We knew that this was the type of team that could beat Maryland. Rider flirted with it. Georgetown flirted with it. Illinois State flirted with it. It was the reason Wisconsin was able to tie the game late before Melo Trimble's heroics bailed his team out.
Stretch the floor and shoot well from the outside and you'll have a chance to beat the Terrapins. Michigan is the most talented team to do that so far this season against Maryland and that combination of skill and executing a game plan earned John Beilein's team a 70-67 upset in Ann Arbor on Tuesday night.
The Wolverines shot 41 percent on 29 three-point attempts. That shakes out to 12 makes, the most converted three-point attempts versus an AP Top 5 team in the last 20 seasons, per ESPN.
Did an early lack of execution on the perimeter defensively hurt Maryland? Absolutely. Michigan's ability to start 3-of-4 from deep, along with 12 first-half points (all on threes) from 6-foot-8 guard Duncan Robinson set the tone and got the crowd into it.
Michigan was able to endure a second-half drought because they came out of halftime still firing and pushing their lead to 13 with 16:38 to go. That was enough of a cushion to sustain them.
Yes, Maryland has things it needs to fix. It starts with perimeter defense. There should be serious questions about the bench beyond Diamond Stone. But take a look at the positives that Maryland now knows about itself.
1) Melo Trimble and Rasheed Sulaimon can combine for 10 points on 4-of-17 shooting with 5 assists and seven turnovers and they still only lose a game by three points on the road to a Top 35 KenPom team. And they had a chance to tie it on the last possession.
2) Diamond Stone is still an unstoppable force inside and a card that Mark Turgeon can keep up his sleeve for when he needs it. Just as he did versus Penn State, Turgeon started Stone in the second half and he fueled the furious comeback, erasing a 13-point deficit to end up with a double-double of 22 points and 11 rebounds.
How much of a luxury must it be to have a five-star guy off your bench who can be thrown into the game whenever and completely change the momentum's trajectory?
3) The reports of Jake Layman's demise have been greatly exaggerated. Yes, Layman has endured criticism in the past for fading into the background offensively in big games. But he was the only thing keeping Maryland afloat in the first half today.
He was confident, strong on the glass, and active defensively. He finished with 18 points and 10 rebounds. At the very least, Layman has progressed to the point where at the very least he earns a spot on the floor because his defense is a cornerstone for the team and he will attack the boards.
Some nights, you get this offensive alpha dog, too.
So look at it this way.
A number of things went wrong for Maryland on Tuesday night, some the result of playing a subpar game and some the result of the basic ebbs and flows of basketball.
Maryland falls to 15-2 over the past two seasons in games decided by six points or less.
And that comes in the second half of as close to a true road back-to-back as you'll get in college basketball, only days after beating Wisconsin in Madison. The Terrapins were again on the road in Ann Arbor. They ran into a hot-shooting team and a wild crowd and they took a loss.
No. 1 Kansas lost on the road Tuesday night, too. North Carolina lost earlier in the year to Texas in Austin. It happens and Maryland will be just fine.


I know some of my friends who are doing their trainings in medical fields with doctors in reputed hospitals. Although they know each and every thing what they are supposed to do in their trainings but the doctors sometimes are leaving their small surgeries to the trainers. Is this kind of behaviour safe for the patients?
How to work effectively as a representative?
The profession of doctor is very important for human beings.They are regarded as god,because they treat the patients to save their life.But some of them don't take his/her responsibility positively & passes it to the trainees or juniors.Of course bossism is every where.In this case the trainees have to see whether they are able to carry over the responsibilities which are given to them by senior doctors,if not they should talk to the concerned doctor about the problems & its consequences to be faced later.If the seniors doctors don't listen to their problems,they should go to the superintendent who is head of the hospital.
The trainees should move forward in pen & paper.There will a solution to the problem.
as you said your friends were well talented then why you should bother for this situation and moreover the doctors were not so blind to give the trainees the surgery.the doctors were confident in their trainees and the way of doing surgeries and they think that they can handle it.so dont bother of the situation and the trainees also have a bit of experience in handling them.and every person becomes a good doctor if he handle such type of situations.
Such kind of a behaviour from senior doctors may or may not harm the patient depending on the efficiency of the trainer, If the trainee is good at his job and the doctor has full trust in him then he can surely leave the small surgeries to him without having to worry about anything at all. So he is not required to constantly supervise the trainee in such cases. But the doctor should be careful in whom to trust and whom to not trust.
So the trainees too will gain confidence only once they perform some surgeries by themselves. In this way the doctors are doing good to enhance their confidence and also this will give them some sense of responsibility as they are not being supervised by anyone. But in case the doctors are blindly giving the small surgeries to any trainee to perform, then surely the patient is not safe. Now this depends upon the doctor and they should be very careful in such cases otherwise they may have to face legal trouble later on.
you said your friends were well talented then why you should bother for this situation and moreover the doctors were not so blind to give the trainees the surgery.
The doctors were confident in their trainees and the way of doing surgeries and they think that they can handle it.
so don't bother of the situation and the trainees also have a bit of experience in handling them.
And every person becomes a good doctor if he handle such type of situations.


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Estrada to support Poe against Binay | Inquirer Opinion
Estrada to support Poe against Binay
By: Neal H. Cruz - @inquirerdotnet
Philippine Daily Inquirer / 12:15 AM December 15, 2014
Manila Mayor Joseph Estrada was at the Tap Room of the Manila Hotel last Dec. 11 to listen to Margaux Salcedo sing. I was seated beside him and we talked politics.
I said the survey ratings of his friend Vice President Jojo Binay are plunging while those of Sen. Grace Poe, another friend, are shooting up.
If the trend continues, the presidential race in 2016 may be a tossup between Binay and Poe, both of whom are his friends. "When that happens, whom will Erap and his Pwersa ng Masang Pilipino support?" I asked Erap pointblank.
Without hesitation, he answered: "I will have a difficult time, but I will choose Grace."
"Why?" I asked.
"Grace is the daughter of my best friend FPJ (Fernando Poe Jr.) who is more than a brother to me," Erap answered. "We have gone through a lot together. Together, we fought the Big Four criminal syndicate that was victimizing movie actors and actresses. When I ran for president, he helped me. He stopped making movies so he would have time to campaign for me.
"When it was his turn to run for president, I was not able to campaign for him because I was already imprisoned, although it was I who convinced him to run. Now that his daughter Grace may run for president, I have to help her. It's the only way I can repay FPJ. My conscience will bother me if I don't support her. Baka pag multuhan nya pa ako (He may even haunt me)."
"What about Binay?"
"Eh, bahala na siya." It was Erap who helped Binay win as vice president in the 2010 elections. Binay was his running mate in the PMP ticket. Erap finished second to P-Noy but Binay beat Mar Roxas. Without Erap's support, Binay could not have won.
After the elections, Binay announced he would go after the presidency (and he has been campaigning since then, in violation of the Commission on Elections rule against premature campaigning). Erap, Binay and Sen. Juan Ponce Enrile then formed the United Nationalist Alliance (UNA).
When Binay had a falling out with his political party, Partido Demokratiko Pilipino-Laban, a member of the UNA coalition, he left it and said he was going to form another party that would be a member of UNA. Until now, it is not known what that party is or who its members are besides the Binay family.
"What about you?" I asked Erap. "You are right behind the leaders in the rankings. If there is a public clamor for you, will you consider running for president?"
"I am 76 years old. I may be too old," Erap answered. "My idol is President Ronald Reagan. He was a grade B movie actor but he became president of the United States, the most powerful nation in the world. If a grade B movie actor like him can be president, why not a grade A actor like me, I asked myself. So I ran for president and won."
Erap continued: "Reagan said, 'I want to retire while I can still carry my luggage.' Me, I want to retire while I can still make love." Erap is known as a ladies' man and has had several partners with whom he has children.
"Does that mean you are losing your ability to make love?" I joked.
"Hindi naman, but I am getting old."
After being pardoned by then President Gloria Macapagal Arroyo, Erap ran for mayor of Manila and won. The mayor of Manila has always been a contender for the presidency of the Philippines. At present, Erap is facing a disqualification case filed by former Manila mayor Alfredo Lim in the Supreme Court. The issue is whether or not the pardon allowed him to run for political office.
The language of the pardon is confusing, hence the controversy. The "whereas" clause says Erap has said he is withdrawing from all political activities, but the dispositive portion gave back all his civil rights, including the right to vote and be voted upon, which means that he can run for public office. Legal experts say the dispositive portion is superior to all the "whereas" clauses. If correct, then Erap can be a candidate for any public office.
The Supreme Court is reported to be ready to issue its decision.
Erap can also have a career as a singer. He has the voice for it. He usually sings at the Tap Room gigs of Margaux Salcedo. Last Dec. 11, he sang "It's Always You" which was repaid with a standing ovation.
Last Thursday, the Tap Room was overflowing, literally. There were so many fans who wanted to listen to Margaux. Extra tables and chairs had to be brought in, but fans still lined the bar and stood at the doorway to listen.
Celebrity singers usually drop in and Margaux invites them to sing. Last Thursday, jazz singer Sandra Lim Viray and Megan
Herrera sang several songs, besides Erap, to the delight of the crowd. Sandra is the wife of drummer Jun Viray (who is celebrating his birthday on Dec. 18). Megan is the widow of bassist Roger Herrera.
With Margaux singing regularly there, the Tap Room is attracting accomplished singers, music lovers and celebrities.
Binay: Some media men were paid to destroy me
Binay ratings nosedive
Binay laughs off claims his political career's over
Who's footing 'Binay' farm's bills?
An OIC for the PNP
TAGS: Grace Poe, Jejomar Binay, Joseph Estrada, nation, news, politics

redpajama_set_name: RedPajamaCommonCrawl


Because of how the Constitution of Burma determined how Citizenship was granted, Burmese with parents or grandparents born OUTSIDE of Burma have a possibility of being granted one of the five forms of British Nationality. This is because of the protection offered to British Subjects born or resident in Burma before Independence.
In particular, and because of the large numbers involved, Burmese with Indian ancestry (parents or grandparents born in India) have a higher likelihood of being granted automatic British Nationality.
Burma became an independent foreign country on 04.01.1948. Prior to that date, Burma was part of the Crown's Dominions.


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New Final Fantasy 7 Remake trailer re-introduces Cloud Strife
A brand new trailer detailing Cloud's journey debuted during The Game Awards 2019, and it's got us salivating over what's up next for Final Fantasy 7 Remake.
Final Fantasy 7 Remake got a brand-new trailer tonight during The Game Awards 2019.
Originally teased over at the official Square Enix Twitter account, the trailer showed off protagonist Cloud Strife and introduced a bit more of him to the audience. Of course, we appreciate any excuse to see more of Final Fantasy 7 Remake, after all.
We've been seeing bits and pieces of the fantastic-looking ground-up remake here and there, and each time, the game has looked leagues better than the last. There's still a lot we haven't had a peek at though, of course. The game's still a few months out, and some things are shrouded in secrecy. Earlier this year, I had the opportunity to go hands-on with Final Fantasy 7 Remake during E3 2019. Here's what I thought:
"Final Fantasy 7 Remake is a clear-cut example of a developer working not to make the same game over again with updated graphics and mechanics, but to expand it beyond what was previously thought possible. Speaking on the game's expanded story and features ahead of my time with the demo, producer Yoshinori Kitase noted that the game will be a fully standalone experience that will focus on the part of the story that took place in Midgar. I know from this annotated slice of gameplay that there's nothing I want to do more when 2020 begins than spend time once again in the hallowed ground of PlayStation's finest role-playing game and see where this new vision of a classic goes. "
The clock continues to tick down to the game's official release. You can pick up Final Fantasy 7 Remake on March 3, 2020 when it hits PlayStation 4 first.
Brittany Vincent posted a new article, New Final Fantasy 7 Remake trailer re-introduces Cloud Strife


Previous Post Sneak peeks from forthcoming dress collection!
Stunning! Beautifully done! I'm swooning over the Claudette, especially.
Thanks, Amanda! I do ship abroad by the way:).
Irma is making my wedding dress, so the other day I was able to have a peak at some of these up close – and they truly are beautiful, impeccably made dresses.
Congratulations Irma on a terrific collection! I especially love Vera.
Thanks very much, Shiona! I'm very excited about making your beautiful wedding dress!
Thanks very much! That's very kind!


Fountains of Boynton Animal Hospital is a Veterinarians facility at 7280 W Boynton Beach Blvd, Ste. 300 in Boynton Beach, FL.
Services Fountains of Boynton Animal Hospital practices at 7280 W Boynton Beach Blvd, Ste. 300, Boynton Beach, FL 33437.


Having a culture that supports and promotes safety efforts has been identified in healthcare and other industries as a key element in improving safety. Therefore, healthcare facilities are borrowing safety culture concepts from high-reliability industries such as aviation and nuclear energy, implementing communication and teamwork models, and creating work environments that support patient safety with the ultimate goal of becoming high-reliability organizations. While numerous patient safety initiatives are under way across the United States, experts say that in order for such initiatives to be successful, a culture of safety is necessary.
Two important concepts affect the safety culture: error reporting and disclosure of errors. The means by which errors are identified, reported, and communicated to those involved or affected have much to do with how well safety is ingrained in the healthcare organization's culture. A starting point for achieving an improved safety culture is to conduct an assessment of the current culture of the healthcare organization to determine whether and how that culture affects the provision of safe patient care. The results of the assessment can identify opportunities to improve systems and prevent harm.
Seek leadership support for the creation of a culture of safety throughout the organization.
Partner with clinicians and managers to assess the existing safety culture in the organization.
Execute an action plan to improve the culture of safety, and establish valid measures to gauge the effectiveness of action plans.
Provide safety science education to frontline staff, managers, physicians, and organizational leaders.
What Is a Culture of Safety?
In response to the Institute of Medicine's (IOM) 1999 report on medical errors calling for the prevention of patient injury and death through safer healthcare, hospital associations, professional societies, regulatory and accrediting bodies, employers, health insurers, and healthcare organizations have attempted to improve patient safety (Leape and Berwick). Having a culture that supports and promotes safety efforts has been identified in healthcare and in other industries as a key element in improving safety (Singer et al.). Therefore, healthcare facilities are borrowing safety culture concepts from high-reliability industries such as aviation and nuclear energy, implementing communication and teamwork models, and creating work environments that support patient safety with the ultimate goal of becoming high-reliability organizations (McCarthy and Blumenthal). Such organizations perform extremely well with few errors or adverse events over the long term despite facing high intrinsic hazards and risks. They are also characterized by a culture that approaches safety systematically—indeed, safety is the number-one priority, even at the expense of production or efficiency (ECRI Institute "Healthcare"). Some contend that the healthcare industry is still in its infancy in becoming highly reliable. Others assert that a culture of safety can never be fully realized by healthcare organizations because they struggle with too many competing demands to make safety the only workplace priority (Hoff). However, many forward-thinking healthcare organizations are forging ahead with a new approach—affecting conceptual, behavioral, and systematic processes—to deliver safer healthcare by creating an organizationwide culture that embraces patient safety (McCarthy and Bloomenthal).
The Centers for Medicare & Medicaid Services (CMS) has encouraged safety efforts by releasing new rules for the hospital inpatient prospective payment system to support greater patient safety. The rules identify specific conditions that CMS has deemed to be "reasonably preventable" during a Medicare beneficiary's hospital stay when evidence-based guidelines are followed and for which CMS may refuse payment. CMS's list of reasonably preventable conditions (known as hospital-acquired conditions) that are subject to potential denial of Medicare payments include certain postoperative infections and other infections, objects left in patients during surgery, blood incompatibility, pressure ulcers, and other conditions. CMS reasons that hospitals will strive more earnestly to prevent these conditions from developing if they will not receive payment for treating them.
While numerous other patient safety initiatives are under way across the United States, including some that focus on particular issues such as reduction of healthcare-associated infections and some that focus on specific areas of care such as the intensive care unit (ICU), many experts agree that these focused initiatives should be preceded by culture change in order to be successful (AHRQ "Conversation"). Experts say that a culture of safety is necessary before other patient safety practices are introduced. Otherwise, individuals expected to implement the safety initiatives do not yet know how best to work together or how to communicate most effectively.
This Risk Analysis will examine what constitutes a culture of safety, how it can be assessed and measured, how facilities can work toward the achievement of a culture of safety, and how it may affect patient safety and risk management.
Various definitions of a culture of safety have been promulgated. Most general descriptions conceive of safety culture as the collective product of individual and group values and attitudes, competencies, and patterns of behaviors in safety performance. Simply put, safety culture, including safety cultures that need improvement, can be described by healthcare facilities as "the way we do things around here" (Mansdorf).
Although there is no firm consensus on what constitutes an effective safety culture, several components are considered vital to patient safety. See Components of a Culture of Safety for a summary of characteristics commonly accepted as necessary for a safety-oriented culture.
Two important concepts affect the safety culture: error reporting and disclosure of errors. The means by which errors are identified, reported, and communicated to those involved or affected have much to do with how well safety is ingrained in the healthcare organization's culture.
An atmosphere in which healthcare workers can report actual or potential errors, events, and hazards without fear of reprisal is the hallmark of a nonpunitive environment and is consistent with the open communication necessary for a culture of safety. Incident and event reporting systems in healthcare organizations should take a nonpunitive approach in order to encourage event and near-miss reporting, to identify problems and work toward their resolution, and to facilitate learning. (For more information, see Event Reporting.) The challenge of overcoming barriers to staff reporting of events, errors, and near misses includes removing the fear of job loss, humiliation, and "shunning" by peers, which has been associated with error reporting in the past. In order to alleviate the stigma associated with medical error reporting, facilities must demonstrate through policy and action that reporting is expected, encouraged, and rewarded. Disciplinary action is reserved for willful disregard, wrongful intent, and noncompliance with reporting procedures. A basic tenet of organizational theory is that reward systems greatly influence behavior (Roberts et al.). Therefore, rewards in the form of recognition and acknowledgment for contributing to organizational improvement, instead of punishment for reporting errors, should be the norm.
Following a highly visible medication error involving the death of a patient, the Dana-Farber Cancer Institute (Boston, Massachusetts) embarked on a mission to improve patient safety, change its culture, and establish a "fair and just culture" that is nonpunitive but also holds individuals and the organization accountable. A fair and just culture, as defined by the institute, is one in which the work environment emphasizes learning rather than blame. Constructive feedback is used, as is fair-minded treatment, so that individuals can reveal errors and help the organization learn from them. (Dana-Farber Cancer Institute) For more information, see "Principles of a Fair and Just Culture," available online at http://www.dana-farber.org/pat/patient-safety/patient-safety-resources/docs/principles-of-a-fair-and-just-culture.pdf.
The IOM report, Crossing the Quality Chasm, A New Health System for the 21st Century, identifies openness and transparency as being among the characteristics of safe healthcare (IOM). Consistent with this framework for safety is honest and open communication among physicians, administrators, and healthcare workers, as is open communication with patients and their families regarding outcomes of care. Ethicists advocate confronting and openly disclosing medical errors as soon as they are discovered because doing so is the right thing to do and the process begins learning and healing for all those involved in the error: patients, families, and healthcare providers. Regulatory, accrediting, and professional organizations, including the Joint Commission, the American Society for Healthcare Risk Management, and the National Patient Safety Foundation, have published standards and guidelines that support informing patients and their families about outcomes of care, including unanticipated outcomes, errors, and adverse events. Demonstrating the acceptance of this philosophy of open communication in healthcare, a number of states have enacted laws requiring disclosure and reporting of serious, or "sentinel," events.
Some experts predict that disclosure and apology may become standard practice and that when an injury-causing error occurs, an offer to compensate the patient, along with the apology, will routinely be made. Disclosure with apology and compensation is advocated because it is accepted as the right thing to do (Leape) and because it is also a viable loss-reduction and liability claim avoidance strategy. According to the Sorry Works! Coalition, removing the patient's anger over an error in medical care and resultant injury through disclosure, apology, and compensation will undoubtedly increase the number of settlements but will result in more justice for injured patients, fewer costly lawsuits and jury awards, and a reduction in defense costs (Wojcieszak et al.). The Sorry Works! Coalition Web site can be accessed at http://www.sorryworks.net.
I would feel safe being treated here as a patient.
It is easy for the staff here to ask questions when there is something they do not understand.
I am encouraged by my colleagues to report any patient safety concerns I may have.
Intended to assess the safety culture of a hospital organization or specific hospital units, AHRQ's survey can be used to track changes and improvements in safety culture over time. AHRQ has provided reports from its comparative database for benchmarking purposes based on data from more than 500 U.S. hospitals using HSPSC. From its data analysis, AHRQ reports that a strength of most participating hospitals is the extent to which staff support one another and work together as a team; questions related to teamwork within units received the highest average positive responses to the survey. Areas for potential improvement for most hospitals include adoption of a safety culture in which staff do not feel that mistakes and event reports are "held against them" so that errors and events are more readily reported. The AHRQ reports are available online at http://www.ahrq.gov/qual/hospsurvey08.
When selecting a survey instrument to assess safety culture, users have been advised to consider the survey tool's validity and reliability (Pronovost and Sexton). A sample survey form that assesses safety climate is reprinted in the Appendix. The term "culture" refers to broader, organizational values, beliefs, and practices, while the term "climate" refers to a particular area of functioning—that which the organization recognizes, responds to, and rewards at a particular time and place. In the context of healthcare, for example, the climate of a care unit in a hospital can affect patient safety, and thus an assessment of the safety climate in that unit can provide information useful to gauging the safety mindedness of the culture (Krause and Dunn).
Conducting a safety culture survey is no small undertaking. Appropriate resources should be dedicated to planning the project, selecting an appropriate sample, establishing data collection procedures and timelines, analyzing responses, and communicating results. ECRI Institute has automated the AHRQ survey for patient safety culture using its Web-based risk assessment tool INsight™ to simplify hospital participation. INsight uses the AHRQ comparative database to provide benchmark reports. For information on the INsight Patient Safety Culture Risk Assessment, go to https://www.ecri.org/Documents/Brochures/INsight_Patient_Safety_Culture_Brochure.pdf.
When assessing safety culture, it is important to remember that perceptions, attitudes, and opinions about what is true are most important; therefore, what leaders, managers, and staff perceive to be true about their work environment and their relationships matters most. Organizational-change experts contend that it is not official policies that drive organizations, but rather the "unwritten rules" (Mansdorf). For example, a nurse skips the critical step of verifying a preoperative patient's identity and administers the wrong drug—one meant for another patient—because of time pressures from the operating room (OR) to get the patient to surgery and keep on schedule. The official policy requires that the nurse check the patient's identity before administering a medication. The unwritten rule, however, is that the OR schedule is not to be delayed, so shortcuts to facilitate compliance with this "rule" are allowed. In this scenario, patient safety is compromised due to the nurse's perception that production and efficiency are valued more than compliance with safety procedures.
Conducting a survey to determine attitudes and perceptions that make up the safety culture is a beginning step in the process of improving patient safety. In essence, the real work—setting priorities for action, making changes aimed at improving healthcare service delivery, and measuring the effect on patient safety—begins after communicating survey results to staff and managers. For one facility, postsurvey interventions were articulated in a strategic plan to improve safety. The plan was deemed necessary to address a disconnect between leaders' perceptions of patient safety and frontline staff's perceptions of patient safety, as well as marked differences in perceptions between physician and nonphysician staff members. Among key findings of the facility's safety culture survey were needs for senior leaders to demonstrate greater visibility to staff in their patient safety efforts, more effort to involve and educate physicians in patient safety, and strategic planning to include a patient safety focus (Pronovost et al.).
A discrepancy between the attitudes and experiences of senior managers (especially nonclinicians) and those of frontline staff directly involved in patient care was apparent in other hospital safety culture surveys reported in the literature. Because uniformity of safety attitudes among members of an organization is necessary for the organization to become highly reliable, the implications for hospitals are clear—efforts to eliminate discrepancies and create shared values among healthcare executives and frontline staff are needed (Singer et al.). Initial safety culture survey results can also provide a baseline from which to gauge the effectiveness of interventions designed to improve the organization's safety culture by comparison with repeated surveys.
In a 2005 commentary on the slow but steady progress since the IOM report on medical errors, patient safety experts Lucian Leape, M.D., and Donald Berwick, M.D., cited the primary obstacles to change and improvement in healthcare as being rooted in beliefs, intentions, cultures, and choices, not in the lack of technology (Leape and Berwick). Emphasizing the responsibility of healthcare leaders to create and nurture cultures of safety in their organizations, patient safety experts at the 2008 National Patient Safety Congress discussed opportunities and barriers faced by leaders as they develop and lead teams to build a culture of safety in their organizations. Essential to sustaining a culture of safety is a foundation built on a just culture and a willingness to learn from failures, said presenters during the congress's leadership day ("Embedding").
Indeed, ongoing high-level commitment to patient safety is a logical prerequisite for culture change (Leape and Berwick). Fortunately, governing boards of healthcare organizations are increasingly getting involved in the support and oversight of quality and patient safety. According to a recent study of the structures, practices, and cultures of governing boards in a selection of nonprofit health systems, boards spend an average of 23% of their meeting time on patient safety and quality issues (Prybil et al.). Responses from a recent HRC System survey also confirm heightened trustee involvement. The HRC poll results indicated that nearly 50% of organizations' boards of directors spend at least 25% of their meeting time on quality and safety initiatives (ECRI Institute "Incentives").
Engagement. Commit to change, and determine how this will contribute to the community and society as a whole.
Execution. Establish an action plan, communicate the evidence for change, and allocate ample resources to implement the plan.
Can you think of any incidents or adverse events that happened in the past few days that have resulted in prolonged hospitalization for a patient?
Can you think of patients we have harmed as a result of problems with how we deliver care?
What aspects of your work environment are likely to lead to the next patient getting hurt?
Have there been any near misses that were averted because of existing systems or an individual's actions?
How does communication between caregivers promote or hinder safe care on your unit?
When adverse events or near misses occur, do you always report them? If not, why not?
Have you developed any means of personal error prevention (e.g., workarounds, reminders, checklists)?
What could leadership do to support you in providing safe patient care?
What changes could be made in your unit to promote patient safety more consistently?
How can walkrounds be more effective?
Often conducted weekly, walkrounds afford leaders the opportunity to solicit staff input on errors, near misses, and other safety issues and to discuss the causes of these events and situations. Key information gleaned from the conversations is recorded and analyzed so that identified problems can be addressed. Continued walkrounds provide an ongoing forum for communication with and feedback to the staff regarding effectiveness of efforts to resolve identified problems and actions taken to improve patient safety. One teaching hospital that studied the effects of leadership walkrounds in its facility found that safety culture attitudes of nurses that participated in walkrounds were more positive (73% gave positive mean safety culture scores on a survey) than attitudes of nonparticipating nurses (53% gave positive scores) (Thomas et al.).
The Leadership WalkRounds concept was developed by the American Hospital Association's Health Research and Educational Trust (HRET).* HRET collaborated with Partners HealthCare (Boston, Massachusetts) to study the implementation process of walkrounds and the resulting change in the safety culture. As a result, HRET has posted a walkrounds culture change tool on its Web site. The tool, which includes a database that facilities can use to analyze walkrounds information, tracks identified hazards and input from staff and allows a comparison of demographic data with other participating facilities. In addition, several safety culture survey instruments are available for download with registration. A manual and instructional DVD, part of a walkrounds toolkit that was released in mid-2005, are also available on the Web site. HRET's Leadership WalkRounds Web site is http://www.hret.org/walkrounds. Another organization that has actively promoted walkrounds as a key strategy for building a culture of safety is the Institute for Healthcare Improvement (IHI), a group involved in numerous patient safety initiatives. Information on IHI's Leadership WalkRounds Web-based series and other patient safety resources can be found on IHI's Web site at http://www.ihi.org.
* The name Leadership WalkRounds is trademarked and owned by the principal developer, Allen Frankel, M.D., and HRET.
Assess the culture of safety.
Establish senior leader partnerships with units.
Learn from one defect per month.
Reassess (remeasure) the culture of safety.
The success of CUSP at Johns Hopkins Hospital has been demonstrated by a reduction in infection rates, SICU patient lengths of stay, and nurse turnover rates (Joint Commission "Improving").
Using this framework, Ascension set priorities based on its safety assessments for action to achieve its goals for no preventable injuries or deaths by July 2008. Actionable goals included the elimination of the following events: facility-acquired pressure ulcers, nosocomial infections, birth trauma, perioperative adverse events, and adverse drug events, as well as the prevention of falls and elimination of falls with injury. While the health system reported in December 2007 that at least 2,000 lives had been saved during this "journey to zero," it also conceded that because some patients' health conditions predispose them to certain events or to poorer outcomes, the lofty goal of zero preventable injuries or deaths will be an ongoing challenge. (Hendrich et al.) Undaunted, Ascension Health outlines its strategies for patient safety and provides links to articles describing successes and achievements at its Web site, http://www.ascensionhealth.org/ht_safe/main.asp#Priorities.
Additional examples of organizations that attempt to improve patient safety by promoting an organizational culture of safety and enhancing teamwork and communication have been chronicled in a report by the Commonwealth Fund, a private foundation that promotes a high-performing healthcare system by supporting independent research on healthcare issues and providing grants to improve healthcare practice and policy. For a summary of the achievements of some of the healthcare facilities described in the Commonwealth Fund's report, see Healthcare Organizations Show Dedication to Safety.
Another critical element of creating a culture of safety is the development of effective teams. Included with IOM's recommendations for making healthcare safer were suggestions for achieving a culture of safety, such as providing teamwork training and improving communication. The Joint Commission also supports these suggestions, citing inadequate communication between care providers or between care providers and patients/families as the root cause of all sentinel events (Joint Commission "Behaviors"). The organization includes requirements in its accreditation manuals for leaders of healthcare facilities to create and maintain a culture of safety. The Joint Commission's National Patient Safety Goals specify requirements for improving communication and teamwork aimed at improving patient handoffs, responding to changes in patients' conditions, actively involving patients in their own care, and improving medication safety (Joint Commission "National").
Gaining support for improving communication and helping physicians and staff work as teams are also keys to changing the safety culture. Risk managers can help gain such support by providing data that shows that communication problems are major causes of medical errors and that teamwork failures can lead to malpractice claims.
Communication is transmitted not only verbally and in writing but also through behavior. Traditional hospital hierarchies that place frontline caregivers at the bottom and physicians at the top can foster intolerance for nonphysicians' input into plans of care, devalue the contributions of nurses and other healthcare workers, and promote acceptance of inappropriate actions or words. Healthcare organizations must strive to prevent or correct intimidating or disrespectful behaviors of physicians or others because they are disruptive to the work environment.
Disruptive behaviors also undermine a culture of safety and have a negative effect on the communication and collaboration necessary for safe patient care. Although the Joint Commission proposed several times to address disruptive behavior in its National Patient Safety Goals, the agency did not do so. Instead, the negative effect of intimidating and disruptive behaviors on patient safety was addressed through the incorporation of specific requirements to define and manage inappropriate behaviors under Joint Commission accreditation leadership standards that obligate the organization to create and maintain a culture of safety (Joint Commission "2009"). The Joint Commission also urged healthcare organizations to address the problem of behaviors that threaten the performance of the healthcare team in a Sentinel Event Alert released in July 2008 (Joint Commission "Behaviors"). For more information on managing and preventing disruptive practitioner behavior, see Disruptive Practitioner Behavior.
Communication that is uninhibited by the potential for disruptive behavior is essential to effective teamwork in a safety-oriented culture. But effective teamwork and good communications do not occur simply because senior leaders mandate them. Ongoing education on communication techniques and teamwork training must be provided to all levels of staff.
An integral part of creating a culture of safety in a healthcare organization is providing education and training in the science of safety to administrators, managers, physicians, and staff. Knowledge of patient safety should extend from the boiler room to the boardroom, with everyone accepting responsibility for creating a safe environment for patients and staff. All new board members, physicians, and employees should be oriented to the organization's patient safety plan and receive specific education and training on goals and action plans aimed at creating and maintaining a culture of safety.
Background: keep information brief, related, and to the point.
Assessment: summarize what you found/think.
Recommendation: describe what you want.
Because it is important for teams of healthcare professionals to practice their skills and rehearse the handling of high-risk or emergency situations, lifelike simulators are used at Kaiser in conjunction with human factors* training and communication training to enhance teamwork. Simulation allows the healthcare team to develop critical thinking skills while rehearsing the procedures to be implemented when certain situations arise. It also allows team members to learn how to work together.
* The study of human factors is the study of the interrelationships between humans, the tools they use, the environment in which they live and work, and interpersonal relations and applies them to the complex systems and processes for delivering healthcare. Source: National Patient Safety Foundation. National patient safety definitions [online]. [cited 2008 Aug 8]. Available from Internet: http://www.npsf.org/rc/mp/definitions.php.
Another health system in the Midwest created a systemwide core patient safety curriculum to address the findings of an employee survey indicating that many respondents lacked education in formal error prevention techniques (20%), training in error reporting (30%), and awareness of common errors occurring in their facilities (49%). Training modules were developed in four areas: safety culture, caregiver communication, human factors, and knowledge of reporting. The health system used a train-the-trainer format and deployed toolkits comprising slide presentations and overheads, instructor guides, unit posters, quick-reference cards, and postprogram tests (Caleca et al.).
Duke University Center for Instructional Technology: http://patientsafetyed.duhs.duke.edu/module_c/module_overview.html.
The positive effect of a change in culture to one that is preoccupied with improving communication and teamwork and reducing errors is becoming increasingly apparent; evidence of the positive effect of a culture of safety abounds at the local level, and reports of regional successes increasingly appear in the clinical and risk management literature. For example, as part of the culture change at Johns Hopkins Hospital, authority gradient issues were addressed with resident physicians, and nurses were empowered to stop central-line insertions when they suspected line contamination. Along with other specific interventions, culture change initiatives contributed to a significant reduction in the number of central-line infections ("Improving").
Perhaps the most dramatic successes thus far have been in the area of critical care. Launched in 2002, an ICU improvement program called Transformation of the ICU helped decrease mortality rates by 20% at participating ICUs by increasing teamwork, redesigning basic processes, and changing to a culture of safety (Landro). Clinical interventions targeted in the ICU improvement programs include better control of blood sugar levels, aggressive treatment of sepsis, prevention of bloodstream infections, and prevention of ventilator-acquired pneumonia. Several similar ICU improvement initiatives that included both culture change and clinical interventions were implemented through several statewide programs. For example, the state of Michigan's Keystone ICU project created a strengthened sense of teamwork between executives and clinicians, provided safer care for patients, and improved communication between caregivers, who together formed an enhanced culture of safety (Pronovost and Goeschel).
Almost half the participating ICUs reported zero bloodstream infections or cases of ventilator-acquired pneumonia for six months or more.
Overall, ventilator-acquired pneumonia rates continue to decline.
more than 246 million healthcare dollars.
While it seems that fewer errors and a smaller number of patients experiencing harm would translate into a reduction of liability claims, a positive effect of a culture of safety on the frequency and/or severity of healthcare liability claims has not been proven. However, some early intervention programs that employ disclosure communication and offer compensation when adverse outcomes occur report success in preventing litigation while maintaining physician/patient relationships and physician and patient satisfaction (COPIC). Other initiatives, such as increased use of mediation and arbitration at the individual facility level and progress in tort reform at the state level, in combination with safety culture improvements, may have the greatest impact on liability over time.
To advance patient safety in their organizations, risk managers and patient safety officers should partner with executives, managers, educators, staff, and physician leaders to articulate strategies for changing the culture to one that embraces safety as a core value. Such collaboration can begin with an assessment of the current culture to identify positive and negative perceptions and attitudes about environments and relationships that promote or hinder the provision of safe patient care. Once barriers to a culture of safety are identified, action plans to replace them with behaviors, attitudes, and policies that embrace and support a culture of safety can be developed and implemented. When it comes to demonstrating appreciable change and improvement, the challenge lies in establishing valid measures, collecting data, and communicating results to reinforce and sustain the commitment to safer care. Measuring the safety culture through staff surveys before and after interventions such as walkrounds, team training, and education in communication techniques can provide both documentation of changes in attitudes about improvements in systems of care and a means of assessing the impact of interventions on culture change.
Seek leadership support to create a culture of safety throughout the organization. Gain support by providing data that demonstrates that communication problems are major causes of medical errors and information on how teamwork failures lead to malpractice claims and by sharing success stories of facilities that have affected patient safety by improving the safety culture.
Partner with clinicians and managers to assess the existing safety culture in the organization. Appoint a project team, accountable to a senior executive, to carry out the assessment using surveys, interviews, or other techniques.
Based on survey findings, formulate and execute an action plan to improve the safety culture. Establish valid measures to gauge the effectiveness of action plans.
Provide safety science education to frontline staff, managers, physicians, and organizational leaders. Include teamwork training and education in effective communication techniques.
Incorporate safety culture initiatives into the overall organizational patient safety plan. Ensure that patient safety initiatives, action plans, and results of interventions to improve safety are periodically reported to the board of directors.
Establish a nonpunitive system for reporting errors, events, and near misses. Consider implementing a reward-based reporting system, and ensure timely feedback to staff on how reports are used to improve patient safety.
Ensure that disclosure policies are in keeping with current regulations and standards. Work toward using disclosure with apology as a claim avoidance strategy.
Share information on improvements and successes based on safety culture changes to maintain enthusiasm for participation and support. Communicate plans to address areas still in need of improvement and other opportunities to enhance patient safety.
In conversation with Peter J. Pronovost, M.D., Ph.D. Web M&M 2005 Jun [cited 2005 Jun 10]. Available from Internet: http://webmm.ahrq.gov/perspective.aspx?perspectiveid=6.
Patient safety culture surveys [online]. [cited 2008 Sep 10]. Available from Internet: http://www.ahrq.gov/qual/hospculture/index.html.
Caleca B, Murphy D, Hill T, et al. Creating a system-wide core patient safety curriculum at BJC Healthcare. Poster at: National Patient Safety Congress; 2005 May 4-6; Orlando (FL).
COPIC Insurance Company. COPIC's 3Rs program [online]. [cited 2008 Aug 18]. Available from Internet: http://www.callcopic.com/home/resources-tools/newsletters/copics-3rs-program.
Dana-Farber Cancer Institute. Principles of a fair and just culture [online]. [cited 2008 Sep 10]. Available from Internet: http://www.dana-farber.org/pat/patient-safety/patient-safety-resources/docs/principles-of-a-fair-and-just-culture.pdf.
Healthcare embracing concept of the high-reliability organization. Risk Manage Rep 2005 Feb;24(1):8.
Incentives for patient safety: holding healthcare executives accountable. Risk Manage Rep 2008 Aug;27(4):8.
Teamwork takes hold to improve patient safety. Risk Manage Rep 2005 Feb;24(1):4.
Embedding a sustainable safety culture: focused approaches for leadership. Leadership Day. Presented at: National Patient Safety Congress; 2008 May 14-16; Nashville (TN).
Hendrich A, Tersigni AR, Jeffcoat S, et al. The Ascension health journey to zero: lessons learned and leadership perspectives. Jt Comm J Qual Patient Saf 2007 Dec; 33(12):739-49.
Hoff T. Establishing a safety culture: thinking small. Web M&M [online]. [cited 2008 Aug 5]. Available from Internet: http://webmm.ahrq.gov/perspective.aspx?perspectiveID=35&searchStr=safety+culture.
Improving Patient Safety: From Rhetoric to Reality [symposium]. 2003 May 28; Johns Hopkins University, Baltimore (MD).
Institute for Healthcare Improvement (IHI). SBAR technique for communication: a situational briefing model [online]. [cited 2005 Aug 3]. Available from Internet: http://www.ihi.org/ihi/topics/patientsafety/safetygeneral/tools/sbartechniqueforcommunicationasituationalbriefingmodel.htm.
Institute of Medicine (IOM). Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academies Press; 2001.
2009 accreditation requirements chapters. Accreditation program: hospital [online]. [cited 2008 Sep 19]. Available from Internet: http://www.jointcommission.org/NR/rdonlyres/8CCED568-76C9-4B3A-AC9C-B99FF0A2ED04/0/HAP_AllChapters.pdf.
Behaviors that undermine a culture of safety. Sentinel Event Alert 2008 July 9;40. Also available: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert.
Improving America's hospitals. The Joint Commission's annual report on quality and safety, 2007 [online]. [cited 2008 Aug 8]. Available from Internet: http://www.jointcommissionreport.org/pdf/JC_2007_Annual_Report.pdf.
2008 National Patient Safety Goals. Hospital program [online]. [cited 2008 Aug 8]. Available from Internet: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/08_hap_npsgs.htm.
Kitch BT. Patient safety culture: a review of survey instruments. Presented at: National Patient Safety Congress; 2005 May 6; Orlando (FL).
Kraman SS, Hamm G. Risk management: extreme honesty may be the best policy. Ann Intern Med 1999 Dec 21; 131(12):963-7.
Krause T, Dunn S. Motivating employees for safety success: what really makes a difference. Presented at: National Patient Safety Congress; 2008 May 16; Nashville (TN).
Landro L. Hospitals push to improve intensive care. Wall St J 2003 Sep 25.
Leape LL. Full disclosure and apology: an idea whose time has come. Physician Exec 2006 Mar-Apr;32:16-8.
Leape LL, Berwick DW. Five years after "To Err Is Human": what have we learned? JAMA 2005 May 18;293(19):2384-90.
Mansdorf Z. Organizational culture and safety performance. Occup Hazards 1999 May;61(5):109-12.
McCarthy D, Blumenthal D. Committed to safety: ten case studies on reducing harm to patients [online]. 2006 Apr [cited 2008 Sep 10]. The Commonwealth Fund. Available from Internet: http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=368995.
Michigan Health and Hospital Association (MHA). MHA Keystone: ICU [online]. [cited 2008 Aug 8]. Available from Internet: http://www.mhakeystonecenter.org/collaboratives/icu.htm.
Paine LA, Baker DR, Rosenstein B, et al. The Johns Hopkins Hospital: identifying and addressing risks and safety issues. Jt Comm J Qual Saf 2004 Oct;30(10):543-50.
Popp P. How will disclosure affect future litigation? J Healthc Risk Manage 2003 Winter;23(1):5-9.
Pronovost P, Goeschel C. Improving ICU care: it takes a team. Healthc Exec 2005 Mar-Apr;20(2):14-6, 18, 20.
Pronovost P, Sexton B. Assessing safety culture: guidelines and recommendations. Qual Saf Health Care 2005 Aug;14(4):231-3.
Pronovost P, Weast B, Bishop K, et al. Senior executive adopt-a-work unit: a model for safety improvement. Jt Comm J Qual Saf 2004 Feb;30(2):59-68.
Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety program.
J Patient Saf 2005 Mar;1(1):33-40.
Prybil L, Levey S, Peterson R, et al. Governance in nonprofit community health systems: an initial report on CEO perspectives [online]. 2008 Feb [cited 2008 May 2]. Available from Internet: http://www.americangovernance.com/americangovernance/files/2008%20Prybil%20Report.pdf.
Roberts KH, Madsen P, Desai V, et al. A case of the birth and death of a high reliability healthcare organisation. Qual Saf Health Care 2005 Jun;14(3):216-20.
Rose JS, Thomas CS, Tersigni A, et al. A leadership framework for culture change in health care. Jt Comm J Qual Patient Saf 2006 Aug;32(8):433-42.
Singer SJ, Gaba DM, Geppert JJ, et al. The culture of safety: results of an organization-wide survey in 15 California hospitals. Qual Saf Health Care 2003 Apr;12(2):112-8.
Studdert DM, Mello MM, Gawande AA, et al. Disclosure of medical injury to patients: an improbable risk management strategy. Health Aff 2007 Jan-Feb;26(1):215-26.
Summers K. Casting your net wide: an innovative process for closing the loop on risk management reporting Nurs Risk Manage 2004:7-16.
Thomas EJ, Sexton JB, Neilands TB, et al. The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical units. BMC Health Serv Res 2005 Apr 11;5(1):28.
University of Texas Center of Excellence for Patient Safety Research and Practice. Safety climate survey [online]. [cited 2008 Sep 10]. Available from Internet: http://www.uth.tmc.edu/schools/med/imed/patient_safety/Safety%20Climate-EWR.pdf.
Wojcieszak D, Banja J, Houk C. The Sorry Works! Coalition: making the case for full disclosure. Jt Comm J Qual Patient Saf 2006 Jun;32(6):344-50.
Hospital survey on patient safety culture. Available from Internet: http://www.ahrq.gov/qual/hospculture.
Patient safety Leadership WalkRounds™. Available from Internet: http://www.hret.org/walkrounds.
Culture of safety toolkit. Available from Internet: http://www.ihconline.org/toolkits/cultureofsafety.cfm.
Patient safety: the quality imperative [patient safety modules]. Available from Internet: http://www.jhsph.edu/ctlt/training/patient_safety.html.
Behaviors that undermine a culture of safety. Sentinel Event Alert. 2008 Jul 9. Available from Internet: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm.
Customized Excel™ data tool for AHRQ's Hospital Survey on Patient Safety Culture. Available from Internet: http://www.premierinc.com/safety/topics/culture.
Commitment to safety is articulated at the highest levels of the organization and translated into shared values, beliefs, and behavioral norms at all levels.
Safety is valued as the primary priority, even at the expense of "production" or "efficiency," and personnel are rewarded for erring on the side of safety even if they turn out to be wrong.
Communication between workers and across organizational levels is frequent and candid.
Unsafe acts are rare despite high levels of production.
There is openness about errors and problems; they are reported when they do occur.
Organizational learning is valued; the response to a problem focuses on improving system performance rather than on individual blame.
Source: Singer SJ, Gaba DM, Geppert JJ, et al. The culture of safety: results of an organization-wide survey in 15 California hospitals. Qual Saf Health Care 2003 Apr;12(2):112-8.
Reproduced with permission from the BMJ Publishing Group, London, England.
Source: Hospital survey on patient safety culture [online]. 2004 Sep [cited 2008 Nov 21]. Agency for Healthcare Research and Quality publication no. 04-0041. Available from Internet: http://www.ahrq.gov/qual/hospculture/index.html.
A number of healthcare organizations have achieved remarkable inroads in providing safer care for patients by focusing on improving the culture of safety, enhancing teamwork and communication, and implementing simplified processes to help avert errors and mistakes. Ten facilities dedicated to safety were profiled in a 2006 report by the Commonwealth Fund; the three case studies presented below are among the stories in the Commonwealth Fund report (McCarthy and Blumenthal).
Sentera Norfolk General Hospital (Norfolk, Virginia). The hospital implemented its ongoing intensive patient safety program, called the Sentara Safety Initiative, in 2002. Main goals of the patient safety program include reinforcing patient safety behaviors so that they become habit, creating a culture of safety extending to all staff and all departments in the facility, and making the changes "stick." The program concentrates on four fundamental areas: behavior-based expectations for healthcare staff, "red rules" representing the most important guidelines that staff must follow, simplified policies and procedures, and a root-cause and common-cause analysis process. Sentara's efforts earned the facility the American Hospital Association Quest for Quality Prize in 2004. This award is presented to organizations that go above and beyond expectations to create a culture of safety at their facilities.
Kaiser Permanente Anaheim Medical Center (Orange County, California). The medical center initiated a preoperative safety briefing project as part of a larger program of organizational learning in 2002 to promote effective teamwork and communication in high-risk areas. Briefings are structured interactions used to achieve clear, effective, and timely communication. Surgical briefings involving a multidisciplinary team at the facility were implemented to enhance basic patient safety practices for surgical site verification prior to incision. During the briefing, the surgeon communicates with the team and tells them what he or she thinks they need to know and then other team members tell the surgeon what they actually need to know. A surgical checklist is used to prompt team members in the briefing communications. After six months, no wrong-site surgeries were reported following implementation of the briefings, as compared with three wrong-site surgeries reported the year before. While firm conclusions cannot be drawn about the effectiveness of the intervention, a retrospective analysis suggested that the three prior wrong-site surgeries could have been prevented by the intervention. The perceived safety culture in the operating room, as measured by the use of a safety attitudes questionnaire before and after the intervention, improved by about one-fourth, from 51% to 63% of respondents reporting positive ratings. Positive perceptions of teamwork doubled, from 20% to 39% of respondents.
Concord Hospital (Concord, New Hampshire). The hospital implemented collaborative rounds involving all members of the cardiac surgery care team and the patient and patient's family to proactively identify and prevent errors and safety threats. During the rounds, a 10-minute daily briefing is held at every patient's bedside following a structured communication protocol. The process is focused on developing and reviewing the patient's plan of care, reviewing medications, recapping the patient's progress and needs, and clarifying responsibilities of cardiac surgery team members for various aspects of care. Following implementation of the collaborative rounds, mortality rates declined by more than half, to 2.1%, compared with an expected rate of 4.8%. Practice patterns and culture became more collaborative, and both providers and patients expressed greater satisfaction with the process than with traditional rounds.
Source: McCarthy D, Blumenthal D. Committed to safety: ten case studies on reducing harm to patients [online]. 2006 Apr [cited 2008 Aug 18]. Available from Internet: http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=368995.


Fez Sizing Using a CLOTH tape measure, have a friend put the tape around your head where you will wear the fez, and determine the INCH measurement. If you measure between sizes, then choose the larger size.
This is a Fez specific hat sizing chart.
For ring sizing, you can get sized by your local jeweler or visit our showroom. If you have any questions, please Email Us .
Copyright © 2010, Los Angeles Fraternal Supply Company (LAFSCO), Inc.


text:
'13 Reasons Why' Renewed for Season 3 — When and What to Expect With Its Return
Beth Dubber, Netflix
Just a few short weeks after its Season 2 release, 13 Reasons Why has been renewed for a third season.
Netflix announced the news via a teaser on Wednesday (June 6), revealing the teen drama will return with 13 episodes in 2019. Based on the show's timeline thus far, it should hit sometime in spring or early summer: Its first installment premiered in March 2017, and its second in mid-May of this year.
17 TWEETS ABOUT '13 REASONS WHY' SEASON 2 THAT WILL LEAVE YOU SO, SO EMOTIONAL
Though initially billed as a mini-series, 13's buzzy — if controversial — reception helped secure it a second run. It's faced heat for its approach toward heavy issues like suicide, sexual assault, and gun violence, with some arguing it goes too far and others contending the topics it broaches help to spark important discussion about the problems facing today's youth. Netflix, apparently, lands on the latter side of the debate.
RELATED: '13 REASONS WHY' CREATOR DEFENDS SEASON 2 RAPE SCENE
As far as where 13 will pick up next year, there were a lot of lingering questions left by its Season 2 finale. Likely, it will explore any consequences Tyler may face (and Clay, for covering for him), how he'll deal with his trauma and mental health moving forward, and what Chloe will decide to do regarding her pregnancy. Fans also shouldn't expect to see much more of Hannah (Katherine Langford): Executive producer Mandy Teefy said last month that, at this point, she couldn't see how the character's inclusion "wouldn't feel forced."
See the Season 3 announcement below.
Netflix Originals Still to Come in 2018
Source: '13 Reasons Why' Renewed for Season 3 — When and What to Expect With Its Return


text:
module Trim
  module Models
    class History < Sequel::Model
      dataset_module do
      end

      one_to_one :url

      def validate
        validates_presence [:url_id, :source_ip]
        set_created_at
      end

      def increment_redirects
        self.redirects += 1
        self.save
      end

      private

        def set_created_at
          self.created_at ||= Time.now
        end

    end
  end
end

redpajama_set_name: RedPajamaGithub


Custom designed contemporary two story home with great attention to detail and finishes. Many natural finishes including copper ceilings, granite counters, cherry cabinets, cherry floors and trim, solid wood doors and brick. Open design includes a spacious kitchen, large dining area plus a charming living room with woodstove. 3 room master suite has vaulted ceilings, den, stunning tiled bath and a private deck. Screened in outdoor living space and wrap around deck overlooking landscaping, yard and woods. A passive solar design in a private setting. Quaint 2 story barn for a multitude of uses.


'Bratzzata' (Pia Altenhofer, R. 2009). Seedling #07 B x Aq 3. MDB, 7" (17 cm). Early to midseason bloom. Standards and style arms signal white (RAL 9003); falls same, veined dark blue-lilac (4005) and curry (1027); beards signal white, hairs tipped melon yellow (1028); slight sweet fragrance. 'Boo' X 'Alsterquelle'.


text:
package it.milidoni.wespeak_online.listener;

import java.sql.SQLException;

/**
 *
 * @author Michele Milidoni <michelemilidoni@gmail.com>
 */
public class TestListener extends org.junit.runner.notification.RunListener {

    public TestListener() throws SQLException {
        System.out.println("TestListener void");
    }

}


PLEASE NOTE: Due to the weight of the stem and shape of the letter, the Letter J Light does not stand up unassisted. You may use double sided tape or picture hanging strips on the bottom to stand the light or the light can be hung on the wall. The price has been reduced to reflect this.
Letter J battery operated mini marquee LED light in white, comes with two modes Bright and Nightlight and can be hung or free standing.


WASHINGTON, DC – October 14, 2009 –—Though he vetoed many of the 700 bills on his desk, California Gov. Arnold Schwarzenegger showed safety is a top priority when he signed a key piece of pool safety legislation into law over the weekend. The law, which was sponsored by Bill Emmerson, R-Redlands, and Fiona Ma, D-San Francisco, provides a framework for local officials to enforce the federal Virginia Graeme Baker Pool and Spa Safety Act at the state level.
Assembly Bill 1020 makes pool safety easier than ever for Californian public pools by making it clear that it is not necessary to drain pools, install split or unblockable drains or embark on expensive upgrades. The law states that all existing public single-drain pools must be outfitted with an anti-entrapment device, such as a safety vacuum release system. All public pools regardless of how many drains must also be fitted with approved safety drain covers, regardless of how many drains the pool has.
Complying with the federal law can be done for as little as $1,500 now.
Pools that fail to comply with the VGB Act Federal face up $100,000 fines per infraction, up to $15 million for any related series of violations. Drain entrapment occurs when a swimmer becomes trapped by the suction power of a pool or spa drain, and often results in horrific injuries or death. To learn more about pool safety, contact us at www.poolsafetycouncil.org or (800) 970-8420.
The Pool Safety Council is a non-profit organization dedicated to the prevention of child drowning nationwide. For additional information, including guidance on Pool and Spa Safety Act guidance requirements, please visit our website at: www.poolsafetycouncil.org.
Top Story: New pool rules: A $29 million pain in the drain?


Irish racing is set to resume after the recent cold snap with Thurles on Thursday described as "good to go" while the following day at Leopardstown could yet see some late Cheltenham festival clues emerge.
However Thurles will have the day to itself after Navan's fixture was called off on Tuesday afternoon due to substantial amounts of snow remaining on the track.
Jessica Harrington is hoping Leopardstown's card on Friday doesn't suffer a similar fate. She hasn't ruled out a post-race school by the Gold Cup hero Sizing John while Willie Mullins has indicated his own 'Blue Riband' contenders could also use the opportunity for final festival preparations.
All of it depends however on the south Dublin track being raceable in time as parts of the course were unfit for racing on Tuesday.
Lorcan Wyer is clerk of the course at both Thurles and Leopardstown and while he gave the Co Tipperary course a definitive green light, Wyer is more cautious about Leopardstown's prospects.
"We're not fit for racing just yet. But we're on the right path. There's been a significant improvement in the last 24 hours. But we're not there yet," he said.
"Thurles is good to go on Thursday. There are no issues. They didn't have anywhere near the same volume of snow as up here but I was bowled over with the state of the ground. Mind you I don't think track records are in danger!" Wyer added.
Nevertheless the prospect of a resumption of racing here for the first time since Sunday week last will be a relief for many, perhaps none more so than Ruby Walsh.
The champion jockey will get an opportunity to get his eye in ahead of next week's festival action for which he is odds-on to be leading jockey once again. Walsh hasn't ridden in a race since breaking his leg in November but has resumed riding out at Willie Mullins's yard.
"I'm ready for action. I was hoping to go last weekend but the weather put a halt to that. Hopefully I'll be back Thursday or Friday with a bit of luck. I don't know what I'd be riding at this stage," Walsh reported.
It's been all-hands-on-deck at most racing stables during the last week trying to cope with the impact of snow and freezing conditions.
The timing of the extreme weather couldn't have been much worse in terms of Cheltenham preparations but Willie Mullins believes his massive festival team escaped "reasonably light".
Nevertheless the champion trainer is keeping his fingers crossed that conditions at Leopardstown recover in time for Friday's meeting.
"I'd imagine we could definitely send some of the Cheltenham horses there to work after racing, depending on the weather. It's a bit close [to the festival] but we could send some of the horses running on the Thursday and Friday of Cheltenham," he said on Tuesday.
The fitness screw is being tightened on Mullins's hopefuls including Douvan who the trainer said is not finished his work ahead of a first start in a year in the Queen Mother Champion Chase.
"I'd say we've got away reasonably light with the snow. I'm able to put covers down on the gallop and we were able to get the snow off it.
"The staff were tremendous because there's a lot of extra work with snow and it was a major effort on their part," Mullins said.
Mullins is a 6-4 favourite to reclaim Cheltenham's leading trainer award from his great rival Gordon Elliott who beat him on a countback of placed horses in 2017.
A racecourse gallop has been on Sizing John's agenda for some time as he prepares to defend his Gold Cup crown on Friday week. Jessica Harrington hasn't ruled out Leopardstown as an option for that workout.
"We may go to Leopardstown on Friday evening to give him a jump and a gallop. I'm not certain; it will depend on what the weather does. We seem to be on course with him," she said.
Parts of the track at Naas are still partially covered with snow ahead of their scheduled Sunday card which includes the Grade Three Directors Plate Novice Chase.
A total of 14 entries remain in the two-and-a-half mile contest after Tuesday's forfeit stage, including five each from Willie Mullins's yard and Michael O'Leary's Gigginstown Stud team.
Mullins's options include the Grade One-winning hurdler Saturans and the course winner Demi Sang. The latter was fourth to his stable companion Footpad in the Irish Arkle last time after making a bad mistake at the first fence.
Sunday's feature is the €100,000 Toals Leinster National which has 25 left in it. They include topweight Baie Des Iles and Paul Nolan's Fine Theatre.
"He ran a respectable race in the Thyestes and I'd be hopeful he could run well at Naas if things go right for him," said Noland.


During christening ceremony at Fincantieri's Sestri Ponente shipyard, founder Sir Richard Branson and Virgin Voyages president and CEO Tom McAlpin announced the company will eliminate single-use plastics and focus on opportunities for women in jobs that historically have been dominated by men.
The Scarlet Lady will hold 2,700 passengers – or sailors as they are called on Virgin Voyages – and 1,150 crew members. There is no upper age limit, but the ship's features speak to a younger crowd: a state-of-the-art nightclub, boxing ring, running track and an oversized gaming area.
Virgin Voyages currently has three ships on order with Fincantieri. Each of the ships will be 912 feet long and 125 feet wide. The fleet will be known as the 'Lady Ships'. All first three ships will be adult-only. Virgin Voyages has stated there may be plans for family-friendly ships in the future. 86 percent of all cabins come with a sea terrace and 93 per cent with an ocean view. The exterior will feature a silver-grey hull and smoked glass. The vessels will convert heat from their engines into electricity, reducing carbon dioxide. Scarlet Lady will arrive at PortMiami in 2020 for her inaugural sailing season, where she will sail to the Caribbean with her first itineraries set to go on sale towards the end of 2018.
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Italy's Mount Etna spews the ash and smoke in Sicily, Italy December 24, 2018.
On Saturday night, lava could be seen erupting into the air before flowing down the mountain, with seismic activity continuing well into Monday. Italy's National Institute for Geophysics and Volcanology said that around 130 earthquakes have been rocking the volcano since 08:00 GMT.
Etna, which stands at 3,330 metres, can experience several eruptions in a year, but the last major eruption hasn't occurred since 1992.
More than 100 tremors have rattled the inhabited slopes of Mount Etna this week, with the most powerful quake registering a magnitude of 4.3.
This weekend's eruption is one of many which have occurred this year, the most recent taking place in November.
Hikers were brought down from higher elevations to 1,900 meters (6,230 feet) for their safety.
A large explosion was felt close to Etna during the morning.
The occupants of 150 units in a 392 unit complex were displaced after an internal wall in the 36-storey Opal Tower failed. About 300 people have been evacuated from the building and surrounds, while a one kilometre exclusion zone is in place.
The Iraqi prime minister recently said Iraqi troops could deploy into Syria to protect Iraq from threats across its borders. Trump's decision comes one week after pulling troops from Afghanistan and Syria.


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Seasonal work and the shadow economy of Armenian agriculture
By Ampop
(Armine Avetisyan /Ampop)
One in five workers in Armenia is employed in informal sector, many of them in agriculture. Lack of employment contracts often subjects them to Labour Code violations by employers.
For 17 years, Rima Aleksanyan has been working from early spring until mid-autumn. She is an agricultural worker.
'Here are potatoes and here are beans. Strawberries are over there. I handpick beans one by one, sort them and then send for sale. I love both my colleagues and my job. We talk and work with other girls', Rima says.
Rima's job is seasonal. Because of the weather and climate, she works for a period not exceeding eight months within a year. The Armenian government has compiled a list of 20 jobs it considers seasonal. Aside from agriculture-related jobs, the list contains occupations linked to road construction, asphalt paving, food stalls, and forestry.
Seasonal jobs in agriculture are the most inclusive ones, because it is done not only by villagers, but city dwellers as well. In August 2017, the State Employment Agency recorded 90,000 unemployed people. Some of them found seasonal jobs throughout the year.
'There are workers from everywhere in Armavir, especially during the harvest period. There are people from Yerevan too. It's an environmentally friendly job, involving work in the soil and harvesting, and avoiding any chemicals. We get ֏5000 ($10) a day', Rima says.
She works in a one-hectare bean field with 11 other women. She says that up to now she hasn't faced any job-related issues.
'We work eight hours a day. We have our break, get a normal lunch and take coffee-breaks. We are not slaves, who work without any rest. We even have a first aid kit if someone has headache. We don't neglect our duties. Take a look at the beans that we've selected for the market', the woman says.
Rima assures that she has a legal contract that regulates her relations with the employer. However, she thinks that personal honesty is of no less importance. She says that she even forgets that there is a contract at all.
'Our employer is a good person. I'd work even without the contract. We can negotiate things even outside the law. And he works with us here', Rima explains.
The share of informal jobs in Armenia is quite large. Agricultural work is considered informal, too. Informal employment arises because the state does not succeed in creating necessary conditions for enough formal jobs. Thus, people who need jobs look for informal employment.
'We don't have any issues although we've never had a contract', says another woman working on an agricultural field. She thinks that she would have much less disposable income had she had to pay taxes.
So the workers' rights are abused: they get a low salary and do not have social security. In other words, the demands of the Labour Code are not met. 21% of workers in Armenia's villages have informal jobs.
Hasmik Jhangiryan, the president of the Branch Republican Trade Union Organisations of Workers of Agroindustrial Division of the Republic of Armenia knows many examples of issue arising in the absence of a work contract.
'Several workers contacted us, telling that their employer had not paid their wages. There were two issues: firstly, they had no contracts, and secondly, they were not members of our union. We hurried to help them, though we had no legal leverage', Jhangiryan tells.
After investigating the case, it turned out that the workers had damaged the equipment of the employer, she explained. This is why the employer refused to pay them. The parties, however, followed the advice of the union and signed contracts, reaching an agreement both over wages and over damage compensation. However, Jhangiryan says that an agreement is not always reached.
'When there is no contract, it is very tough. First of all, one needs to prove that the person really works there. A co-worker's testimony is not sufficient for that. A document must certify that the person received a salary', says Tigran Kirakosyan, an expert on labor relations and human resource management.
Without a contract, a dishonest employer can easily avoid both having to pay a salary and taking any legal responsibility.
The state must come up with a favourable tax policy for the agricultural seasonal jobs. The income tax must be lowered, so that the sphere comes out of the shadow. Otherwise, the employee will yield to the the conditions imposed by the employer and sacrifice their legal guarantees and social condition for the sake of avoiding taxes.
Tigran Kirakosyan, expert on labour relations and human resource management
Under Article 100 of Armenia's Labour Code, a seasonal worker who has a contract either gets a paid vacation or a compensation equivalent to two-day salary for every month if their contract is annulled. Both the employee and the employer have the right to prematurely terminate the contract with a three-day written notice.
Many people think that a seasonal job contract is different from an ordinary one and provides less guarantees both for the employer and the employee. However, according to the Labor Code, there are only two differences:
The term of the seasonal contract can range between one day and eight months (it does not have to be a contract of indefinite duration);
The premature termination notice period can be as short as three days (instead of two months).
Otherwise, the two contracts are identical in terms of rights and guarantees both for the employer and the employee. Thus, the employee has the right to a fixed workday, a minimum wage, a vacation (including a paid vacation every year or a compensation), extra pay for night-shifts or overtime work, appropriate working conditions, and the registering of their work experience as official.
This article is a partner post written by Armine Avetisyan and edited by Suren Deheryan. The original version first appeared on Ampop, on 5 November 2017.
Ampop is an Armenian data reporting platform specialised in explanatory journalism and data visualisation.
#agriculture
#Armenia
#informal sector
#labour
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Editorial: No air conditioning? Not cool.
There's no doubt that students are enjoying the colder weather these days, if it means that their rooms won't feel like 100 degrees. One of the most infamous complaints of this semester is about first-year, second-year and the property management residences not being air conditioned. Though people will argue that students can do without air conditioning, the effect of global warming has made air-conditioning more of a need than a want.
In 2010, the Scientific American published a piece about the effects of the hot weather on human bodies. It turns out that it isn't just the heat: It's the combination of heat and humidity than can have a negative, even fatal, impact on our body systems. Normally, on a hot day, our bodies perspire and the sweat helps us cool off, but the humidity prevents the sweat from drying easily, making us hotter and more tired. With this all in mind, it's important to think about future students, especially with the possibility of Cleveland weather getting worse and worse every year.
There aren't many options to turn to when it gets impossibly humid. Students can hide away in the university's air-conditioned buildings during the day. They can also request air conditioning from Disability Resources if the weather becomes medically dangerous, but they need to have a medical professional sign off in order for the university to allow it. Additionally, if it was that easy to request an air conditioning unit, most of us would have it. Other than that, there are not many options for students to escape the heat and humidity.
In terms of the changes we've seen in construction on campus, there have been many, but none of them have had to do with air-conditioning in first-year, second-year and property management residences. The Tinkham Veale University Center, for example, opened in 2014 and became a hub for students during the day. Last year, in the fall of 2015, the Stephanie Tubbs Jones Residence Hall was built, welcoming upperclassmen into a modernized—and cooler—home that looks a lot like a hotel. And just this year, and maybe forever, there has been construction on Mather Quad to rectify several older buildings that house arts and sciences courses.
Why couldn't all this money be directed towards adding air conditioning to older housing that still serves as a home for a majority of students on campus?
A lot of the construction that has occurred on campus so far seems to be about presentation. All of the pretty new additions are modernized—see Stephanie Tubbs Jones Residence Hall's common space— pretty—see the Tinkham Veale Center's large windows—and even impressive—see Sears think[box], which opened last year. However nothing would be cooler than providing a basic necessity for students, most of whom are just entering Case Western Reserve University and trying to put their lives together. Sometimes it's hard to figure out what major to declare when you're sitting in the type of weather that's akin to a tropical forest.
As we continue to see structural changes throughout campus, we'd like to be updated on why these structures are a priority over our housing. Surely the university will one day change the older residence halls, but until then, we'll just be here, chilling—but not really.
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A wide field fast imager for exoplanet transit timing camera (RISE2) designed by Prof. J. Meaburn. The camera was designed and built by Queen's University of Belfast, Liverpool John Moore's University.
The RISE2 cookbook is available here and the Quantum Efficiency (QE) of the ccd camera is available here.


Questioning Parks' Priorities – Another Citizen Speaks Out about Ashland Parks & Rec Commissioners – A Must Read!
I encourage those who have a deep and abiding love for this park to pay close attention because there is a connection between the recent changes to Ashland's senior program and the fate of our precious park. Within days of passing "recommendations" that essentially ripped the heart out of the 43-year-old senior program, the current director of APRC, Michael Black, then went before the City Council asking for $230,000 to pay a Portland consultant for a plan that will affect Lithia Park for the next 100, yes, 100, years.
Having volunteered and worked part-time for the Senior Center and seen firsthand the mess made of the formerly-robust program, I have little faith in how the current APRC will handle the future of Lithia Park. According to a Tidings article (Aug. 17), Michael Black calls it "a ginormous plan," citing the historic Perozzi fountain as the first project. Black says, "We want to restore and ensure it perseveres," yet in the same article he states that it might be moved inside or replaced with something new; that it will be based on what the consultant recommends. How about basing it on what the people of Ashland recommend? (Other areas: the bandshell, "neglected" rose garden, Japanese garden, tennis court, walkway system, century-old log cabin, etc. (http://www.dailytidings.com/news/20170817/council-oks-230k-lithia-park-study).
I don't shock easily. But the condescension with which the public was treated by the APRC Commissioners at the meetings of Aug. 8 and 9 was offensive. Many seniors, in spite of great physical difficulty, attended the meetings, as well as nurses, social workers, grant writers, volunteers with Meals on Wheels, and family members. The commissioners' disdain toward the needs of the seniors was, in the words of one senior, "stunning." Commissioner Michael Gardiner (Aug. 8) stated, "… quite frankly, I've already made up my decision. I made my decision up before this meeting." That is, before the public had even had a chance to speak.
Have these men forgotten they are public servants? All of them ran unopposed for their seats. Now they are in charge of a $9 million yearly budget, making life-altering decisions with enormous consequences for our city. Yet they chastise the public and seniors, as I witnessed, for daring to speak out against their own appalling lack of understanding or respect for a vital social service program and those it serves. The commissioners were all repeatedly invited to come by the center, to have a Food & Friends lunch in the dining room, to talk with elders. I have been told that not one ever did.
It is not about Commissioner Jim Lewis's astonishingly patronizing words, "I know change is scary." It is about our right to question bad decision-making, not based on genuine, transparent public input. We might also question why Michael Black, who doesn't live in Ashland, receives a yearly salary ($189,000 including benefits) which is higher than the yearly budget of the senior center ($175,000, which included the salaries of the entire previous experienced staff of five).
These men may have never needed help paying their utility bills, or a subsidized warm meal, or other social safety net services. But there are some inescapable truths in life that will catch up with them: everybody either has aging parents, or they are going to get old themselves. Time catches up with all of us.
And that brings me back to Lithia Park. We have the right to hold Mr. Black and the APRC Commissioners accountable and to challenge them. I beseech you to ask yourself: is this who you want in charge of Lithia Park's vision for the next 100 years?


In our last update, we announced that installations were underway in Phase 3 of the Westminster Fiber Network. Construction continues and is partially complete in Phase 3, with the City having finished most of their work in the area.
All of Phase 3 can fill out an access agreement and order Ting service.
Remember, if you want Ting, you have to do both of those things.
There's two areas of Phase 3 where construction action has slowed down. These areas are known as Areas E and F in the city's build plan.
We're almost ready to start installing homes in Areas E and F. The only thing preventing the City and Ting from lighting up customers is a permit from the railroad allowing fiber lines to cross it. This is important because the connection to the greater Internet for your home happens at the new Central Office that was erected in front of City Hall.
To keep the ball rolling, the City of Westminster has decided to construct fiber drops to homes. If you live in this area and you've pre-ordered Ting and signed your access agreement, a fiber drop will be brought to your home in the near future.
If you live one one of the following streets in Phase 3, you already have or will be getting a notice about this drop via email.
Area E: Carroll St, Hersh Ave, James St, John St, Kemper Ave, East Main St, Marbeth Hill, Milton Ave, Monarchs Dr, Monroe St, Pennsylvania Ave, Union St, Ward Ave and Wimert Ave.
Area F: South Center St, North Church St, North Court St, Distillery Dr, Locust Ln, Locust St, Longwell Ave, on East Main St from 270 and below, Railroad Ave, Tuc Rd, Willis St.
Please understand that this drop will not be live. We won't be able to schedule your Ting Internet installation at this time, but rest assured, once the network is live in your area, we'll let you know and our customer service team will be ready to get your installation scheduled as soon as possible.
Construction has officially begun in Phase 4. The City of Westminster is hard at work putting all the necessary infrastructure in place to bring fiber to homes and businesses in the area. Look out for the city's crews and give them a wave.
If you're located in Phase 4 and want Ting, don't forget to pre-order and sign your access agreement.
A pre-order is a one-time $9 charge that is refunded to you on your first Ting bill.
When you pre-order Ting gigabit service by the deadline, you get $200 off your start-up costs (including installation and your first bill).
When you pre-order Ting 10/10 service by the deadline you get $50 off your start-up costs (including installation and your first bill).
The deadline to pre-order in Phase 4 is December 31, 2018.
An access agreement gives the city and its contractors permission to bring a fiber drop to your home or business. A fiber drop is the last bit of fiber that gets you connected directly to the network.
Once your address is ready for fiber, the city will bring the fiber drop to be installed at your property when you decide to purchase Ting services.
You can fill out an access agreement right from our website when you're going through the pre-order process.
The Ting Team attended the chamber of commerce golf tournament on July 13 and had a booth at the Westminster Farmers Market on July 14 and 28, plus August 11 and August 18. We had activities for kids while their parents shopped.
On July 24, the Ting Team hosted an information table at the Carroll County Arts Center movie night. The film screened was The Princess Bride.
Ting Marketing Director, Trish McLean was a judge for this year's Carroll Biz Challenge. Ting is a founding sponsor and we always love to hear all the exciting pitches coming out of Carroll County entrepreneurs and business owners. A huge congratulations goes out to Grand Prize winner and People's Choice Award winner Brewery Fire.
On August 18, the Ting Team participated in a Habitat for Humanity build. Along with Habitat staff and the home's future residents, we spent the day painting doors, molding, installing baseboards and filling nail holes. The residents will have a beautiful home when the restoration is complete and we're proud to have been a part of it.
Ting participated in the Shepherd's Staff Back to School drive, taking donations of back to school supplies to help kids in need in the Carroll County area.
Ting is a presenting sponsor of this year's Fallfest! Join Ting and your community from September 27 to 30 for special events and entertainment. We'll have two Ting booths, one at the entrance and a larger tent inside hosting different games that showcase Ting gigabit Internet. The Ting Makerspace will be open during Fallfest too. Swing by or check out the calendar for fun events this fall.
Follow Ting in Westminster on Facebook, Twitter and Instagram.
Did Ting ever feel like quitting?
Does Ting Internet ever hire people from outside a Ting town?


Ever wondered what's going on inside of wood? Brett Foxwell has. Fascinated by the material, him and musician bedtimes created a short film called WoodSwimmer in which they follow a piece of raw wood through a milling machine. The blend of wonderful textures and layers has been captured on an animation camera. "Fascinated with the shapes and textures found in both newly-cut and long-dead pieces of wood, I envisioned a world composed entirely of these forms," Foxwell told our friends over at Colossal. Definitely worth watching.
This summer is all about white trainers – they're literally everywhere. But these retro Apple trainers are way cooler than anything the summer collection 2017 has to offer. Designed in the 1990s for Apple store employees, only two pairs of these iconic 'Computer Sneakers' are believed to be left worldwide. All the more reason to keep an eye on Heritage Auction where one pair is due to be sold the next week. The bids start at £11,590. Thanks to our friends at The Memo who love the 'Airmax'-style soles, the chunky tongues and the classic striped Apple desktop logo!
If you're planning a trip to Barcelona, the Casa Vicens is one for the must-see list. After two years of renovation, Antonio Gaudís first built house will shortly be open to the public. The 19th century building originally belonged to a tile manufacturer and was used as a summer home. With great attention to detail Spanish architects led by José Antonio Martínez Lapeña and Elías Torres renovated the entire building and restored the beautiful ceramic elements. From now on, it will also display many of Gaudís original designs and host exhibitions.
Climate change affects nature in ways most of us aren't even conscious of. Bee colonies are a great example of this in that they are in real danger of collapse as they struggle to adapt to a new and more volatile environment. Enter Bait Hive… Created by British designer Joshua Akhtar, the flat pack uses a targeted scent to attract swarms of bees searching for a new home, and ensures that they nest in the most suitable locations.
Ever imagined what an empire's tube map would look like? ...no? ...neither have we. Thankfully though, Sasha Trubetskoy from the University of Chicago has taken on the burden so we don't have to. Using data from various different locations, he's plotted the entirety of the Roman Empire circa 125 AD on a nifty subway-style map. Rome built over 250,000 miles of road and this is evident on the map which stretches all the way from Petra to 'Londinium'… Sound familiar?


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