text:
- Research article
- Open Access
Access to primary care and computed tomography use in the emergency department
BMC Health Services Research volume 18, Article number: 154 (2018)
The decision to obtain a computed tomography CT scan in the emergency department (ED) is complex, including a consideration of the risk posed by the test itself weighed against the importance of obtaining the result. In patients with limited access to primary care follow up the consequences of not making a diagnosis may be greater than for patients with ready access to primary care, impacting diagnostic reasoning. We set out to determine if there is an association between CT utilization in the ED and patient access to primary care.
We performed a cross-sectional study of all ED visits in which a CT scan was obtained between 2003 and 2012 at an academic, tertiary-care center. Data were abstracted from the electronic medical record and administrative databases and included type of CT obtained, demographics, comorbidities, and access to a local primary care provider (PCP). CT utilization rates were determined per 1000 patients.
A total of 595,895 ED visits, including 98,001 visits in which a CT was obtained (16.4%) were included. Patients with an assigned PCP accounted for 55% of all visits. Overall, CT use per 1000 ED visits increased from 142.0 in 2003 to 169.2 in 2012 (p < 0.001), while the number of annual ED visits remained stable. CT use per 1000 ED visits increased from 169.4 to 205.8 over the 10-year period for patients without a PCP and from 118.9 to 142.0 for patients with a PCP. Patients without a PCP were more likely to have a CT performed compared to those with a PCP (OR 1.57, 95%CI 1.54 to 1.58; p < 0.001). After adjusting for age, gender, year of visit and number of comorbidities, patients without a PCP were more likely to have a CT performed (OR 1.20, 95% CI 1.18 to 1.21, p < 0.001).
The overall rate of CT utilization in the ED increased over the past 10 years. CT utilization was significantly higher among patients without a PCP. Increased availability of primary care, particularly for follow-up from the ED, could reduce CT utilization and therefore decrease costs, ED lengths of stay, and radiation exposure.
Computed tomography (CT) utilization has more than doubled over the past three decades, increasing in the number of studies performed as well as the total radiation dose per patient [1,2,3]. While this rapid growth was noted throughout various healthcare delivery settings from the 1990s to the early 2000s, studies have suggested that the overall growth of CT use has plateaued [4,5,6] While the growth of CT utilization appears to have slowed down or even stalled completely in alternate settings, this trend does not seem to apply to the emergency department [7, 8].
The widespread availability and use of CT as a diagnostic modality in the ED has likely led significant improvements in patient care . Nevertheless, the rate of growth of utilization has called into question the value of these studies  the risks of overutilization, and the number of incidental findings . The cost, psychological stress, and sequelae of further investigations of these incidental findings must be weighed against the benefit of the yield of early detection of true pathology.
CT carries a small but present risk to the patient of radiation induced malignancy, with the over 70 million studies performed every year estimated to result in approximately 29,000 future cancers [12, 13]. This effect is particularly worrisome in that it appears to preferentially affect children. Lastly, obtaining a CT scan and awaiting interpretation adds to patient length of stay, which may contribute to ED overcrowding as well as cost .
Drivers of the continued increased utilization of CT in the ED are many-fold and likely include systemic factors such as increased availability of scanners and improvements in technology as well as physician specific factors such as malpractice fear and different risk tolerance. Given the potential downsides of overutilization of CT in terms of resource utilization as well as radiation exposure, it is important to identify factors associated with variability in utilization in order to optimize practices.
The decision to obtain a CT scan is complex, involving multiple factors, including the likelihood that a patient has the diagnosis in question (pre-test probability), the inherent risk posed by a given test, the severity of the consequences of missing the diagnosis, and provider as well as patient risk tolerance . CT utilization has been shown to vary according to provider specific factors, including risk tolerance level and geographical location [16, 17], as well as patient factors, such as language barrier .
We hypothesized that patient access to primary care also has an impact on the decision to obtain a CT Scan in the ED. For patients without access to primary care, it may be more detrimental to miss a diagnosis in its first presentation. For example, a provider may be more comfortable sending home a patient with abdominal pain without first performing a CT scan if they believe that the patient will be able to see another provider in 24–48 h, at which point there will be another opportunity for the correct, potentially lifesaving diagnosis to be arrived at. In contrast, for patients with limited access to care, the provider may reason that the patient is less likely to obtain follow-up evaluation, shifting the risk benefit ratio in favor of performing a CT scan during that visit and lowering the test-threshold.
Our primary objective was to determine if CT scans were less likely to be obtained in patients with access to primary care when compared to patients without such access. Specifically, we hypothesized that providers would be more likely to obtain a CT scan in patients without a primary care provider.
We conducted a cross-sectional study of patients who presented to Saint Mary’s Hospital Campus Mayo Clinic, an academic, tertiary care emergency department. The Mayo Clinic ED provides care for approximately seventy-five thousand patients a year and serves a hospital with 1265 beds, receiving approximately four thousand transfers annually. Twenty percent of visits are by pediatric patients and the department features a dedicated pediatric section as well as serving a dedicated pediatric hospital with 85 beds including a pediatric intensive care unit and a neonatal intensive care unit. The radiology department performs and interprets more than one million exams yearly and features 20 CT scanners, including eleven 64-detector machines. Patients who presented to the emergency department from 2003 to 2012 and had a CT obtained in the ED were included. Every patient (or patient guardian) who presents to our center is asked for written permission to have their records reviewed for research purposes. A total of 7.5% of the patients did not provide this permission and were excluded. The institutional review board approved the research protocol.
Data were abstracted from the electronic medical record and an administrative database. We use an institutionally developed health record system across the enterprise. We have access to all visits within the main campus as well as the Mayo Clinic Health System. Our medical record automatically tracks and displays in the main screen, the primary care physician assigned to each patient within our institution, as well as outside institutions (if available). In our healthcare system, primary care can be available at our main institution (Mayo Clinic Rochester) as well as in the surrounding Health Care Systems sites.
CT scans obtained in the emergency department from 2003 to 2012 were identified in billing data using standardized Current Procedural Terminology, Fourth Edition (CPT-4) codes . CT scans were organized by body region into four categories: “head,” “chest,” “abdomen,” and “other.” The category of “other” included a variety of uncommon scans examining the spine, extremities, neck and sinuses. The principal diagnosis for each CT scan was obtained using diagnosis codes from administrative billing data, and these diagnoses were tabulated. The ED disposition and admitting diagnosis were collected. We used the Agency for Healthcare Research and Quality’s Clinical Classification Software to organize the principal diagnoses into categories .
Demographic variables collected included date of birth, sex, chronic conditions, race, and presence or absence of a listed primary care provider. Patients were grouped by age into 6 categories: less than 18, 18 to 34, 35 to 49, 50 to 64, 65 to 79, and greater than 79 years of age. The primary and secondary diagnoses for each ED visit were obtained using diagnosis codes from administrative billing data. We used previously published algorithms- a modification of Hwang- to identify chronic conditions .
Our main outcomes were CT utilization rates per 1000 patients. Overall utilization trends were examined by year, body region, and age group over the study period. The availability from the ED for CT scans and other imaging modalities like ultrasound has remained stable during the study period. At our institution physicians and advance practice providers (nurse practitioners and physician assistants) can order CT imaging without consultation of a radiologist, and the access to imaging has been similar over time.
We report descriptive statistics with frequency counts and percentages. We assessed the association between clinical characteristic, particularly the presence or absence of a PCP, and whether a CT was obtained using logistic regression and report the associations as odds ratios with 95% confidence intervals (CI). Multivariable logistic regression models were constructed to evaluate the association between CT use during an ED visit and patient demographics. Variables were selected as covariates in the model according to their hypothesized influence on CT use. Linear regression was used to assess for trends by year in CT imaging (number of CTs per 1000 patients). All analyses were conducted using SAS statistical software, version 9.1 (SAS Institute, Cary, NC). Statistical significance was set at 0.05. We adhered to the STROBE guidelines for reporting observational studies .
A total of 595,895 ED visits, including 98,001 (16.4%) in which a CT was obtained, were included. Mean (SD) age of the study population was 41.6 (26.0) years, and 51.9% female. Fifty-five percent (328,609) of patients included had a PCP. Those with a PCP had a mean (SD) age of 36.2 (26.0) years and 45.8% were male, compared to 48.2 (24.3) years and 50.9% male for those without a PCP.
CT utilization per 1000 ED visits increased from 142.0 in 2003 to 169.2 in 2012 (19.2% increase, p–value for trend < 0.001). The number of ED visits during this time period remained relatively stable (55,241 visits in 2003 and 52,967 visits in 2012). CT utilization per 1000 ED visits increased from 169.4 to 205.8 over the study period for patients without a PCP (21.5% increase) and from 118.9 to 142.0 for patients with a PCP (19.4% increase; p < 0.001 for the rate of CT use in those with and without a PCP) Table 1. Patients without a PCP (OR 1.57, 95%CI 1.54 to 1.58; p < 0.001) were more likely to have a CT performed in the ED when compared to those with a PCP, as shown in Fig. 1.
An increase in CT use by year was seen in all patients older than 18 years of age and both genders (Table 1). After adjusting for age, gender, year of visit and number of comorbidities, patients without a listed PCP were still more likely to have a CT performed (OR 1.20, 95% CI 1.18 to 1.21, p < 0.001).
Computed tomography was performed in 4.8% of patients younger than 18 years of age and in 26.4% of patients older than 79 years (Table 2). The mean age (SD) for patients with a CT performed was 52.6 (23.0) versus 39.5 (26.0) for those without a CT (p < 0.0001). The odds of having a CT obtained increased by age [OR 3.4, 95% CI 3.3–3.5 for 18 to 34 years; OR 4.4 (95% CI 4.3–4.5) for 35 to 49 years, OR 5.2 (95% CI 5.1–5.4) for 50 to 64 years, OR 6.2, (95% CI 6.0–6.4) for 65 to 79 years, and OR 7.2 (95% CI 7.0–7.4) for patients older than 79 years. Female patients were as likely as males to have a CT ordered [16.7% versus 16.2%; OR 0.96 (95%CI 0.95–0.97)]. A greater proportion of Caucasian patients had a CT obtained compared to other ethnicities [17.1% White, 10.6% African American OR 0.57 (95% CI 0.55–0.60), 12.5% Hispanic OR 0.70 (95% CI 0.66–0.73), 13.9% Asian OR 0.78 (95% CI 0.74–0.83)].
There was a 20.7% admission rate in this cohort. Admitted patients were more likely to have a CT obtained prior to admission, with 30.6% of those admitted having a CT performed versus 12.7% of those who were dismissed home (OR 3.0, 95% CI 3.0 to 3.1). After adjusting for age and gender, admitted patients were still more likely to have a CT performed (p-value for the model < 0.001). After adjusting by age and gender, patients without a usual source of care were more likely to be admitted to the hospital (p-value for the model < 0.001).
Figure 2 shows trends in the number of visits in which a CT was obtained per 1000 ED visits during the study period. Figure 3 shows CT use per 1000 ED visits stratified by age. CT use increased throughout the study period in all ages with the exception of children (< 18 yrs. of age) in whom use decreased from 59.6 in 2003 to 33.5 in 2013 (43.8% reduction; p-value for trend < 0.001).
Figure 4 shows CT utilization rates throughout the study period by body region. CT Abdomen/Pelvis and CT Head are the most frequent types of CTs ordered. CT Head has the highest absolute increase from 40.6 per 1000 ED visits in 2003 to 78.5 in 2012, a 93.4% absolute increase. Headache was the most frequent indication for CT Head and was reported in 26%. Abdominal pain was the indication in 50% of CT scans of the Abdomen and Pelvis, followed by renal colic in 12%. Lower respiratory disease and chest pain accounted for 60% of the CT scans of the chest.
CT utilization per 1000 ED visits increased from 142.0 in the year 2003 to 169.2 in the year 2012, while the number of ED visits remained relatively stable in this time period. This is a 19% percent increase in the 10-year period and an absolute increase of 27.2 per 1000 ED visits. This confirms the results of the majority of previous studies, which have shown the continued growth in CT use in the ED without the plateau or even decrease in use that has been noted in non-ED settings [4,5,6,7,8]. However, our findings are in contrast to one single-center study that noted an initial spike and then dramatic downturn in CT utilization in the ED from 2002 to 2012 . Notably, it appears that the emergency department described in that study underwent significant quality improvement efforts to optimize imaging utilization during that period, which may account for this outlier. The rate of increase noted in our study is less than that observed in similar reports, however our rate of utilization started out higher compared with other centers [2, 3]. We hypothesize that this is likely in part because of early adoption of radiology technology at our center, which introduced the first CT scanner in North America in 1973.
We did note a downturn in the CT utilization rate from 2010 to 2012, which coincides with a pattern described in similar studies [7, 24]. This downturn likely represents a change in coding in which CT of the abdomen and CT of the pelvis are now bundled together under one code. It is also possible that this downturn represents a trajectory towards a plateau or even decrease in CT utilization that continued after 2012, but we cannot determine this based on our dataset.
In contrast to their adult counterparts, CT utilization decreased in pediatric patients during the study period. Notably, our center includes a dedicated pediatric emergency department, which is true of less than 10% of hospitals in the United States . Previous studies have found a decreasing rate of CT utilization in dedicated pediatric hospitals over a similar time period . Our rate of CT utilization in the pediatric population was consistent with that previously reported. This trend is thought to be secondary to concerns about radiation, which are particularly heightened in the pediatric population who have longer remaining life-spans to realize the effects of radiation as well as greater radiosensitivity than their adult counterparts . These concerns have spawned campaigns raising awareness of the potential risk of radiation, widespread use of highly sensitive clinical decision rules, and increased use of ultrasonography for a variety of indications, all of which have contributed to a decline of CT utilization in the pediatric population [28, 29]. This trend suggests that it may be possible to achieve decreased utilization in the adult population as well.
The demonstrated continued growth of CT utilization in adult patients during the time period of the study is part of a national trend which is multifactorial, likely spurred by increased availability of CT scanners, technological improvements and therefore broadened CT indications and capabilities, and changes in standard practice. While greater than 95% of EDs in the United States had access to a CT scanner by 2005, these machines varied in resolution and capability, features which may particularly affect the utilization of certain advanced studies, such as CT venography or angiography [3, 30]. As technology becomes universally available patient expectations as well as perceived standards of care adapt and utilization increases .
Providers are exposed to asymmetrical feedback, wherein positive CT findings that lead to a diagnosis, or conversely a missed diagnosis resulting from an un-ordered CT scan, have a disproportionate impact on clinical judgment when compared to the negligible impact of a negative study or uneventful outcome. Other factors that contribute to the decision to obtain a CT scan in the emergency department include requests by consulting services (for example: orthopedic surgery may request scans for operative planning), fear of malpractice, cost concerns, and the desire to enhance throughput.
It remains unclear and controversial as to whether emergency medicine physicians are overusing or underusing CT [32,33,34]. What is clear is that the rate of CT scans has undergone an explosive growth over the past two decades. A recent publication revealed that over 85% of surveyed emergency medicine physicians believe that we are doing too many diagnostic tests in the ED, listing fear of missing a low probability diagnosis and fear of litigation as top motivators for this trend . This potential overuse of is problematic given the negative consequences of unnecessary CT, including increased costs, the threat of radiation induced malignancies, increased ED lengths of stay, false positive results, and incidental findings.
For these reasons, it is important to identify strategies to optimize and potentially decrease CT scan ordering. One way of accomplishing this it to identify and modulate factors associated with ordering a CT scan. Disposition decisions often rely on a clinician’s perception of the patient’s ability to comply with recommendations and obtain timely re-evaluation, and patients without such resources are more likely to be admitted to the hospital.
We found that patients without access to a primary care provider were more likely to have a CT scan performed in the ED (OR 1.57, 95%CI 1.54 to 1.58; p < 0.001). This association remained after adjusting for age, gender, and chronic conditions. Patients without a PCP were also more likely to be admitted to the hospital a finding also reported by Bindman and colleagues .
In addition to increased knowledge about best practices, malpractice reform, and integrated clinical decision support in electronic health records, increasing access to primary care and systematizing post emergency care follow-up are concrete interventions that can be made in a health system in order to optimize CT utilization and therefore reduce costs, radiation exposure, and ED length of stay.
This study has several potential limitations including its cross sectional design and use of administrative data, which vulnerability to miscoding and data entry errors common to all such studies. Further, this study was conducted at a single ED from a large academic center with a dedicated pediatric emergency department, thus the results may not be generalizable to other populations. Also caution should be taken when looking statistically significant results, and these should be in context of clinically significance.
However, there are several advantages to this study center over broader samples, especially in ascertainment of primary care status. This center features a robust electronic medical record, a highly integrated health system, and provides primary care for most of the patients in the surrounding area, all features which reduce likelihood of missing information based on the study design. Patients with primary care outside the health system were considered as not having a PCP, which is particularly important to note as we are a large referral center with many patients who travel long distances to seek care. This limitation is somewhat ameliorated by the consideration that access to a distant, and therefore less available, PCP is likely not as impactful in provider medical decision making as having a local PCP who could provide timely follow-up. Our emergency department receives about four thousand transfers every year, which has been relatively stable throughout the study period. Patients may have received CT studies at a transferring institution prior that would not be captured in our coding database, therefore potentially lowering our absolute rate of CT scan utilization.
Our study did not evaluate inter-physician variation or the appropriateness of the use of CT, although previous studies have shown dramatic variation in CT use among emergency physicians [37, 38]. Wong et al., using hierarchical logistic regression to facilitate comprehensive case-mix adjustment reported that only about 1% of the variability in ED imaging utilization was attributable to physicians. Predictors of imaging use were ED crowding, a prior ED visit, referral source to the ED, and ED arrival mode; physician-level factors including sex, years since graduation, annual workload, and residency training did not correlate with imaging use . Lastly, our study population is less ethnically diverse and has a higher socioeconomic status than the overall U.S. population, with age, sex, and ethnic characteristics similar to those of the state of Minnesota and Upper Midwest .
CT utilization in adult patients the Emergency Department has increased significantly over the past 10 years. Patients without a primary care provider were more likely to have a CT performed in the ED. Ensuring primary care access, particularly for ED follow-up, for the population might aid in optimizing CT utilization, therefore resulting in a decreases in costs as well as radiation exposure.
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Dr. Bellolio was a Scholar at the Mayo Clinic Kern Center for the Science of Heath Care Delivery. The funding body did not alter the design of the study, collection, analysis, or interpretation of data.
Availability of data and materials
This study used a clinical dataset and publication of the dataset is not possible, as we need to protect patients’ identity. Publication of data could compromise anonymity or confidentiality or breach local data protection laws.
Ethics approval and consent to participate
The Mayo Clinic institutional review board (IRB) approved the research protocol. Every patient (or guardian) who presents to our center is asked for written permission to have their records reviewed for research purposes. The dataset has been de-identified for research purposes in accordance with our IRB.
Consent for publication
Not applicable. No identifying patient data was used in the manuscript.
The authors declare that they have no competing interests, including no financial and non-financial competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Cite this article
Bellolio, M.F., Bellew, S.D., Sangaralingham, L.R. et al. Access to primary care and computed tomography use in the emergency department. BMC Health Serv Res 18, 154 (2018). https://doi.org/10.1186/s12913-018-2958-4
- Diagnostic imaging
- Electronic health records
- Emergency service
- Health services
- Multidetector computed tomography

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Usability testing allows us to monitor and observe real people interacting with your product or service. Providing a way to validate ideas and identify design and functionality issues that need to be corrected early in your project.
End-To-End Design Services.
From research to execution, MaybeForYou provides user-focused end-to-end design capabilities for helping to turn your ideas into measurable business results.
Ways We Can Work Together.
Rather than a one-size-fits-all solution, MaybeForYou offers three methods of working together based on the unique needs of your project and team.
For projects with a targeted mission and deadline, our project-based approach is a perfect fit. Based on our design methodology this is an end-to-end solution for bringing ideas to reality.
Fractional & Retained Services.
For organizations needing to augment and scale your existing team, our fractional and retained services model provides ongoing research, strategy, design, and leadership support.
Workshops & Trainings.
From workshops and Design Sprint facilitation to consulting services around specific aspects of the design process, we help your team improve the way they concept, design, and build products.

domain: design


Newport County confirm Joss Labadie departure
Newport County's former captain Joss Labadie has left the club, manager Michael Flynn has confirmed.
The 27-year-old damaged his anterior cruciate ligament in training last season and has been doing rehab as well as discussing a new deal with Newport.
However, Flynn confirmed the former Dagenham player has not agreed terms and is now free to join another club.
"Joss is a free agent, he has left the club but is someone I would love to see back in the shirt of Newport," he said.
"But there is nothing happening and he will continue to do his rehab."
Flynn said he did everything in his power to try and convince his former captain to remain at the League Two club.
"I personally could not have done more to show how much we value him. I gave him the captaincy. He is someone I have a lot of time for," Flynn said.
Newport open their League Two campaign against Mansfield on Saturday, with Flynn targeting two or three further signings.
"I am happy with the recruitment but would like two or three more players… hopefully we will have some news later," he said.
Flynn also said he is unconcerned by boardroom instability at the Exiles after directors Simon Sadler, Neil Collier and Rob Santwris all quit the fan-owned club within 24 hours.
"The boardroom stuff is what it is. I have a job to do which is to put a football team together," Flynn explained.
"What is or isn't happening behind the scenes is nothing to do with me."


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Taber police and RCMP were out helping gather about 20 ostriches that escaped their enclosure in the town of Taber on Thursday morning.
In a post on Facebook, the Taber Police Service said the birds made their way out of town and “created traffic hazards.”
Police officers and RCMP members were able to confine most of the ostriches so the owner could safely bring them home.
Taber-Vauxhall RCMP started fielding calls about ostriches on the road near Highway 36 and Township Road 94 just before 8 a.m.
About 20 birds were loose, RCMP said. One ostrich was hit and killed on the road.
“Over the last several hours, RCMP have supported the farmer in locating and capturing the loose birds,” RCMP said in a news release.
At one point, the owner was seen riding in an RCMP vehicle grabbing one of the ostriches.
As of 12:30 p.m., all but a couple of the birds had been captured. Officers continue to help the owner track down the remaining ostriches.
More to come…
&© 2022 Global News, a division of Corus Entertainment Inc.
View original article here Source

domain: news


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Cryptocurrency is a notoriously volatile industry, regardless of what coin you’re trading. During periods of extreme volatility, it’s easy to become disheartened when trades don’t go your way. It’s also easy to become overconfident when you get lucky, falsely attributing it to your trading strategy — when, in reality, the price often rose or fell for reasons other than you assumed.
Despite the uncertainty, there are sometimes still strategies you can use to trade certain tokens successfully. Ether (ETH) is arguably where you might be able to succeed this year. Here are three tips that might help.
There are many ways to analyze the price of a given cryptocurrency, and different price valuations will be given depending on the model used and how much weight is given to a specific set of conditions.
But incorrect weighting can produce erroneous conclusions. For instance, a cryptocurrency can generate positive buy signals across the board, but other factors can send the entire market tanking.
This is precisely what happened with Ethereum’s Merge, where a successful transition to proof-of-stake that reduced consumption by 99.9% was not really reflected in the price. In fact, bearish traders ran the price into the ground.
Related: Bitcoin will surge in 2023 — But be careful what you wish for
The crypto market also tends to correlate heavily with Bitcoin (BTC), which is traded by a lot of institutional and hedge fund money that is tied to interest rates and traditional financial markets. ETH currently holds a 0.9 correlation with Bitcoin.
Leading up to May 2021 and November 2021, ETH experienced significant price increases. This was attributed to announcements from big firms, such as the decision of the European Investment Bank toRead more on cointelegraph.com

domain: finance


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The U.S. Supreme Court, forging its way to the end of the current term, unloaded a raft of important decisions Monday, with many more expected in the days to come. At the same time, the court agreed to hear a case next term testing whether there is a constitutional limit to how much partisanship one party can use in drawing legislative maps. Among Monday's decisions were these: In a case that pitted alleged constitutional violations against national security claims, the court ruled that top Justice Department officials in the George W. Bush administration cannot be sued for money damages over policies they devised and carried out after the Sept. 11 terrorist attacks . In a test of the 1946 federal trademark law, the court ruled unconstitutional a...
READ MORE >
As Term Winds Down, Supreme Court Says It Will Take On Political Gerrymandering


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Dream Family Getaway
We love traveling and seeing different places. Now that we already have Jabe, we wanted to be able to travel and explore different places more so that Jabe can be able to see the world. Probably one of my dream family getaway is Orlando, Florida! And I would definitely love to go to Disney World. If given the chance, it would all be our first time to visit not just Disney World and Florida but as well the United States.
This dream, I know will soon come true. But for some, who are also dreaming to go there and that dream is already within reach, have you already tried to plan your itinerary and also look for the best accommodation in the area? For your itinerary, some of the things you might to visit are Lego Land (hubby would definitely love this!), Discovery Cove, Busch Garden, the Old Town, the Wonderworks, and so much more..
For accommodation, vacation packages and hotel deals for families from different Orlando Hotels are now being offered through the internet through Orlandoescape.com. Visit their site for the best deals ever or like their Facebook page to get updated on their latest offerings and also get to know the best things to do in Orlando!
Happy planning and I do hope that you will enjoy your vacation, coz I am sure that whenever that dream of mine is already a reality, we would be having one hell of a vacation!

domain: travel


IUST organises workshop on ‘civil services as a career option’
Post by RK News on Tuesday, December 13, 2022
Awantipora, Dec 12: Dean Outreach IUST, organized a one-day career counseling workshop which was attended by students of different departments.
The program was conducted by Vaibhav Sanas and other experts in the field who introduced the aspiring students to Civil Services held at state and national levels. The students were briefed about the civil services examination pattern and about the strategies needed to qualify them
The students enthusiastically participated in the discussion and posed many questions to the experts. Mr. Vaibhav Sanas encouraged the students that Civil services are a premier career choice for the youth that affords them the opportunities to serve the country and participate in policy-making.
Dean Outreach Prof. Lily Want urged the students to work hard and appear in the Civil Services examination for a glorious career.


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Anita and Scott began preparing the construction of their dream home on Financial institutions Peninsula (near Akaroa) in 2012 when Mary obtained a mortgage loan from the NZ bank with the land and building. Scott and his brother (the builder) have finished the development now. Anita and Mary labored so well together with the progress payments in the lender, the Council compliance and Total remarkable teamwork from when Anita and Scott lived in Sydney to when they moved into their household - evaluate the beautiful lifestyle - what a magnificent location to live!!! An excellent design expertise and joyful clients (plus their happy Puppy)!!
June 2016 Melissa and Martin who definitely have originally resided in Sydney if they acquired an Auckland residence in 2013 and then moved to Wellington completely wherever they've procured an excellent Wellington house which they hope to renovate (Martin currently being an architect with fantastic style and design Concepts).
Corporations in the best quartile for racial and ethnic diversity are 35 % additional more likely to have monetary returns previously mentioned their respective nationwide field medians.
I would much like to thank Mary for all her effort in receiving us about the road with our new obtain of home in New Zealand.
Ellen and Daniel are initially household owners and have discovered it extremely hard to acquire a home in Sydney. Initially from Dunedin, they determined to purchase their 1st house being an financial commitment house this 12 months in Dunedin. At the same time Ellen was due to have a newborn inside the timeframe the settlement happened.
Walter is living in Melbourne and is absolutely thrilled with the cost savings he has obtained via Mary for his Ahipara residence.
An insurer in collusion with the insured human being tried to launder funds by means of insurance coverage transactions. The supervisor of the insurance company offered wellbeing and personal harm insurance coverage guidelines insuring in opposition to the liability from incidents to dummy persons, Ordinarily within the names of friends and relations. These folks paid out why not try this out a small quality charge. Subsequently promises ended up received, supported by false documentation and healthcare certificates to substantiate the losses and also the insurer paid the statements immediately.
Moreover, in the omission from the paper of some mother and father’ beliefs that the vaccine was accountable, enough time url for the lawsuit sharpened. With considerations logged from eleven of 12 family members, the maximum time supplied to the onset of alleged signs was a (forensically unhelpful) four months.
We simply cannot thankyou ample for your tolerance all through the entire process of lacking out on FOUR Homes in advance of last but not least discovering the best spot for us. All of your labor via out that process helped us every stage of how.
Rhett Williams had been buying residential Attributes for approximately six several years. He tried buying his 1st residence in New Zealand with us that resulted into a very smooth and headache-free of charge processing. It straight away followed by A further buy in Logan Queensland and getting knowledgeable a strong funds development on both property encourage him to maneuver to another amount and bought 2 more Homes.
Now we have also benefited from Mary’s awareness, encounter and contacts in connected spots. For example she advisable a superb attorney in Tauranga who also performed an important job in securing our Tauranga assets whilst guaranteeing that we had a agreement which was a safe and audio.
animal instruction and breeding tools, including a “rape stand”, a tool in which a female Pet dog that's too intense to submit to males for breeding is strapped down together with her head in a restraint
This case is meant to function The idea for class discussion as opposed to For instance either the productive or ineffective managing of the situation.
I would not wait to recommend Mary and New Zealand Home finance loan Solutions to any individual on the lookout to get/build either in Australia or abroad and I understand we might be utilizing her again when we discover our up coming venture.


The 9170B/9180B series programmable DC power supplies deliver clean, stable and precise output power due to the supplies’ exceptionally low ripple and noise, low temperature coefficient, excellent regulation and fast transient response time characteristics.
These power supplies offer SCPI IEEE488.2 compliant USB (standard), RS232, RS485, GPIB and LAN interfaces, combined with front and rear panel output and remote sense terminals to facilitate test system development and integration. The LAN interface includes a built-in web server that allows users to configure, control, or monitor basic power supply settings.
In addition to a full numerical keypad for convenient data entry, this series also provides unique features not typically found in comparable power sources, such as LED test modes, modular interface card slots, automatic range selection, and an optional 8-bit bidirectional digital I/O interface.
- Single and dual output models with up to 210W output power
- Exceptionally low ripple and noise
- Front and rear panel output
- List mode for executing up to 10 stored test sequences with a maximum of 150 steps in total
- Overvoltage/overcurrent/overtemperature protection (OVP/OCP/OTP) and key-lock function
- Fast transient response time of < 50 us for most models
- Fast command processing time < 10 ms
- Programmable voltage and current slew rates
- Standard USB interface
- 4 optional types of modular interface cards add LAN and GPIB, Digital I/O and Analog Control, RS485, or RS232 functionality
- LabVIEW (TM) drivers available


HP+ West Africa Joins the OP Donors' Caravan
June 2, 2017
HP+ West Africa's regional director, Modibo Maïga, and deputy director Brahima Bassane joined a high-level delegation of Ouagadougou Partnership donors in Burkina Faso last week to highlight USAID's and the project's pivotal role in developing and supporting the implementation of that country's costed implementation plan.
Each year, donors travel across francophone West Africa to visit select Ouagadougou Partnership countries. Known as the "OP Donors' Caravan," delegates visit with government, civil society, implementing partner, and youth representatives to discuss how they can better align their contributions to combat maternal mortality and promote family planning. This year the caravan made stops in Niger, Burkina Faso, and Benin—countries where HP+ has been working to support the expansion of family planning. Primarily, this work has come in the form of developing costed implementation plans—multi-year roadmaps designed to help governments achieve their family planning goals by prioritizing interventions, forecasting costs, mobilizing resources, and engaging stakeholders around a common strategy.
As the caravan winds down this week, we wrap-up our coverage of the OP Donors' Caravan and reflect on the necessity and difficulty of shifting social norms to reduce fertility, improve health, and spur economic growth.


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Top-Notch gospel singer Moses Bliss delivers another amazing worship track dubbed Taking Care (Remix), in the year 2023.
No Dry Season was composed by highly rated worship leader Moses Bliss starring Mercy Chinwo and it was derived off his remarkable project named More Than Music (Transcendent Worship), disclosed in the year 2023.
Moses Bliss unlocks this invigorating gospel track tagged Taking Care (Remix), as the eleventh soundtrack off his much-anticipated album captioned More Than Music (Transcendent Worship). Mercy Chinwo who was enlisted on this tune performed wonderfully well on her verse part.
More Than Music (Transcendent Worship) album bagged fourteen beautiful live tracks by Moses Bliss, who showcased his enormous talent to the world on this project, with other featured singers too.
Download Latest Moses Bliss Songs / Music, Videos & Albums/EP's here On TunezJam.
Listen to Moses Bliss - Taking Care (Remix) ft Mercy Chinwo Mp3 Here!
Share Moses Bliss - Taking Care (Remix) ft Mercy Chinwo Mp3 with others on;

domain: artistic


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2 June 2011 | Angeline
A number of government agencies in Europe that purchase IT services from the
private sector are continuing to illegally specify particular brands, according
to a recent report.
For the past two years, OpenForum Europe (OFE) has
published a report about the use of specific trademarks by European Union (EU)
member states when procuring IT software and systems. The 2010 report, which is
based on data collected between February and April 2010 but has just been
published, monitors tender notices issued for computer software products by
local government authorities and larger bodies in the EU.
Of the 441 invitations to tender by contracting authorities procuring computer
software, more than one in 10 notices included technical specifications with
explicit references to trademarks, according to OFE’s Procurement Monitoring Report 2010. According to the study, 13 per
cent of tenders published in the supplement to the Official Journal of the EuropeanUnion (OJEU) make reference to a specific
brand name or trademark, which discriminates against a significant part of the
In 2010, the highest number of invitations to tender with specific references
to trademarks were from contracting authorities in Poland, France and Germany.
The report said: “These findings led us to conclude that engaging in a more
comprehensive and global analysis of the EU's procurement market would show
that the use of discriminatory technical specifications is a widespread
practice within the EU.”
OpenForum Europe recommended increased scrutiny and called for the EU to
address the issue when the public procurement directive is next debated.
The report said: “While this report clearly shows
that there is an EU-wide level practice of contracting authorities making
reference to specific trademarks when seeking to purchase IT supplies, this is
merely the tip of the iceberg.
“In light of these results, the forthcoming
revision of the EU Public Procurement Directives should take into account
discriminatory practices persisting in the procurement market and to which the
current legal framework contributes to.”
OpenForum Europe has already collected the data for
the next report and a spokesman told SM
that the figures are “looking very similar to last year”.


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No catches, no fine print just unadulterated book loving, with your favourite books saved to your own digital bookshelf.
New members get entered into our monthly draw to win £100 to spend in your local bookshop Plus lots lots more…Find out more
The extraordinary story of the rise and fall and rise again of Tyson Fury...
THE GYPSY KING.
A Manchester lad from Irish Traveller stock, born three months premature and weighing just a pound at birth, Tyson (named after his father's boxing hero) grew up to become one of the most unlikely heavyweight champions in history. This 'dream come true' soon turned to nightmare, however, as alcohol and cocaine abuse took hold and Tyson was stripped of his titles. What followed was the darkest moment of his life - detailed in this book for the first time - in which he came within seconds of ending everything.
THE PEOPLE'S CHAMPION.
Like all the greatest stories, though, there is redemption and Tyson defies all the odds and literally drags himself to his feet. 10 million people around the globe watched Fury fight Wilder in the biggest fight of the boxing calendar. Speaking candidly about his struggles with mental health, this is Tyson Fury as you have never seen him before.
A BRITISH ICON.
Behind the Mask is an unflinching autobiography from the greatest boxer of our time and a man who has demonstrated strength of a very different kind by conquering his demons.
Closing date: 12/03/2021
'It's a great book, if I could read, I'd buy it' BILLY JOE SAUNDERS, WBO World Super-Middleweight Champion
'I didn't believe boxers could be role models, but Tyson Fury has changed my mind... This 30-year-old Mancunian has made us all think twice about the possibilities of redemption.'
SIMON KELNER, INDEPENDENT
'Tyson Fury has become Britain's most unlikely inspirational figure... the sight of a broken Fury caught a mood with the public. Never was the epithet "People's Champion" more apt'
RON LEWIS, THE TIMES
'Tyson Fury is an amazing real-life champion' SYLVESTER STALLONE, star of Rocky
'You may not have any interest in boxing at all and you will find this story about Tyson's life fascinating' BBC RADIO 5 LIVE
'An unusual, heartening story, nicely told. There is much to amaze and admire' SUNDAY TIMES
Publication date: 14/11/2019
Publisher: Penguin Audio
|Publication date:||14th November 2019|
|Genres:||Audiobooks of the Month, Biography / Autobiography,|
Tyson Fury is the undefeated lineal heavyweight champion of the world. Born and raised in Manchester, Fury weighed just 1lb at birth after being born three months premature. His father John named him after Mike Tyson. From Irish traveller heritage, the Gypsy King is undefeated in 28 professional fights, winning 27 with 19 knockouts, and drawing once. His most famous victory came in 2015, when he stunned longtime champion Wladimir Klitschko to win the WBA, IBF and WBO world heavyweight titles. He was forced to vacate the belts because of issues with drugs, alcohol and mental health, and did not fight again for more ...More About Tyson Fury

domain: library


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South Africa v West Indies
The primary ODI between South Africa and West Indies in East London was washed out with out a toss. The venue, that was set to host its first males’s worldwide sport because the pandemic, witnessed intermittent rain by the day.
Play was finally known as off at 4.35pm native, nearly 4 hours after the unique begin time of 12.30pm. There was rain when the groups entered the stadium, and regardless that there have been a couple of transient dry spells, there wasn’t sufficient time to dry the outfield earlier than rain returned.
The 2 groups meet once more on the identical venue on Saturday, for which the climate forecast seems promising. The third and remaining ODI of the sequence will likely be in Potchefstroom subsequent Tuesday.


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What we definitely have is a pandemic of worry. The entire world’s media is gripped by coronavirus. Here are 10 reasons not to panic and stress out.
Stress, either physiological or biological, is an organism’s response to a stressor such as an environmental condition. Stress is the body’s method of reacting to a condition such as a threat, challenge or physical and psychological barrier. Stimuli that alter an organism’s environment are responded to by multiple systems in the body. In humans and most mammals, the autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis are the two major systems that respond to stress. [Wikipedia]
The world is coming to a still. For many people income have become endangered and we all are going a little bit crazy. Time to start an online business.
Many individuals tend to consider stress as just a bit of discomfort and also a lack of action. In reality, long term stress can even cause heart disease.
Stress does not set your emotions on a rollercoaster. Stress takes from you. Diffuse stress by learning how to modify stress response patterns.
One of the very best methods to ensure you’re able to manage your stress well is to create a stress support system that can assist you as time goes on.
Confidence is the key to so many things in life. It can absolutely transform your life. Confident senior citizens suffer fewer effects of stress in life.
While stress itself is enough to quicken your aging, there are likewise numerous common events in your life that can throw your stress into overdrive.
One of the most common troubles of old age in regards to wellness is that we get weaker bones. It isn’t unique to seniors: chronic stress ages your bones.
Stress is subtracting years from your lifespan. One way to fight it is through the use of an acupressure mat that can be a back pain and sleep aid.
Stress can cause you problems from head to toe. Headaches, stomachaches, muscle discomfort, and more. Use Aromatherapy Essential Oils for stress relief.

domain: medical


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The department of Legal Administration was established in the academic year of 2014-2015. This mobility is a reflection of Kurdistan region’s concern about improving the level of legal and administrative acknowledgement to support those who are employed in the fields of law, judgment and legal administration. The department is also meant to establishing a part of those attempts which are in the field for developing the steps toward improving the humanity evolution in Kurdistan region. In the project towards improvement, we take part in the process of development which the government is ambitious about it.
Legal administration department plays a significant role in improving the level of expertise, legal culture and legal administration of the graduated students of the Legal Administration department in Lebanese French University. To this end both of the theoretical and practical aspects are employed to train qualified and effective graduate students to meet the requirements in the career field.
As a result of the rapid change in the society’s movement forward and to join the revolution in the existing educational and technological fields, Legal Administration department’s duties for increasing knowledge are essential. In the same token, the department tries to catch up with the changes achieved in all the aspects of social life.
This can be done through the appropriate realization of the laws and awareness of the importance of both theoretical and practical fields. It can also be done by an accurate practice of legal administration along with identifying all the necessary tactics, rights and responsibilities. This guarantees this claim that improvement at a unique social level has achieved.
The improvement of the level of specialty in legal administration demands the student’s level of knowledge to be at a high level. It also requires that the department employs knowledgeable instructors with an acceptable educational background, provides a comprehensive library and applies the newest teaching methodology which the most improved technology has ever achieved. The newest laws should be manifested though. We try to keep the department at the level of the similar departments of the other universities to activate educational assessment and to identify the means of studying and practical assessments.
Head of Department
No. of Students:104
No. of Staff:
Number of Modules:
Office Hour: 8:45 AM – 2:30 PM
Contact us: [email protected]

domain: law


On Tuesday evening, April 21 at 6:00, the Sioux City Public Museum will host Odyssey of Acceptance: A look at coming to America from the perspective of immigrants and refugees. Hosted by Erica Deleon, director, Mary Treglia Community House with guest speaker Sanford Center Gang Outreach Supervisor George Sayavong. Erica DeLeon will provide a look at the 21st century struggles of immigrants and refugees and how world events shape people opinions of the many new faces arriving into Siouxland. George will relate his experiences after coming to America in 1988 as a refugee from Laos.
- May 22, 2014
- February 12, 2013


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18 views•2 likes
jake.dubin4/6/19, 5:06 p.m.
Spicy chicken slice. Solid crunchy crust. Good sauce and fresh ingredients. Reheated. That’s the review.
curtis.tinsley2/18/19, 1:35 a.m.
Delicious cheese and slight flop. I’m a sauce guy and it was lacking a little bit on the amount of sauce. Overall very good slice

domain: food


§ House in Committee.
§ MR. LAING
said, he rose to move that a Vote of £654,000 be granted to Her Majesty on account for the purpose of defraying certain expenses for the Civil Service. In doing so, he would take occasion to say that it was by no means the wish or the intention of the Government to have recourse to the practice of taking Votes on account, or to lay down any new system with respect to the voting of the Estimates. The present Vote was proposed under exceptional circumstances, inasmuch as, while a certain amount was immediately wanted for the Civil Service, it was not thought expedient, nor probably would it be the wish of the House, that the discussion on the Estimates for that Service should be at once proceeded with, to the exclusion of those for the army and the navy, the debate on the organization of the Indian army, and other important subjects which claimed immediate attention. The amount, he might add, for which he asked on the present occasion was only sufficient to tide the Government over salaries and other payments due next month, and by no means so large as to preclude the House from exercising to its fullest extent their judgment with respect to Civil Service Esti- 451 mates as a whole, the discussion on which the Government did not wish to postpone a single day beyond the time necessary for the despatch of more important business. It had been said that those Estimates were in a state of constant and rapid expansion, but it would be found that when the whole of the items of the revenue—class 7—were before the House—which would be the case in a few days—they did not exceed the amount which had been stated by his right hon. Friend the Chancellor of the Exchequer in February last, and that upon the whole of the Civil Service Estimates there was a diminution, as compared with last year, of at least £320,000.
1. Motion made, and Question proposed,
That a sum, not exceeding £654,000, be granted to Her Majesty, on account, for or towards defraying the Charge of certain Civil Services, to the 31st day of March 1861.
§ MR. W. WILLIAMS
said, he had great objection to the system of voting sums on account, but seeing the difficult position in which the Government were placed, as they had no moans of going on without these Votes, he should not offer any opposition to that before the Committee. He wished, however, to know how long the present Vote would enable the Government to go on?
§ MR. AUGUSTUS SMITH
said, the Committee must be convinced that, if the Votes on account were granted, there would be an end to all discussion on the Civil Service Estimates. They all knew that by the middle of July the House was in a state of dissolution, and no reduction could then be made in the Votes. He should, therefore, offer a few observations on the first item, the Vote for the Treasury, and, as the Gentlemen representing that departpartment had not done their work this year, and had not got these Votes discussed and passed, they were not entitled to their salaries. The subject was one of importance, as a very unsatisfactory mode of conducting business at the Treasury had recently sprung up, and some fresh organization of that department was much wanted. Formerly the Lords of the Treasury sat as a Board. Everything went before them, and their sanction as a body was required. But of late years he un- 452 derstood the business was transacted by the Secretary and the Chief Clerk of the department. More important matters were arranged between the Chancellor of the Exchequer and the Secretary, and then the clerk wrote the determination that had been come to in the name of "my Lords," although "my Lords" knew nothing of the matter. The Lords of the Treasury ought to be really active and responsible officers. The inquiry before the Packet Contracts Committee showed the necessity of bringing the business of the Treasury into one focus, so that one department might know what another was doing. The Lords of the Treasury were very active in and about that House, and hon. Members were sure to find one at the door, but they were less entitled to their salaries this year than ever, because on two or three occasions they had been active in counting out the House, and preventing it from proceeding with the business before it. He would move as an Amendment that the Vote of £15,000 for the Treasury be postponed until the whole Vote for the Treasury was before the Committee.
Motion made, and Question proposed,
That a sum, not exceeding £639,000, be granted to Her Majesty, on account, for or towards defraying the Charge of certain Civil Services, to the 31st day of March 1861.
§ MR. BENTINCK
said, it was absurd to suppose that the House could properly discuss the Estimates if they were put off to a late period of the Session. The Civil Service Estimates were those upon which their only hope rested with regard to economy. It would be impossible to economise on the Army and Navy Votes, the only fault of which was that instead of being too high they were too low. The increase in the Civil Service Estimates during the last six or seven years was out of proportion to the apparent requirements of the country. The House would do well to make it imperative upon the Government to lay the Estimates before the House at an early period of the Session. If a Resolution of that kind were passed, marking the sense of the Committee upon the delay which had occurred, they would do more towards economising the finances of the country than had been 453 done by any previous House of Commons. The difficulty in which the Government now found themselves was one of their own creation. Still, he did not see that any good would result from refusing this Vote on account; but if the hon. Gentleman (Mr. Augustus Smith) chose to divide the Committee upon it he would go into the lobby with him.
§ MR. BAXTER
said, he thought the suggestion of the hon. Member (Mr. Bentinck) for an earlier production of the Civil Service Estimates was a good one, and he trusted it would engage the attention of the Committee up-stairs, and form one of their recommendations. As, however, it was not through any fault of the Government that the present delay had occurred, he trusted the hon. Member for Truro would not press his Amendment.
§ MR. SPOONER
said, he wished to know whether any part of the money voted would be applied to the Art and Science Department Vote of £94,000, and the Vote of £34,000 for works and repairs about the Palace of Westminster. It was his intention to move a considerable reduction in both these Votes.
§ SIR JOHN SHELLEY
said, he hoped it was not intended to postpone the consideration of the Estimates till the middle of July, because what had happened before might happen again, and when very few Members were present, except those he-hind the Treasury bench, many very important Votes might be taken.
§ VISCOUNT PALMERSTON
said, he could assure the House that there was no intention to postpone unnecessarily the discussion of these Estimates. All that his hon. Friend asked was that there should be a Vote on account to meet the wants of the service up to a particular period. It was desirable to go on as soon as possible with the Navy and Army Estimates, as those related to services of great magnitude and importance to the country; but as soon as those Estimates were gone through, which he hoped would be next week, the House would be able to discuss in the fullest manner all the items of the Miscellaneous Estimates.
§ MR. BRISCOE
said, the statement of the noble Lord would give great satisfaction, as the impression might have gone abroad that the Government had no desire to give the House an opportunity of fully considering these Estimates.
§ COLONEL SYKES
said, he thought they could not conscientiously refuse this Vote, 454 as the Treasury was at a very low ebb. The state of the public business bad given the Government an excuse for asking Votes on account that Session; but he considered the principle of such Votes to be highly objectionable. He was glad to hear the noble Lord say that ample opportunities would be given for discussing the Estimates.
§ MR. H. BAILLIE
said, he wished to ask whether any architect had been appointed as the successor of Sir Charles Barry; and also whether any considerable works were to be undertaken with reference to the Houses of Parliament during the ensuing year?
§ MR. LAING
said, it was not intended to apply any portion of the money then asked to the expenditure upon the Houses of Parliament, the money already taken for that purpose not being yet exhausted. A sum of £12,000 would be appropriated on account of the arts and sciences, the total Vote for which was £94,000.
§ MR. CHILDERS
said, the noble Lord the Foreign Secretary had, a few evenings ago, spoken of the consideration of the Miscellaneous Estimates as business that might be put off without much detriment, and that on an average of years the reductions made in them were very trifling. That was not a position in which the Civil Service Estimates, which were growing in importance every year, ought to stand. It had also been said that the principle of voting on account ought to be acted on by the House, and that it should be the rule— not the exception. When that was laid down as a rule, it was high time for the House to look into the question. He thought that they should act on the principle of no money being spent till it was appropriated, and in order to carry out that principle, the commencement of the financial year should be on the 1st of July, instead of the 1st of April. It was his intention to bring the latter proposition more prominently before the House on a future day.
§ SIR HENRY WILLOUGHBY
said, he agreed with the hon. Member opposite (Mr. A. Smith) that a reorganization of the Treasury was required. That had been shown by the evidence given before the Public Moneys, Miscellaneous Expenditure, and other Committees, for the way in which it had been thereby proved that the Treasury transacted their business was far from satisfactory. The Lords of the Treasury were all very able gentlemen, and he could not understand why more use was not made of them in departments where 455 their ability might be of service. He thought the financial secretary of the day exercised too much power. A remarkable instance of the unlimited exercise of power in that direction occurred when Mr. Wilson was financial secretary, for during that period he alone, without consulting any single functionary, or the Treasury, entered into a most important contract, involving the outlay of £185,000, of which 92,000 had to be paid by one of our colonies. That contract had given great dissatisfaction in the colony, for it had proved to be a complete failure; and Mr. Wilson had avowed that though my Lords were stated to have done this and to have done that, no one but himself had had the least share in the matter. That was a very wrong mode of conducting public business, and Her Majesty's Government and the Treasury should look to it, and be made responsible for all the transactions that took place. He thought the hon. Gentleman had done good service in calling attention to the subject.
§ Motion, by leave, withdrawn.
§ Original Question put, and agreed to.


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28 November 2012
Prevent Child Abuse
Are we doing enough to prevent child abuse? Is the government and social services doing the right things to prevent child abuse? Children are suffering from a national epidemic of child abuse and neglected. “According to a report in May 2010 from United States Department of Health & Human Services, Administration for Children & Families, approximately 772,000 children were found to be victim of child maltreatment in 2008; 71.1% suffered neglect; 16.1% were physically abused; 9.1% were sexually abused, and 7.3% were psychologically maltreated. These figures only represents reported cases of abuse literally thousands more go unreported each year.” (National Child Abuse Statistics) These statistics are too high and there need to be changes to overcome this problem. As a parent you are expected to take care of your children and treat them the right way. Sometimes this is not always the case and children end up being abused in their home were they are supposed to feel safe and love. Every day a child is abused and may lose his or her life. Prevention of abuse is the only way to stop innocent children from more dangerous and abusive maltreatments. In order to prevent child abuse we should be aware of the different kinds of abuse, ways social services can help, and how to prevent child maltreatment. Some readers may argue that the majority of child abuse victims are not counted in official statistics because most abused and neglected children never come to the attention of authorities. Others argue that the numbers actually create the impressions that the problem is more severe than it actually is. However, while some debate the precision of the statistics, few dispute the harm that child abuse can cause on them. Some children die of neglect and abuse, most of the victims survive with mental scars that stay with them thorough their lives forever. There are four major types of child abuse: physical...
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domain: psychology


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Tony Hooper and Elaine Charlson (see Misalliance) also play as part of one of the south of England's most popular barn dance and ceilidh bands, Pitchfork, which was formed in in 1979 as a result of a chance visit to a folk club in Basingstoke. The members have changed over the years, but are still led by one of the original four members, the current line-up having been the same since 1990. The band consists of five multi-instrumentalists, all of whom contribute to vocals when the band perform songs as part of an evening's entertainment:
whistles, recorders, wind synthesiser and percussion
mandolin, guitar, whistles and harmonica
Pitchfork concentrate on live performance rather than studio work, and, working with local Dance Callers, the band operates all over the South of England, performing for private parties, music and dance festivals, weddings, fundraising and social events. Ian Woledge (who sent me information on the band, is also a member of the band Bold Grannydier, renowned for their appearances at Folk Festivals, and featuring Saul Rose of the Eliza Carthy Band. Ian on occasions joins forces with another local band Rogue's Gallery, sharing the lead with electric guitar.
Contact Ian for bookings etc. at The Firs, Malthouse Lane, Tadley, Hants RG26 3NY, 01189-814484 (evenings), 01189-633868 (daytime), Fax 01189-633754 or email him on Ian@pitchfork.fsnet.co.uk
See also Misalliance,


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A recent report by an international advocacy group against landmines has revealed that there were 24 casualties of landmines and explosive remnants of war (ERW) in 2020 in Turkey, Turkish Minute reported, citing Deutsche Welle Turkish service.
Globally, at least 7,073 casualties of mines and ERW were reported in 2020, according to the Landmine Monitor 2021 report released on Wednesday by the Landmine and Cluster Munition Monitor, which provides research and monitoring for the International Campaign to Ban Landmines (ICBL) and the Cluster Munition Coalition (CMC).
The report shows how civilians remain the primary victims of these indiscriminate weapons as they accounted for 80 percent of all casualties whose status was recorded in 2020.
The highest number of casualties (2,729) was recorded in Syria, a state not party to the Mine Ban Treaty, followed by Afghanistan (1,474).
According to the report, massive antipersonnel mine contamination, defined by the monitor as more than 100 square kilometers, exists in nine countries, including Turkey.
Turkey was among seven countries that requested extensions to their clearance deadlines in 2021. The requests will be considered at the 19th Meeting of States Parties in November.
“Turkey reported contamination of 145 km² across 3,834 areas. The majority of contaminated areas are found along its borders with Armenia, Iran, Iraq, and Syria, while 920 areas are not in border regions. Turkey plans to conduct non-technical survey during 2021–2023 of all of the contaminated areas, to provide a more accurate picture of contamination,” the report said.
1997 Nobel Peace Prize co-laureate ICBL called on the international community to step up its efforts for the clearance of landmines.
The Mine Ban Treaty, or the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction, aims to eliminate anti-personnel landmines around the world.


- Cold forged 2.0mm 304 stainless steel with rolled threads - Nipples sold separately - 213g (32 spokes @ 262mm) - Bag of 50
Wheels Mfg axles are made from aircraft quality 4130 alloy steel, made specifically for Wheels Mfg. It’s heat-treated to increase strength without making the axle brittle. Rolled threads make for easy assembly of cones & locknuts. - Fits many Taiwanese hubs with 130mm spacing - Type: Hollow Axle - Threads: 9.5mm x 26tpi - Diameter: 9.5mm - Length: 141mm - 1 axle per bag
Wheels Manufacturing cones are precision machined to Shimano Ultegra or higher quality standards. This ensures that our cones fit correctly, run smoothly and have a long service life. - Fits: Joytech, Joy U, KK 10mm x 1, rear - Compatible with 10mm x 1 axle - Cone Wrench Size: 15mm - Threads: 10mm x 1 - Diameter: 17.0mm - Length: 13.8mm - 1 cone per bag COMPATIBLE HUBS: - Joytech, Joy U, KK 10mm x 1, rear - Taiwanese rear hubs with 10mm x 1 axle
Get rolling again with a replacement 10-speed freehub body for Mavic wheels.
Features - Strong nylon reinforced material handles high-pressures - Adhesive backed for a secure fit - Does not rot - 0.5mm thick
Use Stan's Tubeless Valve Stems when you're converting standard rims to tubeless via the taping method. These also have a removable core for easier application of tire sealant. Note: Schrader valve is for non-stepped Hugo rims. If your Hugo rim decal reads: - MAX RIM PRESSURE: 2.8 tires: 26psi, 3.0 tires: 24psi - ERD 615, 622x49.9, 29 in x 52.3mm Your rim has a stepped valve and is not compatible with this Schrader valve.
$1.50 - $6.25
Wheels Manufacturing Outer Axle Nuts are high-grade steel nuts that provide secure wheel fixing for solid-axle wheels. - 14mm x 1mm (1411-AN) sold in pairs - All others sold individually
Replacement freehub spoke protector, in various sizes for different freehub sizes. - Made of clear plastic - 3 hooks for affixing to spokes
Get rolling again with a replacement freehub body for your Mavic wheels. - For Mavic ID360 hubs
Sta Tru Rear Wheels - Single Wall rim - Hub/Brake Compatibility: Rim Brake - Wheel Size: 27.5" - Cassette Body Type: Shimano/SRAM 8, 9, 10 Speed - ISO Diameter: 584 / 650b / 27.5" - Tire Type: Clincher - Rear Axle: QR x 135mm
- Strong nylon reinforced PVC for a secure fit - Handles high-pressures; does not rot - 0.5mm thick
Maximum stiffness and highest safety—the RWS quick release for road and MTB. Our patented RWS axle system is stiffer, safer, and easier to use than conventional quick-release axles. The RWS quick release is absolutely reliable and offers a strong connection to the frame. The perfect choice for anyone who is looking for maximum performance and safety.
- Straight gauge 2.0mm with cold forging technology - Chrome nickel stainless steel with rolled threads. Black surface treatment resists scratches - 222g @ 32h/265mm - Box of 72 - Nipples sold separately
$59.99 - $65.49
Sta Tru Rear Wheels - Single Wall rim - Hub/Brake Compatibility: Rim Brake - Wheel Size: 24-inch - Cassette Body Type: Threaded Standard 1.37-inch x 24tpi - ISO Diameter: 507 / 24-inch BMX - Tire Type: Clincher - Rear Axle: 3/8-inch Threaded x 135mm
Replacement wheels for Strider Sports balance bikes - EVA-Polymer, no-flat, maintenance-free tire - Fits all 12" Strider models - Cartridge bearings - Wheel Size: 12-inch - Sold individually
Your riding doesn’t need to stop when the weather gets cold. Features - Giant road thru-axle trainer axle - Alloy construction - For use on 2017+ Giant road bikes with a 142x12mm rear thru-axle
$39.99 - $64.99
Sta Tru Front Wheel - Single Wall rim - Hub/Brake Compatibility: Rim Brake - Wheel Size: 24-inch - ISO Diameter: 507 / 24-inch BMX - Valve: Schrader - Tire Type: Clincher
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Members and associate members of the Society and network groups are entitled to 10% discount on book purchases. We also offer discounts on bulk orders.
To avail of your discount, to look at your account or to check whether your membership subscription is paid, you should first log in.
If you are not a member of the Society, just click on the categories above to view the publications we sell. You can order these online.
"This project has been funded by Cavan-Monaghan Rural Development Co-op under the National Rural Development Programme. Funded by the Irish Government and part-financed by the European Union under the National Development Plan 2000-2006."

domain: economics


text:
Government has to take to give back
Published: Friday, August 28, 2009 at 3:30 a.m.
Last Modified: Friday, August 28, 2009 at 12:23 a.m.
Dear Editor: In answer to Dwight Stripling [Aug. 16], without private property (privatization) of everything except government we would have no private health. Without private property, privatization, the government would have no money to provide all those things they are promising and have been promising for 75 years. Every penny the government spends to give us free health service (Medicare), retirement (Social Security) and roads and bridges is money taken from working people as taxes. The money comes from businesses run by private owners and the workers they hire for wages from which withholding is taken. Check your paycheck.
The corruption and greed on Wall Street, which brought about the present difficulties, were instigated by Congress. The financial systems and housing problem was brought about by failure of federal supervisory agencies to properly do their jobs and interference on the part of individual congressmen and congresswomen.
Congress failed us by not controlling and supervising both government and civilian organizations.
Remember the government makes nothing: not cars, food, furniture or any amenities of life. It all comes from the sweat of hard working people like you, Dwight. Everything the government gives has to be taken away from someone else. Or perhaps you.
Gerald G. Jones
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Learning an incredible work ethic from her entrepreneur mom, she persisted on all kinds of obstacle to build a real estate team that’s number one in the world
— Veronica Figueroa
SAN FRANCISCO, CALIFORNIA, USA, November 16, 2022 /EINPresswire.com/ — Veronica Figueroa spent a lot of her childhood working in her mom’s bodegas, serving the Latino community around whatever military base her dad was stationed at. Her mom would see the need, travel to cities to buy the products, and gather the grateful community. As Veronica understands now, she watched her mom become a “niche marketer.” And that’s how Veronica first found success in the real estate market, selling to the Latino community.
Eighteen years later, it has become much more than that. She is the first woman to lead a team selling 2,100 homes in one year. She sits on Zillow’s prestigious Advisory Board. She’s been recognized and honored by real estate companies and organizations year after year. And she is a sought-after speaker. As she herself says, “I don’t know how to do anything small. It’s all gas, no brakes. There’s no in between.” That drive brings incredible success, but it has also come at a cost.
“I’ve struggled with depression. I’ve struggled with abuse. I’ve struggled with alcoholism. I’ve struggled with betrayal. I went through a divorce,” Veronica shares. She provided for her kids financially but now recognizes that being a “workaholic” meant she wasn’t there for them as a mom the way she would have liked to be. “My kids are now adults, and they’re inspired by everything I have done,” she says. “But back then, all they knew was their mom was always working.”
Veronica sees all of her experiences as part of the journey that got her to where she is today, which is sober, healthy, and happy. She and her second husband recently renewed their vows. She is working with coaches who have encouraged a new self-awareness. “I used to think I needed to prove that I deserved people’s attention. Now, I live a completely different life. It’s all about alignment. It’s all about purpose. It’s all about impact,” she says. She is working less, but impacting more people. “I want to now be an advocate for not sacrificing your family to be successful in real estate. You don’t have to lose yourself to win or to be a leader. Because why do we do this? We do this to build a life for the people that we love, and to enjoy it. But I did it the wrong way for a long time.” In fact, she had the greatest success when she stopped focusing only on the awards and focused on her physical and mental health and the relationships in her life.
Agents across the world are inspired by Veronica’s message. As her IG handle says: @veronicafigeroainspires. She invites DMs and even shares her cell number: (407) 301-9574. You can find out more about the “Fig Team” at https://www.figueroateam.com. And Veronica’s whole story plus much more of her valuable advice appears in the compelling new book Women Who Boss Up in Real Estate, a collection of interviews with brokers, agents, and owners who are breaking the mold in real estate and ready to inspire the next generation of women find success in this fast-paced, highly lucrative industry.
About the Women Who Boss Up Book Series
Whether you’ve been bossing up for a while or you’re looking for support on your boss-up journey, the Women Who Boss Up book series is your chance to take inspiration and advice from women just like you. These women come from all backgrounds, all walks of life, and all disciplines—STEM, healthcare, finance, real estate, coaching, nonprofits, and much more. You’ll read about women who left Corporate America to pursue their dreams of business ownership, women who faced seemingly insurmountable challenges but learned how to move forward, women who followed their intuition to create lives of fulfillment and financial success, and much more. Learn more at bossupbestseller.com.


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The Viet Nam Ministry of Health and A&T co-organized an Implementation Workshop to formalize “Centers of Excellence for Breastfeeding” (CoE) with the participation of directors and staff from 29 hospitals, leaders from Departments of Health (DOH), Centers for Disease Control (CDC), and Reproductive Health Centers (RHC) in nine provinces.
The ministry introduced the designation criteria and accreditation roadmap while A&T and the Learning & Research Center for Newborn Care and Human Milk shared assessment results of the first 21 evaluated hospitals, consolidated from surveys of mothers, self-assessments and external evaluators. The innovative CoE approach provides new insight, renewed commitment and a clear path forward for hospitals in promoting early and exclusive breastfeeding and newborn care.
By the end of the workshop, each hospital and provincial DOH/CDC/RHC presented their committed action plans. As the next step, A&T will work with the hospitals to finalize and execute their improvement plans with the aim of 10 CoEs being accredited during this year’s World Breastfeeding Week, Aug. 1-7.
The following resources on the Centers of Excellence for Breastfeeding are available on A&T’s website:


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Chart-topping rap queens Cardi B and Megan Thee Stallion got stiffed at this year’s Grammy Awards — but they got their creative juices flowing again at the 2021 BET Hip-Hop Awards.
Dynamic “WAP” duo Cardi, 28, and Megan, 26, dominated the star-studded night with a trio of top honors: song of the year, best collaboration and best hip-hop video.
The triple trophy win represented a measure of awards show justice for one of the most influential singles of the year, which broke the record for “most-streamed song” in its first week of release with a whopping 93 million listens.
Meanwhile, hip-hop album of the year winner Tyler, The Creator took home two BET Awards, as did his peers Jay-Z and Lil Baby.
The 16th annual telecast was filled with amped-up live performances from hot new talents, but the night’s standout moment was delivered by a veteran entertainer.
“Hot in Herre” rapper and 2021 I Am Hip-Hop Honoree Nelly, 46, stole the show with an emotional acceptance speech and a “turned up” medley of his greatest hits including “Dilemma” and “Country Grammar.”


With the 2017/2018 model change, Harley-Davidson has completely redrawn the entire Softail family. New frame, new engine, new suspension and much more. At Rick's Motorcycles, they reacted quickly and developed a breakout fender kit made of steel.
Rick's Motorcycles offers all the parts needed for the rear conversion of a 2018 Breakout as a complete kit at a discounted price. The kit consists of steel fender, seat base, tank cover, mounting hardware and the matching tailgate attachment kit.
Each steel fender is manufactured in small series, in elaborate manual work and corresponds to the usual high quality standards of Rick's products. There are no changes to the frame to assemble these Bolt-On Fenders. Integrated, 8 mm thick struts provide sufficient stability. A spacious compartment has been integrated to accommodate additional electronic components.
Rick's steel fenders for the Fat Boy models from 2018 are available in either 240 or 260 tires.
For attachment to the bike Ricks recommends the stainless steel mounting kit of four screws that fit into the OEM thread. The screw heads are thus sunk into shapely, rounded covers, which reduces excessive loading of the painted parts and offers a particularly clean look.
The kit includes a custom-fit seat base made of fiberglass, which is perfectly adapted to Fender and original frame.
For a harmonious transition from the seat to the tank, a tank cover made of ABS plastic is included. The material is easy to paint and is adapted to the seat curves and the tank shape.


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Things have not yet become normal in the international market. Call it an outbreak of Covid-19 or the strategy of Crude Producing Countries, at present, there has been a slowdown in the Crude Market. Its effect is also visible in the domestic market. On Thursday, government oil companies reduced the price of both petrol and diesel fuels. In Delhi today, petrol came down to Rs 81.99 and diesel to Rs 73.05 per liter.
Petrol became Costlier by Rs 1.65 on the Second Fortnight of August
Starting from August 16, if left for four days, that is, Wednesday, August 19 and August 26, Saturday, August 29, Monday, August 31, then the price of petrol had increased for the remaining 13 days. The hike, which started at petrol prices at the beginning of the second fortnight last month, continued until September 1. If you talk about Delhi, then in the last 13 installments, petrol has become expensive by 1.65 paise per liter. However, the price of petrol has not increased for six days now.
Last July, only Diesel became Expensive
Last seen in July, government oil companies only increased the price of diesel. During that time, the price of diesel increased by 10 installments. Diesel has become expensive by Rs 1.60 per liter. Now from September 3, diesel has become cheaper by 40 paise per liter in three installments.
Softening in Crude Oil Prices
There is a slowdown in the global market. On one hand, the US has increased drilling for the discovery of oil wells, on the other hand, Saudi Arabia, the world’s largest supplier of crude oil, has reduced the oil prices. Due to this, WTI Crude was cheaper by $ 0.26 per barrel and Brent Crude $ 0.21 at the time of closing the market yesterday.
Know Today’s Expressions in your City
Petrol-diesel prices change daily and are updated at 6 am. You can also know the daily rate of petrol and diesel through SMS (How to check diesel petrol price daily). Indian Oil customers can get information by sending the code of RSP Space Petrol Pump to 9292992249 and BPCL consumers can send information to 9223112222 by writing RSP. At the same time, HPCL consumers can know the price by writing HPPrice to the number 9222201122.


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If you have thought “Is now the time to move?” or “I should buy now before prices go up past what I can afford?” You should be listening to your thoughts. Prices are on the rise. The median in Reno-Sparks was up 9% June 2017 over June 2016. With the continued employment outlook and companies moving to our area there is no sign that prices won’t continue to head up. So now is the time to make your move! The bright spot in this are mortgage rates. They are still at historically low levels.
If you are wondering what your options are, the Shocket Team can help! We can help with strategies for selling and up-sizing or down sizing, as well as buying a home. Contact us today. Reno-SparksRealEstate.com


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For my card I colored this months image with Prismacolor pencils
I added die cut glitter butterflies
The paper is from Recollections.
I am entering the challenge here...
Hi there Tink :) Fabby card - I love the butterflies! It's such a Spring-y card. I so wish I could enjoy spring more, but these darn allergies are kickin' butt this month! LOL. Thanks again for playing with us at Imagine That Digistamp!
Great design - really cute.Thanks for joining us for the Imagine That Designs Progressive Challenge.Helen x
So cute!!! Thanks so much for participating in our IMAGINE THAT! PROGRESSIVE challenge!!! Can’t wait to see you participate again in our next challenge!!Deanne at A Little Bit O’ Paper
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domain: hobby