text:
May you like living room wall borders. Use this opportunity to see some galleries to give you inspiration, we found these are best galleries. We like them, maybe you were too.
Please click the picture to see the large or full size picture. If you think this collection is useful to you, or maybe your friends you can hit like/share button, so more people can visit here too. Right here, you can see one of our living room wall borders collection, there are many picture that you can browse, we think you must click them too.
It is not necessary to go to school and take programs on architectural drawing so as to have the ability to create your own customized flooring plans. For every set of customized ground plans that you simply draw your self, you may very well be saving hundreds of dollars - particularly in your new dream home. Rustic lighting can actually set the tone. You'll be able to study architectural drafting in only a few months - relying on how fast you want to study. Here is how one can study architectural drafting rapidly and save some money in your new home. Besides that, saving a few thousand dollars could even offer you enough money to build that gazebo, a pool, a ravishing deck and patio, or some other lovely addition to your new house that you really want! This leaves an attractive wealthy feel, but could leave you yearning to add coloration. In case you select a residing room rug with a bear or moose print, you might want to pick out a easy pattern or solid color in your upholstered furniture.
Another solution to inject shade is in the choice of rugs. Cabin fashion rugs use geometric shapes or repeating patterns of animals, fish, mountains or relevant components to produce the suitable appear and feel. The first course covers how to draw home plans for a ranch model residence, and the second course shows you the way to draw two story home plans. A part of the cost of a brand new dwelling, nonetheless, will be decreased in the event you find out how to draw your personal floor plans. Many smaller communities and rural areas do not require that an architect draw your home plan for you. Normally, an architect would do that, but it surely will not be necessary for you to use an architect. There is no commitment to an architect - you possibly can change your plans when you wish to, or even scrap them altogether and begin over once more. All buildings require that there have to be blueprints made earlier than anything will be built. There are lots of options when searching for cabin furnishings. Birch bark, twig and hickory furnishings and equipment at all times look good, and by some means make a camp or cabin extra relaxing.
Many web sites focus on rustic decor and more and more manufacturers are adding high nation lodge items to their traces. Cabin model wall decor takes care of this properly. Hickory sofas and love seats with lodge style fabric are a pure fit. Deer, moose and elk shed their antlers seasonally, so in case you are involved about animals being harmed to create these works, be certain you choose an organization that uses naturally shed or resin antlers. With the ability to own your own home is a great privilege. Searching by antique stores is a superb exercise for a rainy day, ikea sultan holmsta and may turn right into a enjoyable passion whereas on weekend getaways. Antiques offer an amazing look and have already taken years of use and abuse. Many look ahead to the prospect of it for many years, and then are solely in a position to buy after saving for a few years. An added convenience is that programs are available on-line, which means you'll be able to work on them at your leisure.
Stained glass, mica and twig lamps are additionally out there in lots of rustic kinds. Decorating a rustic cabin could be a fun and rewarding expertise. Reproduction signs might be customized to allow you so as to add your loved ones, cabin, lake or town identify and make it your own. This means that someone with information of architectural drafting should make floorplans for that constructing or home with floor plan software. Once you begin taking the web architectural drafting course, it won't be lengthy before you will have to start out drawing your personal home plans. You will note that it's not troublesome and can even be enjoyable - especially as you see your dream house plans start to take form. Architectural drafting could be learned rather quickly and it will allow you to place your dream residence into usable house building blueprints. By studying architectural drafting yourself, you possibly can save some huge cash.
If you beloved this report and you would like to obtain more details concerning moreno overbed unit kindly take a look at the website.
Below are 25 best pictures collection of living room wall borders photo in high resolution. Click the image for larger image size and more details.

domain: design


Belforter Str.Belforter Str. 28, 10405 Berlin
- execution period:
- August 2015 - July 2017
- Belforter Straße 28 Immobilienverwaltungs GmbH
- bhap, Blaschke Hülsey Architects
- order volume:
- 905.000,- Euro
- Residential and commercial building
- service specification:
- Refurbishment and attic conversion
- detailed service description:
The residential building in need of renovation was extensively repaired and modernised, it was converted into a modern residential and commercial building while retaining the original character of the building.
Ahle, Fischer & Co. was commissioned with the structural work as well as plaster work and the execution of roofing and roof plumbing work.
Within the framework of the structural work, foundation and earthworks were carried out to underpin the existing foundations. The roof truss construction was renewed, the attic floor was extended and will be used as additional living space in the future.
The high-quality renovated apartments were sold.
We would also be pleased to carry out high-quality roofing & roof plumbing work for you.


text:
At meeting held on 17 April 2017TCI Industries announced that the Board of Directors of the Company at its meeting held on 17 April 2017 has issued and allotted 1788, 0% Non-Convertible Redeemable Preference Shares (NCRPS) of Face Value of Rs. 100/- (Rupees Hundred only) each at a premium of Rs. 300/- (Rupees Three Hundred only) each to Ved Prakash & Sons HUF belonging to the Promoter & Promoter Group of the Company.
Powered by Capital Market - Live News
(This story has not been edited by Business Standard staff and is auto-generated from a syndicated feed.)

domain: economics


text:
R | | Drama, Romance, Sci-Fi
When their relationship turns sour, a young couple undergoes a medical procedure to have each other erased from their memories.
random thoughts for Valentine's day, 2004. Today is a holiday invented by greeting card companies to make people feel like crap.
When Mary first comes to Joel's apartment to visit Stan and Patrick, she goes into the kitchen to pour drinks. Just after she says "Let me do the honors," the pendulum of the clock on the wall is not moving. About 2 seconds later, as she is pouring the drinks, the pendulum on the clock is swinging.
The opening credits don't begin until about twenty minutes into the film and after much action and plot.
$8,175,198 (USA) (21 March 2004)

domain: entertainment


text:
Inverted perovskite solar cells with a power conversion efficiency of 22.3%
Photovoltaic (PV) cells, which can generate energy from the sun, could be very useful in tackling the current environmental crisis. Perovskite PV cells, cells made of metal halide perovskite semiconductors, have recently proved to be particularly promising, as researchers have managed to improve their power conversion efficiencies substantially, from 3.8% all the way to 25.2%.
Their remarkable efficiencies make perovskites a leading contender in the development of the next-generation of low-temperature-processable PV technologies. Perovskite PV cells can have two main design archetypes: the so-called regular (n-i-p) structure and the inverted (p-i-n) structure. So far, cells with a regular structure have achieved the highest power conversion efficiencies, while those with an inverted structure have achieved far longer operation times.
Researchers at King Abdullah University of Science and Technology (KAUST) and the University of Toronto were recently able to reduce the previously observed efficiency gap between perovskite PV cells with a regular structure and those with an inverted structure. Their paper, published in Nature Energy, introduces a new design strategy that allowed them to fabricate inverted solar cells with long operation lifetimes and power conversion efficiencies of 22.3%.
"Perovskite PV devices with the highest efficiencies, which are based on the regular structure, have to incorporate ionic dopants in their hole transport materials," Xiaopeng Zheng, one of the researchers involved in the study, told TechXplore. "By getting rid of these unstable dopants, inverted PV devices have contributed to the advances in the technology's operational stability. Unfortunately, the power conversion efficiencies of inverted perovskite PV lag significantly behind those of regular structured devices (20.9% vs. 25.2%)."
According to Zheng, for perovskite PV technologies to have a real commercial and environmental impact, researchers will first need to ensure that they excel both in their operational stability and power conversion efficiency. The design strategy that he developed in collaboration with his colleagues at KAUST and the University of Toronto could help to achieve this by improving the structural and optoelectronic properties of perovskite materials that are typically used to make PV devices.
Zheng and his colleagues added a trace amount of surface-anchoring alkylamine ligands (AALs) with different chain lengths to their perovskite material. This allowed them to alter some of the material's properties, leading to higher power conversion efficiencies than those typically observed in perovskite PV solar cells with an inverted structure.
"We found that only a trace amount of alkylamine during processing was enough to alter the properties of the perovskite material in the following advantageous ways: (i) promoting crystal grain orientation; (ii) suppressing trap state density; (iii) reducing charge carrier nonradiative recombination (i.e. loss), as well as enhancing carrier mobilities and diffusion lengths; (iv) inhibiting ion migration in the perovskite," Yi Hou, another researcher involved in the study, told TechXplore.
The AAL surface-modified perovskite films used by Zheng, Hou and their colleagues exhibit a (100) orientation and a substantially lower trap-state density compared to non-modified films. They also present enhanced carrier mobilities and diffusion lengths, which result in devices with a certified stabilized power conversion efficiency of 22.3%.
"Perovskite PVs are a young technology and they still have room to improve their stability to approach other well-established PV technologies, such as c-Si and inorganic-based thin films," Ted Sargent, another researcher involved in the study, told TechXplore. "We have substantially reduced the efficiency gap between inverted devices and regular devices using just trace amounts of alkylamine as grain and interface modifiers."
The researchers found that perovskite solar cells created using their approach can operate for over 1,000h at the maximum power point under a simulated AM1.5 illumination, without any loss of efficiency. In the future, the design strategy they introduced could bring perovskite materials closer to fulfilling the demanding conditions required for the commercialization of solar cells.
"For the next stage of our research, we will look into ways of producing perovskite PVs, to achieve large area devices without compromising on high performance and reliability," Osman Bakr, another one of the researchers involved in the study, told TechXplore.
More information: Xiaopeng Zheng et al. Managing grains and interfaces via ligand anchoring enables 22.3%-efficiency inverted perovskite solar cells, Nature Energy (2020). DOI: 10.1038/s41560-019-0538-4
Journal information: Nature Energy
© 2020 Science X Network

domain: literature


Worcester based singer/songwriter Sean Jeffery is an established musician on the local music scene, and has continued to perform under “new normal” circumstances, with almost daily live streams on a number of platforms. On top of that, he’s been working on the release of his upcoming EP, set for release later this year.
Gravitational Wave, released on 26th March, is the lead single. It seemed an obvious choice, as it became popular for the online gig audiences. Of the track, Sean says “I’m a bit of a science geek, so the song first came into being when I heard on the news about the first direct observation of gravitational waves in 2015.”
From there, the lyrics took a more accessible journey into everyday reflections on relationships, while retaining the notion of travelling back in time to win over the subject of the track on the crest of the very first gravitational wave. The song was given a chance to develop further as it, and other tracks, were test-driven during the lockdown live streams.
The track opens with a light shuffling beat and a prominent twang of a guitar riff, before the vocals kick in with Sean’s distinctive lyrics that cleverly take on a universe and space theme that deceptively tell an intriguing love story. After the first verse and chorus, there is a moment where you feel the track is finishing, but in fact it’s just warming up, and more levels are mixed in to add more musical texture.
The song is delightfully upbeat, a fitting declaration that embraces the joy that the singer would feel if the object of their affection changed their mind and decided to give things a go. A joyful journey back in time would be taken, to this feel good soundtrack. During the chorus and second verse, a female voice takes on an ethereal backing vocal, courtesy of former Hitchhiker band mate Anna Mason, who also provides guest guitar. It’s a track that drifts through the air with ease, it’s upbeat yet gentle, with no harsh unexpected twists or turns. It lifts your spirits and steers you away from the black hole.
Recorded and mixed in Sean’s home studio, Gravitational Wave has all the qualities needed for a heart-warming tune. Lyrically, Sean’s songwriting skills shine, and I truly believe this is where he stands out, and is the element that makes him a distinguished artist. With a lyric video on its way, and eye catching artwork created by A Level Fine Art student Megan, Sean’s daughter, this is a great introduction to the collection of tracks set to appear on the EP. Track available on Spotify and all major streaming platforms from 26th.
By: Kate Ford


text:
It’s become popular in the last few years to do thirty days of thankfulness in November as we look forward to celebrating Thanksgiving. I’d like to expand on that idea this month and write about the books and authors I’m thankful for.
I can’t write about the authors I’m thankful for without beginning with Madeleine L’Engle. Madeleine (I feel we’d call each other by our first names if I’d had the chance to know her) has had a deep impact on my desire to write and the types of stories I choose.
Most people are familiar with A Wrinkle in Time, her Newbery award winning book. L’Engle persevered through 26 rejections before finding a publisher for her book. Anyone who writes knows the sting of rejection and how hard it is to continue when those ‘noes’ begin to pile up. Yet Madeleine didn’t give up on her science fiction story when others told her it was too adult, too strange and too overtly Christian. Lucky for us.
Of course, A Wrinkle in Time is just one of five books in the series, and if you haven’t read the others, you should do so right after you finish reading this blog. All of the books are equally wonderful in their eccentric plots and settings, from traveling inside the body to traveling to other worlds, to traveling into the past to a Biblical story. Madeleine centered her stories around the big questions. Why are we here? Why does evil exist? How do we live in the midst of evil? Is God real? Does He love us? These are the same questions many kids are asking themselves as they grow into adults, and questions adults continue to ask.
L’Engle’s other books range from autobiographical to the Austin Family Chronicles to her thoughts on spirituality. All of them encourage me in some way or another to push the boundaries of my known world. Her deep interest in science and the way the universe works spurs on my own interest in these topics. Her unwavering faith and eloquent interpretation of what it means to be a Christian help me understand my own faith.
Without a doubt I’m thankful for the written legacy Madeleine left for me and for many others for generations to come.
Glimpses of Grace
A Ring of Endless Light
A Circle of Quiet
Night Time with Stars in Sky Image courtesy of moggara12, Autumn Maple Leaves Image courtesy of Aduldej, and Planet and Star Background Image courtesy of Photokanok, all at FreeDigitalPhotos.net


text:
Nick Cannon revealed that he wants to get married once more in the future during an interview on the podcast “All The Way with Shelley Wade.”
Nick Cannon has recently confirmed that he will be expanding his family after making headlines in recent years for fathering several children with various women.
The comment was made toward the end of his response to Wade’s question about whether the TV personality would ever think about getting married again.
“I love the concept. I love the ceremony of it,” he said. “I’ve failed miserably so many times at monogamy and relationships. But like, you know, God ain’t done with me. We gonna figure it out.”
Together with his former spouse, singer Mariah Carey, Nick Cannon has fraternal twins named Moroccan and Monroe.
He has two children with model Brittany Bell: Golden and Powerful Queen.
Then, DJ Abby De La Rosa and her twin sons Zion and Zillion.
At the age of five months, Zen, a son he had with model Alyssa Scott, passed away from brain cancer.
Also, Cannon is thought to be the father of another child with De La Rosa, who just revealed that she is expecting again, and is also expecting a child with model Bre Tiesi who is 31.

domain: celebrity


text:
Featuring a swimming pool in the garden this 2-star hotel is located 7 km from Aix-en-Provence. Free Wi-Fi access is provided in public areas.A flat-screen TV and minibar are included in the rooms which feature period furnishings and tiled flooring. Some of the rooms offer a view of the pool and others have a view of the Sainte Victoire.A continental breakfast is served every morning at the Mas de la Bertrande. You can enjoy a drink in the bar or on the shaded terrace.Marseille Airport is 35 km from the hotel and free private parking is available on site. Aix-en-Provence Train Station is 20 km away.
- Pets allowed

domain: travel


text:
Happy September – it is really hard for me to believe that we only have a few months until Thanksgiving and Christmas! Can you believe it? But that means it’s time for a new cookbook – and this one has great ideas for baking for the holidays!
This month, the new cookbook is titled “Simple Old Fashioned Baking.” The tagline is “The Best Recipes from Grandma’s Kitchen.” You can see the picture on the back that shows what every grandmother should look like!
I found this book several years ago in a used bookstore. Visiting used bookstores is one of my favorite hobbies and I always look for books on baking. Anywhere we go, I am always scouting out used bookstores. I have found some great deals at these places.
This was one of those deals. The title of “baking” drew me in first and then I was hooked the minute I saw the easiness of most of the recipes. Quite a few of these recipes have only 4 or 5 ingredients. How much easier can you get in baking?
This is why I prefer older cookbooks and recipes. In my opinion – and you can do with it what you will! – it seems that in an attempt to come up with new and fabulous, simplicity and ease have gone by the wayside. When our grandparents and great-grandparents were cooking and baking, they didn’t have a gourmet grocery store or tons of ingredients to use. They had to rely on simplicity and their pantry. Enter this cookbook.
The first recipe I want to share is the first recipe I tried from the book – Easy Lemon Cookies. Most everyone in the house loves lemon desserts, so this one seemed perfect to try. It has only four ingredients and makes up so quick you won’t even believe it! That is baking at its best!
EASY LEMON COOKIES
- 1 stick butter, softened
- 1 cup sugar
- 2 tablespoons lemon juice (can go up a little if you like a strong lemon taste)
- 2 cups flour
Preheat your oven to 350 degrees. Cream together butter and sugar until fluffy.
Add lemon juice and cream again.
Slowly add in flour. Dough will not be sticky and will leave sides of mixer bowl.
Drop teaspoonfuls of dough on to well greased cookie sheet. I used the smallest Pampered Chef scoop to do this as it was the perfect size. They will come out as balls but you can flatten if you want.
Sprinkle on a little bit of sugar. I used regular sugar this time, but you can use decorative colored sugar if you want.
Bake 14 to 15 minutes until just brown around the edges.
Remove to cooling rack and cool on pans for 3 minutes, then remove to rack and cool another 5 to 10 minutes (if they last that long without getting snatched off the rack!).
That’s it! Can you believe how simple that is? The cookies come out easy and delicious – and rarely last long in my house!
I will be sharing more great recipes from this month’s cookbook and most all are easy to make. Many have only a few ingredients that you may have in your pantry already!
I would love to know below if you made these cookies. How did they turn out? Did you change up the recipe? Let me know!
Until next time

domain: food


Minisled /g-lock /lock up
The G-sled accelerates a retractor or its webbing to determine the lock distance for programmed accelerations.
Retractor Tilt lock test stand
The tilt lock test stand measures the locking/unlocking angles, starting from any car installation angle, using 5 axes.
Extraction retraction force test stand
The extraction force test stand measures the forces during the extraction and retraction of the webbing, including friction and comfort testing.
Buckle release test stand
The buckle release test stand measures the force required to open the buckle after a programmed pre-load profile. The machine can also measure the required insert force.
Combined retractor g-lock/tilt lock test stand
The retractor test equipment combines the strengths of the G-sled and the tilt-lock, to test both the angle and acceleration at which a retractor lock occurs.


text:
Elephant Safari Tour
|Adult US$.99||Child US$.79
5-12 Years Old
ELEPHANT SAFARY TOUR
Elephant Safari Long Trek (60min)
HOTEL PICK UP TIMES: 07.30 – 08.00 am
Pass through unworldly beauty – natural rice paddies, quaint Balinese villages, temples and local markets – on the scenic drive to Bali Elephant Camp, located in the historic village of Carangsari, birth place of Bali’s national hero ‘Ngurah Rai’ and only a short distance from the Sangeh monkey forest. Bali Elephant Camp is situated between the rice paddies, jungle, and the Ayung River (where we also do white water rafting) and is one of the most natural places in Bali.
Our elephants come from Sumatra, and as part of our efforts to conserve this magnificent species, we’d like you to learn more about them, go trekking and experience life with our incredible elephants! By riding our elephants you help us help other elephants in Sumatra by providing funds for food and land to make sure their homes remain protected.
After enjoying the drive, be welcomed to Bali Elephant Camp with a refreshing welcome drink at the ‘Trunk’n’Mahout’ valley-view café. Watch the elephants enjoy their morning or afternoon bath and then meet our Head Mahout to learn about the daily life of a Sumatran elephant as the elephants get saddled-up for the ‘Explorer’ or ‘Adventurer’ treks.
USD 99.00 /Adult
USD 79.00 /Child (5-12Years)
USD 49.00 / Infant
USD 120.00 /Adult
USD 85.00 /Child (5-12Years)
USD 52.00 / Infant
* Hotel Transfers
* Park Admission
* 60 minutes Elephant safari
(Pick up in Tabanan and Ungasan area USD 40.00 per car for return transfers)
WHAT TO BRING:
Cameras, Some cash for souvenir or extra meals and drinks.
NOTES: Departs everyday with minimum 2 persons, Time schedule could be changed with out notice.


text:
PH Testing Kit
In aeroponics, the level of "pH" in your reservoir is an extremely important factor, and your pH levels need to be tested and balanced every time you add water to your Airgarden.
A PH kit is included with your Airgarden. Only buy this as a replacement.
Ideally, the pH level in your Airgarden should be 6.3, however maintaining the range of 6.0 to 6.5 is acceptable.
HY-GEN® COMPLETE pH KIT is an easy and accurate way to keep track of the pH levels in your Airgarden. The kit gives you everything you need to test the levels, as well as adjust your pH using the pH UP and pH DOWN solutions provided.
Adjusting the pH is quite easy and after some time and experience it becomes an art as you start to learn more about your plants and growing system.
The concentrated indicator solution allows you to obtain a reading by using just one drop in the test tube provided. The calibrated colour chart provided helps test your pH to within 0.5 of a pH unit. Testing and adjusting your nutrient solution regularly will ensure your plants are healthy and happy.
HY-GEN Complete Kit includes:

domain: chemistry


text:
What is considered a surgical extraction?
Surgical extraction is the removal of a tooth that presents clinically with a condition that does not safely or adequately allow access using a non-surgical approach. Surgical extractions require an incision, elevation, and bone removal when indicated.
What is the difference between an extraction and a surgical extraction?
There are two main types of dental extraction, simple extraction and surgical extraction. Simple dental extraction is used to remove teeth that can be seen and are easily accessible, whereas surgical dental extraction typically requires an incision into the connective tissue to gain access to the tooth to be removed.
How long does a surgical tooth extraction take?
A dental extraction is generally a simple procedure. One tooth extraction study determined that a single extraction generally takes 20-40 minutes. This includes time for preoperative duties, numbing the tooth, extracting the tooth, and postoperative duties.
How is surgical extraction performed?
Why Surgical Tooth Extraction May Be Necessary
- Review your health history. …
- Administer anesthesia. …
- Incise and elevate gum flap if necessary. …
- Release periodontal ligament fibers. …
- Remove bone as needed. …
- Place a gauze safety net. …
- Section the tooth if necessary. …
- Loosen the tooth and expand the bony socket.
How painful is a surgical tooth extraction?
Does the procedure hurt? No, despite what you may have imagined, you having nothing to worry about. Having a tooth extracted, whether surgically or not, should not hurt. Usually you’ll feel a slight pinch as the area is numbed using anesthetic, then after this you will not be able to feel the procedure.
Can a normal dentist do a surgical extraction?
Dentists and oral surgeons are both able to perform tooth extractions, but dentists are not qualified to extract teeth in all types of circumstances.
What happens during a surgical tooth extraction?
– With this procedure, an incision outlining a section of gum tissue is made. The area of tissue is then reflected (peeled) back, thus providing your dentist with access to the bone tissue and/or tooth that lies underneath.
What is the best painkiller for tooth extraction?
Pain After Tooth Extraction
Pain medications are normally required after tooth extraction surgery. If you can take ibuprofen (Motrin® or Advil®), take 400–600 mg every 6–8 hours or as prescribed by your doctor. Ibuprofen will help with pain relief and as an anti-inflammatory.
How long does pain last after surgical tooth extraction?
How Long Does Pain Last After Tooth Extraction? A typical tooth extraction healing process can take between one and two weeks. On the other hand, the pain of a tooth extraction typically fades in the 24 to 72 hours following the surgery.
Are you awake during oral surgery?
What is General Anesthesia? General anesthesia is the only true sleep dentistry option. Under general anesthesia, patients remain completely unconscious throughout the treatment process. This ensures total comfort and relaxation, during even the most advanced oral surgery.
Can a dentist pull an infected tooth?
If the affected tooth can’t be saved, your dentist will pull (extract) the tooth and drain the abscess to get rid of the infection. Prescribe antibiotics. If the infection is limited to the abscessed area, you may not need antibiotics.

domain: medical


text:
Quality of care is of paramount importance to both patients and nurses. This article examines how the existing patient/nurse partnership is the result of a variety of clinical, political, and organisational power paradigm shifts over time. The significance of this partnership on the quality of care, particularly in terms of the necessary power base required, is then considered. Next the education, health care systems, and diversity issues found in the UK and the US are compared and contrasted. The conclusion focuses on a transatlantic vision for the future in the consolidation of the patient/nurse transaction for the achievement of negotiated, competent, compassionate care and as a continuing force for quality at policy, strategic, and operational levels.
‘You’re the red rag to my raging bull
You see red when I sing the blues’
The poem develops by stripping away the complex layers that make up this nuanced relationship that, ultimately, works exceedingly well
‘You say we were a mismatched couple
but I’m reminiscing too.
I remember how we made the colour purple
And my eyes are red from missing you.’
This idea of two colours/people, mixing together to produce the colour purple is a useful metaphor. It can be utilised for effectively unpacking and understanding the symbiosis achieved by the blending of the patient/nurse relationship. This relationship has the potential to forge a powerful force for quality on the anvil of global changing health care needs and health care delivery.
This article will examine the way that the existing patient/nurse dyad is the result of clinical, political, and organisational power paradigm shifts over time. Using this exploration of the history of nursing in the UK as a contextual framework, the commentary will then consider the way that nurses have contributed to the emancipation of patients, and vice versa, in the quality endeavour, using various bases of power. This will be expanded to compare and contrast United Kingdom (UK) and United States (US) scenarios, using the themes of (a) education, ( b) the NHS/the US health care systems, and (c) issues of diversity, in terms of both the development and the significance of the patient/nurse partnerships as a power base for quality. The conclusion will include a transatlantic vision for the future in terms of the consolidation of the patient/nurse transaction to achieve, not only the common goal of negotiated, competent, and compassionate care, but also as a continuing force for quality at strategic and operational levels.
History of Nursing Power from the UK Perspective
Historically, there has been a number of shifting power paradigms in relation to patients and nurses. These have been much influenced by the economic, political, and social structures in which they took place. Black (2005) attributes the transformation of UK hospitals in the nineteenth century to "…medical advances, nursing reform and improvement in buildings" (p. 1394). Conversely, Dean et al. (1980) illustrate how some areas of the development of nursing in nineteenth century England were influenced by the need by the politicians of the day to exercise social control by managing the sick poor.
Understanding our history is an important facet to understanding the shifting power base of patients and nurses.
Williams (1980) provides further insights into the socio-political imperatives that shifted nursing from a largely unskilled, low-paid job to that of a more respected, contributing role in society. She sees the major shapers of this development as the increase in medical interventions, the health care needs of the rich, and the requirement of a burgeoning industrial, capitalist economy for a healthy workforce.
Understanding our history is an important facet to understanding the shifting power base of patients and nurses. The rights and responsibilities of both constituencies become enmeshed with the socio-political infrastructures of the period. In the UK, social class, access to education, gender, franchise rights, and economic status have all been important elements in the power brokering equation for these two groups.
Nearly 20 years ago, Clay (1987) wrote that:
Nursing is a remarkably insular profession, which has taken little heed of the great social, political and economic forces that have shaped and surrounded its practice….We are sometimes guilty of not taking time to lift our heads from the bedside to look at what is happening around us (p. 1).
More recently, Black (2005) reappraised nursing from a historical perspective and concluded that nurses made a major contribution to nineteenth century health care delivery. He makes powerful arguments, with supporting evidence, that not only is the contemporary UK patient public losing faith in hospital care, but that today’s nurses, as in the nineteenth century, have the potential and are the key to:
- replicating a transformation of hospitals similar to the nineteenth century change
- improving the hospital environment
- reducing the need for hospital care
- improving the hospital environment, in addition to also reducing the need for hospital care
Some progress has been made in relation to this last point. On November 9, 2006, the Chief Executive of the English National Health Service (NHS) wrote to every Member of Parliament to inform them that the NHS was developing a new model of care with fewer patients being treated in hospitals "...and more in local clinics and hi-tech specialist centres. This would require fewer beds in hospitals" (Cavel, 2006, p. 12). Black (2005) points out that the nursing contributions to the transformation of health care can only be achieved if doctors, managers, and politicians recognise and respect the contributions that nurses can make and there are enhanced opportunities and improved leadership opportunities available.
...nursing contributions to the transformation of health care can only be achieved if doctors, managers, and politicians recognise and respect the contributions that nurses can make...
Perry (1991) asserted that, in the past, nurses had increased their knowledge by observing a variety of pathologies and interventions from the perspective of the sick poor. Doctors, however, were more associated with the care of the rich; and thus the status of the two occupations became derived from the social class of those receiving care. This resulted in nurses having a more subordinate position in the health care hierarchy. In recent times, this relationship has changed dramatically as a consequence of increased education for both patients and nurses. Mackay (1993) believed that this potential narrowing of the relative educational gap between doctors and nurses could result in negative attitudes towards, and some discomfort about, graduate nurses by medical colleagues.
The adage that knowledge is power is becoming more of a lived reality for both patients and nurses in a UK health care system, which has previously been grounded in paternalism (the father/child analogy to describe superior/inferior relationships) and biomedical reductionism (the artificial distillation of health issues to fit a biological/medical model without taking into account psychosocial factors for a more holistic approach).
...there is no way to deliver quality care in highly complex, frequently chaotic, organizational environments without power.
This article describes power as a force towards achieving goals (Marquis & Huston, 1996). For example, education is often identified as powerful; it is the movement of one’s mind from one point to a different point that captures the educative experience. Both nurses and patients are often averse to identifying themselves as powerful. Nevertheless, there is no way to deliver quality care in highly complex, frequently chaotic, organisational environments without power.
Nursing is the process of accompanying someone on a journey of recovery, end of life, or the promotion and maintenance of health; and yet, regardless of the journey’s destination, living each moment to the highest quality. At times, when the patient does not have the power to see his/her way forward due to lack of physical, psychological, or emotional capacity, the nurse leads in the direction of healing. At other times, it is the patient who leads. With healing as a destination, with power as the fuel, the possibilities for creative leadership by both the nurse and the patient are infinite.
Using Nursing’s Power Base to Move from Vision to Reality
Without power, there is no action.
A vision is a picture, an image of the destination, the goal one is trying to achieve. The antecedent for visioning is dreaming. Dreaming requires time, practice, and permission from one’s self to think illogically and irrationally (Malone, 1991). It requires power to move the dream from vision to reality. This can only be accomplished by sharing it with others and transforming the vision as others buy into it and joint ownership occurs. A vision without action is a hallucination (Malone, 1996). Without power, there is no action. The concept of power is multidimensional and complex. The following power perspectives have been selected for their relevance to the professional practice of nursing and the therapeutic relationship between nurses and patients. These power perspectives are clinical power, which has several forms: (a) informational, (b) legitimate, (c) charismatic, and (d) extended (French & Raven, 1960), political power, and organisational power, each of which will be described below.
Clinical power is at the core of the nursing profession and of individual nurses. Patients are an essential part of, and make an important contribution to, this clinical power base. Without patients, there is no clinical power. Without patients, nurses would have no clinical power, which is created by the interdependence of nurses and patients. It takes power to shape and massage an organisational system, such as a hospital, and extract the best care for our patients (Malone, 1996).
Informational Clinical Power
Informational clinical power is multi-directional and generated through listening, reviewing, examining, discovering, intervening, and being together with the patient.
Nurses share more information (and vice versa) with patients than any other provider group.
Legitimate Clinical Power
Legitimate clinical power is based on one’s position and/or credentials. The most significant legitimate clinical power that all nurses in the UK have is their Nursing and Midwifery Council (NMC) registration. The NMC affirms every nurse’s power and authority to provide safe, competent care to the people of the UK. This is every patient’s right. This is currently under threat with the recent Department of Health’s (DH) Foster Non-Medical Regulation Report (DH, 2006). This recommends a diminished role for the NMC in its monitoring and disciplinary activities. The Royal College of Nursing (RCN) and the NMC are speaking out in opposition to any steps that constrain nursing’s ability for self-regulation.
...legitimate power emanates from an accepted ethical framework...in which patients' rights are enshrined.
From a patient perspective, legitimate power emanates from an accepted ethical framework (incorporated in most professional codes of conduct) in which patients’ rights are enshrined. The first public document which acknowledged a more knowledgeable and autonomous public in the UK was the Patient’s Charter (DH, 1991). Additionally, professional bodies such as the RCN have also always been at the forefront of spelling out protocols for patient’s rights in areas such as health care research (RCN, 2005a). Over the last two decades there has been a burgeoning of patient pressure groups, often related to specific conditions, such as the Stroke Association. Nurses are often active in these groups, particularly if they are related to their practice specialisms. The public and the professionals also involve themselves in raising money for such enterprises as Cancer Research. This has particular resonance if they, or family members, are affected by the condition. For instance, the daughter of one of the authors recently ran a half marathon for Cancer Research, designating her effort on her sweatshirt ‘For her Mum’!
Charismatic Clinical Power
Charismatic clinical power is related to the power to inspire others (Weber, 1947).
For charismatic power, the nurse must present an element of joy or passion for the profession, for the act of caring and healing.
Extended or Referential Clinical Power
Extended or referential clinical power is built on the premise that providing quality care is not a solo endeavour. If the nurse is the only health provider, the caring is accomplished with the collaboration, cooperation, and support of the patient, family, and community.
...nurses are frequently unaware of their power as they move through their work...
All of these versions of power have the potential to liberate both patients and nurses. They underpin the nurse clinician’s ability to provide quality care to patients in a variety of settings, ranging from hospital to community. Yet nurses are frequently unaware of their power as they move through their work, 24 hours a day, 7 days a week, and 365 days a year. It is critical for nurses to be able to identify their power in order for them to manage it and apply it in collaboration with the patient and other health care providers. Yet power must also move beyond the clinical frame and extend to the political and organisational arenas.
Nursing must have an opportunity to shape policies...[or they] are continually working at a disadvantage, waiting for others to make policy decisions that nurses are then expected to implement.
Political power refers to the ability to shape and influence policy and the processes, including people, for developing and implementing the policy. Nursing must have an opportunity to shape policies that determine the quality of care, and the quality of life to which patients, people, and communities are entitled. Without this opportunity, nurses are continually working at a disadvantage, waiting for others to make policy decisions that nurses are then expected to implement, regardless of the consequences. This not only undermines the patient/nurse relationship, but also is key to the diminished morale among nurses. The RCN mission statement states, "The RCN represents nurses and nursing, promotes excellence in practice and shapes health policy" (RCN, 2003, p.2). This pro-active mission is reflective of the determination by UK nurses to be involved in decision making early in policy development through think tanks, government task forces and commissions, and any other power shaping groups.
Organisational power is demonstrated by an astute appreciation of systems, boundaries, tasks, transactions, and organisational life.
...nursing's arena for action has to stretch beyond the clinical setting and into the boardrooms of decision makers and policy shapers.
Clinical, political, and organisational power are essential for nursing as a predominately female profession in a predominately male health leadership culture.
Hennessy (2000) also offers a useful synopsis of the organisational empowerment of patients, which began with the previously mentioned publication of the Patient’s Charter (DH, 1991). This was accompanied by the statutory inclusion of lay members on Trust Boards and Purchasing Authorities. Greater emphasis has been placed on managing patient complaints, patient choice, and the development of patient/health professional partnerships. Hennessy (2000) points out, "There are excellent opportunities for nurses to take up the baton here and truly attempt to provide care in partnership with their patients.…There are opportunities at the present time for nurses to be very influential" (p. 114).
Clinical, political, and organisational power are essential for nursing as a predominantly female profession in a predominantly male health care leadership culture. An awareness and capacity to effectively utilise power does not eliminate the need for emotional intelligence.
...emotional intelligence [is]...another frequently undervalued and perhaps underdeveloped source of power for nurses.
The effective use of the clinical, political, and organisational power base as the infrastucture for a sensitive patient/nurse relationship has the potential for not only realising the richness and regality of ‘…the colour purple’- the metaphor mentioned in the introduction. It also has infinite possibilities for producing the magnificence of the whole rainbow spectrum of the power dynamic when patient and nurses work together. This, in turn, can become a power house for change in influencing the dynamics of health care in the interests of the major stakeholders who matter most – the patients.
Similarities and Dissimilarities between the UK and the US
In reviewing these different types of power, the question may arise as to the similarities and differences along the power dimension between UK and US nurses. Overall, the same values underpin nursing on both sides of the Atlantic Ocean. These values include: listening, caring, respect, inclusiveness, and equality. Vance (2000) describes the universal power of nursing: passion – what we believe in; presence – who we are; practice – what we know and do; and partnerships – how we connect with others. The passion, along with the presence, can be linked to charismatic power as discussed earlier, while presence can be associated with charisma, but extends to clinical power. The power of partnerships is more aligned with referential or extended power. These are common power attributes of nurses in both the UK and the US.
Overall, the same values underpin nursing on both sides of the Atlantic Ocean.
In contrast, the differences between the patient populations are found in the types of health care systems they have experienced throughout their lives. For example, the UK population’s expectations are higher in the area of free service at the point of delivery; while US patients are accustomed to a fee for service and payment for ongoing care, with no expectations of a universal system free to all citizens. At the same time, US and UK patients are similar in feeling vulnerable and exposed when ill and reliant on the heath system for healing. In the UK, the patient population has a tendency to be more dependent on the system because it is free. At the same time, patients also have higher expectations. In the US, patients are expected to self finance their health care usually by a health care insurance plan. The differences between the two groups of nurses along the different dimensions of power is embedded in the systems of (a) education, (b) the NHS/the US health system, and (c) issues of diversity. Each of these differences will be discussed below.
Hennessy (2000) charts the development of the UK Project 2000, university- based diploma level education (normally three years in length but equivalent to the first two years of a three year undergraduate degree programme), for all nurses from 1989. This included the introduction of education-led supernumerary status (where the student is not included in the official workforce ratios), compared to the previous service led apprenticeship mode of training. There were already 5% of all pre-registration (leading to accreditation as a first level nurse) programmes at degree level at that time. To date, England is the only country, out of the four in the UK, that does not offer an all-graduate (an undergraduate, degree-level preparation) entry to nursing. The Chief Nursing Officer (CNO) for England has recently indicated that there is a strong consensus to move to an all-graduate entry to nursing, as well as a need for a more holistic approach to the pre-registration nursing branch programmes (Time is right, 2006).
Branch programmes are currently divided into four clinical areas, i.e., adult, mental health, paediatric, and learning disability. These different branches inevitably create a level of separatism among nurses, but simultaneously create an army of specialists at post-registration level who have a significant commitment and passion for their area of specialty. This exclusive process, at times, serves as a disincentive for nurses to use the power of unity. By separating into branches at an early stage in their career, there is less likelihood of coordinating and utilising the total power of the UK nursing profession.
Compared to the US system of preparing a generalist nurse first before specialisation, the UK model offers a less flexible route for nurses to move from one branch to another. This lack of flexibility may also contribute to fewer nurses being prepared at masters’ and doctoral levels in the UK than in the US. In the US, specialisation, advanced practice, is acquired at masters’ level (Gillis & Mundinger, 1998). The opportunities for certification and other acknowledgements of advanced specialist work are also available through advanced, higher degree education.
Issues related to power are taught and experienced during graduate studies in both the UK and the US Systems theories and change-agent strategies are often part of the curriculum (Brown, 1995). It is at post-graduate level that one is introduced to transacting across boundaries, transforming systems, and using one’s political skills in negotiating with willing and unwilling significant others. In the US, the fact that, in order to be certified as an Advanced Practice Nurse (APN), an advanced (graduate level) degree is considered baseline. This gives US nurses an edge in effectively using power to engineer and coordinate policies and strategies for populations as well as for individuals. Over 10 years ago, the then UK regulatory body, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), published a position statement on advanced practice (UKCC, 1994). This statement included ideas around:
- adjusting the boundaries of professional practice, i.e., increased responsibility and accountability
- developing new roles, i.e., nurse led clinics
- advancing clinical practice, research, and education, i.e., developing, disseminating, and utilising evidence-based clinical practice through research and education
- determining health need, i.e., being able to assess health care needs of individuals, groups and populations from the available evidence
- contributing to health policy and management, i.e., participating in both the strategic development and the operational delivery of health care at local, regional, and national levels
The Council members, at that time, were not prepared to specify a particular qualification for fear of stifling innovation and progress! However, they did go so far as to suggest that "…such levels of study are likely to be at the academic level associated with a Master’s Degree" (UKCC, 1994, p. 20). Brown (1997) notes that this was the first time ever that it had been officially acknowledged that "…some of those professional colleagues who remain in [clinical] practice would benefit from, and contribute to, postgraduate level work" (p. 8). As Davies (1995) pointed out, promotion in the UK, and by implication, extra qualifications, usually involved a move away from the interface with patients into such areas as education, management, and research. In the past, such nurses in the UK have been criticised for adding ‘alphabets’ after their names (Devlin, 1987).
Yet the passion and commitment that is achieved in the UK branch system of nursing education is remarkable. It instantly creates an army of specialists who are devoted to their area of caring. As more of these nurses become prepared at an advanced degree level, there will be an increasing number of nurse leaders using their power to position and shape policies and practice at the highest level of the systems, both governmental and health care. There is early evidence of this in the increasing number of nurses who are undertaking both the Clinical and Political Leadership Programmes at the RCN. Additionally, there has been an exponential increase in the number of UK nurses presenting research findings at the RCN’s Research Society’s International Conference and also submitting applications for the Nursing Standard Nurse of the Year Awards. All of these activities demonstrate ordinary UK nurses are engaging in quite extraordinary endeavours at both local and national levels.
For both countries, changes in education will be required to ensure that all the potential elements of power that result from the patient/nurse dyad are realised. Lindeman (1995) summarise this as a move from:
- individual, autonomous functioning to interdisciplinary models
- episodic to care over the continuum
- provider-centred care to partnership with consumers
- technology as an optional tool to technology as a foundation for practice
These changes in education will form a platform for more effective use of power by nurses on both sides of the Atlantic. In the UK, there have already been developments towards achieving this kind of framework as required by the NMC’s Standards of Proficiency for Pre-Registration Nursing Education (NMC, 2004) which includes the following standards:
- Provide a rationale for the nursing care delivered which takes account of social, cultural, spiritual, legal, political, and economic influences
- Demonstrate sound clinical judgment across a range of differing professional and care delivery contexts
- Demonstrate knowledge of effective inter-professional working practices which respect and utilise the contribution of members of the health and social care team
- Enhance the professional development and safe practice of others through peer support, leadership, supervision, and teaching (NMC, 2004, p. 5).
Similar developments are taking place in the US as evidenced by Gebbie and Qureshi’s (2006) excellent overview of the US nursing profession’s response to the challenges of emergency situations. Sommers (2006) extends this perspective as a global phenomenon by focussing on injury as "...significant health problem for the world’s population.…" as a major concern for culturally relevant nursing scholarship (p. 319). Considerable progress has already been made in the US in relation to the establishment of specialist and advanced practice roles and the post-graduate development of such practitioners (Brown, 1998). In the UK, recent evidence (Gleeson, 2006) suggests that nurses are becoming highly sophisticated users of information technology to support high quality care delivery.
The NHS and US Health System
The NHS began in 1948 and is generally viewed as a national treasure. Created after World War II, it represents more than just the delivery of health care for all, free at the point of delivery; it also represents social justice as a core principle in the UK health care. More than 350,000 nurses deliver services to in excess of one million patients per day. The NHS is the third largest organisation in the world following behind the Chinese Army. It is the largest employer in Europe. It was created, and is managed centrally, by the government, which is striving to decentralise the management and policy making to local level as quickly as possible. It is a system in constant change, one which is much influenced by the political imperatives of the day. Even with the chaos of change, nurses and other health providers take a reactive approach to government decisions and then frequently revolt against those decisions. This mode of behaviour on the part of health care professionals is detrimental to the effective use of power and is often described by government officials as the whining and moaning of the professions. This description is particularly disabling to a predominantly female nursing profession.
To return to the RCN’s mission statement, as described above in discussing organisational power, the powerful phrase ‘shapes health policy’ speaks to a proactive mode of behaviour that has the potential to transform the image of nursing as well as the reality of nursing’s use of power. As the NHS continues to reform at, sometimes breakneck speed, the need for the strategic use of power by nurses is essential. The new structure of the NHS is based on local commissioning, which includes local organisations working closely with local authorities, within the framework of national, political imperatives. The desired outcome is for a locally negotiated health, social care, and well-being strategy (Hodders et al., 2005). This completely fits with nursing’s belief system of transforming the NHS from an illness system to a health system. However, nurses are frequently excluded from the policy decision- making process. Since policy centres on better expenditure control, greater productivity, and efficiency, nurses are not considered primary players in this strategic work. Yet it is nurses, with their patient partners, who have the experience of safeguarding the deeply rooted moral imperatives of the NHS, which are to maintain universal access to care and equitable distribution of resources (Hennessey, 2000). Through strategic leadership and the use of power from a patient-centred approach, nurses must become essential in helping to create this new NHS that continues to maintain core values.
The US system of health care is fragmented, private, and highly competitive. It is a system where bridges of collaboration and cooperation are frequently built only around economic gain, rather that national political imperatives as in the NHS. Interestingly, however, this market-oriented system has pushed the rapid consolidation of health-care providers, i.e., hospitals, professional groups, and other health care delivery assets, into integrated systems of care. Some of the integrated systems incorporate the old health insurance entity along with providers to create comprehensive systems of care. Overall, the US system can be described as more integrated, intensively managed, evidence-based, and community-oriented, with both an emphasis on information/communication technology and on the psychosocial/behavioural dimensions of health care (O’Neill, 1998). This description is a recipe in need of the nursing profession. Nurses coordinate and facilitate the integration of services, manage patient services, are evidence and community-based, and emphasise information technology and psychosocial/behavioural care which illustrate the efficacy and level of patient (consumer) response, and satisfaction with health care interventions. To address these issues, another one million nurses are required for the US health market by the end of this decade.
While US nurses fight for inclusion in the board room and other policy-shaping venues, their political strategies and vehicles have been more fully developed over a longer period of time than their UK counterparts. Having to challenge health care systems built on profit models, or at best, cost containment principles, US nurses have developed into strong, assertive advocates for patients and consumers. Without the basic value of health care free for all, US nurses have within their professional and trade union bodies articulated and implemented strategies for working with government at both local, state, and national levels. With a greater emphasis on advanced education, many nurses in the US are educationally, as well as clinically, prepared to work as colleagues and leaders in health teams. Career opportunities are more plentiful in the US than in the UK. With a centralised system of care and few top nursing posts available, the UK does not offer the range and extent of career growth that is possible in the US. For example, posts such as the CNO for England and the General Secretary of the RCN are few and far between in the UK. The reality is that there are too few opportunities for the vast numbers of excellent nurses throughout England.
Whilst the emancipation of both nurses and patients in the US would appear to be well-advanced along the clinical, political, and organisational power continuum, the power position of nurses and patients in the UK is making great strides forward in a health care system that is currently free at the point of delivery. The two differing health care systems of the UK and the US are important variables in considering the emancipation and power base of nurses and patients in both countries.
Diversity: A Race Issue
Finally, on the issue of diversity in the UK and the US, there are more opportunities for nurses of colour in the US than in the UK. At one count, there were only five black Directors of Nursing throughout England, out of a total of 425. This difference in opportunity relates to the historical background of the two countries. Jim Crow laws in the US that required separate-but-equal education for blacks and whites produced historically black colleges where nurses were educated to be meaningful participants and leaders in the health care of the nation. Vestiges of slavery resulted in predominantly white universities seriously implementing strategies to recruit and retain students who could progress, not without challenges, into the mainstream of health care.
Nurses in the US and UK still struggle with their invisibility and questions from the dominant culture concerning their legitimate power to be a nurse.
This lack of an infrastructure to support the development of black leadership throughout the UK is a barrier to black nurses excelling within the new and old NHS. Many black nurses came to the UK in the fifties to rescue the staffing dilemma of the newly established NHS. These nurses were treated with disregard and that legacy extends into the 21st century. Recent UK statistics show that, generally, it will take 45 years to close the employment prospects gap between white and black job seekers in the UK (Branigan, 2006).
Despite these pessimistic observations, some attention has begun at the strategic level to progress the promotion of a more diverse and representative nurse leadership in the NHS (DH, 2002). Mensah (2006) graphically describes her positive experience of the NHS leader initiative when she recently undertook the DH ‘Breaking Through’ programme. In addition, the RCN has been particularly active in supporting the diversity and the political/clinical leadership agenda on a number of fronts (Large et al., 2005; RCN, 2002a; 2002b; 2005b).
In both of these wealthy, democratic countries, racism is alive and well. Nurses in the US and UK still struggle with their invisibility and questions from the dominant culture concerning their legitimate power to be a nurse.
A Transatlantic Vision for the Future Vision for the Future
Nurses must use the power within their reach and stretch for the power that seems slightly removed.
The family of nursing cuts across education, health care systems, and diversity to bind nurses together with the same belief in quality patient care for all. Nurses must use the power within their reach and stretch for the power that seems slightly removed. With the patient as a partner, the power of nursing is essential to the future well-being of nations throughout the world.
Perhaps Colin Marshall, former Chief Executive of British Airways, should have the last word:
What is the essential element any successful leader absolutely must have? I think it can be reduced to one word and a rather simple one at that: caring. I cannot claim that caring leadership is terribly clever or even terribly new. I can only promise that within my experience it works better than anything else (Ritchie & Goldsmith, 1987, pp. 172-173.
Nurses and patients have a great collective knowledge about caring. Knowledge is power. Combining the two will enable us to realise the dream of a powerful force for quality.
Roswyn Hakesley-Brown, MPhil, RN
Roswyn Hakesley-Brown is an experienced educator and author. She is also a past President of the Royal College of Nursing in the UK. In this role, she initiated and led the Presidential Task Force for Nurse Education. A major recommendation of this task force was that graduate preparation for nurses at the point of registration be expanded to all of the four countries of the United Kingdom (UK). This is currently being considered by the CNO for England. As chair of the UK Task Force for Refugee Nurses, Roswyn is also the leading advocate for refugee nurses. In this role she is required to think and act strategically in a politically sensitive area. This necessitates engaging with and influencing multiple stakeholders at regulatory, political, and operational levels. She is currently the project lead for the first refugee nurses project in Wales where she is privileged to work face-to-face with refugee nurses. Her guide for refugee nurses, funded by the Department of Health, was published in 2006.
Beverly Malone, PhD, RN, FAAN
Beverly Malone is the General Secretary at the Royal College of Nursing in the UK. Prior to this position, Beverly served as the Deputy Assistant Secretary for Health in the Clinton Administration, the highest position any nurse has held in the government at this time. She has also served two terms as President of the American Nurses Association. Beverly has worked closely with the governments of both the US and the UK, meeting regularly with Tony Blair, Prime Minister. These positions have all involved the use of strategic power and the knowledge, confidence, and skills gained from working with patients.
Article published January 31, 2007
Gebbie, K.M., & Qureshi, K.A. (2006). A historical challenge: Nurses and emergencies. OJIN: The Online Journal of Issues in Nursing, 11(3). Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume112006/No3Sept06/NURSESANDEMERGENCIES.aspx
Gillis, C., & Mundinger, M. (1998). How is the role of the advanced practice nurse changing? In E. O’Neill, E. & J. Coffman, (eds.), Strategies for the Future of Nursing, pp.171-191. San Francisco: Jossey- Bass.
Willey, E.L. (1990). Acquiring and using power effectively. In E.C. Hein, & M.J. Nicholson (Eds.), Contemporary Leadership Behaviour (3rd ed.). Glenview, IL: Scott, Foresman/Little, Brown Higher Education.


text:
Consider somebody who owns property in Vancouver but does not use it, does not rent it and does not pay any income taxes in Canada. This person is clearly benefiting from our society because over time their property is gaining value.
It seems reasonable to ask them to contribute a bit through a marginally higher property tax payment. Plus, an absentee owner potentially detracts from the vibrancy and livability of the community. Therefore, the extra revenue should be used to reduce property taxes or otherwise compensate the nearby residents. Above all, an empty homes tax would get a few property owners to rent or sell their empty homes, either way increasing our housing supply.
tap here to see other videos from our team.
For sure not a perfect solution, the infringement on property rights being a serious issue. But until we gather the political will to remove the obstacles to new housing supply, a vacancy tax can be justified. It is not surprising, then, that an idea along these lines was proposed by a number of local economists, myself included. Both the City of Vancouver and the province took notice.

domain: politics


I'm trying to pin down the requirements or the optimal setup for using an Oracle View in GeoServer 2.16.2. From what I have read in various forums is that for an Oracle View to work right in GeoServer it must have the following:
- an entry for the Oracle View in user_sdo_geom_metadata
- a spatial index that is owned by the user or profile that is making the call.
- Oracle User needs privileges to MDSYS Views & Tables
My specific situation is that I cannot create a Materialized View or other Table that is rebuilt periodically.
The current setup is similar to the following example: The GeoServer has a store using USER1 that uses an Oracle View that is owned by USER1. However, the underlying tables and indexes for the Oracle View are owned by a different user, call them USER2. Currently, the performance of this setup is terrible.
I would like to push harder to having this setup conform to the 3 requirements that I listed above, but I cannot find the exact documentation that says that points 1, 2, 3 are required. It is just a theory.
With respect to item #3. I'm seeing processes in the log that seem to be stuck on queries such as the following:
SELECT SDO_INDEX_OWNER,SDO_INDEX_NAME,SDO_PARTITIONED,SDO_LAYER_GTYPE,SDO_INDEX_VERSION,SDO_INDEX_DIMS,SDO_RTREE_DIMENSIONALITY,SDO_INDEX_GEODETIC,SDO_INDEX_TYPE,SDO_LEVEL,SDO_NUMTILES,SDO_NUM_ROWS,SDO_NUM_BLKS,SDO_OPTIMIZED_NODES,SDO_MAXLEVEL,SDO_INDEX_TABLE,SDO_INDEX_PRIMARY,SDO_RTREE_HEIGHT,SDO_RTREE_NUM_NODES,SDO_RTREE_FANOUT,SDO_RTREE_ROOT,SDO_RTREE_SEQ_NAME,SDO_INDEX_PARTITION,SDO_RTREE_PCTFREE,SDO_RTREE_QUALITY,SDO_TABLESPACE,SDO_INDEX_STATUS,SDO_NL_INDEX_TABLE,SDO_DML_BATCH_SIZE,SDO_RTREE_ENT_XPND, SDO_ROOT_MBR FROM MDSYS.SDO_INDEX_METADATA_TABLE WHERE sdo_index_owner = :owner AND sdo_index_name = :iname ORDER BY SDO_INDEX_PRIMARY
When I try and query the table
MDSYS.SDO_INDEX_METADATA_TABLE with the User that I have in my GeoServer Oracle Store, it says the ORA-00942: table or view does not exist. I can see the table in the
MDSYS in Oracle Developer.
I would change the permissions myself for the User that I use if I could. Can someone tell me if the USER needs to be granted SELECT privileges for MDSYS for a GeoServer layer that connects to an Oracle database to be efficient?
I'm kind of surprised that the layer works at all since there seems to be no access to the MDSYS objects and no GEOMETRY_COLUMNS. If I select all 50,000 records in the layer it never completes. If I just change my GeoServer query to return just the first few hundred records it works which is surprising.


text:
How Beta-Amyloid Builds Up in the Brain
Alzheimer’s disease biomarker begins to accumulate in different brain regions at the same time.
One major hallmark of Alzheimer’s disease is the accumulation of beta-amyloid peptides in the brain. Even though these molecules play an important role in the development of the disease and show a consistent spatiotemporal distribution, it has not been clear exactly how they aggregate in different brain regions over time. A study published Nov. 16 in the Journal of Nuclear Medicine addresses this question, providing evidence that beta-amyloid peptides start to accumulate in different brain regions simultaneously rather than originating and spreading from a small number of seed regions.
The researchers applied mathematical modeling to positron emission tomography imaging data from 769 subjects, comprising healthy controls, individuals with mild cognitive impairment, and patients with Alzheimer’s disease. The model that best described the imaging data suggested that beta-amyloid peptides start to accumulate in different brain regions at the same time, with the same growth rate for all regions. Moreover, the results indicated that some brain regions have a higher carrying capacity than others, accumulating more beta-amyloid over time.
Taken together, the findings suggest the properties of the local tissue environment determine the distribution of beta-amyloid in the brain. The observations also provide evidence against a competing hypothesis that beta-amyloid spreads from a small number of seed regions over a long period of time.

domain: health


text:
Preserving a healthy way of living is an essential aspect of living a healthy and balanced life. The term healthy lifestyle can be made use of to refer to a number of points. A lot of them are about making certain that the body remains healthy with diet plan and normal exercise. A healthy way of life additionally indicates making certain that the body is not deprived of the things it requires to operate correctly. For one person, this may imply walking a little mile after mile every week, consuming just fast food two times a day, and also investing even more virtual or in-person communication with relative every day.
Along with keeping the body healthy with diet plan and also workout, one more part of a healthy and balanced lifestyle is to do something to help reduce high blood pressure. Exercise as well as exercise can help reduce high blood pressure. This is due to the fact that exercise can enhance the heart’s capability to pump blood through the body. Exercise additionally helps keep a person physically fit and fit. здоровье и долголетие сайт
One kind of exercise that can have a positive impact on the heart health is exercise. Nonetheless, many people locate it hard to start with working out. It can be very hard to begin with because lots of people discover it hard to motivate themselves to participate in physical activity. Fortunately, there are plenty of options available to help individuals get started with their exercise regimen. One of these choices is to consume healthier foods as well as pick even more exercise.
Among the easiest ways for individuals to begin promoting a healthy way of life is to develop a diet and also exercise plan. These strategies must consist of whatever from obtaining the correct amount of physical exercise to including healthy foods to their diet regimen. Healthy diet plans consist of eating much less calories as well as even more fruits and vegetables. They likewise consist of an adjustment in the amount of fat as well as sodium that are taken in.
The psychological wellness of an individual can also be enhanced with a healthy way of living as well as suitable diet plan. Psychological health and fitness describes the capability to manage modifications in one’s day-to-day live. A psychologically healthy person is able to adapt faster to the various conditions that encounter them as well as to manage tension more successfully.
A good diet and also exercise program will certainly promote a healthy way of life. Nevertheless, it is important for individuals to recognize that the very best time to begin is now. People require to ensure that they begin eating healthier foods right now. Some fruits and vegetables that are really beneficial to diet regimen and health and fitness include apples, pears, carrots, celery, broccoli, beetroots, oranges, grapefruit, Mandarin chinese oranges, pineapples, prunes, strawberries, raspberries, sunflower seeds, papaya, bananas, and watermelons. Some vegetables and fruits that are thought about to be great nutritional selections are: black beans, prunes, carrots, cabbage, kale, romaine lettuce, spinach, green beans, cucumber, cauliflower, tomatoes, cabbage, peas, mushrooms, broccoli, squash, spinach, kiwi fruit, apricots, melon, mango, guava, spinach, halibut, bananas, strawberries, blueberries, raspberries, as well as grapes.
A well balanced diet plan gives a variety of nutrients that supply the basis for a healthy lifestyle. These nutrients in the form of vitamins, minerals, carbohydrates, fiber, protein, fat, and also calories are essential for a health. It is very important to choose foods that contain an equilibrium of these nutrients. Fruits and vegetables are wonderful sources of every one of these nutritional elements. здоровый образ жизни
Healthy way of living and also healthy and balanced actions can protect against typical diseases like heart diseases, kind II diabetes, stroke, weakening of bones, cancer, as well as Alzheimer’s disease. With a healthy and balanced way of life and also proper medications, an individual can likewise handle stress. This is due to the fact that healthy habits and ideas can assist a person deal with tension. Research studies have actually proven that the impacts of stress can be alleviated by handling stress and anxiety and also transforming unhealthy habits. For that reason, it is essential to learn the healthy and balanced behaviors in life.
A healthy way of living just refers to living an active way of living that promotes joy and also helps you attain your goals. For one person, that might imply strolling a marathon five days a week, eating healthy everyday, as well as hanging out with household or close friends each day. For an additional individual, that may suggest taking long strolls in the timbers with the youngsters, going hill biking on a Friday night, as well as playing tennis at a country club. Your objectives for living a healthy lifestyle can be as differed as your creative imagination. The factor is, it requires more than just consuming right as well as exercising to be successful in your efforts to be and do healthy.
One of one of the most crucial aspects in a healthy lifestyle is workout. Studies have actually revealed that not just is exercise crucial for the heart et cetera of the body, however it also lowers anxiety and in fact helps you lose weight. There are various kinds of exercise, from walking, running, biking, swimming, and also dancing to name a few. Similar to any type of type of exercise, you will certainly locate that it does not matter how much or how little you do if you do not do it properly. If you’re not complying with the exercise program on the pamphlet, there’s a great chance that you could be setting on your own up for heart disease, diabetes mellitus, hypertension, excessive weight, stroke, or something else that could trigger long-term damages to your body.
Along with workout, you will certainly additionally need to develop excellent healthy routines. For instance, it’s been shown that eating fruits and vegetables aids you slim down. In addition to this, healthy and balanced routines normally bring about a longer lifetime. The reason for this is that good habits develop a much better body immune system, which means that you’re much less most likely to get ill, contract infections, or end up being ill. Another positive side result of consuming healthy is that it can help you live longer, a sensation referred to as the “Durability Impact”. читайте на этом блоге
Developing a healthy and balanced way of life also consists of regular exercise. Whether you choose to join a health club or employ a cyclist, you ought to make sure that you are doing some form of workout at the very least 3 times a week. Many individuals who are leading an unhealthy way of life are stunned when they begin feeling older. The physical activity that they are not taking part in is what is keeping them from keeping a young looking appearance, even though the quantity of exercise that they are doing is still really marginal. By adding in an exercise every week, you will be able to enhance your health and wellness and slow down the effects of aging.


text:
Yosemite Climbing Pioneers in "The Big Walls"
Half a century of climbing comes to life in the new film Valley Uprising.
“It’s not just a film about climbing, but about living life in this very free, present way where the focus of one’s existence is experiential, not materialistic,” says Pete Mortimer, co-director of the upcoming feature documentary Valley Uprising: Yosemite’s Rock Climbing Revolution, which will premiere in Boulder, Colorado, on Thursday and Friday before hitting the Reel Rock Tour to 450+ cities worldwide. (Watch the trailer.)
The film begins in the 1960s, known as the Golden Age in Yosemite. The climbers of that era—pioneers such as Yvon Chouinard, Royal Robbins, Steve Roper, and Chuck Pratt—were the first to tackle such towering, vertical walls, and their ideas and accomplishments significantly influenced climbing not only in Yosemite, but around the world. In this exclusive bonus clip to the film, those living legends share their memories from the ascending big walls.
Below, Mortimer tells us about this epic clip, how the 1960s-era climbers influenced the future of climbing, and how they made 50-year-old photos come to life with 2.5-D animation.
Adventure: Who do these voices belong to and how did they shape climbing culture in Yosemite Valley and in general?
Pete Mortimer: These voices are from Yvon Chouinard, Royal Robbins, Steve Roper, and Chuck Pratt, who were part of the first group of climbers to scale the big walls of Yosemite. Their era is known as the Golden Age, and they are hugely important in Yosemite and global climbing history. Before them, nobody had climbed walls of such verticality and scale anywhere in the world. Huge routes had been done in the Alps, but nothing so continuously steep as the northwest face of Half Dome or El Capitan. It was a huge breakthrough to know that you could spend days and nights up there in the vertical realm and come out the top alive.
A: Did they know at the time that they were part of something important?
PM: I think they were aware that they were part of something bigger in climbing circles, but that was a very small world back then. In terms of the growth of climbing and their influence in the whole outdoors and adventure world, I don’t think that was clear at that time. They were really living on the fringes of society, and it wasn’t till the following generations that this alternative lifestyle really started catching on.
A: These climbers did not have the benefits of modern gear to protect them on the wall. How did they get by? What did they use?
PM: Well they actually hand-crafted some of their own gear, like pitons. Yvon Chouinard was a blacksmith, and he started forging gear and selling it to the other climbers. But some of the other stuff was totally makeshift, especially when they started. But one of the contributions of this group was the evolution of climbing equipment as well as the evolution of the sport itself.
A: What were the most important climbs of this era?
PM: The northwest face of Half Dome was the first big one because that is such an iconic wall—it’s just so steep and intimidating. Then The Nose of El Capitan was a major undertaking by Warren Harding with a series of partners that fixed ropes on the wall and spent 18 months going up and down the thing. After that, Royal Robbins did the first ascent of the Salathe Wall on El Capitan, and he did that with a small team and in essentially a single push over roughly a week. That was actually a big breakthrough because of the style in which they climbed it—continuous, and using as little fixed gear like bolts as possible. After the Salathe Wall, there was a real sense of possibility and new routes went up all over the faces of Half Dome, El Capitan, Mount Watkins, and other big walls.
A: Where did you find the photos?
PM: Most of these photos come from Glen Denny and Tom Frost, two renowned photographers who documented many of the people and the climbs from that era. Denny was a real artiste, documenting events but also with an eye toward light and composition—his photos were a big inspiration for this film. Frost was involved as a climber in so many ascents of the era, and he always seemed to have his camera so he has some of the most iconic and historic shots ever taken from Yosemite.
A: How did you animate the photos? Did you make the animation fit the music or the other way around? Why did you use this technique?
PM: It’s a bit of back and forth with animation and music. We work with a 3-D artist named Barry Thompson, and we put the scene together and kind of rough everything into place, and then we do lots of back and forth with him about how we can bring each photo to life. We have ideas, but Barry brings so much to the table in terms of his artisitc and technical vision—he knows what is possible.
- Nat Geo Expeditions
A: What should people expect from Valley Uprising?
PM: It’s not just a film about climbing, but about living life in this very free, present way where the focus of one’s existence is experiential, not materialistic. Most of the heroes of this film are living in dire poverty, but they are doing exactly what they want with the people they want to be with, and they are performing ground-breaking athletic achievements in the most spectacular positions one can imagine. It’s a very enriching lifestyle, one that has inspired me and affected the way I want to interact in the world.
I think it’s also neat to see the lineage of people who have been drawn to Yosemite, and when you see guys like Alex Honnold and Dean Potter scale these walls, they are not just acting alone but are part of this bigger movement and this connection to the past. I think that adds a level of meaning and enrichment to their actions.
A: Why did Peter Sarsgaard want to do the narration? Does he climb?
PM: Peter Sarsgaard is a bit of a climber, and he’s also a runner and outdoors enthusiast. He knows Alex Honnold and some of the people in the film, and I think he connects deeply with the philosophy and lifestyle behind climbing. He’s kind of a countercultural guy, if you meet him he’s not like some Hollywood star and he just naturally fits in with this whole scene.

domain: geography


text:
New Delhi: Convicts Akshay Kumar Singh and Pawan Kumar Gupta on Saturday moved a Delhi court seeking a stay on the execution of death warrants against all four, scheduled for March 3, in the Nirbhaya gang rape and murder case.
Additional Session Judge Dharmender Rana issued notice to Tihar Jail authorities on the plea of Singh, directing them to file their response by March 2. The four convicts – Mukesh Kumar Singh, Gupta, Vinay Kumar Sharma and Akshay Kumar Singh – are scheduled to be hanged at 6 AM on March 3.
In his plea moved through his lawyer, Singh claimed that he has filed a fresh mercy petition before the President of India, which is pending. Advocate A P Singh, appearing for Singh, said that his earlier mercy petition that was dismissed by the President did not have complete facts.
He had moved his original mercy petition on February 1 and President Ram Nath Kovind had rejected it on February 5.
Gupta, in his plea, contended that his curative petition is pending in the Supreme Court. Gupta is the last of the four convicts to have filed a curative petition.
The mercy petitions of the three convicts – Mukesh Kumar Singh, Vinay Kumar Sharma as well as Akshay Kumar – have previously been dismissed by the President. The Supreme Court had earlier dismissed the pleas filed by Mukesh Kumar Singh and Vinay Kumar Sharma that challenged the rejection of their mercy petitions.
A Delhi court had on February 17 said the convicts will hang on March 3, which was the third death warrant issued by the court. The two earlier ones could not be carried out as the convicts took it in turns to use every legal option available to them.
The four convicts, along with two others – one of them a minor – had gang-raped the young woman and tortured her with an iron rod on the night of December 16, 2012. She died on December 29 at a hospital in Singapore.

domain: news


text:
- A city in Bath and North East Somerset, Somerset, England, famous for its baths fed by a hot spring.
- A city, the county seat of Sagadahoc County, Maine; named for the city in England.
- A town and mineral spring in Saint Thomas parish, Jamaica; named for the city in England.
- A town in New Hampshire; named for William Pulteney, 1st Earl of Bath.
- A town and village, the county seat of Steuben County, New York.
- A town in North Carolina.
- A town in Ohio.
- A borough of Pennsylvania; named for the city in England.
- A village in Illinois.
- A village in the Netherlands.
- A village in New Brunswick.
- An unincorporated community in Indiana.
City in England
- Hyphenation: Bath


text:
The Delta Commissioner for Trade and Investment, Mr Chika Ossai says the ministry is proposing N1.9 billion for 2021 fiscal year.
The commissioner said this during the ministry’s annual budget defense with the State House of Assembly Committee on Trade and Investment on Tuesday in Asaba.
Ossai said that the ministry intended to embark on projects that would facilitate the actualisation of the present administration’s mission for a” stronger Delta’’.
”The ministry intends to embark on ventures that will lead to the rapid industrial and commercial growth of the state such as development of modern and rural markets.
”This is with the aim of facilitating the growth of commercial activities in the state,” he said.
On the achievements of the ministry in 2020, Ossai said that the total budgetary provision for capital expenditure was N5.3 billion, out of which N3.6 billion was earmarked for Agro-Industrial Park.
According to him, as at Sept. 21, the amount received for the execution of capital projects is N103 million representing 94 per cent performance.
”It is my hope that before the budget year runs its full course, there will be more releases for the execution of capital projects, which will boost the ministry’s . performance to an appreciable level,” Ossai said.
The commissioner also revealed that the ministry generated N34 million through registration of business premises in 2020 and N4.2 million from registration of cooperative societies.
”The overall performance of the ministry’s budget for the year 2020 is 5.9 per cent. The poor performance may be attributed to COVID-19 pandemic which slowed down government activities,” he said.
The Chairman of the Committee, Mr Austine Chikezie, who decried the poor performance of the ministry and advised it to improve on its performance by attracting more investors to the state.
He said that the state had huge potential that could create employments for the people if well harnessed.

domain: finance


The Logan | The Last Command
Casual and relaxed. Cool ethical fashion style you must have. The Logan is a mid-rise utility pant with a straight cropped leg and large pockets. It comes in a military green wash and is made with recycled cotton reducing its carbon footprint and water usage.
Front Rise: 9 1/2”
Leg Opening: 15 1/2”
-Machine wash cold inside out with like colors
-Do not use bleach
-Do not tumble dry
-Hang dry / Warm iron if needed


Timor-Leste making strides in human rights but further efforts needed – UN
In a new report released in Dili, the UN Integrated Mission in Timor-Leste (UNMIT) noted that the 11 February attacks against President José Ramos-Horta and Prime Minister Xanana Gusmão constituted a significant security challenge.
“The national authorities responded to these challenges in a way which indicates increasing institutional stability and adherence to the rule of law,” according to a news release issued by the Mission. “The cooperation between the military and police, as well as the successful efforts to apprehend those wanted in connection with the attacks without resorting to use of force, were positive developments.”
However, important challenges remain, according to the report, which covers the period September 2007 to June 2008.
“The notable increase in the number of cases of ill-treatment by members of the security forces reported during the state of exception is of particular concern,” the Mission said.
UNMIT also received reports of death-threats and arrests that did not follow legal procedures. While national leaders made commitments to address such violations, accountability mechanisms remain “weak.”
The report also noted some progress in strengthening the justice system, including the growing number of Timorese judicial personnel and their increased presence in the districts.
“However, effective access to justice remains constrained,” the Mission stated, pointing out that the backlog of cases has grown to an estimated 4,700 criminal cases. In addition, key legislation for dealing with gender-based violence – which continues to be a major concern – has not yet been adopted.
In terms of justice for past violations, the final report of the Indonesia–Timor-Leste Commission of Truth and Friendship was submitted to the Presidents of Indonesia and Timor-Leste on 15 July. The two Presidents issued a joint statement recognizing that gross violations of human rights had occurred, expressing remorse to all those who suffered.
“However, progress towards holding accountable those responsible for criminal acts during the 2006 crisis was slow,” said UNMIT.
Timor-Leste – which the UN shepherded to independence in 2002 – is now at a “human rights crossroads,” noted Louis Gentile, Chief of UNMIT’s Human Rights and Transitional Justice Section.
“The Timorese people and state institutions can continue to build on progress achieved – or can turn back towards a more violent past. The United Nations stands ready to assist them to move forward,” he stated.
The report, which is the second produced by UNMIT on the country’s human rights situation, contains a list of recommendations relating to key human rights developments in relation to the security sector and access to justice.