text:
You are here
2nd International New Technologies and Expert Meeting (Part 1)
In 2015, the Non Inva Meeting has transformed itself into the 1st New Technologies and Expert International Meeting. We were happy to welcome again friends in Lyon and to continue to deliver state of the art expertise and a focus on innovative technologies in the bariatric field. The general theme of this 2017 meeting has dealt with weight-loss trajectories after bariatric interventions: Can they be improved? For a given intervention, is there a specific trajectory (or a set of trajectories) that can be well defined, i.e. a "signature".
Organising such a meeting has become a challenge over the past few years. We are still convinced that while bigger meetings are important, more focus on key-issues and more discussion with a perspective are provided in smaller reunions. Times have changed, and there is nobody to blame for this. The industry has reduced is support, and new regulations have made it difficult for physicians to attend meetings abroad. We will continue to discuss the strategy with the companies designing new materials, while staying optimistic: innovative devices are implemented every year, and need a thorough evaluation, particularly in the endoscopic field.
General and follow-up
Surgical Outcomes of Current Bariatric Interventions, a Nationwide Study
Presented by Antoine Duclos (France)
Currently, the reoperation rates at 6 months after bariatric surgery (Chang et al, JAMA Surg 2014) are 7% (95% CI, 3%-12%) in RCT, and 6% (95% CI, 4%-8%) in observational studies. The risk seems more important with Gastric Banding than with Gastric Bypass and Sleeve Gastrectomy. Comprehensive data on a nationwide scale are important.
This study aimed at evaluating the real risk difference between bariatric procedures. This is a preliminary analysis in order to compare the reoperation risk among cases of sleeve gastrectomy, gastric bypass and gastric banding. 184 332 patients were operated on in 606 hospitals. The data came from the French nationwide hospitals database. Outcome: Reoperation within 6 months following bariatric procedure. Design: Exploratory descriptive analysis (2011-2014), retrospective cohorts of patients (2013-2015); matching inside hospital using propensity score (sex, age, comorbidities, BMI, median income, year of procedure); Cox proportional hazards models accounting for dependence of matched pairs and for competitive risk of death.
Reoperation risk increased over time and was lower for sleeve gastrectomy at 6 months compared to other procedures, final results are pending. This corroborates the previous literature based on a direct comparison of procedures at a nationwide level, with a longer follow-up. Questions remain: What is the validity of our findings according to the severity of reoperation? What are the underlying reasons of reoperation after an initial procedure? Are reoperation rates associated with patient-reported outcomes?
Immediate post-operative follow-up with IoT/ phone application
Presented by Vincent Frering and Marie-Cécile Blanchet (France)
The goal was to improve safety in bariatric patients, following a protocol of enhanced recovery after surgery (ERAS). Several means of tracking were used, while nurses stay on call 24h a day. 200 patients have been included from 08/2016 to 12/2016. There were two reoperations (1 bleeding, 1 occlusion), 47.4% of the patients have been contacted by smartphone, 35.7% by computer, 16% by tablet. There were 7 re-hospitalizations, and 15% unscheduled visits. In conclusion, a strict follow-up within weeks post-surgery benefits from tracking tools and increases safety.
Follow-up in bariatric techniques with telemedicine (MethodCo)
Presented by Vianna Costil (France)
Sustaining weight-loss after a bariatric surgical or endoscopic technique is a challenge that requires holistic solutions. A local system (Paris) has been initiated with 3 consultations a month by video-conference, including food-rebalancing, behaviour modifications, and physical activity advice. Connected tools are also available, for fitness tracking, personalized counselling, recipes, body-mass index scale.
Thirty patients with gastric balloon have been included, and 2 patients with Overstitch, and in parallel 30 after bariatric surgery. This initial experience is highly encouraging.
Bariatric surgery
Novel technologies in bariatric surgery: Are they properly evaluated?
Presented by Kamal Kumar Mahawar (United Kingdom)
There is none amongst the currently available bariatric and metabolic procedures that can permanently "cure" obesity or type 2diabetes mellitus without any complication or adverse consequences. There is a further need to lower the cost of our interventions and simplify them if possible. This has led to a rapid surge in the number of new bariatric and metabolic procedures in recent years. Some surgical procedures were adopted in routine practice too soon, only for the problems to become apparent later. It is hence incumbent upon us to ensure that any new procedure is thoroughly tested before rolling them out widely.
In a recent survey of 396 bariatric surgeons from around the world, we found that most surgeons would be happy with evaluation of a new procedure in at least 5 adequately supervised clinical studies (four of which must be randomized comparisons with one of the existing alternatives) reporting at least 5 years results on a minimum of 500 patients, before it is inducted into routine clinical practice. This was just an attempt to gauge community opinion prior to what we hope will lead to a serious discussion and attempts at consensus building.
The fact that we don't yet fully understand how our existing operations work makes the development of new ones difficult. In the past, we have rather simplistically used terms like "restriction" and "malabsorption" without defining what restriction means or understanding how much the success of a given bariatric procedure can be attributed to malabsorption. It is only recently emerging that profound and long-term suppression of appetite lies at the heart of how many of our procedures work.
There is no denying the fact that our processes of adoption of new procedures have in the past been somewhat arbitrary and dependent on "expert opinion" rather than a robust scientific process. Our recent survey will not answer all of a number of difficult questions that face us concerning the future innovations in our specialty. Nonetheless, it should help kick start a conversation. A little bit of time spent now will not only save us a lot more of it in the future but also potentially prevent embarrassment and ridicule from other groups of healthcare professionals.
Laparoscopic gastric banding: Game over?
Presented by Jerome Dargent (France)
The Laparoscopic Adjustable Gastric Banding (LAGB) procedure has been used in bariatric surgery for over 20 years. Having learned the technique of LAGB in 1995 from Mitiku Belachew (Belgium), a true pioneer in bariatric surgery, I remember the tremendous momentum owing to the surgical approach that was transformed. Gastric banding became the most commonly performed bariatric surgical procedure in
Reviewing current as well as historical results of laparoscopic gastric banding does not seem to help much against this trend. The spectacular and recent decision made by Johnson and Johnson, stopping the production of their gastric band, has come as a surprise, yet fully justified in this context. Whatever the endeavour and competence of any dedicated bariatric team, mediocre food compliance seems to be the main issue, and induces the patients to turn themselves to alternative procedures such as LSG.
It's not so easy to pronounce the demise of a surgical technique: one may be misled by temporary trends, success of alternative operations that will eventually fail, etc. The most important questions when deeming a surgical technique terminated result from definitions: Does this happen when nobody does it anymore? When it has no legacy? When nobody teaches it/learns it anymore? When no data are presented anymore and/or Evidence Based Medicine no longer supports its claims? Answering theses questions is often ambiguous in the case of LAGB, and perhaps makes the death certificate premature. Besides, technique may survive for a long time as a niche (vertical banded gastroplasty (VBG) is still an example of this), and we may also consider that a field of clinical research that has been opened cannot be entirely shut down.
Literature is difficult to analyze: the technique has evolved (ex pars flaccida approach in the years 2000), those still in favor of LAGB tend to minimize the necessity of switching to another operation even in the long term, and those against have most often abandoned it a while ago, therefore presenting a high rate of failures that led to revision.
In a personal series of 2200 cases for 22 years, our results show that complications continue to occur in the long term, but that the incidence of slippage and erosion has decreased over time. Esophageal dilation can be a serious problem, but this can be resolved by downward adjustment of the band. Most late removals of bands are indeed performed because of long-term lack of efficacy, and stand as a preliminary to conversion to a different procedure. The most commonly reported problems are related to long-term food intolerance or band adjustments difficulties, resulting in band removal and conversion to a different procedure when combined with weight regain. These problems lead to a high rate of band revision and/or removal, with great variations according to different reports, from 10% up to 60%. Repeated adjustments are initially useful, but the need for such adjustments is regarded as a disadvantage in the long term. Undeniable adverse effects explain why LAGB is no longer popular: short term inefficacy for a variable percentage of patients, difficulties with adjustments and follow-up, and food intolerance complaints, are the most cited.
Paradoxically, part of the literature is still in favor of LAGB, which could be compared to a patient dying in good health! Minor suggestions have been suggested, like banding a sleeve/a bypass as an adjunction or a failure treatment, using LAGB for adolescents, etc. This kind of strategy is unlikely to do more than buy some more years. More importantly, gastric banding is likely to remain useful in combination with future techniques, particularly endoscopic, and/or as a re-do procedure after these techniques have been implemented.
In general, we have to maintain a set of options for obese patients that includes simpler operations than GBP and even LSG; best candidates are endoscopic procedures such as gastric internal plication. In that sense, there is a strong legacy to the band, mostly playing the role of a "simple restrictive intervention" in comparison to more demanding procedures. When considering a larger spectrum of obesity treatments, for instance including class I obesity cases, there is a need for minimally aggressive techniques that would operate with a comparable status as LAGB.
LAGB has increased our understanding of the mechanisms underlying effective restriction of food intake. It has represented a major step in the field of obesity treatment, and using it for a long period has been valid and sound. But time passes rapidly in this field and this is for the best if new opportunities arise, which is the case now with novel and less invasive methods. There are no reasons to dwell on a technique that is not satisfactory in the eye of most patients and physicians anymore!
Omega bypass (One Anastomosis Gastric Bypass), biliary reflux, and denutrition: myths and reality
Presented by Jean-Marc Chevallier (France)
From October 2006 to December 2015, 1294 patients (721 women : 63,4 %) had an OAGB; mean age was 41.12 ( 17.5-62.4 ), weight 131.9 (75-221 ), BMI = 47.03 (32.8-80.2 ). 228 patients had a previous restrictive operation (17.6 %): 156 gastric bandings (111 removed simultaneously), 13 VBG, 59 LSG.
There were 16 early complications: 6 leaks (3 at the gastro-jejunal anastomosis), 5 trocar's incarcerations, 2 abscesses, 1 splenectomy, 1 endoscopic sclerosis, 1 dilatation. 22 late complications occurred: 3 perforated ulcers, 14 intractable biliary reflux, 5 obstructions. Failures, 6 cases: 4 weight regain, 2 malnutrition, no internal hernia and no hypoglycemia were reported.
There were 16 conversions to RYGB / 1294 = 1.2 %, 14 for intractable biliary reflux, 2 for marginal ulcer. At 3 years, 162 endoscopies were performed among 288 patients: normal in 75% (136), simple ulcer in 4, complicated ulcer in 7, foveolar hyperplasia in 15, dysplasia and metaplasia = 0. At 5 years, 74 patients, 55 endoscopies: normal in 68% (37) simple ulcer in 5, complicated ulcer in 1, foveolar hyperplasia in 12, dysplasia and metaplasia = 0. Questions asked: Does biliary reflux imply a risk of oesophageal adenocarcinoma? Does the presence of bile in the stomach involve a risk of stomach cancer in the long term? OAGB is wrongly compared to Billroth II, and the risk of cancer is not significantly increased after BII at 30 years, or slightly increased but if there is an ulcer. In retrospective studies, the role of Helicobacter Pylori is not taken into account, HP being a major risk factor of gastric cancer, as a type 1 carcinogenic agent (N Engl J Med 1996). Gastric cancer has environmental causes (smoking, HP, salted or smoked meat and too little fruit or vegetables). In the USA, mortality from gastric cancer has dropped from 28 to 5 per 100,000. The risk of gastric cancer is not increased after partial gastrectomy (J Gastroenterol Hepatol 2000). Cancers have already been reported after RYGB and OGB but in the excluded stomach mostly. The OAGB has nothing to do with the Mason initial OAGB procedure: it uses a long and narrow gastric tube, resembling the vertical part of a LSG.
Experimentally, we have submitted 14 rats to a prolonged exposition to biliary reflux: 14 rats after OAGB + 4 Sham, operated when 20 weeks old (5 months rat's life = 24 years human's life), followed for16 weeks (16 years in man's life), and sacrificed at 36 weeks (40 years in human). At16 weeks there was no dysplasia or metaplasia; there was hyperpapillomatosis in the lower esophagus in 50 % of OGB rats, 75 % in Sham. Foveolar hyperplasia was present at the level of the GJA, not above. RNA of specific genes for Barrett or EG carcinogenesis was not different in both groups.
Efficacy and safety of OAGB have been demonstrated in a randomized trial and confirmed in our preliminary results; the complication rate is low (5.3%) because there is only one anastomosis. Late reoperation rate was 3.6 %, marginal ulcers: 2 %, intractable bile reflux: 1%. Until now, no dysplasia nor metaplasia have been seen at 3 and 5 years. The main concern is the limb length: 1.5 m is enough when BMI < 50. Perspectives: we plan to collect 10 years-results after OAGB, with routine endoscopy and impedancemetry.
Sleeve Gastrectomy: is gastro-esophageal reflux a real killer?
Presented by Patrick Noel (Abu-Dhabi)
Patrick Noel presents the controversies related to GERD after sleeve gastrectomy, although being a very successful operation nowadays. In a consensus conference on LSG in 2016, 80% of participants deemed Barret's ulcer a contra-indication for LSG, 23.3% if there was a GERD, 11.7% in case of hiatal hernia, 5% if BMI>60.
Only 2 studies have reported the improvement of GERD >5 yrs after LSG, versus 8 the onset of new GERD symptoms (10-23%). Problems of definition: symptoms, questionnaires, endoscopy (high variability, low sensibility), 24h impedance monitoring, HRM, gastrografin swallow. GERD is also present in RYGB: 0.28% at 10 yrs. Comparisons of pre and postop GERD in RYGB, LAGB, LSG: 2.8 Vs 1.33/ 2.77 Vs 1.63/ 2.82 Vs 1.85 (change in GERD composite score). All exams: real de novo GERD occurs in 5.4% of LSG only. Hendricks (2015): 919 SG, 4% GERD (3% de novo, 1% pre-existing), 10.5% required conversion in RYGB. HH repair does not influence the evolution of GERD.
Yet the series of Prager, 2016, is more worrisome: 102 patients with minimum 10 years FU, 3 centers: 14% Barrett (5/36). Radiofrequency ablation and RYGB represent current options. Esogastric cancer: scarce reports. SOARD 2017, Maret-Ouda, esophageal cancer after RYGB, LSG, LAGB: 34437 pts, 239775 person-years of FU (Sweden): 8 cases of cancer, the risk did not decrease owing to bariatric surgery.
Laparoscopic RYGB Vs Omega-loop bypass Vs LSG after gastric band failure: a multicentre comparative study (more than 1000 cases)
Presented by Juan Pujol Rafols (Spain)
A wide collection of data (still ongoing) of conversion from a gastric band to a gastric bypass or a sleeve gastrectomy has been reviewed in a retrospective way. So far, 1219 patients have been included (905 bypass, 314 sleeve). A BMI < 35 was obtained in almost all cases at 5 years. The success rate (EWL>50%) has been 76% (67% in sleeves, 85% in Omega bypass, 75% in RYGBP). The complication rate has been 11.5% (4.1% leak, 2.6% bleeding, 0.9% death).
Comparative study between Sleeve Gastrectomy and Gastric Bypass, 280 pts, 3 years FU
Presented by Jean-Marc Catheline (France)
This comparative study between LSG and RYGB included 277 patients, with 3 years of follow-up. The design is a multicenter, prospective study comparing complications, efficacy, and quality of life.
Two hypotheses have been tested: a difference in morbidity and mortality events; a non-inferiority in reduction of excess weight by more than 50% at 36 months. The percentage of patients with EWL > 50% at 36 months was not different. The study showed a better benefit /risk ratio in LSG patients compared to RYGB, while the two hypotheses were tested in parallel. However, this was not a fully randomized study.
Pouch and sleeve reduction for weight-loss, with or without banding, long-term results
Presented by Sébastien Murcia (France)
Reducing the gastric pouch or the sleeve in case of weight regain is a strategy that makes sense in selected cases, possibly in combination with the placement of a non-adjustable band around the pouch/sleeve. 41 patients have been included from 2009 to 2017, 23 after RYGB, 16 after LSG, mean BMI 46 at the time of primary surgery. Mean interval between procedures was 5.4 years. Resection of the primary staple line was always performed. There were two cases of late staple line dehiscence (D 30 and 90), and 2 bandings had to be removed. Median EWL was 49%, mean FU was 4.9 years.
Single Port revival! Standardized approach for RYGBP with SILS (initial 100 patients)
Presented by Elie Chouillard (France)
Single Incision Trocar has still supporters, who use it on a routine basis. In this series, 104 patients, 88F, 16M, age 33, BMI 42.2 (35-53) were operated on. 14 patients had a conversion to a multiple port procedure. Early morbidity was 3.8%. Mean operative time was 136 min (75-265). SILS-RYGBP is feasible, reproducible but with a learning curve. We need more evidence based data.
Likewise, Guillaume Pourcher (France) has presented his series of SILS-LSG, with overall good results.
SADI procedure after sleeve gastrectomy failure (20 pts)
Presented by Elie Chouillard (France)
What to do when LSG fails? Re-SG is an option that has limitations. We used SADI in 24 patients, 18F, age 39, with an early morbidity of 4.2%, and 0 mortality. FU was 19 months (6-28). EWL at 12 months was 57% (31-99). FU is organized like in BPD-DS. SADIs is safe as an alternative to DS after LSG failure, but the question is asked: should it be a primary or a second step procedure? It also fits to current trends: less invasiveness, less anastomosis, more preservation of the anatomy, less malabsorption and less exclusion, and a multi-stage approach.
Pre or post-pyloric one anastomosis bypass, evidence based discussion
Presented by Karl Miller (Austria)
Addressing the issue or choosing between pre and post-pyloric one anastomosis bypass. The total length of the small bowel ranging from 2.75 to 10.49 m, a common channel below 2 m carries a risk of short bowel syndrome. Risk of dumping: 17% after GBP, 1.5% after LSG. Pre-pyloric one anastomosis bypass entails 2% bile reflux.
In summary, one can argue that pre-pyloric anastomosis is technically easier, safe and effective, tension-free anastomosis, less internal hernia, anatomical obstacles, but more dumping? Bile exposure? Easier revision?
New approaches to Laparoscopic Greater Curve Plication, hopes and expectations
Presented by Martin Fried and Karin Dolezavola (Czech Republic)
In our experience, 212 patients had more than 5 years FU, 79.2% achieved >50% EWL, 20.8% <40% EWL, maximum EWL regain was 9.2%. Mean operative time 69 +/- 11 min, hospitalization 38 h, 1.6% urgent reoperation rate and 3.27% elective reoperation rate. There was an improvement in insulin sensitivity and increased beta-cell glucose sensitivity. 49 of 52 pre-op diabetic patients had improvement or remission of T2DM: 94.2% at one year, 89.7% at 2 years, 65.5% at 5 years.
Since 2009, more than 3000 operations have been performed. Predictors of success: BMI 35-40, F age 50, EWL 45 kg, waist-height ratio<0.7. Stapled plication seems to increase the durability of the plication, its reproducibility, its standardization (with a more symetrical pattern). Suturing skills can be improved, with adequate spacing of the stitches, and carefully considering the anatomy (avoiding a twist around the incisura angularis).
Patient selection: no Evidence Based medical approach, individual clinical profile, perioperative risk, team and institutional experience. Quality of life remains as long as WL is maintained above 10%, a realistic goal being a 5-10% WL. This method should be positioned between LAGB and LSG.


text:
Pic credit – omnibeaux
1. Epsom salt and wam water – In hemorrhoids the nerves gets inflammated causing pain and irritation so this remedy is very helpful in this . After bowel movement warm some water and mix Epsom salt in it and sit in it so that to prevent pain and stiffness in your hemorrhoids. Don't sit in extra warm water that might cause more pain in it for sometime.
Must check this : Home remedies for Constipation
2. Aloevera – This component is very helpful in hemorrhoids as it provides coolness to the swellen part and also is anti inflammatory so it'll also reduce stiffness and pain there. You can directly apply fresh aloegel from plant or can use market products which are pure but remember don't ever use products that contains perfumes artificial fragrance and chemicals.
3. Fibre rich diet – Eat fiber-rich fruits like bananas, oranges, apples, mangoes, strawberries, raspberries and vegetables like beetroot, green vegetables and beans, breads ,grains and nuts any many more things. These fibres foods boosts up the digestion level resulting easy bowel movement without much pain and blood.
Check out this : Home remedies for Gas
4. Cool compress – Apply some ice covering with light cloth or towel. Don't apply ice directly over hemorrhoids. The purpose of doing this is cool feel will calm the nerves and reduces the pain and swelling as well. Do once a day in afternoon or evening time for around 10-15 minutes.
Check this also : Home remedies for Stomach ache
5. Drink alot of water – For hemorrhoids patients water must be life they have to drink atleast 5-6 litres of water daily. As water boosts the digestion level resulting smooth bowel movement and also helps to shrink down the h hemorrhoids to a certain level.

subset: commoncrawl


text:
All you need to bring is a smile. But it can be nice to show up in a 1st Saturdays shirt!
After a many year wait, the shirts are finally back!
This makes for a great staple t-shirt. It's made of a thicker, heavier cotton, but it's still soft. And the double stitching on the neckline and sleeves add more durability to what is sure to be a favorite!
• 100% ringspun cotton
• 4.5 oz (153 g/m2)
• Pre-shrunk
• Shoulder-to-shoulder taping
• Quarter-turned to avoid crease down the center
Model is wearing a size M. He's 6.2 feet (190 cm) tall, chest circumference 37.7" (96 cm), waist circumference 33.4" (85 cm).


text:
Who wants a slice? Hot and ready, this clutch features a 3D pizza slice. Hand crafted to perfection. All bags come with a removable cross-body chain, logo dust bag, clear vinyl inner pocket and are individually signed.
- Dimensions: 12.5 x 7.5 x 1
- Proudly handmade in the USA.
- Individually signed by the Artist.


text:
The Rock to the rescue! Dwayne Johnson saves puppy from drowning00:50
Wrestler and movie star Dwayne Johnson shared a photo and a scary story of how one of his new French bulldog puppies almost drowned over Labor Day, prompting the star to dive into the pool fully clothed to rescue the pup. The Fourth Hour ladies share the cute Instagram photo he posted after the close call.


text:
We rigorously test, benchmark and handpick products to enhance your water experience. We then make these products available to you at special prices. Offering world-class tested and rated products at competitive prices is our way of thanking you for being a loyal customer and giving you more value.
Place your trusted jobs in the most experienced hands in the region.
Get in touch with us anytime.
How we work Contact us
Copyright © 2018 Saniservice® LLC All rights reserved. Terms & Conditions | Privacy Policy | Blog | Press


text:
In a contest featuring a steady downpour of heavy precipitation falling from the sky the Mercer Island Islanders boys soccer team registered a statement victory on the road against the rival Interlake Saints.
The Islanders scored two first half goals and held on for a dramatic 2-1 win against the Saints on April 11 at Interlake High School in Bellevue. Mercer Island improved its overall record to 8-2-1 with the win while Interlake dropped to 6-3-2 courtesy of the defeat.
With just a few seconds left in the regulation, Interlake unleashed a free kick from about 35 yards away from Mercer Island's goal. Interlake player Will Meadows leapt into the air and landed a header shot on goal from about 10 yards out. The sensational shot on goal caromed off the left post. Mere seconds following the sequence, the referee blew his whistle signaling the end of the game. The Saints played the majority of the first half of play on Mercer Island's side of the field but found themselves trailing by two goals. Interlake head coach Dan Peterson was proud of his team's showing against the Islanders.
"Both halves I thought we gave ourselves lots of chances (to score goals). They (Mercer Island) defended with lots of people behind the ball so they crowded everything right in front of the goal. We figured out a way to get one in but we couldn't figure out a way to get a second one in," Peterson said of his team's comeback bid. "The last play of the game we hit the post. I really thought Will was going to finish it and he came really close. We gave a great effort and Mercer Island gave a great effort too. It is frustrating but the boys sure played well."
Mercer Island player Emil Talerman, who scored a goal in the 28th minute giving the Islanders a 2-0 lead, was nervous while he watched what ended up being the final moment of the game go his team's way.
"It was a bunch of commotion and it was just really crazy. We snuck it out. We really did. It was a crazy game and not really the kind of soccer you want to be playing but you know a win is a win so its all good," Talerman said.
Mercer Island scored the first goal of the game in the opening minute when Luca Mtskhetadze found the back of the net. Interlake's Owen Gortner scored on a header in the 50th minute of play as well. Mercer Island head coach Colin Rigby was jovial following the triumph against Interlake.
"It was actually what our team needed. We needed to prove that we could win gritty games and that was a gritty game. I give a ton of credit to the guys for just sticking with it and not giving up," Rigby said. "You have to give Interlake a lot of credit because the way that they play, you can never let off. They're always going to put pressure on you and they're always going to have opportunities to score. They're always going to be a challenge. We're super excited about the result."
In consideration of how we voice our opinions in the modern world, we've closed comments on our websites. We value the opinions of our readers and we encourage you to keep the conversation going.
Please feel free to share your story tips by emailing firstname.lastname@example.com.
To share your opinion for publication, submit a letter through our website https://www.bellevuereporter.com/submit-letter/. Include your name, address and daytime phone number. (We'll only publish your name and hometown.) We reserve the right to edit letters, but if you keep yours to 300 words or less, we won't ask you to shorten it.


text:
- Home
- Government
- Election Commission
Election Commission
Welcome to our website! The Madison County Election Commission is located in Jackson, Tenn. We are responsible for the conduct of all elections held within Madison County, including those for the cities of Jackson, Medon and Three Way. These responsibilities include polling place arrangement, appointment and training of election officials, printing of ballots, preparation of election supplies, purchase, storage and maintenance of voting machines and the certification of election results.
Register to Vote Online
This link can be used to register to vote or to update your address if you are already a registered voter in Madison County, Tennessee and have moved to a new address within this county. When you move to a new county, your registration does not transfer. You must register to vote in the new county. The U.S. Postal service does not notify the Election Commission that you have moved. It is the responsibility of the voter to notify the Election Commission.
Next Election
August 6, 2020 - State Primary and County General Election
Voting by Mail
As long as a registered voter has either registered in person or has voted at least once, voting by mail is an option as long as you attest to one of a number of reasons. Anyone who reached the age of 60, is disabled or is the caretaker of a disabled person may vote absentee by mail. There are other reasons that would allow you to vote by mail.
Madison County Election Commission Members
Phil Bryant, Chairman
Nell Huntspon, Secretary
David Johnson
Phyllis Means
Mike Bledsoe
Next Election Commission Meeting
March 26, 2020 - This meeting will be held by conference call. If you would like to attend by telephone, the meeting will begin at 10:30 am. Dial 1-888-585-9008. When you are asked for a "conference room number", enter 309-487-275. When you are admitted, please identify yourself. The purpose of this meeting is to approve the Election Commission's budget request.


text:
Many of us know the feeling: Our world seems to be falling apart. Familiar sources of security crumble to dust. Long-enjoyed relationships suddenly evaporate. Assumptions which underlie our daily confidence turn hollow and false.
David experienced such a time when he was sojourning among the Philistines. He and his six hundred men returned home to Ziklag one day to find the entire city burned to the ground and their families gone. The story in 1 Samuel 30 tells us that the Amalekites had raided and burned the town and taken everyone there captive, including David's wives and children.
The loss was emotionally devastating both to David and his men. "David and his men wept aloud until they had no strength left to weep."
To make matters worse, his men—loyal through many a battle—began to turn against him. "David was greatly distressed because the men were talking of stoning him; each one was bitter in spirit because of his sons and daughters."
David had lost his family, his possessions, and the respect of his men—and now seemed in danger of losing his life as well.
What could he do? He could escape from his men and try to start life over somewhere. Or he could ask the men to pick another leader, hoping they would let him alone. Or he could attempt some clever maneuvers to keep control by purg ing any conspirators.
But David chose none of these. Rather, he turned to the relationship he had come to rely on even more than food and breath. He "found strength in the Lord his God." God was real to David, made real by his regular fellowship with God in prayer, a fellowship we see evidence of continuously in his Psalms.
Once strengthened, David wasted no time in seeking God's guidance on what to do in this bitter situation caused by the Amalekites. "And David inquired of the Lord, 'Shall I pursue this raiding party? Will I overtake them?'" God's answer: "Pursue them. You will certainly overtake them and succeed in the rescue."
The Bible doesn't say how David got his men to follow him on the subsequent exhausting pursuit of the Amalekites. Perhaps some went only out of a desire to rescue their own families, still seething inside against David. But more likely, they saw in him now the same God inspired leadership they had seen in previous difficulties. For throughout his life David led men by keeping his eyes on God. He lived and breathed the love, the hope, the power, the mercy of God.
In the end, David recovered unharmed his wives and children and those of all his men, along with all their possessions, plus a bonus of spoil. And it was not long after this that David was made king.
What was David's secret? His confidence in always calling on God—even when his world was crumbling around him.
Use the phrases recorded below from Psalm 3 to praise God and to pray for yourself and others.
"You are a shield around me, O Lord"
—Father, you are my protection.
"You are . . .my Glorious One, who lifts up my head"
—You deserve all honor, and yet you honor and encourage me.
"To the Lord I cry aloud, and he answers me from his holy hill"
—You know me, and you hear my prayers.
"I lie down and sleep; I wake again, because the Lord sustains me"
—Day and night you watch over me, and meet my needs.
"I will not fear the tens of thousands drawn up against me on every side"
—I face difficulties ahead, but because of you I will not be afraid.
"Arise, O Lord! Deliver me, O my God!"
—Lord, make your presence and your power real to me, and cause me to overcome the problems I face.
"From the Lord comes deliverance. May your blessing be on your people"
—Thank you for the victory you have won for us through the death and resurrection of Jesus Christ. Let us experience to the fullest his victory in our lives.
You've been reading from Issue 1 of the Discipleship Journal. This article was written by Don Simpson.


text:
Interesting situation. The usual rule of thumb is take the benefits earlier if you need the money, but your account creates a bell curve on the time scale to income.
Also, with your spouse not able to receive SS benefits you would want to add the extra money early in case something happens to you earlier than expected.
And, making your SS benefits check smaller lessens your provisional income so potentially less of your SS benefits will be exposed to federal taxation.


text:
My daughter took the day off from work (she's a 5th grade teacher) and came over. We went out to breakfast at IHOP (they'd sent me a coupon for a free birthday breakfast). I had cheese blintzes and fruit, which is my favorite.
My daughter also brought me a really nice juicer, which I wanted. I can't wait to make healthy juices. She also brought me a really cool necklace and this hilarious t-shirt. I love it!
After breakfast, we went shopping. I got two new pairs of shoes (that I didn't need!) and some personal things at Victoria's Secret. Then I went to James Avery and purchased a necklace and earrings to commemerate my half a decade. My husband gave me a new camera, the awesome Nikon D3100. I can't wait to start using it.
Lastly, I got these beautiful flowers.
Tonite, we're all going out to dinner at Blue Mesa, which is a Mexican place. I plan to drink some margaritas and chow down on some good food.
So far, a very nice day!


text:
Courtesy of AgileCXO, Jeff Dalton wrote a synopsis of his speaking session discussing 'Great Big Agile: Leading Agile at Scale'. Click here to download the full presentation.
Big Agile is Coming
Since 2016, General Motors, the Department of Defense, Health and Human Services, Fiat Chrysler, and other large companies have begun to adopt agile within their software organizations. Along with their combined $100 billion IT budgets, they are bringing their biases, bureaucracies, documentation, and leadership infrastructure with them. What will be the effect on the agile community?
"Big Agile" requires leadership at all levels, just not the kind we are used to. Simply working with an agile coach to implement well-known ceremonies is not enough. Metaphorically, the leadership "operating system" needs an upgrade.
In today's corporate hierarchies where command-and-control structures, low trust, long-term planning, and risk management reign supreme, the skills required to thrive and survive are anything but agile. This leaves agile teams to push the culture uphill, leading to unpredictable results once business operations expand beyond the boundaries of the core agile team. This creates a "cultural type-mismatch" due to information technology, operations, marketing, infrastructure, business development, sales, and end-users not being on the same cultural page.
Performing agile ceremonies and techniques without self-organization isn't agile at all. There is nothing inherently wrong with adopting ceremonies and techniques identified as being agile, and many companies have found some success with that, but the power of agile values and their associated frameworks grows exponentially once self-organization is perfected.
An "Agile Transformation" where the scope is hiring an agile coach, and the adoption of basic ceremonies or techniques, is doomed to failure. Agile isn't a process or a framework like scrum, XP, or SAFe. It's a collaborative, transparent, and self-organizing culture where the operational model is high-trust, empirical, and calibrated for relentless improvement in the pursuit of high quality and increased speed to value. Jim Bouchard, author of The Sensei Leader, sums it up for leaders: "Don't even attempt to transform your organization until you can transform yourself."
Jeff Dalton,
Chief Evangelist,
BTOES is the industry's biggest and best, senior-level, cross-industry gathering of Business Transformation & Operational Excellence industry leaders and senior executives.
It also hosts the Business Transformation & Operational Excellence Awards, which showcase globally the most outstanding organizational achievements through the application of Operational Excellence programs.
The summits hosts a number of private forums for C-Level & Global corporate-level leaders as well as business unit heads.
With over 150 speakers, over 100 sessions, 12 Keynotes, 9 Track Themes, 5 parallel tracks, 60+ track sessions, 50 roundtable discussions, 20 Interactive Workshops, 6 Thought Leader Panels, 5 Leaders Boardrooms, 5 co-located events, the Industry Awards Program, Site Visits, 20+ hours of social networking including 2 gala cocktail parties, dinners, numerous group activities, this is the ultimate event to benchmark, network and drive Operational Excellence to the next level.
Quick Links
There is a strong focus on Cultural Transformation, Customer Delight, Sustaining an Operational Excellence program, Need for end-to-end Business Transformation, Keeping up with new technologies/impact of digitalization and Leadership Buy-in & Understanding. We dedicated two tracks to advanced technologies, such as AI, Machine Learning, RPA, Predictive Analytics, Blockchain, Cloud infrastructure etc.
The agenda is designed to encourage active meaningful conversations though all day enhanced networking and interaction opportunities, including
All-day Refreshment & Themed Breaks
1¼ Hour Hot Breakfast Networking Sessions
1½ Hour Hot Plated Networking Lunches with Topic & Industry Sector focussed tables
1½ Hour Roundtable Sessions by Topic & Industry Sector.
Keynote & Themes Panel Sessions
Hosted Welcome Receptions from 5.30pm
Expanded more lavish Awards Program
Newly launched Night Summit for attendees to meet after dinner
For more information or to discuss the summit in more detail please schedule a call below,
Welcome to BTOES Insights, the content portal for Business Transformation & Operational Excellence opinions, reports & news.
Full-length speaking sessions from the Business Transformation & Operational Excellence World Summit, accompanied by featured articles from the Speakers themselves.


text:
Hangin' with Team Kanan, Episode 38: Catrina's Return and Part 2 Quiz
Join HANGIN' WITH TEAM KANAN's Catrina Dennis, Jeremy Konrad, and Johnamarie Macias as they enthusiastically discuss the latest episode ofContinue Reading
Providing news, reviews, and opinion pieces about the Star Wars animated shows
Join HANGIN' WITH TEAM KANAN's Catrina Dennis, Jeremy Konrad, and Johnamarie Macias as they enthusiastically discuss the latest episode ofContinue Reading
Various exclusives are going to be available at this year's San Diego Comic-Con, but if your tastes and preferences fallContinue Reading
If you're headed to San Diego Comic-Con this summer, make sure to save up every last penny because Bioworld willContinue Reading
Ashley Eckstein stopped by the set of The Star Wars Show to talk about the latest project that involves herContinue Reading
Galactic Fashion is a monthly podcast dedicated to Star Wars and geek fashion, hosted by Johnamarie Macias and Teresa DelgadoContinue Reading
Exciting new things are on the horizon for fans of Lucasfilm Animation. As recently announced, Star Wars: Forces of Destiny willContinue Reading
Prepare to dive into a series of original animated shorts that will explore the everyday heroic acts of some ofContinue Reading
While Star Wars Rebels remains on break until the fall and LEGO Star Wars: The Freemaker Adventures kicks off theContinue Reading
Johnamarie and Maria discuss the following Star Wars: The Clone Wars episodes from season three: "Heroes on Both Sides" andContinue Reading
It's always exciting when new information surfaces regarding the upcoming micro-series from Lucasfilm Animation, Star Wars: Forces of Destiny. FansContinue Reading
Writer Jennifer Muro recently spoke with Super News Live and The Koalition about the upcoming animated micro-series Star Wars: ForcesContinue Reading


text: We are your Saskatoon carpet store. Nothing can compare to the plush, warm and relaxing features of carpet. As an exclusive Stainmaster Flooring Centre, we carry more carpet colours, styles and textures than any other Stainmaster retailer in Saskatchewan. Our extra large carpet samples provide you with a better idea of how the carpet will actually look in your home.With our exclusive stock of Ultra Life products, we are able to offer high-performing carpets with superior warranties against stain and wear to our customers. And with the support of Stainmaster's Customer Satisfaction Program, we can guarantee that you will be more than satisfied with your new carpet.


text:
Warning: Last items in stock!
Availability date: 0000-00-00
Our ceramic worktop marble effect is the most expensive of the worktop because it offers an aspect very close to marble and a excellent resistance to heat, chocs and acids.
Price by sqm.
It is setup on an existing worktop that we can provide in pine for instance.
For any questions : firstname.lastname@example.com


text:
The UN's Sustainability Plan Is 'Doomed,' According to Linguistic Analysis
The 17 Sustainable Development Goals (SDGs), which seek to end poverty and hunger while creating sustainable societies, look like great news at first glance. But a report circulated to UN officials argues that the entire SDG process has been "fundamentally compromised" by powerful corporations with an interest in sustaining business as usual.
Phi Beta Iota: Nafeez Ahmed is a distinguised author and one of the few that thinks at the meta level. He is correct. The Fall 2015 meetings at the UN, including a much-acclaimed visit by the Pope to address climate change, will fail as sadly as Tom Steyer failed (by his own public admission) with his $74 billion attempting to influence policy in a constructive direction. The UN — as with its member governments — lacks intelligence with integrity. It lacks the ability to do holistic analytics, true cost economics, and open source everything engineering solutions, especially open source provisioning (energy, water, food, shelter). Despite the existence of a UN White Paper explicitly addressing a low-cost solution for changing the UN dynamic in constructive ways, the Secretary General — who may seek a third term — is impotent, surrounded by staff committed to business as usual.
See Especially:
UN Paper: Beyond Data Monitoring – Achieving the Sustainability Development Goals Through Intelligence (Decision-Support) Integrating Holistic Analytics, True Cost Economics, and Open Source Everything
See Also:
2012 Robert Steele: Practical Reflections on United Nations Intelligence + UN RECAP
Robert Steele: Open Power Electoral Reform — Open Letter to Tom Steyer with Proposed Action Plan for Re-Asserting Public Sovereignty


text:
Yesterday, I spoke to the Steel City SQL User group on T-SQL window functions. Below is a short summary and links to the sample scripts and database. The T-SQL window functions came about in SQL Server 2005, but you really want SQL Server 2012, because many functions were added and also because support for PARTITION … Continue reading T-SQL window functions talk summary and sample scripts
Category: SQL Server 2012
After a one-year hiatus, SQL Saturday is back in Birmingham on Saturday, August 23, 2014. I am presenting two sessions, the information for which I've included below.
While working with an SSIS package that uses a custom component (in this case the RegexClean transformation from Konesans) that was upgraded from SSIS 2008 to SSIS 2012, I ran into this error trying to delete it from the designer when I realized I couldn't work with it: "SSIS Designer does not allow this component … Continue reading Removing an Upgraded Component from SSIS Designer Results in Error
As part of my research for my Managing SSISDB talk, I came across an interesting script by Mike Davis. The script intends to copy an environment in the SSISDB. Mike does a good job explaining why this is useful. The SSIS Catalog does not provide a UI for that. Mike's script seems to work, but it has … Continue reading Copy or Duplicate an SSIS environment in the SSIS 2012 Catalog (SSISDB)
SQL Saturday Atlanta 2013 is around the corner: this Saturday, May 18. Like in previous years, the event will be held at the GSU location in Alpharetta, GA. It looks to be a full event with a great roundup of speakers and sessions. I wasn't originally scheduled to speak. Due to a cancellation in the … Continue reading Speaking at SQL Saturday Atlanta #220: Managing the SSIS Catalog
Just a quick post to publicize the PASS DBA Virtual Chapter meeting on Wednesday where I will be presenting an online session on Configuring and Managing FILESTREAM and FileTable in SQL Server 2012. The link for registration (enters you in a drawing for a $50 Amazon gift card) is https://www.livemeeting.com/lrs/8000181573/Registration.aspx?pageName=58svx93t12hx5f16. If you just want to … Continue reading Presenting for PASS DBA Virtual Chapter on Wednesday
Even though Service Pack 1 for SQL Server 2012 was released almost 2 months ago, it's only now that I've had a chance to check if the FileTable security flaw was addressed. And I am pleased to report that the problem was resolved with the release of Service Pack 1, so that is good news … Continue reading FileTable Security Flaw Resolved in Service Pack 1


text:
Hobby Lobby Credit Card is issued by US Bank, it offers cardholders some unique benefit. Access your credit card online to manage your finances with our online banking portal. View balances, make payments, set up account alerts and much more.
How to log in?
- Customers of Hobby Lobby credit card can easily sign in into their account by going to the log in page.
- Enter your user name and password at the sign in page.
- Next, click on the "log in" button.
How to pay your Hobby Lobby Credit Card?
The Hobby Lobby credit card is issued by US Bank, so you have many options to pay your credit card bill. You can pay by:
Log in to your Hobby Lobby Credit Card account at the US Bank sign in area to make a payment.
By mail:
Make your payment to the following address:
PO Box 790408, St. Louis MO 63179-0408
By phone:
The customer service phone number for payment is 800-285-8585


text:
Board Certification FAQs
Licensure is a mandatory, entry level credential required by most states. If you are licensed, it does not necessarily mean you are certified.
Board Certification is the highest voluntary credential in the profession today. Achieving Board Certification shows a higher level of commitment to the profession by meeting greater educational and work experience requirements.
To complete applications with NCBTMB, you must first login to your NCBTMB account on www.ncbtmb.org by clicking "Login" at the top of the page.
If you do not have a NCBTMB account, click "Register" at the top left of the page, fill out all required information, and Submit. You can then login to your NCBTMB account.
To access applications once logged in, click on "Initial Applications" from the Quick Links portion of your dashboard.
To become Board Certified, you must meet or exceed the following requirements:
- Graduation from a NCBTMB Assigned School*
- Passing score on the Board Certification Exam
- Pass a criminal background check
- Verification of current massage therapy state license
- Agree to uphold NCBTMB's Standards of Practice and Code of Ethics
The cost to apply for Board Certification is $250, plus a $25 background check fee (performed by NCBTMB).
*If you did not graduate from a NCBTMB Assigned School, your school is now closed, or you completed international training, you may instead apply for Board Certification via Portfolio Review.
**If submitting a transcript with transfer credits, submit transcripts from the original school you've attended.
The cost to become Board Certified is $250. An additional $25 will be required to process your criminal background check (performed by NCBTMB).
Apply for Board Certification entirely online with these simple steps:
- Login to the NCBTMB website with your username and password
- If this is your first time taking an NCBTMB exam, please create an account by clicking "Register" at the top of the NCBTMB homepage
- If you do not remember your username and password, please click "Forgot Password" or email email@example.com
- Once logged in, click "Initial Applications" from the Quick Links menu
- Click the "Board Certification Application"
- Complete all necessary information.
- Submit your payment.
That's it! Contact us at email@example.com or by calling 1-800-296-0664 with any questions.
NCBTMB partners with Prometric, a computer-based testing solution, to administer the BCETMB exam. Prometic has multiple testing centers in each state; most centers are open 5-6 days per week.
Once you are eligible to schedule your exam, you will receive an email notification with instructions on how to search all available testing locations available (as well as the dates and times) to conveniently schedule your exam within your eligibility period. Within this email, you will be linked to Prometric's system directly, as well as provided with a phone number to contact them.
The Board Certification exam contains 140 questions and you will have 140 minutes to complete the exam. Content found on this exam embraces application of technique and is assessment based—simulating real-life scenarios you will more than likely encounter as a certified massage therapist.
The Board Certification Exam is built around the below main categories:
- Assessment (25%)
- Applied Science, including Anatomy, Physiology, Kinesiology, Pathology/Injury, and Pharmacology (25%)
- Massage Modalities, Techniques, and Manual Forces (20%)
- Professional Communication (15%)
- Professionalism and Ethics (10%)
- Laws and Business Practices (5%)
To download the full BCETMB breakdown, click here.
Yes! NCBTMB is proud to offer our exclusive Online Practice Exam, which contains Level 1 (entry-level) questions to better prepare you for any licensing exam, as well as Level 2 questions to better prepare you for the Board Certification (BCETMB) exam.
The NCBTMB Online Practice Exam is the only study tool created by NCBTMB for the NCBTMB Board Certification exam.
For more information on the Online Practice exam, click here.
For a list of resources utilized to create the Online Practice Exam, click here.
For the Board Certification Study Guide, click here.
To request a Duplicate Certificate, you must first login to your NCBTMB account at www.ncbtmb.org.
Once logged in:
- Click Additional Forms (from "Quick Links" menu on left)
- Complete the Duplicate Certificate Request Form
- Fill out the appropriate information
- Click Submit
There is a $15 fee per Duplicate Certificate requested.
As a Board Certified Massage Therapist, your benefits may include:
- Recognition by third parties and other professions, such as health care
- Increased credibility and professional reputation among peers and the public
- Commitment to lifelong learning through continuing education to advance your skills
- Demonstrated higher level of knowledge and skill with the credentials to back it up
- Increased opportunities for career advancement
- Potential for increased earnings with access to higher-level positions
As an added benefit, NCBTMB performs a criminal background check on each of its therapists when they apply and again each time they recertify—reassuring employers and the public they are working with a reputable and trusted massage therapist.
As a member of NCBTMB, your benefits include:
- 30+ College Credits to earn your BAS or AAS Degree
- Free Website
- Discounts on thousands of products through our Affiliate Program and Resource Center
- And much more!
Is portfolio review available if I don't have a massage school diploma or other formal massage therapy training?
Yes! NCBTMB's Portfolio Review process allows applicants like you to demonstrate you have the educational equivalent to the standard eligibility requirements.
Click here to view the Portfolio Review Candidate Handbook for BCETMB.
To begin, please login or register at the top of the NCBTMB website or contact us at firstname.lastname@example.com.
To receive a refund for the Board Certification (BCETMB) exam or Massage Therapy Assessment for Certification (MTAC) exam, you must cancel your application no later than 48 hours prior to the date of your scheduled exam.
Refunds must be requested within 90 days from the date of payment. Processing, background checks and portfolio review fees will be deducted from the refund total.
On the exam application, candidates are required to attest that they are eligible to receive an NCBTMB credential and are not disqualified under our Felony Policy and Criminal Conviction Policy. Not disclosing disqualifying events on your application for the exam will result in no refund being given.
If, for any reason, any part of your application is denied, refunds will not be issued.
Candidates for MTAC and Board Certification have ninety (90) days from the time they are deemed eligible to take the exam to schedule and sit for their examination. Candidates who do not take the exam during this time period will forfeit their exam fee in full. Candidates will also have to reapply and pay the full exam fee in order to again be considered eligible to take the exam.
Candidates for Board Certification — Fees are refundable less a $75 processing fee and a $25 background check fee. For full breakdown of fees and policies, review the Candidate Handbook.
Candidates for MTAC — Fees are refundable less a $75 processing fee and a $25 background check fee.
Portfolio Review for Certification — Fees are non-refundable.
Approved Providers — Fees are non-refundable.
Online Practice Exam — Fees are non-refundable after the program has been activated.
Specialty Certificate Exams — If you have not yet received access to a Specialty Exam at the time of your request, fees are refundable less a $25 processing fee. If you have received access to a Specialty Exam at the time of your request, fees are non-refundable. Refunds must be requested within 30 days from the date NCBTMB receives your application on exam.ncbtmb.org.
Once you are Board Certified, please use the credential BCTMB after your name on all business cards, websites, social media accounts, etc.
To download the official BCTMB seal, click here.
Not necessarily. You must successfully pass the NCBTMB Board Certification Exam, as well as meet the requirements, in order to become Board Certified.
Also, it's important to check with your state, or any state you wish to practice in, to verify the appropriate state requirements.
Once you become Board Certified, you will be required to renew your Board Certification every two-years.
To renew your Board Certification, you must meet the following requirements:
- Complete 24 CEs from NCBTMB Approved Providers within a two-year period, including:
- 3 hours in Ethics
- Note: No more than 4 hours will be accepted in Self-Care (Self-Care is not a requirement)
- NCBTMB approved scientific, anatomy, physiology, kinesiology, and business courses are also acceptable (read more)
- Pass a criminal background check (performed by NCBTMB)
- Agree to uphold NCBTMB's Standards of Practice and Code of Ethics
All 24 CEs must be completed within your two-year renewal period; you may NOT carry over or apply past CEs to meet this requirement.
Please Note: NCBTMB Approved Provider courses submitted for Board Renewal must be pre-approved. To check the approval status of an AP course for Board Renewal purposes, utilize the "Find An Approved CE Provider" app. If a course is approved, it will be listed within the app under the appropriate AP number/name. If the course is not listed, please contact us at firstname.lastname@example.com or check with the AP for clarification prior to submitting the course for Board Renewal.
The cost to renew your Board Certification is $85 every two years, plus a $25 background check fee (performed by NCBTMB).
You can renew your Board Certification entirely online with these simple steps:
- Login to your account at www.ncbtmb.org
- Click "Renewal" from the Quick Links menu
- Complete the Board Certification Renewal Form.
- Make Payment
- Click Submit
- Renewal Application Fee: $85/2 years
- Background Check Fee: $25
NOTE: Your email address registered to your NCBTMB Account is your username. Click "Forgot Password?" if you cannot recall your login information.
It costs $85 to renew your Board Certification every two years. There is an additional $25 background check fee (performed by NCBTMB).
NCBTMB Board Certified Massage Therapists are required to seek out and participate in additional continuing education courses to further advance practitioner skills and competencies, strengthen business skills, enhance modality knowledge and professional ethics, and develop a greater depth of advanced knowledge in order to demonstrate higher standards and skills than entry-level, state licensed massage therapists.
It has come to the attention of NCBTMB that several Board Certificants are currently taking more advanced courses. Advanced courses and modalities are important to our profession to further elevate practitioners' knowledge in science, business, and other realms—but may not necessarily be practiced legally without a trained professional present.
NCBTMB stands firm that all massage therapists—certified or not—may NOT practice beyond their legal Scope of Practice (as defined by each state/legislation). It is important to note, however, that NCBTMB does encourage massage therapists to further educate themselves in other professions to better understand how to communicate and collaborate with other medical professionals to provide the best possible care for clients. Any massage therapist who wishes to practice other modalities outside of the Massage Therapy Scope of Practice (as defined by each state/legislation) must first attend and successfully graduate from that program.
To learn more about what NCBTMB will accept regarding advanced science courses, please click here.
Board Certification is the highest voluntary credential to ensure all of us, as a profession, live up to the same mission. Certification is well known and accepted throughout different medical professions—massage therapy is no different. In fact, Board Certification is now a requirement to work in many health care settings, as well as some high-end spas, across the country.
As a Board Certified massage therapist, you prove to other medical professionals (and the public!) that you have obtained higher credentials and are more than just an entry-level massage therapist. Credentials matter. You matter!
To renew your Board Certification, please login to the NCBTMB website using your username and password. If you do not remember your username and password, please email firstname.lastname@example.com.
Board Certificants are required to earn 24 CEs from NCBTMB Approved Providers every two years to maintain their Board Certification credential, including:
- 3 CEs in Ethics
- Note: No more than 4 CEs will be accepted in Self-Care (Self-Care is not a requirement).
- NCBTMB approved scientific, anatomy, physiology, kinesiology, and business courses are also acceptable (read more)
All 24 CEs must be completed within your two-year renewal period; you may NOT carry over or apply past CEs to meet this requirement.
Please Note: NCBTMB Approved Provider courses submitted for Board Renewal must be pre-approved. To check the approval status of an AP course for Board Renewal purposes, utilize the Directory. If a course is approved, it will be listed within the app under the appropriate AP number/name. If the course is not listed, please contact us at email@example.com or check with the AP for clarification prior to submitting the course for Board Renewal.
While NCBTMB actively promotes Board Certification and those who attain it, we strongly encourage you to speak directly with your clients about the definition and the importance of Board Certification. Not only will it help to strengthen the relationships you have with your clients, but also confirms to your clients that they are receiving the safest, most advanced, and ethical care available.
If you need assistance in educating your clients, we invite you to download our user-friendly Consumer Guide by clicking here.
Together, the more we educate the general public about the value of Board Certification, the further we will together elevate the entire massage therapy and bodywork profession. Credentials matter. Let's give them some meaning.
NCBTMB is proud to partner with two esteemed universities to award college credits with proof of current Board Certification—Siena Heights University and HACC. Both of these educational institutions have assessed the Board Certification credential and agreed to award 30 or more college credits towards the respective degrees offered at their premier institutions.
Exclusively for Board Certificants, Siena Heights University in Adrian, MI awards 30+ college credits toward the 120 total credits required to achieve this degree. Courses available on campus and online. BAS Degree candidates ordinarily have 60 credits before beginning with Siena Heights.
Learn more about this degree program.
Exclusively designed for actively credentialed or licensed health care professionals currently working in their fields, HACC in Harrisburg, PA awards current Board Certificants 30 college credits toward the total 61 credits required to achieve this degree. Courses available on campus or online.
Yes. Our Candidate Handbook contains all the information you need to know about NCBTMB, certification, the Board Certification exam, costs, how to register for your exam, how to retrieve exam score information, and much more.
Click here for the most recent version of the Candidate Handbook.
You should receive a pass/fail score report before leaving your testing center on the day you sit for your NCBTMB exam. If for some reason you require an additional official score report for yourself or another organization stating you passed your exam, please login to your NCBTMB Account (www.ncbtmb.org) and click "Score Report Request Form" from your Dashboard. There is a $25 processing fee per score report request.
Please note that NCBTMB does not send out score reports for failed exams, nor does NCBTMB reveal numeric exam score information.
Visit www.ncbtmb.org and click "Register" from the top-left corner of the page. Fill out all required information and click "Create Account." Once created, you may login to your account using your chosen username and password.
NCBTMB reviews all approved CE provider courses. This helps to ensure that the CE courses MTs take will be within NCBTMB's acceptable content. Additionally, CE providers must supply their educational and practical background as well as their teaching experience. It is also necessary for each instructor to hold a practice pilot course for at least 5 individuals, or had prior formal teaching experience. These processes will also help to procure a highly qualified educator and overall better educational experience.
A large percentage of states have NCBTMB written in their CE rules for renewal of licenses. Massage Therapists like to move around between states, and each state has different educational hourly requirements. So, the NCBTMB approved CE courses may also be applied towards those hourly requirements, if your foundational education needs to be bolstered to obtain licensure in another state.
Since many states do require the CE courses to be NCBTMB approved, many MTs rely on the NCBTMB website course listings to find their Approved CE Provider courses. It also ensures that any course you complete with an NCBTMB AP will be accepted towards your Board Certification Renewal.
Lastly, all NCBTMB Approved CE Providers agree to uphold the NCBTMB Approved CE Provider Code of Ethics and Standards of Practice. When spending your time, money, and energy to invest in your professional development, it is wise to make that investment with someone who is also committed to go through, and maintain the processes which establish their credibility as a professional educator.
With the introduction of Board Certification in 2013, NCBTMB revised its renewal cycle to every 2 years due, in large part, to feedback from Certificants and continuous research. As research leads the way to change within the massage therapy and bodywork profession, the Board felt two years was an appropriate timeframe to ensure Certificants remain up-to-date on the latest techniques, sciences, and advances in the profession. Such a change also meant a more cost-effective price point for Certificants, as well as a more realistic, attainable number of required CEs.
The principals behind creating the requirements for Board Certification are to ensure that Certificants meet NCBTMB's goal of elevating the profession by recognizing and encouraging excellence in schools, continuing education, therapist competency and high standards. Certification is an advanced credential; as such, the following describes NCBTMB's rationale for creation of each requirement.
Graduation from an NCBTMB Assigned School – NCBTMB reviews all of its schools to ensure they are operating legally within their state. Additionally, curriculum, instructor qualifications, license to operate, programmatic information and all other information that ensures the program meets NCBTMB requirements are reviewed to guarantee candidates who graduate from these programs have received a complete and proper massage therapy education prior to applying for Board Certification.
Passing Score on the Board Certification Exam – The exam is a comprehensive tool that tests advanced knowledge in areas of assessment, applied science, massage modalities, professional communication, professionalism and ethics, and laws and business practices. Scenarios that could occur in a clinical practice are presented to test candidates' critical thinking skills. The exam is based on advanced knowledge, so candidates who pass the exam would be able to work at the highest levels within the profession, such as with other health care professionals in a health care facility.
Pass a Criminal Background Check – NCBTMB's Board Certification is the highest voluntary credential in the massage therapy profession. To ensure Board Certificants are held to the highest standards, NCBTMB performs a criminal background check on its certificants during the initial application process and with each renewal. NCBTMB does not deny certification due to minor, non-violent offenses.
Verification of Current Massage Therapy State License (If Applicable) – State licensure is the minimal requirement to practice legally in most states. All Board Certificants must already meet entry-level requirements and have begun practicing prior to becoming Board Certified if their state requires licensure. Note that a handful of states currently do not license massage therapy statewide.
Agree to Uphold NCBTMB's Standards of Practice and Code of Ethics – NCBTMB expects its certificants to uphold its Standards of Practice and Code of Ethics at all times.
The Standards of Practice describe the professionalism, legal and ethical behavior, confidentiality, business practices, roles and boundaries, and prevention of sexual misconduct and inappropriate touch a Board Certified massage therapist must demonstrate while working with the public.
The Code of Ethics describes NCBTMB's expectations of Certificants' behavior to act in a manner that justifies public trust and confidence, enhances the reputation of the profession, and safeguards the interests of individual clients.
Per the NCBTMB Standards of Practice (which all BCTMBs agree to uphold upon application and renewal), it states as follows:
Standard III(d): Securely retain client files for a minimum period of four (4) years from the termination of the therapeutic relationship; and
Standard III(e): Dispose of client files in a secure manner.
- If you currently have an account with us, login to that account at www.ncbtmb.org
- If you do not have an account, click Register at the top of the page.
- Once logged in, click "Initial Applications" from the Quick Links menu
- Complete the Board Certification Application.
- Upload your massage therapy transcripts from an NCBTMB Assigned School.
- Upload a government issued ID, (driver's license, passport, state ID)
- Make Payment
- Click Submit
- Initial Application/Exam Fee: $250
- Background Check Fee: $25
NCBTMB must send all official Score Reports to state boards; you cannot send a Score Report on your own behalf.
- Login to your account at www.ncbtmb.org
- Click on "Score Report Request" from the Quick Links menu
- Fill out all required information
- Make Payment
- Click Submit
The fee per Score Report is $25.
The NCBTMB Directory is a free, personalized listing aimed to help promote your practice, organization, and/or school. As all Directory Listings are 100% customizable, you have complete control of what information is displayed on the NCBTMB Directory for public use.
To access/edit your Directory Listing:
- Login to your NCBTMB account at www.ncbtmb.org
- Choose the NCBTMB account you wish to edit (displayed as large blue tiles on your Dashboard):
- Click on "Board Certified Therapist" to view/edit Board Certified Listing(s)
- Click on "Approved CE Providers" to view/edit Approved Provider Listing(s)
- Click on "Courses" to view/edit your AP Course Listing(s)
- Click on "Assigned Schools" to view/edit your Assigned School Listing
- Click "Edit My Free Directory Listing"
- A new window will appear showcasing all available fields/information
- Edit your Directory Listing as you see fit
- When done, click "Review My Listing" to preview how your listing will look (including your updates)
- When ready, click "Publish" to make your updates live
You can access/update your Directory listing 24/7, 365. All you need to do is login to your NCBTMB account on www.ncbtmb.org and follow the same process.
The Directory replaces our previous "Find A…" apps.
As all Directory Listings are 100% customizable, you have complete control of what information is displayed on the NCBTMB Directory for public use.
To access/edit your Directory Listing:
- Login to your NCBTMB account at www.ncbtmb.org
- Choose the NCBTMB account you wish to edit (displayed as large blue tiles on your Dashboard):
- Click on "Board Certified Therapist" to view/edit Board Certified Listing(s)
- Click on "Approved CE Providers" to view/edit Approved Provider Listing(s)
- Click on "Courses" to view/edit your AP Course Listing(s)
- Click on "Assigned Schools" to view/edit your Assigned School Listing
- Click "Edit My Free Directory Listing"
- A new window will appear showcasing all available fields/information
- Edit your Directory Listing as you see fit
- When done, click "Review My Listing" to preview how your listing will look (including your updates)
- When ready, click "Publish" to make your updates live
You can access/update your Directory listing 24/7, 365. All you need to do is login to your NCBTMB account on www.ncbtmb.org and follow the same process.
The Directory replaces our previous "Find A…" apps.
All applications will expire within 30 days if left Pending. Incomplete applications (not yet submitted) expire within 30 days.
You will have the option to "Save & Continue Later" on most NCBTMB Forms. This function allows you to email yourself with a link to continue your application. You must be logged in to your NCBTMB account when accessing this link in the future.
Once an application has expired, applicants will have to complete a new application and add all required documentation to the new application. Expired applications are non-refundable.
NCBTMB will only accept transcripts with transfer credits from NCBTMB Assigned Schools. Credits listed from schools that are not currently approved by NCBTMB, or have been denied or revoked, will not be accepted by NCBTMB for any of its tests or programs.
When accepting transfer credits, the school must ensure that all courses being transferred are completely covered in the courses that are excused by the school. Transferring hours of education without verifying content will not be accepted.
A student may attempt to transfer credits from a school that is not approved by NCBTMB; however, when applying for Board Certification, the candidate will have to submit the Portfolio Review Application. NCBTMB will review all education taken.
The Board Certification exam is graded in Scale Score Format. A Scale Score of 410 is required to pass the Board Certification Exam.
Board Certification in Therapeutic Massage and Bodywork (BCTMB) represents the highest attainable credential within the massage therapy and bodywork profession. Board Certification is an advanced credential separate from entry-level massage therapy state licensure.
As Board Certification is voluntary, its achievement represents the highest level of commitment to clients and to the advancement of the massage therapy and bodywork profession. Board Certificants must meet higher standards of education, possess a higher level of critical thinking skills, and pass a rigorous exam. The exam requires candidates to apply assessment skills, orthopedic knowledge, applied science skills (such as pathology, pharmacology, and more), and more to real-life scenarios in an effort to develop treatment plans that achieve positive results.
In addition, all Board Certificants must undergo a routine criminal background check upon initial application and renewal (every two years) as a means of ensuring employers and the public that they are working with a trusted and reputable professional.
Board Certification was created to tier the massage therapy profession, just as you often see in other allied health and medical professions.
In 2012, NCBTMB recognized that many massage therapy professionals did not truly know the difference between entry-level licensure and certification. To rectify this problem, NCBTMB had to do two things: 1) Create a Board Certification exam, and 2) Raise its minimal requirements. These changes enable massage therapists to work towards higher certification than just entry-level licensure, as well as mirrors other allied health and medical professions—bringing credibility and validity to our profession.
When submitting CE courses toward your Board Renewal, keep in mind the following:
- All courses must be completed within your eligible two-year Renewal period
- All courses must be through an NCBTMB Approved Provider or accredited college or university
- The course itself must be approved by NCBTMB (the AP being approved is not enough; check with your AP to ensure the course is also approved)
- You have the correct AP Number and/or Name to enter on your Application
If you are unsure of your eligible two-year Renewal period, or have any questions on a course, contact us.


text:
eNdymioN is a simple company. We create Systems and other programs in order to make good memories.
Yes, Systems we do create! In total, we have over a hundred Systems in our posession, and over 50,000 Systems we have worked on, to help them achieve better memories!
That is really all there is to us. We enjoy helping others, including those at the TSUKI Project. That includes a lot of intel all around Systemspace, on threats and other happenings throughout it. Furthermore, we have a lot of spare Aurora which we can supply the Project with (in fact, we closed a small developer System just for more Aurora for the TSUKI Project!)
If you have any questions, feel free to ask the TSUKI Representative!
Use all animations
Always show marquee
For if you see 404s, etc. often. Off


text:
Kathy Ludwig
Responsible for the overall direction and management of the Association, School, and Foundation; works closely with the Association Board of Directors on the mission, strategic plan, and budget for the Association; serves as the School Director and provides overall direction for the school's educational opportunities; and ensures that the Foundation's objectives are carried out.
Stephanie Mount
Director of Member Engagement and Communications
Serves as the point person for member communication and engagement; responsible to engage our members through a variety of communications channels including social media; responsible for promoting the benefits and services for all three levels of membership; works with the Foundation; coordinates the Association's REALTORS® Reach Out efforts; and handles event planning, public relations efforts and press releases.
Kim Tauriello
Director of Professional Development
Serves as the Assistant School Director; responsible for developing, planning and marketing of our pre-licensing, continuing education, appraisal, broker and designation courses; handles the scholarship programs, New Member Orientation, Information Sessions and the REALTOR® Code of Ethics Training Requirement; and executes Grievance, Professional Standards, and Mediation Procedures.
Margaret Parsons
Director of Government Affairs
Organizes the Association's government affairs efforts; responsible for grassroots advocacy, key contact program, candidate screening process, and RPAC fundraising; works with the Commercial Council Board of Directors to provide services to our commercial members; handles the Municipal Database.
Cindy Cuddeford
Provides administrative support to the Chief Executive Officer and the Government Affairs Director; handles the overall maintenance of committees; responsible for equipment and our rental agreements; responsible for the Association's Trade Fair; assists with the Association's special events and the Special Award process; and serves as staff liaison for the Thanksgiving Food Drive.
Chris Deimler
Membership and Member Services Manager
Handles aspects of membership; responsible for membership lists and the REALTOR® Store; issues and trains new members on key box products; issues key boxes in addition to upgrades and downgrades of keys; coordinates monthly MLS training with Bright MLS; responsible for the annual dues billing; coordinates various Association events including the Shredding Event; responsible for building maintenance; and responsible for the Foundation Golf Outing.
Dee Hyatt
Handles all administrative responsibilities for the Greater Harrisburg REALTORS® Institute (GHRI); primary point of contact for GHRI questions; assists in the planning, developing, marketing and implementing of school's courses; serves as the school registrar; assists with the tracking of the REALTOR® Code of Ethics Training requirement; and assists the Director of Professional Development as needed.
Mary Keck
Responsible for New Member Orientation sponsorships and preparation; responsible for annual sponsorship solicitation from our affiliate members; serves as back up to issue key boxes and keys; assists in the planning and implementing of information sessions; serves as back up on all administrative responsibilities for GHRI; handles the vending area.
The Greater Harrisburg Association of REALTORS® Association members are served by six full-time and two part-time staff members at its location in Enola.


text:
Recent Comments
Quirkworthy on Strange Days Golden the Gamer on Strange Days Quirkworthy on Strange Days precinctomega on Strange Days Game Design: The Dre… on Game Design: A Load of Ch…
News Sites I Check
Partners in Crime
Resources (Board Games)
Resources (Painting & Modelling)
Resources (Terrain)
I'm looking for…
Quirkworthy Archives
Post Categories
Category Archives: Deadzone
DZ2 FAQ up
This has gone live on the Mantic download page.
Posted in Deadzone, FAQ Tagged Deadzone, FAQ 28 Comments
With the unexpected arrival of the Deadzone beta, I've been a little sidetracked into answering the questions on that thread. This is fine – after all, that's why the thread is up in the first place. However, it might make … Continue reading
Posted in Deadzone, Dungeon Sagas, Random Thoughts Tagged Deadzone, Dungeon Saga 17 Comments
Deadzone Redux Movement
Another little snippet from the current version of DZR. I've added a Speed stat to the models. This is a way of including a lot more variation in the model's rate of movement, and doing so very simply. Speed is … Continue reading
Posted in Deadzone Tagged Deadzone, Game Design 51 Comments
Deadzone Redux Command Dice
I've shown a few pics of us playtesting DZR recently, and you may have noticed some bespoke D6s we've had lying around. So far, nobody guessed quite what they are, though there have been some fun suggestions. Today I thought I'd explain … Continue reading
Posted in Deadzone Tagged Deadzone, Game Design 112 Comments
DZR In Action
Showed some more folk how to play the new DZR last night over at Mantic. One game was Pathfinders against Veer-myn, the other Plague against Enforcers. I didn't get a lot of pics of the Pathfinders/Veer-myn game as that was … Continue reading
Posted in Deadzone, Dungeon Sagas 23 Comments
Playing Deadzone Redux
Just sorting out some tweaks before I go and play DZR with the latest iteration of the rules (and some new victims to try them on). Been tinkering with the missions again, and have a new trick to try out. I … Continue reading
Posted in Deadzone 28 Comments
Cards in Deadzone Redux
I've had a few queries about cards in the upcoming Deadzone Redux, so I thought I'd answer them here by explaining my current thinking on the topic. When we started looking at updating the rules, I read a lot of … Continue reading
Posted in Deadzone 127 Comments