterhead is a compulsory item for just about any organization. Your organization letterhead is frequently the very first prospect for the audience to maintain your business identity in their palms. It is easy to create your personal letterhead based on among our many expert design that features all of your organization's information!
A personalized letterhead is a opportunity to bring a small bit of colour to your business communications. Ordinarily, a letterhead involves the title of your enterprise or organization (or your name) and your organization speech. The business's letterhead is often an official means to earn an incredible first impression. When you decide to design a new business letterhead, you're going to wish to be sure your other substances such as envelopes, business cards and even the website are consistent in the way they portray the brand. A letterhead is used to offer written communication a professional look in formal correspondence. Sending a letterhead as opposed to a normal piece of newspaper can actually make a big difference.
In case the item is an upgrade, you may need your promotion requirements to tackle the changes. Marketing, the same as all other companies, calls for its own different set of business documents. Work together with the product designer to provide your marketing sufficient depth to consult the audience with this gadget. For example, if your business is finance-related, you may need to say if you're a member of the Financial Conduct Authority. If you are in the company of sport, the chances are that you are perpetually seeking new customers. The organization letterhead template plays a substantial part in corporate. Therefore, you might choose to work with the item developer or service provider to set up a marketing requirements document. To be able to edge in front of the contest, you would like to make sure you have all of the files that include as much as an expert marketing and advertising operation.
Next, you have to actually set a record for printing. It's likely to find our templates . Today, a great deal of individuals are also choosing letterhead templates for personal usage. It's possible to use templates to design your letterhead, but you want to always use a distinguishing business logo to reflect professionalism. Especially in the event that you begin with a business letterhead template.
Whenever your design has movement, people are more inclined to check at it. Just be certain it includes enough contrast so that the text stays simple to read. A beautiful, memorable bespoke letterhead layout is a substantial method to boost your brand and showcase your own design skills at the specific same moment. No matter which kind of business you have, brand value is a substantial factor of your business image. You can search through our examples of business letterheads and find the perfect one for you! To fall under the domain exclusion, but the usage of the deceased or retired partner's name needs to be permitted under the law related to someone's property worth in the industrial usage of her or his name. Make certain that the printing and paper technique you pick works with the copier that is frequently employed by employees.
Your emblem is often the very first impression you're in a position to create to your clientele and will be the face of your business. A basic logo ought to be resized and adapted to several advertising materials. Use completely free images and graphics to visually describe your goods and services until you have a custom-made logo of your own. A logo isn't only part of letterhead. When you own a logo that's very likely to use up a great deal of room on the webpage, positioning it correctly can really make a difference in the effect of your own design. Logos and letterhead printing are a few of the high marketing and marketing tools that could possibly be utilised to make the brand identity to your enterprise.
Resumes are available in many formats, despite the fact that they share typical sorts of data and attributes. Understanding how to tailor your resume will clearly offer you an advantage. Let's begin by seeing the 3 key types of resumes and that would be ideal for you. If your resume surpasses one particular page, make certain your name and contact information will be listed on top of every page. Broadly speaking, there are just three unique forms of resumes that are well recognized in the business enterprise. Writing a resume for job in the art business can be difficult. Simply make sure, whichever format you select, which you are targeting it for the job which you are applying to. If you don't happen to be a graphic designer looking for employment, there is no need to over think the design of your one-pager. It is quite tricky to get a fresher to get work, so likely everything is dependent on the specific's resume. Whenever you are asking for work, it's mandatory that you submit a resume. You have got a job that you love and now's the opportunity to make it occur! If you are trying to obtain work in accounting or finance you need averystrong resume.
Lets say you have learned plenty of abilities and you've got the resume content to show for it. Because your abilities and employment history will consume the majority of your resume area, you can want to get rid of optional segments such as volunteer work or identifying interests. For some jobs, you will want to highlight particular skills, while others, you're wish to demonstrate related experience. The excess skills can be in agreement with all the job or entirely different. You use your finest skills which are about the task as subheadings.
Since you wouldn't have lots of specialist experience, it might be hard to set your resume things into skills. If work experience is not your crucial highlight or whether you've got an inconsistent work history, its finest advisable to begin your resume with your own qualifications. If you do not truly feel totally comfortable in your understanding of resume writing it's very simple that you break the accepted standards in resume formats. Make certain you highlight technical knowledge and certifications. It's likely to get ideas about what to include, along with insight in the very best performing formats for specific positions. If you get a significant assortment of honors or awards, a more different category is most likely appropriate. It is always sensible to be as specific as possible so as to share information that might really convince employers that you are worth their time. If you do not provide the advice needed for the hiring agency to find out your qualifications, you may not be considered for the job.
Beneath, you'll find examples of several attorney resumes to help you locate the best one for your own circumstance. The work description may also make a difference. You should modify every resume that you send out dependent on the job description. If you're smart enough to tailor your resume to the work description, then it's not difficult to direct the attention of the recruiter to where you desire. After you format your resume you would like to make certain that your leave enough margin area to allow for printing. Straightforward resume formats help you in making your resume. There is not anyone golden resume format. Then consider a few essential questions to allow you to clarify which format would be great for you.
Therefore, for people who have a resume that isn't within an ATS-friendly format, it's probable you will not be contacted for a meeting. In that case, then the reverse chronological arrangement could be perfect for your resume! At length, it does not really supply the ideal format for those who have zero expertise. There are lots of distinct procedures to format your resume. Have a peek at the examples to choose which format is most acceptable for you. Simply have a look to specify which format you need to use. As mentioned before, you want to decide on a resume format that is suited to your personal profile. Part of creating an effective resume is choosing the ideal format to notify your personal story. If you're interested in an infographic format, below are a few infographic samples to check out. Most formats for lawyer professional documents incorporate similar sections, even in the event the order is slightly more different.
Most resume templates may be used to apply for several types of tasks. You might also download totally free templates out of our Resume Library to get going on your resume. Resume Templates also make sure to don't miss out any sensible bit of information about yourself that can be significant for the corporation. There are cover letter samples and templates as well which will teach the crucial people how to write an outstanding cover letter which will boost your odds of success.
With freelancers you've got flexibility to answer quickly and you are simply paying the freelancer when they are working on one of your endeavors. The flexibility of having the ability to quickly hire several freelancers just when they are needed is a compelling reason to incorporate outsourcing in your own organization. The most significant advantage is that you don't have to be worried about losing your keys and getting locked out.
1 case of science fair projects is to find out which type of impact music will have about the increase of plants. An example might be as straightforward as their location. In your writing you have to determine how far would you like to select your example of analogy. Hopefully this case of analogy will help you. There is not anything like a situation of analogy to help you in your songwriting. Just commit to completing one section at the same time and decide on a desire to finish a couple of segments per day and in approximately 5-7 days you'll have completed your entire project dependent on the number of articles you desire to include.
The available projects are continuously updated and it simple to observe that the jobs and rates provided. Simple science fair projects are excellent when you have a limited quantity of time to complete themor in case you only wish to do a fast project for pleasure. It's apparent that graphic design is growing more important and making lasting relationships with contractors and salespeople is important if you would like to have the ability to benefit from the market opportunities they represent. It's extremely important to get it written even in case the project appears clear and simple. There are lots of projects that have a project rate rather than an hourly rate so it may be a bit difficult estimating the period that the endeavor could require.
Well, needless to say, you always have the choice to make your own experiments just so your middle school science fair projects stick from the remainder of the contest. The above mentioned homeschool curriculum experimentation will supply you a fantastic idea about how ball bearings are employed in machines that are simple to cut back friction. Pedaling technique is just one of the most vital aspect where injuries may be avoided. By branding your picture, you are identifying your presence in your area. Total explanation of instruction is beyond the reach of this discussion. As you're writing your outline you may find you will come up with a variety of ideas for future products and or items that you could promote with your small report. The intelligent door locks include a touch-screen that's quite easy to use, in which you've got to form a code rather than adding a key to unlock it. Besides lock systems that are reliable, ensure you also get door and window detectors to fortify the security of your house. You can block the alarm from your mobile phone. Home security ought to be at the peak of the priority list for everyone who cares about the safety of their nearest and dearest. Window Alarm Sensors You might have all the safety systems on the market, but in case your doors and windows are not well secured, it's very likely your house will nevertheless be broken into as you are gone. This homemade easy machine is a sort of a lever which can assist lift a ping pong ball and assorted heavy objects.
There are several sorts of credit it is likely to use to perform arbitrage. You have pay off your debt in order that it will not damage your credit rating. On-line payday loan is an ideal example of debt which will potentially request payments bi-monthly or according to your paycheck . At any time you have more cash in the ending of the lighter months you are going to have the ability to concentrate on paying down debt or creating a savings accounts. It is crucial that you are wholly conscious of who'll be getting your money. It's easy not to devote additional cash. Microsoft Money is a case of bookkeeping programs that are available to businesses today.
The graphic design market has been expanding with picture design being a substantial part any provider. Charge card companies send convenience checks to some couple of their clients from time to time. By means of example many businesses have a website, built by way of a neighbor's kid or the neighborhood web design company and may have even establish a Facebook page. This sort of simple endeavor would cost a fantastic deal more if you employed a graphic designer due to all the associated costs in addition to needing to make sure enough job to earn their employment rewarding.


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I've successfully opened a US checking bank account with Chase with my H1B-visa passport, listing the address of a friend of mine who is a national as my residence address. I've been wondering if treating this account as a savings account where my salary is sent to via Direct Deposit but wiring part of that to my account in Colombia is a good idea from a tax/law standpoint, especially considering that I actually work for an US company as a foreign contractor.
I've signed a W8-BEN declaring that I don't have to pay any US taxes, but I'm wondering if actually holding money in the US may void that document? Would the IRS have grounds to go after me? I'd be receiving 4000 USD monthly and wiring 3500 USD to Colombia monthly.
I do not intend to use the account as a sort of tax-evasion scheme, as I plan to report my overseas assets to the DIAN, Colombia's equivalent of the IRS. Moreover, Chase asked me to provide my national tax id and I replied truthfully.
Bonus points: Could not actually living at the residence address provided ever be grounds for account termination? My friend is able to forward any documents that Chase sends me to my actual residence, and I set things up so Chase sends all documents to me electronically. Chase provided me with a Visa debit card which I plan to use in Colombia.


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Vueling Flight status
Check Vueling Flight status
Domestic flight VY2215 from Sevilla (SVQ) Spain and Canary Islands to Barcelona (BCN) Spain and Canary Islands operated by Vueling - Live flight status, flight schedule, flight arrival and departure times, flight route and flight duration.
On average, nonstop flight takes 1 hour(s) 23 minute(s), with the flight distance of 811 km (504 miles).
All VY2215 flights are operated using A320 aircraft.
Flight VY2215 arrives in Barcelona-El Prat Airport at Terminal 1.
1 flights per week. The Flight VY2215 is operated on Monday.


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These Two-Ingredient Reese Cups were inspired by the fact that you can never in a million years go wrong with a combination of almond butter + dark chocolate. Never.
So here is a quick little background on these PERFECT little sweet treats. Oh. My. Goodness. My husband actually declared them the all-time best ever thing that has come out of our kitchen. Awe shucks babe. He whined when they were all gone the next day and has kindly demanded I make more for him ASAP. On several occasions.
We know for a fact you are going love these decadent little sweet treats just as much as he did. And one last thing you must know. These taste extremely indulgent but are actually a well-balanced sweet treat. Just remember, the darker the chocolate the better it is for you. Now go enjoy this perfect combination of almond butter + dark chocolate!
Hope you Enjoy! =)
Two Ingredient Reeses Cups
- Prep Time: 10 mins
- Total Time: 10 mins
- Yield: Makes 12 1x
- Category: Vegan, Paleo
YOu'll never need to buy peanut butter cups again after you make this recipe!
- 2 cups dark chocolate chips (use Enjoy Life Brand for vegan + paleo)
- 1 cup creamy Peanut Butter (almond butter works too)
- Prepare a muffin tin with muffin liners
- Melt ingredients together in a small saucepan over low heat
- Stir continuously to be sure the chocolate does not burn
- Once melted together, evenly divide sauce into prepared muffin pan
- Place in freezer for at least an hour before serving


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Case StudyBulletproof Problem Solving
A website designed to promote a book launch and supporting touring events
Rob McLean and Charles Conn, authors of Bulletproof Problem Solving, asked us to create a one page website to support the launch of their book and surrounding events. It was to be made in the same style as the site for an event they were hosting (which we made just before), Solve It, Australia!.
We created a website for people to buy the book, read case studies included in the book for a taster of the problem solving process, and see what supporting events are coming up.
This site design involved taking an established look and feel and applying it to the site in a style that supported both quick snippets of information and long pieces of text and example charts.
Supporting a book launch and harmonising with the related event site
Rob McLean & Charles Conn, authors Bulletproof Problem Solving
Lara & Elise
Corporate Business, Government and Problem Solvers at home!
Working Women's Centre South Australia
A hub for women to come for support to the WWC South Australia.Intro Assisting women needing workplace help, support & advice in South Australia The Working Women's Centre South Australia provides information and assistance on topics including:Dismissal,...
Case Study: Tide Productions
Video production website for Brisbane and Sunshine Coast based studio.Intro A videography studio site, case studies of projects, and services for new clients. Tide Productions is a videography and photography studio based in Brisbane and the Sunshine Coast of...
Case Study: Queensland Social Enterprise Council and Unconference
Intro Promoting social enterprise in QLD and a 6-month sector research project and unconference We met Queensland Social Enterprise Council (QSEC) through a Brisbane City Council social enterprise accelerator we were a part of, and were initally asked us to create a...


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Campaign Events
Mardi Gra Parade
Mardi Gra Parade in Millbrook is scheduled for Sat, February 15, 2020 at 11:00am. Bob Rogers will be participating in that parade. Come and join us.
Venue: Millbrook
Address: Main Street
Date: February 15, 2020
Time: 11:00 AM - 12:00 PM
Link: http://bobrogersforcongress.com
Email: firstname.lastname@example.com
Eufaula Candidate Forum
The Barbour Coun,ty GOP will have Candidate Forum at the Chamber of Commerce Building down on the River February 4, 2020, 6:00pm.
Bring some friends and come join us.
Venue: Eufaula GOP, Chamber of Commerce Bldg
Address: On the River Eufaula, AL
Date: February 04, 2020
Time: 06:00 PM
Social at 5pm. Come join in with us on one of our last forums before March 3rd Primary.
Early Morning Coffee Meetings
I am starting a program where we will go to the various locations, coffee houses, convenience stores, donut shops etc., (providing the management will allow it) speak with the members who normally show up and discuss politics and general issues of the day.
Some of the locations are, but not limited to:
Donut Heaven, Prattville
Chappy's Deli, Perry Hill Rd., Montgomery
Citgo Station, Slap Out (Holtville)
D&D One Stop, Hwy 31 and Co Rd 20, Marbury
Julia's Restaurant, Hwy 231, Troy, AL.
If you have other locations you would like to add to the above list, please respond to me and we will try to include and coordinate a date/time to meet.
Bob Rogers
Candidate for Congress, D2
Venue: Various Coffee Shops
Date: September 14, 2019
Time: 06:00 AM


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ARB Intensity 4x4 Driving LED Spot Light - AR32F
CONDITION : New - With tags or in original packaging - Brand new items with original tags or in original packaging.
- Flood light
- 32 LEDs
- Engineered in Australia, the ARB Intensity LED light range has been specifically designed to meet the demanding requirements of 4WDers throughout the world.
- From producing white light that is the closest possible imitation of sunlight, to a virtually indestructible polycarbonate lens, these lights are the premium choice. Unlike high intensity discharge (HID) lights, the LED range does not require time to warm up, and performs brilliantly on uneven roads by producing a broad field of light that helps diffuse vibration.
- Submersible to 3m, the ARB Intensity LED lights have been vibration tested to military specifications to ensure they can withstand extended periods of extreme conditions to keep the road ahead brightly lit.
- Intensity LED Flood Light
- Dimensions - W 220.5mm x H 245.5mm
Complete kit includes:
- 1 flood light
- 1 clear cover
- 1 mounting bracket
- 1 mounting hardware kit
- Input - 10-36V DC
- Power - 90W
- Current draw - 6.25A at 14.4V
- Output - 8200 raw lumens
- Lux at 10m - 770
- Spread - 20° full width
- Operating temperature - -40°C to 63°C (-40°F to 145°F)
- Colour temperature - 6500K
- Weight - 3.1kg
- UV emissions - 0
For more information on this item or any other of our products please contact us. Our normal opening hours are 9.00 am to 5.00 pm Monday to Friday.
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