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As tax season closes, Drew Altman looks at why the ACA’s individual mandate and tax credit reconciliation process “passed their first major hurdles this tax season with no significant public backlash,” in his latest column for The Wall Street Journal’s Think Tank.
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As tax season closes, Drew Altman, in his Wall Street Journal’s Think Tank column, looks at why the ACA’s individual mandate and tax credit reconciliation process “passed their first major hurdles this tax season with no significant public backlash”.
The health policy stories included in this month’s Kaiser Health Policy News Index were followed closely by about 4 in 10 Americans. Of the stories asked about this month, the one that garnered the most attention was coverage of the white police officer charged with the murder of an unarmed black man in South Carolina. Over half report closely following other stories, including the Germanwings plane crash in the French Alps, a new religious freedom law in Indiana that allows business owners to refuse service to gay customers, negotiations over Iran’s Nuclear Program, and a terrorist attack by Islamic militants at a university in Kenya. The only non-health story to receive less attention than the health stories this month was coverage of the Congressional Republican budget proposals, followed closely by just over a third of the public.
How much do you know about the Affordable Care Act federal income tax requirements — what the individual mandate means for taxpayers, what penalties may apply, and how those who receive premium subsidies will reconcile the amounts based on actual income? Take this interactive quiz to find out.
This analysis estimates the range of repayment or refund amounts of the advanced premium tax credits issued to enrollees who experience income volatility between the time of enrollment and tax credit reconciliation. Using a simulation model among all households eligible for advance payments of the premium tax credits under the Affordable Care Act, it estimates that half would owe a repayment while 45 percent would be issued a refund of some or all of premium subsidies received.
New Analysis: Half of U.S. Households Eligible for a Tax Subsidy Under the Health Law Would Owe a Repayment, While 45 Percent Would Receive a Refund
Estimated Average Repayment is $794. Estimated Average Refund is $773. Half of U.S. households eligible for a 2014 tax subsidy under the Affordable Care Act would owe a repayment to the government, while 45 percent would receive a refund, according to estimates from a new analysis by the Kaiser Family Foundation. The…
At Five Year Anniversary of the ACA, Gap Between Favorable and Unfavorable Views Among The Public Narrows to Smallest Spread in More Than Two Years
Most Expect Negative Consequences if Supreme Court Prohibits Subsidies in States Without Their Own Insurance Exchanges; Two Thirds of the Public and Those in Affected States Want Congress or Their State to Close Any Gaps As April 15 Tax Deadline Nears, Nearly Half Unaware Insurance Reporting Requirement Starts This Year…
As the Affordable Care Act (ACA) marks its fifth anniversary, this month’s poll finds the gap between favorable and unfavorable opinions of the law has narrowed to the closest margin in over two years. Although the Supreme Court heard oral arguments for the King v. Burwell case in early March, the majority of the public continues to say they have heard only a little or nothing at all about the case. The survey also includes a look at Americans’ experiences reporting their insurance status on their taxes for the first time, and finds that nearly half are unaware that the requirement to report health insurance status on their taxes takes effect this year.
This list of Frequently Asked Questions (FAQs) about Obamacare covers the Affordable Care Act’s marketplaces (aka exchanges), individual mandate, benefits, and more. It provides answers to questions about specific groups, such as young adults, smokers, the uninsured, and non-traditional households.
The brief provides an overview of what consumers can expect during the second annual Open Enrollment period under the Affordable Care Act (ACA), which runs from November 15, 2014 through February 15, 2015. It is the second opportunity for uninsured individuals to enroll in private insurance coverage, premium tax credits and cost sharing subsidies and the first time that people newly insured in 2014 can renew their health plan coverage and subsidies. It also overlaps with the start of the tax filing season, during which subsidized individuals will undergo tax reconciliation of their 2014 financial assistance and the individual responsibility provisions of the ACA will be enforced.

domain: finance


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The company combines sustainability data from brands with information on customer transactions – rewarding environmentally conscious choices
Spotted: Swedish fintech startup Gokind has set out to transform consumer awareness of brand sustainability. The company aims to encourage ethical and environmentally conscious decisions by reaching customers through something they use every single day – their bank account.
The Stockholm-based startup has developed what they claim to be the world’s first loyalty programme for the planet. Leveraging expertise in behavioural science, software development, sustainability reporting, and business law, Gokind is making it easier for consumers to become eco-conscious. The startup encourages consumers to buy from more ethical and eco-friendly companies through rewards and loyalty incentives – using open banking to help customers understand which brands have sustainable practices.
To use the app, customers simply connect Gokind to their existing bank or credit accounts. With every purchase from an ethical or sustainable brand, customers will earn ‘impact credits’. The more ethical the brand, the more credits they get. The credits can then be exchanged for products and services, or put towards donations.
Thanks to the financial data they can access through open banking, Gokind can give consumers personalised advice and nudge them to make changes in their consumption habits – such as switching to a greener electricity provider or building credit with companies that support more diverse leadership.
Next steps in the company’s development include expanding beyond Sweden to provide sustainability insights to consumers across the world.
Gokind is just the latest example of a fintech innovation that encourages sustainability. Others spotted by Springwise include a fintech app that powers the circular economy, and a credit card that tracks the carbon emissions associated with purchases.
Written By: Katrina Lane


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domain: travel


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Objective To evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.
Design Retrospective cohort study.
Setting Alder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.
Participants From October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.
Results 5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.
Conclusions Introducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.
- primary care
- emergency department
- quality improvement methodologies
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The total number of visits to emergency departments (ED) in the National Health Service (NHS) in England exceeded 22 million in 2014–2015, an increase of 35% over the last decade.1 Over 30% of these visits could potentially be managed in primary healthcare facilities.2–8 A number of strategies have been developed to manage demand on ED services in the UK (eg, telephone triage, walk-in centres and minor injury units), yet visits continue to increase. Perceived severity of the condition, reputation of the hospital, availability of diagnostic and treatment options, accessibility of primary care or out-of-hours services are common reasoning behind the decision to attend ED.5 9 10 Moreover, parents with young children are more likely to attend than those with older children due to increased concern over the potential severity of the condition and need for urgent treatment.2 5–7 11–13
A key challenge for paediatrics is to recognise seriously ill children. The most common medical presentations in ED are breathing difficulty, febrile illness, diarrhoea and vomiting, abdominal pain, seizures and rash, all of which could be potentially serious.14 While most cases eventually turn out to be symptoms of a minor illness that does not require emergency treatment,11 13 15 it is critical that seriously ill children are not missed. Long wait times and overcrowding in EDs are associated with delays in delivering urgent treatments such as antibiotics for sepsis.16 In recognition of this, one of the key recommendations of a report by the Royal College of Emergency Medicine was colocation of out-of-hours primary healthcare provision within ED.17 These services may deliver shorter waiting times, a reduction in additional diagnostic tests and examinations, and increased patient satisfaction, although their cost-effectiveness remains unclear.18–23 Evaluations have been conducted in general hospitals, but not in a paediatric setting. Our study makes use of a natural experiment by assessing the impact of the introduction of a primary care service on waiting times, admissions and antibiotic prescribing within a large paediatric ED in the UK.
Study setting, population and design
The study was conducted at Alder Hey Children’s NHS Foundation Trust, one of Europe’s largest tertiary paediatric hospitals with 270 beds located in Liverpool, England. The hospital serves a population of 1.3 million, and the ED receives 56 000 children annually. Children are triaged on arrival, and care is allocated based on clinical urgency. The department is staffed by at least one senior doctor from 08:00 to midnight, and by a combination of general practice, emergency and paediatric trainees along with emergency and advanced nurse practitioners over a 24-hour period.
From 1 October 2014 to 31 March 2015, a general practitioner (GP) employed by a Liverpool out-of-hours GP service (Urgent Care 24) was placed in the ED as a separate, but colocated service. The service had its own clinical and clerical staff, with a general practice-based electronic information system. The service ran between 14:00 and 22:00 hours, 7 days a week. The GPs were there almost all of the time, there may have been the very occasional day when they were not there, but the allocation only took place if the GP was present.
All patients were initially seen by a qualified ED nurse who conducted an initial evaluation using the Manchester Triage System (MTS) reference.24 The MTS was used to identify children who triaged ‘Green’. These are standard cases without immediate danger or distress, and identify a group of less urgent patients. The MTS assessments follow a flow chart based on the patient’s reason for contacting the ED. The chart begins by identifying possible criteria indicating life-threatening conditions for the patient, and if none of these conditions are present, the nurse continues along the flow chart asking questions until the nurse assigns the patient an appropriate category. The nurse’s experience can contribute to the assessment, but on the other hand, the risk of the nurse missing serious conditions is reduced because the flow chart forces the nurse to ask key questions and make vital inquiries.
Children who triaged MTS ‘Green’, without any complicating factors or comorbidities, and presenting with conditions that were deemed suitable to be treated by a GP were labelled ‘GP appropriate’. The GP could refuse to see the patients and have them re-enter the ED queue if they were unhappy with the allocation. Parents could also refuse to see the GP. In addition, nursing staff could use ‘common sense’ to allocate certain patients to ED if they deemed it appropriate. Children labelled as ‘GP appropriate’ outside the GP working hours of 14:00–22:00 were treated by the ED clinical staff following the standard procedures of the service. Patients seen by the GP and referred to the ED (n=178) were analysed within the GP allocated group.
The introduction of this service presented an opportunity to evaluate a ‘natural experiment’25 conducting a retrospective evaluation on the cohort of children attending the ED over a 6-month period between 1 October 2014 and 31 March 2015, triaged as ‘GP appropriate’. The main comparison was between patients triaged as ‘GP appropriate’ and seen by a GP between 14:00 and 22:00 hours (GP group) compared with patients triaged as ‘GP appropriate’ seen outside of those hours (ED group) when the GP service was not available. The GP group were analysed as the GP group regardless of whether they refused to see the GP or the GP refused to see them.
Outcomes and covariates
Data were collected retrospectively on all patients over the period of the study from ED and GP service databases. For all cases, information on arrival and discharge date and time, reason for attending, initial diagnosis, final diagnosis, discharge status, prescription of antibiotic and attending physician (GP or ED doctor) were available. Additionally, information on age, gender and home postcode for each patient was also collected. Postcodes were used to generate IMD 2015 (Index of Multiple Deprivation 2015) scores for each patient. The following outcomes were considered: admission to hospital (yes/no), total time spent in the ED, exceeding the UK government’s 4-hour waiting target (yes/no), antibiotic prescription (yes/no) and leaving before being seen by a doctor (yes/no).
First, descriptive statistics were generated for both groups. Differences in proportions were compared using the χ2 tests and differences in continuous measures assessed using the Mann-Whitney U test. We then used the equivalent of an intention-to-treat (ITT) analysis to compare the GP and ED groups to assess the primary outcomes. ORs were calculated using logistic regression to assess effect sizes between the two groups, along with 95% CIs, adjusting for age, deprivation score and diagnostic category. All statistical analyses were conducted using STATA V.12 (Stata, College Station, TX, USA) or SPSS V.20 (IBM Released 2013. IBM SPSS Statistics for Windows, V.22.0).
We repeated our main analysis using the equivalent of a per-protocol (PP) analysis (comparing only those who actually were treated by the GP in GP hours to those seen by ED staff in ED hours); restricting the sample to those seen between 10:00 and 18:00 hours since daytime circumstances between the comparison groups are fairly similar in terms of children being awake, parents working, ED staffing and other such unmeasured confounders; and stratifying the analysis by age (under and over 5 years).
A total of 28 655 patients attended the ED at Alder Hey in the 6 months between 1 October 2014 and 31 March 2015, of which 5223 (18.2%) were triaged ‘GP appropriate’ and included in the study cohort. Of the ‘GP appropriate’ patients, 2821 (54%) were seen between 14:00 and 22:00 hours, and 2402 (46%) were seen outside these hours. Tables 1 and 2 show the characteristics and discharge status of both groups.
Patient age ranged from 4 days to 16.6 years (median 31 months), and 48.8% were male. No significant differences were observed in sex between those attended by the GP and ED, but those seen by the GP were younger (median age 29 months) compared with those seen by the ED (median age 34 months). No significant differences were observed in the distribution of deprivation scores between the GP and ED groups. Over 80% of the ED patients arrived in hospital between 10:00 and 21:59 hours, and 111 patients (2.1%) did so in the early hours of the morning (02:00–05:59).
The proportions of patients in each diagnostic category were similar in the GP group and the ED group (table 1 and online supplementary table S1). Infection diagnoses (eg, ear infection, urinary tract infection, conjunctivitis, balanitis) were recorded for 2629 (50.3%) patients. In the GP group, 1438 (51.0%) had infection diagnoses, compared with 1191 (49.6%) in the ED group. Gastrointestinal illness/abdominal pain was the second most frequent diagnostic category, with 989 cases (18.9%). The majority of these patients (540, 55%) were seen by the GP. Dermatological conditions and minor injuries (especially head injuries) were seen in 485 (9.3%) and 416 (8.0%) cases, respectively, and 60% of patients with either of these diagnoses were seen by the GP (table 1).
Supplementary file 1
During the evaluation period, 2821 (54%) patients were in the GP group. Of those, 2689 (95.3%) were managed by the GP alone, and 178 (6.3%) were referred to the ED for further evaluation. Fifty-one (28.7%) of the referred patients were hospitalised, and the two common diagnoses among these were infection (n=27, 52.9%) and gastrointestinal/abdominal conditions (n=12, 23.5%).
A total of 94.6% of children in the GP group (and seen only by the GP) were discharged with no further action, or advised to seek follow-up with their own GP. Twenty-seven children (1.0%) were admitted, and 31 (1.2%) were referred to other services (23 to outpatient services, 6 to further ED clinic, 2 to community services). Eighty-eight (3.3%) left before being treated. In comparison, of the 2356 in the ED group (excluding those initially seen by GP then referred to ED), 1971 (83.7%) were treated and discharged without further follow-up or discharged to their own GP for follow-up, 109 (4.6%) were referred to other services and 140 (5.9%) were admitted. One hundred and thirty-six (5.8%) left before being seen by the ED team (table 2 and online supplementary table S2).
Evaluation of outcomes of interest for the intervention
Admission to hospital
In total, 78 (2.7%) patients in the GP group and 140 (5.9%) patients in the ED group were admitted. Adjusting for age, deprivation score and diagnostic category, the odds of being admitted were significantly lower (55%) if the patient was seen by the GP (OR 0.45; 95% CI 0.34 to 0.60; p<0.001) (table 3 and online supplementary table S3).
Antibiotics (oral and topical) were prescribed to 1177 patients. A total of 715 (26.0%) in the GP group and 462 (20.5%) in the ED group were prescribed antibiotics. The majority of antibiotic prescriptions were given to patients diagnosed with infection (987, 83.9%). Those treated by the GP were 36% more likely to receive antibiotics using ITT analysis (OR 1.36; 95% CI 1.19 to 1.55; p<0.001) (table 3 and online supplementary table S3). Amoxicillin was the most commonly prescribed antibiotic by both the GP and the ED clinicians. Penicillin V was prescribed significantly more frequently by the GP than the ED (figure 1 and online supplementary figure S1).
Supplementary file 2
Exceeding the 4-hour government target
Overall, patients who attended the ED and were designated as ‘GP appropriate’ spent a median of 102 min from arrival to discharge, with times ranging from 14 min to 9 hours. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.005).
Allocation to the GP was associated with decreased odds of patients exceeding the 4-hour waiting time target set by the Department of Health26 by 54% (OR 0.46; 95% CI 0.33 to 0.63; p<0.001) for ITT analysis (table 3 and online supplementary table S3).
Leaving before being seen
Our results were similar using the equivalent of the PP analysis (online supplementary table S2 and S3). We conducted a sensitivity analysis of patients seen between 10:00 and 18:00 hours, comparing patients seen between 10:00 and 14:00 hours for the ED group and 14:00 and 18:00 hours for the GP group. This was to compare outcomes within a period when arguably factors potentially related to time of day do not vary. During the hours of 10:00–14:00, staffing levels and levels of services available in the hospital (phlebotomy, radiology, laboratory) are more homogeneous.
The conclusions are the same (online supplementary tables S4–S6). We also conducted a sensitivity analysis comparing age less than or equal to 5 years and age greater than 5 years, and demonstrated that there is no difference in outcomes between under 5-year-olds and over 5-year-olds (online supplementary table S7). This supports our finding that there is no age bias in the outcomes.
We assessed how big the unobserved confounding would need to be to change the estimated treatment effects significantly, and this provides further reassurance that our results are robust. We split the data by first half of each month versus the second half of each month and found no difference in outcomes (online supplementary table S8).
During a 6-month pilot scheme which colocated a primary care GP service in a busy paediatric ED, patients seen during the hours when the GP was available were significantly less likely to be admitted, exceed the 4-hour waiting target or leave before being seen, but more likely to receive antibiotics. The introduction of a new service within a tertiary paediatric ED presents the opportunity for a natural experiment, with the exposure group being seen by a GP. We have performed both ITT analysis (all those who were eligible to receive the new intervention rather than just for those who actually received it) and PP analysis (those who were eligible for the new treatment and actually received it). The conclusions remain the same with both analyses.
A report commissioned by the UK Department of Health and published by the Primary Care Foundation in 2009 evaluated different aspects of the integration of primary care services colocated within or alongside EDs in England.20 The report estimated that between 10% and 30% of cases attending EDs in England could be appropriately managed by primary care services. This is consistent with our finding of a little over 18% of cases attending the ED in Alder Hey were deemed as ‘GP appropriate’. Our intervention was implemented to try and address increased workload and long waiting times in the ED. We evaluated the first 6 months in order to produce evidence of the utility and value of the intervention. The service is currently undergoing continuous modification in order to best serve the needs of patients and derive most benefit from the primary care team, and further studies will evaluate these aspects, including health economic evaluation.
The UK Primary Care Foundation report highlighted that although the colocation of GP services within ED (adult EDs only) was operating in around two-thirds of the services in England, there was a lack of evidence on whether this model provided any benefits. The main drivers for the decision to introduce primary care within the ED appeared to be reducing economic costs and meeting the 4-hour target. Some analyses suggest colocation of GPs in ED is unlikely to have a significant impact on cost per patient,22 27 28 but may in fact result in increased costs due to extra personnel.28 However, since reductions in the number of additional tests required, prescriptions, referrals and admissions have been well documented,27 29–32 a beneficial cost-effectiveness of the measure cannot be ruled out.
In this study, we documented a 55% reduction in admissions among patients seen by the GP in comparison to those seen by the ED. However, we observed that a substantial number of patients seen and managed exclusively by the GP were referred to their own GP for further follow-up. This could indicate that universalisation of the measure of incorporating a GP in paediatric ED departments could potentially result in shift of the burden to primary care, and the impact on the whole system requires further investigation.
Finally, the GP was significantly more likely to prescribe antibiotics than the ED, suggesting that the permanent inclusion of a GP within the ED would require a close monitoring of prescription practices to avoid overprescription or inappropriate prescription of antibiotics. Judicious antimicrobial use involves prescribing antibiotics only for probable or definite bacterial infections, rather than for probable viral infections such as upper respiratory tract infections. Standardisation of antibiotic prescription guidelines at a national level, periodic training and continuous monitoring of prescription practices among clinicians with prescribing authority would be beneficial to overturn this trend. A recent study reported that a feedback regarding prescribing can significantly reduce unnecessary antibiotic use.33
Our intervention provided evidence that the presence of the GP in a busy paediatric ED resulted in a significant reduction in waiting times for patients seen by the GP. This has important implications for NHS trusts, as breaching the target of resolving at least 95% of the attendances within 4 hours can have negative economic consequences for hospitals.34 However, a decrease in overall time spent in ED and waiting times is to be expected due to the additional resources added to the department with the addition of the GP. The findings of this study need to be considered in the context of current efforts to integrate care and to deliver more services in the community.35 Ideally, patients triaged as ‘GP appropriate’ should be seen by GPs in the community. Providing GP services colocated with ED may encourage patients to seek secondary care instead of primary care closer to home. Any service redesign needs to balance cost, clinical effectiveness and patient preferences across the whole system, and should be carefully evaluated.
Strength and limitations
To our knowledge, this pilot study is the first to assess the impact of a GP service within a large paediatric ED in the UK, and is likely to be generalisable to other similar settings. A strength of the study is the completeness of the data obtained from two reliable sources, the GP and the ED databases, which were matched and carefully cross-checked. We have made use of a natural experiment, and routinely collected data, to pragmatically evaluate the impact of an intervention in one of Europe’s largest paediatric EDs.
Our study has a number of limitations. Data collection was limited to that collected in the routine data systems, and we could not evaluate the time between arrival and being seen by a doctor, which is of importance to patients when they visit an ED, and can have an impact on the overall satisfaction with the service. Second, we extracted the information retrospectively from the databases, and relied on ICD-10 (International Classification of Diseases) codes for diagnostic information, and there is thus scope for misclassification. We did not collect data on staff workload, number of staff in the ED or any placebo outcomes. There was a potential for bias to have arisen through differences in the way that the triage was implemented within GP hours versus outside of GP hours. It is possible that the criteria for determining whether or not a patient was designated ‘GP appropriate’ were implemented differently between 14:00 and 22:00 hours, because the designation would not make a difference to the patient’s care if the patient arrived after 22:00 or before 14:00 hours, when the GP was not present anyway.
We were able to adjust for a number of important confounders in our analysis, and the GP and ED groups were broadly similar in terms of age and case mix. One of the assumptions of our analysis is conditional exchangeability of the comparison groups, but it is possible that the groups differ on the basis of unmeasured confounders. It is possible that the groups differ on the basis of factors related to time of attendance, disease severity and age (which was significantly different at baseline). However, our conclusions do not change in sensitivity analyses restricting the time of attendance to daytime, and stratifying by age. If, for example, there were systematic differences in years since qualification between GPs and ED doctors, this might mean that the time taken to see the GP was shorter. We did not collect data on year of qualification of doctors, so we were unable to explore this.
Furthermore, the fact that all patients were a relatively homogeneous group of less complicated cases reduces the risk of confounding by case mix. Finally, we did not set out to evaluate the cost-effectiveness of the incorporation of a GP within the ED, as evidence would have been challenging to collect in such a brief period.
The results presented in this study highlight both the advantages and challenges that can arise when integrating a GP service within a busy paediatric ED. Integrative approaches are currently being seen as a plausible solution to meet the needs of overstretched healthcare services, and further research is needed to guide an evidence-guided decision. Our pilot intervention could be seen as a ‘natural experiment’ that provides some evidence that locating a GP in ED can reduce waiting times and admissions, but increases antibiotic prescribing.
DT-R and D contributed equally.
LS and YN contributed equally.
Contributors EDC, DTR-R and MR designed the study. LS, YN and KE collected the data. AIP and SL performed statistical analysis. KJ and SB contributed to data collection. LS and YN wrote the first draft of the paper. SL, AIP, DT-R and EDC wrote subsequent drafts. All authors contributed to the final draft of the paper, and read and approved the final draft of the paper.
Funding Professor David Taylor-Robinson is funded by the MRC on a Clinician Scientist Fellowship (MR/P008577/1).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data were obtained from an NHS hospital. There are no additional unpublished data available.
Presented at Presented in part Royal College of Paediatrics and Child Health annual meeting 2016. Abstract G211

domain: medical


text:
Former U.S. President Jimmy Carter, 98, was placed under at-home hospice care at his home in Plains, Georgia, the Carter Center announced over the weekend.
The 39th president of the U.S., Carter is also the longest-lived American president. The Carter Center said on Saturday that he “decided to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention.”
The statement said that the family "asks for privacy at this time and is grateful for the concern shown by his many admirers.”
Carter opened the Carter Center in 1982 with his wife and former first lady, 95-year-old Rosalynn. In 2002 the former president won a Nobel Peace Prize.
Hospice care is typically put in place to focus on increasing comfort for patients and their family for end of life care.

domain: news


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Copper Plate Found at Jagjivanpur
The copper plate inscription recovered at Jagjivanpur has been found to contain Siddhamatrika script which was highly used in Sanskrit language during 9th century. At the top of the plate, a royal seal has been found attached which consists of a 'dharmachakra' at centre with deer on its either side, a lotus and the legend Shri Mahendrapaladeva. Weighing 11.85 kilogram, the plate was issued by King Mahendrapaladeva during the seventh year of his reign on the 2nd day of Vaisakha month. According to the inscription, Mahendrapaladeva was the son of Devapala. He had made an announcement on the occasion of a land grant ceremony before his officers and other people that his General had intended to donate the land besides the Nandadirghika Udranga Mahavihara. Nandadirghika Udranga Mahavihara was constructed by the emperor for the worship of Buddhist deities and performing religious rituals.
Other Artefacts Found at Jagjivanpur
Apart form this, circular terracotta seals have also been discovered with inscribed legends. Most of them were monastic however some of them were votive or personal. The most important among them was the monastic seal with depictions of 'dharmachakra' and deer motif along with the name of a Vihara. Siddhamatrika inscriptions have been found on the seal. Excavations of collapsed debris of a Stupa complex have revealed over 250 terracotta plaques. The plaques were usually of rectangular shape and red colour composed of fine clay. Evidences suggest that the plaques were probably the embellishments of the outer structure of the Stupa. Various images can be seen on the plaques such as Avalokitesvara, Surya, Shiva, Garuda, Kinnaris, peacock, deer, warriors and many more. Titled bricks with beautiful adornments have also been recovered from Jagjivanpur. They have depictions of various motifs including lotus petal, diamond shaped and others. Excavations have also revealed beads of semi-precious stones, iron or terracotta bangles, terracotta lamps and red and grey potsherds.
(Last Updated on : 18-12-2013)
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domain: history


Posted Aug 11, 2012
LONDON (AP) — David Svoboda of the Czech Republic has tied an Olympic record by winning 26 of 35 fencing bouts and leads the modern pentathlon at the London Games after the first event.
The 20th-ranked Svoboda's feat Saturday matched a mark set by Alexei Moiseev of Russia on his way to winning gold at the 2008 Beijing Olympics.
World champion Aleksander Lesun of Russia and Cao Zhongrong of China are sharing second, winning 25 bouts each. Defending champion Moiseev is fifth with 22 victories.
All 36 competitors fenced for one touch against each of the other athletes using an epee sword. The competition continues with a 200-meter freestyle swimming event.
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The Colorado Rockies played the Philadelphia Phillies in Denver on Saturday, April 19, 2014.
The Colorado Avalanche hosted the Minnesota Wild for game 2 of their Stanley Cup playoff series at the Pepsi Center
Photos from the 420 Rally at Civic Center, in Denver, Colorado, April 19-20, 2014.


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In this community, you will learn the exact steps you can implement in order to see radical transformation in your relationship with your teen/tween and form even greater emotional connections with him/her.
Tinuke Fawole is an Author, Speaker and Relationship Strategist. She is the host of the YouTube Channel, Optimum Families where she helps bridge cultural and generational gaps between parents and children. She is the author of “The Immigration Gap” and “Master of My Destiny.”
Tinuke is happily married to her college sweetheart, Alaba and their union is blessed with children and grandchildren. Tinuke loves traveling, entertaining and spending time with her family. She lives in Snellville, GA with her husband.

domain: psychology


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Louisiana Lawmaker Pushing For Changes To Industrial Tax Exemption Program
The Industrial Tax Exemption Program, or ITEP, is the most expensive tax incentive program Louisiana offers to manufacturers. In exchange for spurring economic development, manufacturing companies can get a break on their property taxes for 10 years.
For decades, there was one state board responsible for approving or denying these requests. That changed in 2016, when Governor John Bel Edwards signed an executive order giving local governments a chance to have a say.
The new policy came to a head last month, when the East Baton Rouge Parish School Board denied an ITEP request from ExxonMobil, sparking concerns from the company, city and state officials about Exxon’s future investments in Louisiana.
State Senator Bodi White represents part of Baton Rouge in the Louisiana legislature. He plans to bring a bill next session that would change ITEP once again.
On this week's Capitol Access, Senator White discusses the changes he'd like to see made to the tax incentive program.
Copyright 2021 WRKF. To see more, visit WRKF.


The confirmation by the Health Ministry that A Ramadoss would comply with the court order to sign the degrees of AIIMS doctors is amusing.india Updated: Sep 09, 2007 23:16 IST
The confirmation by the Health Ministry that A. Ramadoss would comply with the court order to sign the
degrees of AIIMS doctors is amusing. Any self-respecting person would have resigned since the court not only ordered appending his signature on the degrees but also fixed a time limit of 24 hours.
Though the Delhi High Court has put a dampener on his bloated ego time and again, his continuing as the health minister is not feasible any longer. Putting at stake the careers of many doctors like he did is unpardonable.
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letters to the editor at:
First Published: Sep 09, 2007 23:14 IST


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NEWPORT NEWS — The 11- and 12-year-olds are the royalty of officially sanctioned Little League baseball.
Experienced enough to know the game, diminutive enough to look like miniature figures playing it. This is the age you see every year in the nationally televised Little League World Series in Williamsport, Pa., with teams from American regions, plus Taiwan, Mexico and other far-off locales.
In order to make it to Williamsport, the Parkview All-Stars, who play their games at Huntington Park, first must win the District 7 title this week. Then they must defend the state title they won last year, advance through various regional rounds, and ... well, they've got to win a lot of games.
It's a daunting task, except in the eyes of a 12-year-old. Aaron Merritt pitches for the Parkview All-Stars and watches the Little League World Series each year. The kids are his own age, and he says he can picture himself playing there.
''I watch them play, and I compare,'' Aaron says. ''I look at the pitchers and compare them to myself. I look at the hitting and compare it to our team. It looks like they're doing some really hard stuff - but I've seen us do some of those things, too.
''When I watch them play on TV, I can really imagine us playing there.''
It's a magical age, really. Old enough to temper childhood fantasies with reality, but still young enough to let the fantasy win out in the end - whether that fantasy is Williamsport or an even bigger World Series.
''This is the age when the dream is the strongest,'' says Dennis Merritt, Aaron's dad and the president of Parkview Little League.
It is also the age where everything changes in the ranks of youth baseball. The age when the kids are almost visibly shifting gears, from learning the game to seriously playing it.
On the developmental ladder of Little League, kids start out in tee ball and work their way up through the ''minor-league'' division, picking up fundamental skills and gradually learning to apply them.
''Those two divisions probably take four or five years,'' Dennis Merritt says. ''And then the 11- and 12-year-olds get to the `Major' division. That's when you start to really play baseball. Real, hard-nosed baseball.''
The players - almost exclusively boys at this point, as most girls are siphoned off into softball either by choice or by societal force - are maturing physically, but also emotionally. To that end, the Parkview Little League in recent years has allowed the players at each level to vote for their own postseason all-star teams - an important chore, since these are the 12 players who will represent the league on the road to Williamsport.
The obvious benefit to this system is that it takes the heat off the coaches and league administrators who used to pick the all-stars - and who inevitably dealt with the ire of countless parents who were mystified and miffed that their kids were not chosen. It's much harder for irate parents to question the purely democratic vote of fellow players.
But more to the point, Dennis Merritt says, the peer voting teaches the honor system. And it's a duty they take seriously.
''The all-star picks are a motivator for each player to excel - a real honor,'' he says. ''And it's impressive to see how they vote. These kids know who belongs on the team, and they're very honest with their votes - they don't just vote for themselves or for their friends. When they're done voting, they've pretty much picked the same team that we would have chosen - but it's better, because they've done it themselves.''
Making the Little League all-star team is the first serious step toward the dream that resides in the heart of every young player. If you're an all-star at age 11, you start thinking about playing American Legion ball when you get a bit older. And Legion ball could lead to a college scholarship or even a shot at the professional draft.
Hampton native Daniel Rodriguez, 12, who was selected to the Northampton Little League all-stars, was asked if he dreams about playing in the majors. Without a moment's hesitation, he replies, ''Sure.''
But ask if he believes that dream could come true, and he takes time to ponder his answer, weighing fantasy and reality. Like any Little Leaguer worth his weight in baseball cards, he decides that it could.
''If I work hard enough,'' Daniel says, ''and if I keep on getting good grades so I can maybe earn a scholarship to college, sure, I could get picked in the draft one day.''
Asked the same question - could your big-league dream really come true? - Aaron Merritt comes up with the same combination of idealism and pragmatism.
''I think it could, yeah, but I think it would take a lot of work,'' he says. ''I'd have to do a lot of stuff along the way - but I believe I could.''
Neither player sounds like he is bragging. They are simply expressing a goal that, at this point, feels realistic.
''It's good to have goals like that,'' Dennis Merritt says. ''The kids follow baseball, and they see that there's a whole lot of money being made in the majors. But I don't think that's what they're dreaming about - I think it's just playing up there, being on that big field.''
And how realistic are those 11-and 12-year-olds' hopes?
''I think they ultimately grow out of it,'' he says. ''They learn how really hard it is - and as teen-agers, they develop other interests. They start to see it not happening.
''But, you know, for a few, it will happen. When these kids dream about it, they feel like they have that chance - and at this age, they very well do have that chance.''
Mike Holtzclaw can be reached at 928-6479 or on-line at email@example.com.

domain: sports


Former President Donald Trump has officially opened an office in Florida that will serve to continue his political agenda.
A statement from the office Monday night said it will manage Trump’s correspondence, public statements, appearances and official activities to “advance the interest of the United States.”
The office will also “carry on the agenda of the Trump Administration through advocacy, organizing, and public activism,” the statement says.
The move comes less than a week after Trump left the Oval Office.
Last Friday, Trump said he will make a comebackin some form, but did not specify how.
“We’ll do something, but not just yet,” Trump told journalist Rob Crilly of the Washington Examiner.
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FRANKFORT — Fox News Sunday host Chris Wallace said his goal is to give Kentucky U.S. Senate candidates Jack Conway and Rand Paul "a fair shake" during their first debate Sunday on national television.
"That's all I care about at the end, that both sides got the opportunity to express their views and that it was fair," Wallace said Thursday during a telephone interview.
Wallace, who has never met either candidate, said his job moderating the discussion should be easy.
"There couldn't be a sharper contrast between Paul and Conway on almost every issue," Wallace said. "It should be easy to get them talking and expressing their differences on a variety of issues."
The show, to be aired live at 9 a.m. on most Fox affiliates and again at 2 and 6 p.m. on Fox News, will broadcast from the studios of WDRB-TV in Louisville. The show will air live on WDKY-TV in Lexington.
Conway, a Democrat who is Kentucky's attorney general, and Paul, a Republican and Bowling Green eye surgeon making his first bid for public office, have agreed to five debates before the Nov. 2 general election.
Fox News Sunday is the only debate scheduled for national television. Paul has declined Conway's challenge to debate on NBC's Meet the Press. Wallace said the format of Sunday's show will be "me at a desk with the two candidates."
"It will be a normal Sunday show," he said. "There will be no rules, no time limits. I will keep the conversation going. When I think they have discussed enough, we will move on.
"If I think one person is monopolizing the conversation, I will cut them off. There won't be those minutes to restrict conversation. It will be a normal, free-flowing conversation."
Conway and Paul will appear on the first half of the show, for about 27 minutes, Wallace said.
Wallace, who has been with Fox News since 2003 and was a moderator on Meet the Press, declined to give a preview of his conversation topics with Conway and Paul.
"There won't be surprises," he said. "It's not a game of 'Gotcha.' I want to get them talking about each other. Obviously there are huge national issues and very pressing state issues. We will talk about all of that."
Asked whether he feels any pressure from people who think Fox News is right-wing and will not be fair to a Democratic candidate in a debate, Wallace said, "No, because that is not true.
"Look at my history. I ask probing questions of all my guests."
The four other debates scheduled between Conway and Paul will be Oct. 11, Northern Kentucky Chamber of Commerce in Covington; Oct. 14, Paducah Area Chamber of Commerce; Oct. 17, University of Louisville/WHAS-TV on the University of Louisville Belknap Campus; and Oct. 25, KET in Lexington.


Scripps National Spelling Bee
A marathon Scripps National Spelling Bee resulted in a lot of champions.
But can they spell better than the president?
The 14-year-old from McKinney, Texas survived one of the most intense competitions in the 93-year history of the spelling bee.
Introducing the "Make America Grate Again Spelling Bee."
Racist jokes further perpetuate racial privilege.
The more you know!
She correctly spelled the word marocain, a dress fabric made of warp of silk or rayon and a filling of other yarns.
Humorist and journalist Mo Rocca chats with HuffPost's Alyona Minkovski about moderating last week's 28th annual National
Pneumonoultramicroscopicsilicovolcanoconiosis? For real?


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Inglot/Lindstedt Clinch Second Team Title In Istanbul
It had been exactly two years since Dominic Inglot and Robert Lindstedt, who made the 2015 US Open semi-finals and triumphed that year in Winston-Salem, teamed. But the British-Swedish pair showed that their chemistry is still there, defeating top seeds Ben McLachlan and Nicholas Monroe 3-6, 6-3, 10-8 on Sunday to claim victory at the TEB BNP Paribas Istanbul Open.
The triumph marks the 400th match-win of Lindstedt’s career, and the 41-year-old has now won 22 tour-level doubles titles. His partner, Inglot, has now won back-to-back titles after coming out victorious last week in Budapest. He now owns nine ATP World Tour trophies.
"I knew starting this year that reaching 400 was a possibility. Maybe I could've done it sooner than I did. But once I knew I could reach 400, it was a big goal for me," Lindstedt said. "It's an amazing feeling. It's something I didn't think was going to happen to be honest when I started playing tennis. Everybody's so good and better than me."
For a moment it appeared the pair might not make the Match Tie-break. Despite earning a 4-0 double-break lead in the second set, McLachlan/Monroe broke twice in a row to get back on serve. But Inglot began to find his range, especially on the forehand return, taking advantage of Monroe’s serve with crosscourt returns to the feet that the American could not handle, recovering the break before closing out the set.
Inglot/Lindstedt trailed just once in the Match Tie-break — at 0/1 — and lost only one point on serve. On their third match point, a heavy serve out wide by Inglot elicited a high, short return that Lindstedt smashed away to clinch the victory. The unseeded duo earns 250 ATP Doubles Rankings points each and a share of €23,090 for their efforts.
"It was great to get some wins because we had a good time playing together when we played regularly," Inglot said. "The fact that we had only got one win was a bit of a shame because I feel like we deserved to have more. We played really well. We came close and it just didn't happen. It's nice to almost go back and relive it in a good way."
It was a strong week despite the loss for McLachlan/Monroe in just their second appearance as a team. The Japanese-American duo leaves Turkey with 150 points each and a split of €12,140.
Did You Know?
In its fourth edition, Inglot and Lindstedt are the first players from Great Britain and Sweden, respectively, to win the TEB BNP Paribas Istanbul Cup.


From: Barack Obama 2008
Posted: Tuesday, October 7, 2008
As RNC Attacks Obama's Plan To Save Space Industry Jobs, NASA Administrator Praises Obama's Leadership
ORLANDO - TOMORROW, WEDNESDAY, October 8, engineers and other space industry workers will hold a press conference to denounce Senator John McCain's plan to freeze NASA spending and his Republican Party's attack on the space program.
Workers will also be making phone calls to Space Coast voters to inform them about McCain and his Republican Party's troubling stance on NASA and Senator Barack Obama's plan to invest an additional $2 billion to help save vital space industry jobs.
The Republicans' criticism of Senator Barack Obama's $2 billion plan to save space industry jobs comes as NASA Administrator and Republican appointee Dr. Michael Griffin thanked Senator Obama personally for his "leadership" in getting critical legislation passed to help maintain an American presence in space. Griffin wrote to Obama: "without your leadership, this would not have happened." Obama urged the Congressional leadership to pass the waiver NASA had asked for, which will allow it to purchase trips for American astronauts aboard Russian spacecraft if necessary to maintain an American presence in space. The New York Times also recently credited Obama with breaking the gridlock on this legislation and helping get it passed.
Obama's plan would reduce the gap between the retirement of the Space Shuttle and the launch of its replacement, helping to save the jobs of thousands of space industry workers and keep their families from becoming victims of Florida's historic economic slump. Speaking during a conference call with reporters on Monday, Senator Bill Nelson of Florida said the Republicans do not understand the impact of letting NASA fall apart.
"They're attacking now Barack and me about wanting to put more money into NASA in order that we don't end up where we are, laying off American NASA engineers," Sen. Nelson said. "This is not only ridiculous. It shows they are just totally out of it and don't even know what they are talking about."
Event is open to the media:
WHO: IBEW Union Members and Space Industry Workers
WHAT: Press Conference; phone bank to follow
WHERE: Space Coast Labor Council, 1122 Lake Drive, Cocoa, FL
WHEN: WEDNESDAY, October 8 at 2:45 pm
// end //


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Gigi and Bella Hadid may be on vay-cay in Mykonos, but it hasn’t stopped the model sisters from perfecting their superstar poses.
The runway stars are currently enjoying the rays of the sun on the Greek island in celebration of their older sister Alana Hadid’s 34th birthday.
But despite being away from their A-List fashion jobs Gigi, 24 and Bella, 22, couldn’t help but show us mere mortals how taking a bomb holiday picture is really done.
To start with, the IMG models were clearly feeling the heat with their choice of teeny-tiny bikinis and simple accessories. But when in Greece, right?
Taking on the role of the photographer for the day, Bella sported a small white and lilac triangle bikini with flip flops to match and a hat to protect her head.
While Gigi modeled a black-and-white polka dotted bandeau bikini with a blue patterned kimono blowing in the wind, topped off with a feather embellished hat.
The younger sister of the two even gave us friendship goals as she crouched down to get the perfect shot for her model sibling. It’s all about the angles.
While the Hadid sisters paraded outside their luxury villa, the pair – who are daughters of real-estate developer Mohamed Hadid, 70 – can at least treat themselves on holiday after it was revealed mum Yolanda keeps them on strict diets.
Back in April, the 55-year-old, came under fire for telling daughter Gigi to ‘get back on your diet’ and even rationed off her birthday cake for her so she could stay runway ready.
In an unearthed clip released by Bravo, the Real Housewives Of Beverly Hills star was seen telling Gigi that Volleyball is a very ‘masculine’ sport compared to modelling.
She said: ‘These girls, they train four hours a day after school so their bodies are big and bulky, and they eat like men. I wanted [Gigi] to develop as a woman.
Meanwhile, with the model expressing how excited she was for the food at her birthday party, her mum told her: ‘You can have one night of being bad, right? And then you’ve got to get back on your diet though.
‘Because, you know, in Paris and Milan they like the girls just a tad on the skinny side.’
Later, Yolanda then made the bizarre remark that Gigi was ‘bred for this [modelling],’ before only letting her daughter have a slither of her own birthday cake.
The mum-of-three and former model’s comments didn’t go down too well with viewers with one fan writing: ‘She didn’t let her daughter have one normal piece of cake for her fricking birthday. im amused.’
Another person wrote: ‘YIKES… those comments Yolanda was making about volleyball & looking masculine & all that ….’
Got a showbiz story?

domain: celebrity


Civil bodies want local MLA’s intervention in rape cases
IMPHAL | May 15 : Civil bodies claimed that handing a chairman post of Manipur Building and Others Construction Workers Welfare Board to Sekmai MLA, who is the accused of Thagmeiband rape case, is an act of the government giving promotion to a person involved in crime.
The civil bodies are Socialist Students’ Union of Manipur (SSUM), Proletarian Feminist Movement Manipur and Thangmeiband Apunba Nupi Lup.
Briefing to media persons today at SSUM office at Keishampat, Imphal its co-convenor, Bushan Longjam said that there are many rape cases where the victim has not disclosed the incident to anyone due to fear of social stigma.
He also said that if justice is not delivered to the victims of rape cases, then victims of rape cases may not disclose the matter in the future, thinking that they will never get justice.
Stating that there is a big political pressure regarding the Thanga gang rape case, he said “it is very unfortunate that the Thanga MLA is remaining silent regarding the matter.”
The co-convenor claimed there has been a threat to the Thanga rape victim family and the victim health is in bad condition.
If any unwanted thing happens to the family and the victim of the Thanga rape case, the government should be held full responsible as it failed to arrest one of the accused, he said.
Bushan asked the government to stop the culture of shielding rape accused for having political and money power.
Asking the Thangmeiband MLA whether it is right to keep silent regarding the incident the co-convenor warned to boycott Thangmeiband MLA and Thanga MLA if there remained silent over the matter.
IMPHAL | May 26 : Police today have arrested Erendro Leichombam, convener of Peoples’ Resurgence and Justice Alliance (PRJA) party, after the latter allegedly refused to take down a hate video which was posted in his facebook. The developments came a day.....
IMPHAL | May 26 : Chief minister, N. Biren Singh has urged people of the state saying that they should stay away from dirty politics played by some frustrated group of people who have the intention to bring down the present government. The CM was speakin.....
THOUBAL | May 26 : The results of class XII board examination conducted by CBSE were declared today in which a Manipur boy secured the overall second position for Uttarkhand state. Panthoiba Akoijam from Thoubal Melaground who is a student of Parvati Pr.....
IMPHAL | May 26 : Former chief minister, O. Ibobi lambasted the NDA government as a government of propaganda and publicity which befools the public by giving false promises. He was briefing to media persons today at Manipur Pradesh Congress Committee hea.....
CHURACHANDPUR | May 26 : Agriculture minister, V. Hangkhanlian has clarified today in a press conference at his residence located at Zenhang Lamka that the allegation made by former ADCC chairman upon him for being responsible of the crisis in ADCC and de.....


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September Inflation Falls to 1%
CBJ — Figures released by Statistics Canada indicate the annual rate of inflation dropped to 1.0% in September due to lower gas prices. However, the cost of groceries and most other consumer products were actually higher.
The consumer price index for September rose 1.0% compared with a year ago, marking a smaller increase than the 1.3% posted in August.
Prices were up in seven of the eight major categories, with the overall increase driven by higher food prices.
The price of food was up 3.5% compared with a year ago. The index for recreation, education and reading was up 2.5%, while the clothing and footwear category gained 1.2%.
Only the transportation sector, which includes gasoline, was lower as it fell 3.5% from a year ago due to an almost 20-cent per litre decline in gasoline prices compared with last year.
Meanwhile earlier in the week, the Bank of Canada held its key interest rate this week at 0.5% as it downgraded its 2016 and 2017 outlook for the economy due to the continued fallout of low energy prices.
Statistics Canada says prices rose in eight provinces with Saskatchewan posting the largest increase with a gain of 1.4% for the year. Ontario gained 0.9%, while Quebec increases 1.0%.
Prince Edward Island saw prices drop 0.8% compared with a year ago, while Nova Scotia reported no change.

domain: economics


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Case Studies | Library Science | India | Volume 11 Issue 8, August 2022
Evaluating User's Satisfaction of Information Resources and Services in University Library: A Case Study of Shrimati Hansa Mehta Library the Maharaja Sayajirao University of Baroda, Gujarat, India
Murtala Aminu | Mayank Trivedi
Abstract: Academic libraries must provide various services and facilities for users to motivate them to use the library. The general objective of this study was to determine the users' satisfaction with information resources and services provided to all the staff and students in Smt. Hansa Mehta Library, The Maharaja Sayajirao University of Baroda Gujarat, India. Some related literature review was put in place in this study. The study adopted the survey method and the population in this study covers the staff and students of Smt. Hansa Mehta Library. A random sampling technique was adopted in this research work. The questionnaire was structured (close ended) and the analysis was carried out by using simple descriptive statistics, results presented in tables, simple percentages and frequencies computed for the data analysis. The findings suggest many librarians should improve their collections and services to complement users' needs and also increase patronage to the library.
Keywords: Users Satisfaction, Information resources, Services, University Library
Edition: Volume 11 Issue 8, August 2022,
Pages: 757 - 761

domain: library


You’ve taken the journey with them from those first arena auditions, sat on the edge of your sofa during the dramatic six-seat challenge, followed their path to judges’ houses and will be tuning in to the studio show: now is your chance to see The X Factor Live.
And, as expected, it's coming to Belfast's SSE Arena.
Kicking off on February 12 in Aberdeen, The X Factor 2016 Live Tour is going across the UK and the arena tour which as well as Belfast and Dublin will also travel to Glasgow, Brighton, Bournemouth, Leeds, Birmingham, Cardiff, London, Nottingham, Liverpool, Newcastle, Sheffield and Manchester with contestants performing classic songs and viewers’ favourites from the TV series.
Attended by over three million people, The X Factor Live Tour has been one of the most successful annual arena tours in the UK & Ireland for the past eleven years.
Tickets go on sale Friday 23 October at 9am for the February 17 Belfast date.


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2 edition of Two studies in Chrétien de Troyes. found in the catalog.
Two studies in Chrétien de Troyes.
Helen C.R Laurie
Includes bibliographical references.
|Series||Histoires des idées et critique littéraire -- v. 119|
|LC Classifications||PQ1448 L3|
|The Physical Object|
|Number of Pages||225|
Erec and Enide essays are academic essays for citation. These papers were written primarily by students and provide critical analysis of Erec and Enide by Chretien de Troyes. Honor Over Love in Chrétien de Troyes’s “Erec and Enide” and “The Knight of the Cart,” and Through “Sir Torrent of Portingale”. Chrétien de Troyes (Modern French: [kʁetjɛ̃ də tʁwa]; ?–?, fl. c. –) was a French poet and trouvère known for his writing on Arthurian subjects, and for possibly originating the character of étien's works, including Erec and Enide, Lancelot, Perceval, and Yvain, represent some of the best-regarded of medieval literature.
Find many great new & used options and get the best deals for Cambridge Studies in Medieval Literature: The Arthurian Romances of Chrétien de Troyes: Once and Future Fictions 12 by Donald Maddox (, Paperback) at the best online prices at eBay! Free shipping for many products! In the middle of the fifteenth century two anonymous writers "translated" into prose Chrétien de Troyes's first verse romances, Erec and Cligés (dating from the twelfth century), for the circle of Philip the Good, duke of Burgundy. For a long ti.
The twelfth-century French poet Chrétien de Troyes is a major figure in European literature. His courtly romances fathered the Arthurian tradition and influenced countless other poets in England as well as on the continent. Book Review Digest Accessible and graceful version."—Sarah White, Speculum—A Journal of Medieval Studies "The. In Chrétien's romance, Perceval progresses from a naive boyhood in rural seclusion to a position of high respect as a knight at Arthur's court. With the help of two teachers—his mother and Gornemant of Goort—Perceval is ultimately able to reject the worldly adventures chosen by other knights and seek important moral and spiritual answers.
Experimental determination of the cross section for multiple particle production in carbon by cosmic rays at balloon altitudes.
Herbert the snail
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Two Studies in Chrétien de Troyes [Helen C. Laurie] on *FREE* shipping on qualifying : Helen C. Laurie. Genre/Form: Criticism, interpretation, etc: Additional Physical Format: Online version: Laurie, Helen C.R.
Two studies in Chrétien de Troyes. Genève, Droz, COVID Resources. Reliable information about the coronavirus (COVID) is available from the World Health Organization (current situation, international travel).Numerous and frequently-updated resource results are available from this ’s WebJunction has pulled together information and resources to assist library staff as they consider how to handle coronavirus.
Originally published inthis book provides an interpretation of the five Arthurian romances of Chrétien de Troyes. It attempts to show the ways in which this most enigmatic and influential of medieval romance-writers reveals his ideas about man, society and by: of results for Books: Chretien de Troyes.
Skip to main search results Amazon Prime. Eligible for Free Shipping. (Arthurian Studies) by Chretien de Troyes and Nigel Bryant. out of 5 stars 9. Kindle $ $ 8.
03 $ $ Paperback $ $ Get it as soon as Wed, Nov Chrétien de Troyes is arguably the creator of Arthurian romance, and it is on his work that later writers have based their interpretations.
This book offers both crucial information on, and a comprehensive coverage of, all aspects of the work of Chrétien de Troyes - the literary and historical background, patronage, his influence on other writers, manuscripts and editions of his work and, at.
Chrétien de Troyes was a French poet and trouvère who flourished in the late 12th century. Little is known of his life, but he seems to have been from Troyes, or at least intimately connected with it, and between and he served at the court of his patroness Marie of France, Countess of Champagne, daughter of Eleanor of Aquitaine, perhaps as herald-at-arms (as Gaston Paris /5(52).
Chrétien de Troyes has 96 books on Goodreads with ratings. Chrétien de Troyes’s most popular book is Arthurian Romances. Chrétien de Troyes, whose contribution to twelfth-century literature is unsurpassed, wrote for two of the most notable cultural patrons of his time.
Like all literary patronage in the Middle Ages, the respective roles of Chrétien and his patrons represented a reciprocal and mutually beneficial relationship. Dr Topsfield demonstrates the importance of Chretien de Troyes for the development of the genre of medieval romance, and the establishment of Arthurian material within the Western literary tradition.
In this respect, the book will be of interest to all those involved in European medieval studies. In Chretien de Troyes Revisited, author Karl D. Uitti at last places Chretien in context, offering a strong sense of the author's identity and the milieu in which he lived and wrote.
Uitti's 30 years of work on the subject pay handsome dividends for the reader, as we view Chretien - likely for the first timeoutside of a vacuum. Uitti locates Chretien within the theological and philosophical 3/5(2). Students of Chrétien de Troyes’s Le Chevalier au lion who are now of a certain age will almost certainly have used at some stage the edition of this text that was published in by Mario Roques (Les Romans de Chrétien de Troyes édités d’après la copie de Guiot (Bibl.
nat. ), iv: Le Chevalier au lion (Yvain) (Paris: Honoré Champion)). THINKING THROUGH CHRÉTIEN DE TROYES An exciting reassessment of the works of Chrétien, making use of modern critical theory to test orthodox opinion.
This co-written, multi-stranded book challenges assumptions about Chrétien as the author of a canon of works. In a series of lively exchanges, its five authors reassess the relationship between lyric and romance.
The Supplement builds on and completes the Chrétien de Troyes Bibliography first published in Together the two volumes constitute the fullest and most complete bibliographical source now available on this major medieval author.
Chrétien de Troyes bequeathed a corpus of highly original and widely influential Arthurian : Douglas Kelly. of results for Books: Chrétien de Troyes. Skip to main search results Amazon Prime. Eligible for Free Shipping. (Arthurian Studies) by Chrétien de Troyes and Nigel Bryant | Apr 1, out of 5 stars 5.
Hardcover $ $ 07 $ $ FREE Shipping. More Buying Choices $ (18 used & new offers) Kindle. Erec and Enide, the first of five surviving Arthurian romantic poems by twelfth-century French poet Chrétien de Troyes, narrates a vivid chapter from the legend of King Arthur.
Chrétien's romances became the source for Arthurian tradition and influenced countless other poets in England and on the Continent. Yet his swift-moving style is difficult to capture in translation, and today's 4/5(1).
SuperSummary, a modern alternative to SparkNotes and CliffsNotes, offers high-quality study guides that feature detailed chapter summaries and analysis of major themes, characters, quotes, and essay topics.
This one-page guide includes a plot summary and brief analysis of Yvain, or The Knight with the Lion by Chrétien de Troyes. Yvain, or The Knight with the Lion is an Arthurian [ ]. This Study Guide consists of approximately 86 pages of chapter summaries, quotes, character analysis, themes, and more - everything you need to sharpen your knowledge of Arthurian Romances.
Arthurian Romances is a collection of five stories written by Chretien de Troyes during the twelfth or. The Depiction of Lancelot in Chrétien de Troyes’ The Knight of the Cart and Malory’s ‘Book of Sir Lancelot and Queen Guinevere’ in Le Morte Darthur INNERVATE Leading Undergraduate Work in English Studies, Volume 3 (), pp.
suggest that all Lancelot's strength and honour as a man have been directed towardFile Size: KB. Chrétien de Troyes or Chrestien de Troyes (both: krātyăN´ də trwä), fl.French poet, author of the first great literary treatments of the Arthurian narrative romances, composed c–c in octosyllabic rhymed couplets, include Érec et Énide; Cligès; Lancelot, le chevalier de la charette; Yvain, le chevalier au lion; and Perceval, le conte del Graal, unfinished.
Chrétien de Troyes: a study of the Arthurian romances. [L T Topsfield; Chrétien, de Troyes] This book provides an interpretation of the five Arthurian romances of Chretien de Troyes.Books Advanced Search Amazon Charts Best Sellers & more Top New Releases Deals in Books School Books Textbooks Books Outlet Children's Books Calendars & Diaries of results for Books: Chretien De Troyes.Chrétien de Troyes's masterpiece Lancelot, The Knight of the Cart is a riveting tale of knightly valor and courtly love.
This romance marks the first known appearance of Lancelot as a major player in the Arthurian canon, and it also provides the first account of his affair with Guinevere. The first half of the narrative follows Lancelot (then unnamed) as he rescues Guinevere, who has been.


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Fall’s arrival makes many of us feel sad that our gardening season is nearly over. But it doesn’t have to be that way! Fall gardening can include more than yard cleanup and winter prep. In fact, one of your garden activities can be to plant bulbs in the fall.
Planting bulbs in the fall is the primary way to ensure early spring colors. Some flowers bloom so early in spring that you must plant them in fall; waiting until spring would be too late. Also, many bulbs must be exposed to cold soil temperatures to force or encourage flowering. If you’re uncertain about which bulbs to plant, when, and how, keep reading.
Best Bulbs to Plant in Fall
Let’s start by choosing the best bulbs for fall planting. Some of these are spring-flowering bulbs, though a few bloom a bit later in the season.
Daffodils. Members of the narcissus family, daffodil bulbs erupt in shades of white and yellow in mid-March. Historically, the yellow daffodil symbolizes rebirth and new beginnings.
Iris. Hardy, reliable, and easy to grow, irises make beautiful arrangements of cut flowers. They also attract butterflies and hummingbirds to your yard.
Tulips. A later bloomer, most tulips pop up after the grape hyacinths and daffodils have made their appearance. Note that all parts of the tulip plant are toxic to dogs, so take care to plant them away from areas that pets frequent.
Lilies. Known for their sweet, strong scent, lilies are a staple in many landscapes. These beauties bloom for weeks in the summer, adding color after other fall-planted bulbs have stopped blooming.
Anemone. Symbolizing fragility and love, anemone resembles some varieties of poppies but is much easier to grow and makes great cut flowers. The Japanese Anemone’s scent helps keep deer away from your garden.
Crocus. Available in shades of purple, blue, pink, yellow, orange, and white, the tiny crocus is one of the first flowers to blossom in the cold. Plant them by the dozens for a great show of color.
Grape hyacinth. The intensely fragrant grape hyacinth produces compact carpets of bright purple in early to midspring. Tiny flowers stand about 6 inches tall and spread easily.
Snowdrop. One of the first flowers to show in the spring, these little white bells often push through a light layer of snow. Hence, their name!
Scilla. One of the few bulbs that will survive in partial shade, scilla can be planted under shrubs or trees. They provide waves of brilliant blue color in early spring.
Allium. The allium family includes veggies such as onions, shallots, and garlic. Plant ornamental allium to add rodent- and deer-resistant plants that require little care and thrive in dry, sunny spots.
Choosing Flower Bulbs
To get the best from your bulbs, you need to start with high-quality specimens. When shopping, look for these things:
- Look for firm, plump bulbs with no soft spots, mold, or off odors. Also, make sure the bulb hasn’t sprouted yet.
- Buy the largest bulbs you can find. Bigger bulbs produce bigger flowers. However, if you are naturalizing (planting in informal plantings so bulbs self-propagate and spread freely), then you can purchase smaller bulbs.
- Make sure the resulting flowers are appropriate for your area’s plant hardiness zone.
When to Plant Fall Bulbs
Planting times for bulbs vary slightly depending on where in the United States you call home.
- For Northern climates, it’s best to plant in late September to mid-October, to get bulbs in the ground before the first frost. Make certain you plant before the ground freezes so the roots have a chance to grow. Tulips are an exception; as long as the ground isn’t frozen, you can plant these hardy bulbs as late as December.
- For Southern climates, plant bulbs in mid-October through November or until early December in the far South. The later you wait, the less time the bulbs have to establish themselves before colder temperatures set in.
How to Plant Bulbs in Fall
If you’re already familiar with planting other perennial or annual ornamentals, the steps to planting bulbs will seem similar.
Keep in mind that bulbs are difficult to tell apart, so keep the labels close by. That way, you can keep the yellow tulips separate from the red ones or prevent an errant daffodil from popping up in your irises.
- Check the area where you plan to plant bulbs. Do your bulbs need full sun, partial sun, or shade? Spring bulbs will bloom earlier if planted in a south-facing location.
- Prepare the flowerbed to make it light and friable. Bulbs need well-drained soil to keep from being waterlogged and possibly rotting. If you have clay soil, soil amendments are especially needed. Work compost or sphagnum peat moss into the top 8 to 10 inches of soil. That will add organic matter and improve drainage
- Adding fertilizer before planting is also helpful. Generally, work a teaspoon of fertilizer into the soil for a planting of 5 to 10 bulbs. Be sure to follow the directions on the fertilizer and bulb packages.
- Determine the planting depth for each bulb type. The rule of thumb when planting flower bulbs is to bury them two to three times as deep as the bulb is tall. But check the bulb’s package for precise directions.
- Dig holes at the recommended planting depth. Set bulbs in the bottom pointy-side up and with the roots down. Specialized bulb-planting tools, available online or at gardening stores, include augur-style drills and tubular steel planters
If you’re unsure which end should go up, plant the bulb on its side. Through a process known as geotropism, the roots of most bulbs will make their way down into the soil while the shoots grow up.
- Fill in the hole with soil, tamping gently without packing the soil too much. Water well initially and then avoid watering through the winter unless you live in an area with very low winter precipitation.
Tips for Growing Flowers From Bulbs
A few steps will help your bulbs to bloom successfully in the spring:
In cold areas, cover bulbs with a couple of inches of mulch to protect them during the winter. Be sure to remove it in the spring.
Protect bulbs from rodents or other animals. Place a mesh or screen over the soil surface to prevent critters from digging.
Leave the foliage in place until it turns yellow or brown. This helps the bulb prepare for next year by storing food.
Dig up tender summer blooming bulbs — also known as “spring bulbs” — in the fall so they don’t succumb to winter temperatures. Replant them in the spring. Spring bulbs include:
- Amaryllis (Caution: these are toxic to dogs and cats.)
- Calla (one of many outdoor potted plants to bring indoors for winter)
- Elephant ear
- Gladiolus (Night gladiolus is a good night-blooming plant for a moon garden.)
Tips For Designing Your Garden With Bulbs
Flower bulbs can be used to develop any type of garden you choose — from one that showcases its colors during the day, or a moon garden that graces your evenings. A few suggestions:
Don’t plant in a straight line. Plant in groups or clumps for the most impact visually. If possible, try for at least 12 bulbs in a group.
Pay attention to height. Plant bulbs that produce taller flowers to the back, shorter flowers in front. (Though keep blooming times in mind.)
Add companion plants with different bloom times (early spring, late spring, early summer, late summer) in various heights and colors. That will extend color well past your spring garden.
Bulbs can be planted in groups, along borders, or in rock gardens. Or you can plant them under deciduous trees; they’ll finish blooming before the tree sprouts its leaves.
One method is to sprinkle repellents, such as cayenne pepper, red pepper flakes, and paprika, around the planting area. Or try planting garlic or spreading coffee grounds. However, Smithsonian Gardens’ Horticulturist Christine Abelow says the best solution is to cover the planted space with wire mesh. Remove before the bulbs begin to sprout.
Generally, no. Usually, soaking bulbs in a rooting solution is used when forcing them to grow inside. However, to improve their chances of growth, some gardeners soak the hard anemone and winter aconite bulbs overnight to soften them.
Not if you live in a northern state; tulips should get the cold time they need to grow properly in the spring. (Times vary according to area, but the range is 8-15 weeks.) However, if you live in a southern state with mild winters, your tulip bulbs need to be chilled before planting.
Some nurseries and garden centers sell the bulbs chilled. Or you can try keeping them in your refrigerator (not the freezer) for 6-8 weeks. Put them in a mesh bag, and don’t store them near apples — they give off ethylene gas that will cause the bulbs to rot.
When to Call in a Professional
While planting bulbs in the fall can bring colorful rewards in the spring, finding time to hit that planting window can be a challenge. Or perhaps you’re unsure about the best flowers to use or the best places to plant those bulbs. In that case, consider calling a landscaping professional. A local pro can help you design the perfect spring garden and take care of all the planting and maintenance for you.
Main Image Credit: Adobe Stock

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Over 24 years of combined experience fixing garage doors in West Linn
We are a subsidiary of Portland Doors and Locks and are in no way affiliated with any other West Linn garage door company.
At D&L’s West Linn garage door repair, we know time is money. That’s why we’re available 24 hours a day, 7 days a week! We are confident that you will be 100% satisfied with all of our products and services. We offer a wide range of garage door services, including garage door repair, garage door replacement, garage door spring repair, garage door spring replacement, new garage door installation, and more!
90 day guarantees
All of our services are backed by our patented 90 day guarantees, and we are constantly training our West Linn garage door repair technicians on the most up to date techniques and procedures to provide you with quality work at the lowest prices possible.
When a garage door is not working properly
Garage door repair can be a tricky thing, as there are many parts, wires and other things that can cause a garage door to not work as it should. When a garage door is not working properly, it can be extremely dangerous to work on, as well as a massive security risk. These days, most of us use the garage as a main entrance into your home. When a garage door is off track, misaligned, not closing, or is slightly off balance, anyone can open it and walk in. Don’t let this happen to you!
Replace your garage door springs every 5 to 6 years
It is recommended to replace your garage door springs every 5 to 6 years. Garage door springs become worn, rusted and damaged, which can cause serious injury and in some cases death. Every year, thousands of people are hurt in garage door accidents because of a faulty or broken spring. We can do a 25 point inspection to make sure your West Linn garage door is in perfect working order, anytime of the day! Call us today to schedule same day service, an appointment, or to learn more about our products and services.


Bologna, Saskatchewan and Florence kick-off the international screenings for The Ladies Almanack. Historians, Art lovers, Dykes and Literature nerds of Italy or Canada, find your way to these three glorious festivals!!! Stay tuned for more screenings and events near you.
Some Prefer Cake - Bologna Lesbian Film Festival
September 21-24th (see site for screening date)
Queer City Cinema in Regina, Saskatchewan, Canada
The Ladies Almanack screens Friday, September 22nd!
Florence Queer Festival
The Ladies Almanack screens Saturday, September 30th!
Indiewire picks The Ladies Almanack for Project of The Day!
January 15, 2016
Director Daviel Shy interviewed by Megan Milks for Weird Sister!


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From Our Editors
At Yogurbella, staff members mix nonfat frozen yogurt fresh each day, preparing every original batch with nonfat fortified skim milk and yogurt with live and active cultures. More than 20 different frozen-yogurt flavors range from mainstays such as original and lemon to seasonally rotating varieties such as green apple, pistachio, and cookie dough. Patrons may opt to adorn their 5-, 8-, or 12-ounce dishes with healthful fresh fruit, nuts, and granola, which can top scoops of chocolate chips and cheesecake bites. Customers also can sip on yogurt smoothies blended with mixed fruits and apple juice.

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Perched in the heart of New England High Country, Armidale is Australia’s highest city and is best known for its picturesque natural beauty, heritage architecture and surrounding national parks. It’s also the perfect entry point for a driving tour of the scenic gorges and waterfalls of Waterfall Way, NSW.
Reasons to fly with Qantas
Whether you’re in town for the warm summer sun, winter days by an open fire or the vibrant autumn colours, you’re sure to be captivated by the relaxing charm of this historic New South Wales city. With natural beauty, history and culture waiting to be explored, it’s easy to find great deal for your accommodation for a holiday or weekend away.
Centrally located in town, you’ll find comfortable motels and inns within walking distance to the city’s cafes, shops, gardens and museums. If you prefer to stay in boutique accommodation or a guesthouse, there’s a range of elegantly appointed and fully-self-contained cottages just perfect for couples.
Corporate travellers, families and groups may prefer to choose to stay in an apartment with kitchen facilities and the comfort of more space. Friends away for a weekend can look no further than a cosy farm-style bed and breakfast on acreage just out of town. Around town you’ll also find a range of pet-friendly accommodation, campsites and holiday parks. Whatever your holiday style, the New England High Country has plenty to offer.
Boasting a locally-grown food scene, buzzing university culture and some of the best cool climate vineyards in the NSW, there’s something for everyone in Armidale.
First-timers may wish to explore the city’s heritage on the Armidale Heritage Bus Tour - a two hour experience departing the Visitor Information Centre every morning at 10am. You'll be taken on a journey through the city’s history, gardens, churches and museums and stop at highlights along the way - such as the Folk Museum, The Aboriginal Cultural Centre or the New England Regional Art Museum.
If you love to indulge in local produce, visit during the Armidale Autumn Festival to discover regional food, wine and entertainment. While in in the area, sample the cool climate wines at Peterson’s Winery cellar door, and if you’re visiting over the weekend they also offer a fantastic lunch menu featuring seasonal flavours.
The World Heritage-listed national parks and waterfalls along Waterfall Way are perfect for those seeking outdoor activities with walking trails, viewing platforms and serene picnic hideaways waiting to be discovered. For a slower place, take a step back in time with a tour of the heritage-listed Saumarez Homestead - a 30 room Edwardian mansion now managed by the National Trust.
From the airport: Armidale Airport is ten minutes' drive from the city centre. Hire cars and taxis are available from the terminal.
In and around the city: walking is a great way to see the city centre. Armidale Radio Taxis service the city and Edwards Coaches offer services around Armidale and the wider New England region.
Disclaimer: ^ Qantas Frequent Flyer members will earn 3 Qantas Points per A$1 value unless otherwise specified, for hotel stays booked through qantas.com/hotels, except Classic Hotel Rewards and Airbnb bookings. Points Club members will earn 25% more Qantas Points, and Points Club Plus members will earn 50% more Qantas Points. Qantas Points will be credited to your account at least 8 weeks after check-out. Qantas Points may be earned by the member in whose name the booking is made. Members will not be able to earn points on additional charges paid to the accommodation provider for extras (including cots, breakfasts and other incidentals) on check-in or check-out (as applicable).
Disclaimer: ^ You must be a member of the Qantas Frequent Flyer program to earn Qantas Points. A joining fee may apply. Membership and Qantas Points are subject to the Qantas Frequent Flyer program terms and conditionsOpens in a new tab or window. 4 Qantas Points will be earned per A$1 spent on time and kilometre charges within Australia, excluding GST, insurance, package tour, government, travel industry, some corporate rates and miscellaneous charges or 700 Qantas Points will be earned per rental outside of Australia with Avis and Budget. Members must provide their Qantas Frequent Flyer membership number to the chosen car partner. Vehicle hire is subject to availability. Avis or Budget age, credit and driver requirements apply. For further details, contact or Budget. For further details see cars important informationOpens in a new tab or window.
Disclaimer: ∆ Meals, beverages, entertainment offerings vary between flight times.
Disclaimer: + The number of destinations is correct as at 25 January 2024 but is subject to change.
Disclaimer: # You must be a member of the Qantas Frequent Flyer program to earn and redeem Qantas Points. A joining fee may apply. Membership and Qantas Points are subject to the Qantas Frequent Flyer program terms and conditions.


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Nearly 60 years ago, Canadian oil workers made the trek to the Lone Star State, bringing with them their whisky of choice, Crown Royal. Known for its regal history and distinguished flavor, Crown Royal became a mainstay in Texas and has left its mark with innumerable Texas fans. Today, Crown Royal is giving back to Texas with its first ever limited-edition release of Crown Royal Texas Mesquite.
The Texas Mesquite Mule features a unique twist on the classic cocktail offering a sweet and smoky taste. Crown Royal pays homage to two great Texas traditions, barbecue and whisky, with the introduction of Crown Royal Texas Mesquite.
Marrying two iconic Texas traditions, barbecue and whisky, Crown Royal Texas Mesquite combines the smoky flavor of locally sourced Texas mesquite wood with the signature smoothness of Crown Royal De Luxe. Crown Royal Texas Mesquite adds a special smokiness to summertime grilling, barbecues and celebrations of all kind that are in need of a little Texas kick.