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Special Communication | August 2008
Emergency Department Tobacco Cessation Program: Staff Participation and Intervention Success Among Patients
Marna Rayl Greenberg, DO; Michael Weinstock, MD; Deborah Gaston Fenimore, LSW; Gina M. Sierzega, MBA
From the Lehigh Valley Hospital in Allentown, Pa.
Address correspondence to Marna Rayl Greenberg, DO, 1909 Earls Ct, Allentown, PA 18103-6980. E-mail: mrgdo@ptd.net
Addiction Medicine / Emergency Medicine / Preventive Medicine
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 391-396. doi:10.7556/jaoa.2008.108.8.391
Figures Only
Greenberg MR, Weinstock M, Fenimore DG, Sierzega GM. Emergency Department Tobacco Cessation Program: Staff Participation and Intervention Success Among Patients. J Am Osteopath Assoc 2008;108(8):391–396. doi: 10.7556/jaoa.2008.108.8.391.
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Context: The emergency department (ED) is often the primary source of healthcare for uninsured and underinsured patients.
Objectives: To evaluate ED staff attitudes toward and participation in referring patients to a tobacco cessation program, and to assess the program's effectiveness.
Methods: A nonvalidated survey on smoking cessation and preventative services for ED patients was mailed to ED staff at a suburban hospital. After survey completion, ED staff was encouraged to refer smokers with diagnoses substantially worsened by tobacco use to a brief intervention delivered in the ED. An incentive was provided to staff beginning in the second month of the 3-month period. Referred patients were briefly counseled by a hospital social worker or an ED physician or nurse. Follow-up telephone interviews with patients occurred 1 to 3 months postintervention.
Results: Of the 70 ED staff contacted, 63 (90%) responded to the survey. Most staff members (81%) agreed that they should facilitate clinical prevention. Fewer staff (60%) were comfortable advising patients to quit tobacco use (P<.03), and fewer still (51%) agreed that ED staff should assist patients in tobacco cessation (P<.001). Tobacco users were more likely to favor implementing patient education in the ED (P=.01) and were less comfortable advising patients to quit (P=.06). Staff referrals increased with program incentives (P=.008), with a total of 150 interventions occurring in the 3-month span. Of the 36 patients (24%) reached for follow-up, 13 (36%) attempted to quit and 6 (17%) succeeded. Overall, 45% of the patients reached for follow-up either cut down or quit tobacco use.
Conclusions: Staff members' attitudes toward tobacco cessation are not a firm barrier to the successful implementation of an ED tobacco cessation program. In addition, the ED provides an important opportunity to encourage patients to quit or cut down tobacco use.
Adult racial and ethnic minority populations, Americans living in poverty, and younger patients are more likely than other US populations to use the emergency department (ED) as their primary source of healthcare.1 In addition, the prevalence of tobacco use among ED patients, who are most often from such patient populations, is high.2,3 Surprisingly, even though nearly half of ED tobacco users are "ready" to quit, many state that they have never been told to do so by a physician.1-4 In fact, one study5 revealed that although most physicians discussed tobacco use habits with patients, only 56% of such discussions included advice to quit.
Considering these data, the effectiveness—and appropriateness—of preventive health measures implemented in the ED is frequently discussed.1-12 Although a consensus statement on the value of such programs remains to be seen, the ED continues to be a safety net for indigent and underinsured patients.1,13 If clinical preventive services are demonstrated to be effective and time-efficient, ED healthcare providers might be more likely to deliver such services, therefore positively impacting the health of the community.
Staff attitudes toward the delivery of ED preventive and public health services are a potential barrier not only to the willingness of staff to participate in such programs but also to the success of an intervention program. As part of a community service project, the present study sought to evaluate how ED staff attitudes toward community service, patient education, and preventive health affected their participation in referring patients to an ED tobacco cessation program. The success of the intervention in decreasing tobacco use among patients was also assessed.
The institutional review board at Lehigh Valley Hospital in Allentown, Pa, reviewed the present study's methods. Because it was determined to be minimal risk as a patient education and evaluation project, the current study was exempt from full review. Also, because the outcome measures were dependent on patients' self report and because patients' knowledge of participation in the study may have resulted in artificially inflated results, patients' consent was not obtained.
In 2001, a nonvalidated survey was mailed to the ED staff at the Lehigh Valley Hospital. A second mailing was sent to staff who had not yet responded 1 month after the first mailing. The ED nurse responsible for coordinating patient care and the primary investigator (M.R.G.) provided e-mail and verbal reminders to ED staff. A 90% response rate was used as the survey endpoint.
The 8-question survey asked respondents to rate their agreement with statements regarding their role in patient education and disease prevention. A 1 to 5 Likert scale was used, with 1 indicating "strongly agree" and 5 indicating "strongly disagree." Respondents were also asked to indicate their job title (eg, nurse), years working in an ED, and personal tobacco use. Although staff members did not include their names, each survey was numbered to track responses.
After all completed surveys were received, an educational session was provided by Coalition for a Smoke Free Valley, a community agency that sponsors professional healthcare training and education in accordance with the standards set by the National Cancer Institute.14 This session was designed to increase ED staff's knowledge about tobacco use and intervention as well as to provide guidelines for the implementation of a tobacco cessation program. Attendance was encouraged but not required. Departmental meetings and informal updates were used to reinforce the teachings from this session.
Program Implementation
Patients were eligible to participate in the tobacco cessation program if they were 18 years or older and if they used tobacco. In addition, ED staff physicians recommended inclusion criteria based on diagnoses that might be adversely affected by continued tobacco use. Although all patients were eligible for the intervention, those who presented to the ED with heart disease, gastritis, pregnancy, or a respiratory illness were targeted by ED staff. These patient popluations were selected by ED staff physicians for two reasons: (1) to help those patients who would receive the most benefit from reduced or ceased tobacco use, and (2) to narrow the patient population so that adequate staff would be available to administer the interventions. Patients were excluded from participation in the program if the severity of their condition precluded intervention.
To determine patient eligibility, staff members (ie, physicians, nurses, and administrative and technical partners) simply asked patients—particularly those with the previously defined conditions—if they were tobacco users. If a patient said yes, he or she was referred to the cessation program. The intervention was provided within the physical space of the ED proper and was administered by an onsite social worker, when available. In the event that a social worker was not available, an ED physician or nurse administered the intervention.
For the first month after program implementation, ED staff was encouraged simply to refer patients to the intervention program. In the second month, a gift basket valued at approximately $100 was displayed within the ED as an incentive for staff participation. Gift baskets were awarded to the doctor and to the nurse or other staff member who made the most referrals into the cessation program. Weekly referrals were tallied, and the winner-to-date was posted prominently within the department and distributed via e-mail to further encourage competition for the basket.
The number of referrals to the tobacco cessation program was assessed for the month before and the 2 months after the incentive. Participation was evaluated not only for the number of referrals or consults done but also in relation to the total number of hours an employee worked in the department during the specified time period. Survey responses and personal tobacco use among staff were evaluated to determine potential influences on staff participation in the tobacco cessation program.
The tobacco use intervention consisted of a 1-page, nonvalidated form to record and assess tobacco use attitudes and behaviors among patients. The form, which was already in use for inpatient consultations throughout the hospital, consisted of the items listed in Figure 1. As it did after inpatient consultations, the completed form became a part of the ED patients' permanent medical records.
The intervention administrator assessed and determined patients' "impression stage of change" for tobacco use cessation to be in one of the following categories: precontemplation, contemplation, preparation, action, or maintenance/relapse prevention. Depending on this initial impression, the administrator provided an appropriate action (eg, education on health risks) and recorded a treatment plan. For example, if a patient was determined to be contemplating tobacco cessation, he or she would be instructed on the various quitting methods and programs available and then would be advised to contact the Center for Health Promotion and Disease Prevention when he or she was ready to quit tobacco use.
Staff was instructed to provide additional encouragement and resources (eg, educational brochures from the National Institute of Health) to patients in preparation and action stages when time permitted. Information provided to patients was recorded on the intervention form. Staff was also asked to obtain the name of the patient's primary care physician when available and include it in the "Comments" section of the intervention form. If a primary care physician was indicated in the form, ED administrative staff sent him or her a form letter regarding the patient's evaluation and treatment. The form included the ED's telephone and fax number in case the primary care physician wanted additional information.
Staff was encouraged to conduct the intervention during "dead" time (eg, when the ED was backed up and wait times were long) to minimize disruption of flow within the ED or any delay in the discharge of the patient. Total time allocated to the intervention was not recorded. Although a 2- to 3-minute intervention was described as ideal, as little as 30 seconds was considered influential, as indicated in previous studies.15,16 Variability in actual time spent on the intervention was expected by nature of the logistics.
Components of the intervention form used in the tobacco cessation program implemented at the emergency department at Lehigh Valley Hospital in Allentown, Pa.
View Original | Slide (.ppt)
Follow-Up Telephone Survey
Telephone follow-up with patients occurred 1 to 3 months after the intervention. The primary investigator (M.R.G.) attempted to reach all patients. For those patients reached, the following five items were assessed and recorded:
the patient's overall attitude (positive or negative) toward tobacco cessation
whether or not an evaluation by a primary care physician occurred since the ED visit
the patient's attempts to cut down or quit tobacco use since the ED visit (indicated by "Yes," "No," or "Cut Down," with recorded current tobacco use)
the patient's stage of change (precontemplative, contemplative, etc)
whether or not the caller instructed the patient on available tobacco cessation programs
Responses to the ED staff survey were dichotomized into agree (scores of 1 or 2) and did not agree (scores 3, 4, or 5) and reported frequencies between individuals' mean attitudes toward the four general questions and the two tobacco-specific questions. Attitudes were compared between "nonsmokers" (tobacco-free for at least 1 year) and "smokers" (tobacco use within the past year). Respondents were also dichotomized above and at or below the median for the mean score of the general ED questions and opinions regarding personal effectiveness in improving patients' health through preventive measures.
Results were confirmed using the general linear model to adjust results for gender, length of ED employment, and job role. However, because we found no differences when controlling for these variables, we only report the results of univariate analyses. We reported confidence intervals (CI); however, our analysis included P values by using the paired t test when comparing responses from the same respondents and when comparing responses across groups. When comparing multiple-item scales, we verified the equality of variances before reporting results, using .4 as a minimal P value for the test of equivalence. Findings were consistent in both forms of analysis.
Generalized estimator equations analyzed univariate and multivariate relationships between individuals' attitudes and the number of referrals to the tobacco cessation intervention program. However, the relationship of the attendance at the educational session to referral patterns was not assessed because of the staff's documented high attendance.
Staff Survey and Referral Participation
A total of 63 (90%) staff members—comprising 29 (46%) attending physicians, 16 (25%) nursing staff, and 18 (28%) administrative and technical partners—responded to the ED survey (Table 1). Nearly half of the respondents (46%) admitted ever having used tobacco (smoked cigarettes, cigars, or both) on a regular or occasional basis. Time working in an ER ranged from less than 1 year to 20 years or more. In general, staff agreed that the ED was appropriate for patient education (79%), preventive health activities (81%), and community service programs (78%). Staff attitudes were also favorable toward educating patients about preventive health (76%) (Table 2).
Characteristics of Emergency Department Staff (n=63)
No. (%)*
▪ Job Title
□ Physician 29 (46)
□ Nurse 16 (25)
□ Other 18 (28)
▪ Years Worked in Any Emergency Department
□ Less than 1 9 (15)
□ 1-5 16 (26)
□ 6-10 13 (21)
□ 11-19 14 (23)
□ 20 or more 10 (16)
□ Unknown 1 (2)
▪ Tobacco Use†
□ Cigarette 29 (46)
□ Cigar‡ 4 (6)
□ Other (eg, snuff, pipe, chew)
*Percentages may not total 100 because of rounding.
†Data reported for tobacco use includes respondents who reported previous tobacco use (>1 y ago), as well as current or recent tobacco use (any tobacco use in the past y). Current or recent tobacco users totaled 19 (30%).
‡The 4 cigar smokers were also cigarette smokers.
Emergency Department (ED) Staff Agreement With Survey Statements* (n=63)
Agreement, %
▪ Our ED should participate in patient education. 79
▪ Our ED and its staff should have a role in community service. 78
▪ Our ED and its staff should facilitate clinical prevention when possible. 81
▪ I am interested in helping to educate my patients and the community in preventive health. 76
▪ Our ED staff should help people to stop using tobacco. 51
▪ I feel comfortable with advising people to quit using tobacco. 60
▪ We should do more education, prevention, or community service projects to assist patients to improve their health. 69
▪ I feel my efforts toward patient education, prevention, or community service projects could make a direct impact on a patient's health.
*Respondents were asked to rate their agreement with these questions based on a 1 to 5 Likert scale, with 1 indicating strongly agree and 5 indicating strongly disagree. For the present study, a response of 1 or 2 was considered "agree."
Seventeen respondents were less favorably disposed to the ED as a site for prevention than the median score for the four-item construct. These respondents were less comfortable with tobacco education in the ED (two question mean, average difference, 1.5; 95% CI, 0.9-2.0), felt less able to impact patient health through education, prevention, or community service (mean difference, 1.5; 95% CI, 1.0-2.0), and were less comfortable advising patients to quit tobacco use (mean difference, 1.7; 95% CI, 1.0-2.4). These respondents represent sizable differences on a 5-point scale. In addition, the seventeen respondents who had less than the median belief in their effectiveness were less likely to have favorable attitudes toward a smoking cessation program (mean difference, 1.6; 95% CI, 1.0-2.1). These respondents also expressed much less interest in providing preventive health education (mean difference, 1.3; 95% CI, –0.8-1.8).
A total of 19 staff members (30%) reported current or recent tobacco use (ie, at least once in the past year) in the form of cigarette and cigar smoking. These respondents viewed the ED's role in prevention and community service more favorably, though this difference was not statistically significant (mean difference, 0.4; 95% CI, –0.2-0.9). Smokers were less likely to support tobacco cessation in the ED (mean difference, 0.5; 95% CI, –0.1-1.2) and were much less likely to feel comfortable advising patients to stop smoking (P=.06; mean difference, 1.0; 95% CI, 0.2-1.7). By statistical analysis, employees who smoked were more likely to view the ED as an appropriate site for patient education (P=.01).
Overall, staff respondents (76%) were interested in educating patients about preventive health but were less likely to feel comfortable advising patients about tobacco cessation (60%, P<.03) or to agree that ED staff should assist in tobacco cessation activities (51%, P<.001), as noted in the Table 2.
All 70 staff members (ie, not just the staff who responded to the survey) were encouraged to participate in the tobacco cessation program. Despite survey findings, staff characteristics (eg, tobacco use, job title, years working in the ED) did not correlate with referral performance in univariate or multivariate analysis. However, the gift basket incentive offered during month 2 and 3 correlated with a significant increase in staff referral rates (P=.008).
A total of 150 referrals and interventions occurred, with 33 (22%) occurring before the incentive, and the remaining 117 (78%) occurring after the incentive. Increased participation was more likely among the nurses and among others who favored education, community service, and clinical prevention. Interestingly, the nursing incentive for the most referrals was won by an employee who smoked cigarettes.
Telephone Follow-up
Telephone follow-up was successful at reaching 36 patients (24%). As related by the patient in the telephone interview, the primary ED diagnosis of patients receiving the intervention was respiratory disease (39%) followed by cardiac, gastrointestinal, and infectious disease (14% each). Because pregnancy tests were not administered for all patients, the number of pregnant patients who received the intervention is unknown. Although 33 patients (22%) of the total number of patients who received the intervention identified primary care physicians, a negligible number reported a visit with their primary care physician between the ED intervention and telephone follow-up.
Because a proportionately small number of patients used tobacco in a form other than cigarette smoking, the follow-up survey measured changes in tobacco use according to the number of packs of cigarettes smoked. Thirteen (36%) of the 36 patients reached by telephone reported that they had attempted to quit tobacco use after the intervention, and 6 (17%) were no longer smoking at follow-up. Of note, 2 of the 6 patients who quit tobacco use reported being pregnant.
Reports of current smoking behavior among all 36 patients indicated that 17% of patients (95% CI, 4%-39%) no longer smoked, 28% (95% CI, 13%-42%) had cut down tobacco use by at least half a pack of cigarettes per unit of time in their quantitative estimate of the number of cigarettes smoked, and 56% (95% CI, 39%-72%) still smoked at a level comparable to the time of the initial ED visit (Figure 2).
While staff attitudes and personal habits may be important, they do not appear to be a firm barrier to participation in a tobacco cessation program in the ED. In the present study, we were unable to identify specific demographics that predicted staff members' responses to the incentive. Although attitudes toward tobacco cessation interventions were less supportive than general attitudes about prevention and community service in the ED, the latter was most important for predicting successful participation in an incentive program designed to increase referrals from ED staff to tobacco cessation.
In the present study, more than one-third of ED patients reached for follow-up attempted to quit smoking following a brief intervention in the ED. Nearly half of them succeeded. Overall, 45% of patients reached for follow-up either had quit smoking or had cut down meaningfully in their smoking, according to self-reports. These research data implications are amplified by the fact that 78% of this patient population expressed either no relationship with or no access to a primary care physician.
A potential unexpected benefit may have occurred soon after the tobacco cessation program began. The primary investigator of the current study (M.R.G.) observed an increased desire among staff to stop personal tobacco use. In fact, several staff members were noted to be attempting to quit. If this observation was accurate, improved employee health might be an unexpected benefit of the implementation of a tobacco cessation program. However, further study is needed to quantify staff tobacco cessation rates.
Of course, there are a number of limitations to the present study. For example, the tobacco cessation program reported in the present study was performed at a single urban hospital. Future studies may consider investigating varied patient-payer mix and ED volume using multiple ED sites.
Also, the present study had a small sample size, both in terms of the number of patients who received the intervention and the number of patients who were reached for follow-up, limiting the strength of the reported results. For example, during the 3-month period of the present study, hospital records indicated that a total of 5064 patients were treated in the ED. Previous analysis17 revealed that the prevalence of tobacco use of the population is approximately 28%. Accordingly, 1400 patients used tobacco during the study period—indicating that the 150 patients who received the intervention accounted for only 11% of the ED patients who used tobacco.
The number of patients in the present study who were reached for telephone follow-up was modest (36 [24%]). Yet, the phenomenon of unreliable phone numbers for follow-up in ED patient populations is well documented.18,19 In addition to inaccurate phone numbers, factors such as a language barriers and patient fear that phone calls were related to bill collection may be potential causes for low survey follow-up rates.
Smoking behavior of patients after emergency department referral to a tobacco cessation program. Follow-up occurred 1 to 3 months after the patients were discharged from the hospital.
Also, a greater success rate was expected in patients counseled by physicians (rather than nurses or social workers) and those who visited their primary care physician in the interval between consultation and follow up. However, the actual number of those reached for follow-up was too small to generate any reliable conclusion in this regard. Although the patients' stage of change was recorded before and after the intervention, the raw number is too small to identify the relationship of patient stage at intervention and success at quitting. In follow-up studies, closer attention should be given to obtaining accurate follow-up information.
In addition to the need to improve patient follow-up, the final results of the tobacco cessation program would benefit from a long-term follow-up (eg, 1 y). Although one study12 suggested that tobacco cessation counseling was ineffective in the ED, that study's results may simply reflect an incomplete outcome measurement. In order to understand addiction and the tobacco cessation process, a study cannot consider only those inidividuals who quit. Although it is a difficult endeavor, the process of change itself must be assessed.20 For example, a physician just bringing up the topic of tobacco cessation (screening) might cause a patient to consider quitting. During a teachable moment, patients might have a personal level of change (eg, precontemplative to contemplative). Although such change—or progress toward cessation—might have been unmeasured in previous research, it may bring patients one step closer to quitting tobacco use.
In addition, successes might not have been as great as possible as a result of lack of confidence of staff in making a difference in the patient's future tobacco use.9,20 Interventions have been shown to be more effective when the provider has confidence in their own ability to influence the patient's success—something difficult for ED staff to envision because they have little or no opportunity to see the positive effects of their efforts.15
If healthcare providers deliver brief smoking cessation messages, the potential positive impact on public health is great.21 For example, if only half of all US physicians gave brief advice to their patients and were successful with only 10% of them, there would still be 2 million new nonsmokers in the United States each year.22 With such compelling reasons to promote smoking cessation, why don't all physicians do so? A common reason related to emergency medicine is "lack of time."1,16,20 However, even a 30-second intervention can influence a patient's success in tobacco cessation.15,16 Also, "lack of time" may be a result of the lack of training focus and culture within the ED setting.
The Agency for Health Care Policy and Research and the US Public Health Service recommend that all physicians ask all of their patients about smoking status and offer cessation assistance at every visit.23 However, lack of training, support staff, and backup materials or programs are legitimate issues to be resolved in any department preparing to initiate this type of program.4 The opportunity for physicians to encourage the discontinuation of tobacco use is vital to any ED patient population.
Our findings demonstrate that an incentive-based program can increase intervention rates in the ED, thereby encouraging successful cessation through brief counseling interventions. In future studies, more consideration should be given to length of time from intervention to follow-up and the amount of time spent counseling patients. The interventions in this study were considered by design to be minimal and of low intensity (fewer than 10 minutes), but other research in the area suggests that success is related to intensity of treatment.24 The use of more sensitive measures of behavioral change might generate more positive findings in future studies.
The ED presents an important opportunity for hospital staff to intervene with patients who use tobacco. With a change of focus and dedication to the concept of tobacco cessation, ED staff can make a significant contribution to the overall health of their community—and the nation.
Editor's Note: Readers interested in obtaining a copy of the intervention form used in the present study are encouraged to contact Marna Rayl Greenberg, DO, at mrgdo@ptd.net.
Elders MJ. Smoking Cessation Efforts. Acad Emerg Med. 1995;2:161-162.
Richman PB, Dinowitz S, Nashed A, Eskin B, Cody R. Prevalence of smokers and nicotine-addicted patients in a suburban emergency department. Acad Emerg Med. 1999;6:807-810.
Lowenstein SR, Tomlinson D, Koziol-McLain J, Prochazka A. Smoking habits of emergency department patients: an opportunity for disease prevention. Acad Emerg Med. 1995;2:165-171.
Brown RA, Larkin JC, Davis RL. Current concepts in the management of smoking cessation: a review. Am J Manag Care. 2000;6:394-403. Available at: http://www.ajmc.com/files/articlefiles/AJMC2000MrBrownCE394_404.pdf. Accessed June 16, 2008.
Vokes NI, Bailey JM, Rhodes KV. "Should I give you my smoking lecture now or later?" Characterizing emergency physician smoking discussions and cessation counseling. Ann Emerg Med. 2006;48:406-414.
Gordon JA. The hospital emergency department as a social welfare institution. Ann Emerg Med. 1999;33:321-325.
Bernstein E, Bernstein J, Levenson S. Project ASSERT: an ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med. 1997;30:181-189.
Bernstein E, Goldfrank LR, Kellerman AL, Hargarten SW, Jui J, Fish SS, et al. A public health approach to emergency medicine: preparing for the twenty-first century. Acad Emerg Med. 1994;1:277-286.
Williams JM, Chinnis AC, Gutman D. Health promotion practices of emergency physicians. Am J Emerg Med. 2000;18:17-21.
Love AC, Greenberg MR, Brice M, Weinstock M. Emergency department screening and intervention for patients with alcohol-related disorders: a pilot study. J Am Osteopath Assoc. 2008;108:12-20. Available at: http://www.jaoa.org/cgi/content/full/108/1/12. Accessed June 18, 2008.
Cummings GE, Francescutti LH, Predy G, Cummings G. Health promotion and disease prevention in the emergency department: a feasibility study. CJEM. 2006;8:100-105.
Richman PB, Dinowitz S, Nashed A, Eskin B, Sylvan E, Allegra C, et al. The emergency department as a potential site for smoking cessation intervention: a randomized, controlled trial. Acad Emerg Med. 2000;7:348-353.
Ong Eng Hock M, Ornato JP, Cosby C, Franck T. Should the Emergency Department be society's health safety net? J Public Health Policy. 2005;26:269-281. Available at: http://findarticles.com/p/articles/mi_qa4020/is_200501/ai_n15349652. Accessed July 21, 2008.
Aldrich C, Diercksen K, Scheetz T. A Common Sense Approach to Training and Documentation. Bethesda, Md: National Cancer Institute; 2005. Available at: https://cabig.nci.nih.gov/2005_Annual_Meeting/2005_Presentations/9_A_Common_Approach_to_Training_breakout_ca_041005.pdf. Accessed June 18, 2008.
Parran T, Shahady E. Physicians make a proven difference. Effective Strategies for Smoking Cessation in Primary Care. Darien, Conn: Cliggott Communications, Inc;1998 : 7-9.
Jaèn CR, Crabtree B, Zyzanski SJ, Goodwin MA, Stange KC. Making time for tobacco cessation counseling. J Fam Pract. 1998;46:425-428.
Smith S. Clinical prevention: ED tobacco screening and cessation. Paper presented at: LVH Clinical Prevention Work Group; October 1 , 2001; Allentown, Pa.
Boudreaux ED, Ary RD, St John B, Mandry CV. Telephone contact of patients visiting a large municipal emergency department: can we rely on numbers given during routine registration? J Emerg Med. 2000;18:409-415.
Thibodeau LG, Chan L, Reilly KM, Reyes VM. Improving telephone contact rates of patients discharged from the emergency department. Ann Emerg Med. 2000;35:564-567.
Prochazka A, Koziol-McLain J, Tomlinson D, Lowenstein S. Smoking cessation counseling by emergency physicians: opinions, knowledge, and training needs. Acad Emerg Med. 1995;2:211-216.
Warner K. Report from the 10th World Conference on Tobacco and Health. Effective Strategies for Smoking Cessation in Primary Care. Darien, Conn: Cliggott Communications, Inc;1998 : 4-5.
Glynn TJ, Manley MW. How to Help Your Patients Stop Smoking: A National Cancer Institute Manual for Physicians. Bethesda, Md: National Institutes of Health; 1995.
Bock BC, Becker B, Monteiro R, Partridge R, Fisher S, Spencer J. Physician intervention and patient risk perception among smokers with acute respiratory illness in the emergency department. Prev Med. 2001;32:175-181.
Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al; Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. US Department of Health and Human Services; May 2008. Available at: http://www.surgeongeneral.gov/treating_tobacco_use08.pdf. Accessed July 2, 2008.


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Home » Sanity Checks » Peanuts Fawcett Crest Book Covers
Peanuts Fawcett Crest Book Covers
16 RARE VTG Peanuts Charlie Brown Fawcett Crest Comic Strip Booklet Cover Art – $474. Find it on eBay (affiliate links).
What a strange thing to find! Sixteen unused covers from Peanuts Fawcett Crest books published in the 1980's and 1990's. With no creases from binding, it's obvious these were never, ever used. How did anyone get a hold of such a thing? The covers were printed in the United States. Someone who worked at the publisher may have brought them home. Or perhaps, this is the portfolio of the cover artist. Maybe they were an archive held by the printing company. We may never know. There are no further details in this listing.
Beyond their origin, I would also like to know, how are they mounted to those pieces of paper? Some of the covers have what looks to be discoloration. Depending on the glue and the paper, these might only get worse over time. If someone wanted to preserve these, demounting them would be job number one. Even for display purposes, it would be better to have them remounted for a more handsome display.
How much is a Peanuts Fawcett Crest Book Cover worth?
With no previous sales data, there's no baseline for comparison. At $30 a cover, I wouldn't be interested. First, the condition. I just don't know what I'm really getting. Second, the back story. There is none and there aren't any little clues to follow. Finally, they're just not that interesting. They're lovely designs, don't get me wrong. I love how the title is secondary to the great Peanuts art. They have a nice cohesiveness across the entire line of books. However, even though this is the era I started collecting Peanuts books in, I'm just not that nostalgic for them!
With today's printing technology, I could scan any book cover I wanted and print it out as a display for less than $30. There's much more pleasing artwork I could have on my walls than a barcode and an ISBN. However, that's me. A book collector might find these a perfect pinnacle for their collection. A part of the story on how Peanuts books were made. If there was more connection to the original artist, or these were proofs for the final product, then perhaps it would be a better investment. Lastly, if someone could prove these weren't used for some interesting reason, perhaps that would be the tale worth $474.
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Frederiksberg is a leafy suburb with wide open green space and its own palace.
Frederiksberg is one of Copenhagen's more opulent suburban enclaves. Stylish boutiques and hip cafes populate the main street, whilst modern street art adorns the walls of narrow lanes and back alleys. For the foraging music fanatic, Sound Station offers three rooms crammed from floor to ceiling with shellac LPs and CDs. It's easy to lose a day exploring the rarities and European versions of rock and jazz classics.
As luck would have it (and some savvy AirBNB exploration, we've secured an open and spacious apartment just off the main street, Gammel Kongevej. The hosts have left behind an encyclopedic tome recommending a range of quality restaurants and eateries in the area.
For our first night, we try local favorite, Sans Souci, which has been a permanent fixture since 1902. Nestled in a cozy corner block, the ambience is warm and inviting and the vibe is casual. Most of our fellow diners appear to be business travelers or people on first dates. Boasting a French bistro menu, we opt for the Steak Tartare, Squid Salad, Mussels and a tender veal dish, washed down with Tuborg beers. Delicious!
A short walk from our AirBNB and you'll find yourself in the Frederiksberg Royal Garden. Entering through a stone forecourt, the park lands are initially underwhelming, but as you explore deeper along the winding paved walkways through the leafy forest, you're rewarded with an open lake and quaint boathouse, part of the English-influenced romantic-era garden.
Dominating the top of the hill is the baroque Frederiksberg Palace. Completed in 1735, it was a royal residence until 1852, eventually becoming an Officer's Academy. Being so early in the morning, the only others around are a gardener and a few joggers. We can walk right up to it and peer inside the windows. There's no security in sight.
The boundary of the palace borders the Copenhagen Zoo. From the fence we can hear groups of school children already lining up for entry to the early feeding enclosures. We can see the flamingo enclosure, very hard to miss with hundreds of fluorescent pink birds standing out among the muddy watered enclosure.
From outside of the grounds you can hire a city bike with its own built-in navigation system, for a really cheap way to get around or take one of the city's many public buses servicing the area. Note: Don't take a taxi in this town if you want to save money for the more important aspects of travel—Copenhagen is expensive enough on its own.
Frederiksberg is a perfect base for exploring Copenhagen. In its own right, there are plenty of bars, shops and points of interest. Plus we found a great coffee at Hecknell and delicious Smørrebrød (Danish rye open sandwiches) at Frederiksberg Smørrebrødsanretning. (it's cash only).
Frederiksberg is a dress circle suburb of Copenhagen.
It is nestled just west of the city center.
Riding is the best way to experience the area, but it is well serviced by buses, taxis and Uber.


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text:
/* eslint spaced-comment: 0 */
/* eslint no-redeclare: 0 */
/* eslint no-unused-vars: 0 */

const assert = require('chai').assert;

/// title: Problem 3: Largest prime factor
/// type: project-euler

/// categories:
/// math

/// difficulty: ?

/// benchmark:
//replaceWithActualFunctionHere;

/// description:
///

The prime factors of 13195 are 5, 7, 13 and 29.

///
What is the largest prime factor of the number 600851475143 ?

/// challengeSeed:
function euler3() {
  // Good luck!
  return true;
}

euler3();

/// solutions:
function euler3() {
	var number = 600851475143;
	var max = 0;

	for (let i = 2; i <= number; i++) {
		while (number % i == 0) {
			max = i;
			number /= i;
		}
	}

	return max;
}

/// tail:

/// tests:
assert(typeof euler3 === 'function', 'message: euler3() is a function.');
assert.strictEqual(euler3(), 6857, 'message: euler3() should return 6857.');
/// id: 5900f36f1000cf542c50fe82

redpajama_set_name: RedPajamaGithub


text:
Q: UIButton properties for UIBarButtonSystemItemDone I want to create a UIButton same like UIBarButtonSystemItemDone.
That is, my UIButton should looks like the following image

Can i make the same effects (rounded corner, shading of colors, size) on my UIButton?
Share your code please..

A: You can make a custom button and provide an image for it.
UIButton *button = [UIButton buttonWithType:UIButtonTypeCustom];
[button setImage:urImage forState:UIControlStateNormal];

redpajama_set_name: RedPajamaStackExchange


Easyrabbit is a cryptocurrency exchange service formed around user privacy and simplicity. Exchanges between cryptocurrencies are complicated, time-consuming and not fully private. Our vision is that everyone is able to exchange on a simple, rapid and anonymous way with absolute safety. No account needed.
How does it Work without a Registration?
No account registration is required which indicates that there is no custodial risk for your funds and information. This means that we do not maintain or store user data. For example, if you want to exchange BTC with ETH, we provide the BTC address in order to send BTC and we send the convertible ETH to the address you provide. It is so simple.
How to Exchange Coins on Easyrabbit?
Go to the homepage of Easyrabbit.net.
Select from the coin list the coin you will Send.
Select from the coin list the coin you want to Receive.
Enter the address where you would like your funds to be sent to and your refund address for the coin you deposited. If you would like you can enter your email address too.
If everything looks OK, proceed to the next step by clicking 'Start Transaction'.
Send the Exact Amount that you agreed to Deposit to the Displayed Address within 60 minutes.
Note that if you Don't Send the Exact Amount your Order will Fail.
When should I Receive my Funds?
Easyrabbit transactions take 5-30 minutes to be processed. If blockchain capacity is congested the transactions may take longer.
Every currency has a different network fee, depending on the coin network abilities and according to the blockchain congestion. The "You Get" amount that is displayed is the amount that we will send in your wallet and includes all the fees (network + commission fees). Commission fees are from 0.2% - 0.3% depending on the selected coins.
If you are facing any problem with a transaction you can submit a ticket by contacting us. Our team will review your request and get back to you.
The Transaction Failed message is displayed when you Fail to Deposit the Exact agreed amount to our address. If you sent the amount but your Order Failed open a Ticket by contacting us, our team will review your request and get back to you.
For security reasons we only accept one Order with the same amount for each Deposit currency until the Order is complete. What you can do is to enter a slightly Lower or Higher amount. For example: Getting an error while trying to place an order with 0.45 BTC. Enter 0.449 or 0.451 BTC. Otherwise you can Wait until the processing Order is complete.
How much is Support waiting time?
We provide 24/7 support. In case of increased response time please be aware you are not ignored and someone from our support team will attend to your needs as soon as possible. Your emails will be replied to individually by one of our staff.
If for some reason you opened a ticket but you can not find any reply please check your spam folder.
Unfortunately, blockchain transactions are irreversible. Once a transaction is made (money is sent to a particular wallet address), it cannot be rolled back. So, if you are going to exchange cryptocurrency, be sure to double check all payment details carefully before proceeding.
I send funds to an incorrect address.
Unfortunately no. Once funds are sent to a wrong address, there is nothing we can do to recover them. This is why it is extremely important to double check the destination address you enter on the order page.
All transactions take time to be processed (usually 5-30 minutes). Given the volatility of cryptocurrencies, the exchange rate is subject to change during the processing time, which means the final rate may be slightly different from what you expected. This happens because Easyrabbit doesn't fix currency rates.


text:
Dyson condemns "desperate" MoJ over enhanced court fees
Posted By Nick Hilborne On January 26, 2016 @ 1:12 pm In Latest news,Technology | No Comments
Lord Dyson: "the research was hopeless"
Lord Dyson, the Master of the Rolls, has launched an extraordinary attack on the Ministry of Justice over the introduction of enhanced court fees.
Giving evidence to the justice select committee this morning, Lord Dyson accused the Ministry of Justice (MoJ) of carrying out "hopeless" research before the new fees were brought in last spring, in a rush to plug a "great big gap" in its finances.
Lord Dyson said the judiciary "warned of the real dangers" posed by enhanced court fees and "we also warned that the research undertaken by the government before it embarked on this course, was lamentable, frankly".
He went on: "The first time round they made 18 telephone calls, 12 of them to big users of the court. Then they got up to 31, but only a very small number were people likely to bring larger claims of more than £10,000.
"We warned that the research was hopeless, but the impression I have is such was the need to rush this through because there was a great big gap in the department's finances which had to be plugged.
"I got the sense it was almost a desperate way of carrying on. I'm sorry to use this very strong language."
Lord Dyson said the level of fee remissions available to litigants were set so low, it only captured "really poor people", and the ordinary people on modest incomes who did not qualify would "inevitably be deterred" from litigating.
He was particularly concerned about SMEs, and gave the example of a builder seeking £50,000 from a client, where the old fee would have been around £800, but who now had to pay a fee of £2,500.
"That is a massive increase and it is bound to be seriously deterring – not of the really rich people, it won't deter them, but the small businesses. They are the people who are most at risk and most likely to be put off. It's just a matter of common sense."
Lord Dyson said the evidence suggested that immediately before the introduction of enhanced fees there was a "huge spike" in civil claims, followed by a "big drop" afterwards.
"What we want to see is where it all levels out. The signs are that it is going to level out lower than it was before, but it is too early to make any definitive statements to that effect."
Lord Dyson welcomed the government's decision not to double the cap [2] on court fees from £10,000 to £20,000.
However, by deciding to increase fees across the board by a further 10%, he accused it of "building on an extremely unsatisfactory foundation and making it worse".
He added that he was "very sceptical as an ordinary human being" that enhanced court fees would not reduce demand for civil litigation.
Lord Dyson said that if a thorough survey ever was carried out, he would be surprised if it did not find that assumption to be false.
In a double blow for the MoJ, Sir James Munby, president of the family division, said he was "disappointed" how little progress had been made with the introduction of online divorce after "many months of work" with the MoJ.
He went on: "Court modernisation will only work with an IT revolution and online divorce is an obvious front-runner.
"The ability to deliver is a question on which the jury is still out. I am disappointed as to where we've got after many months of work."
Sir James said he was very concerned because of the impact of the lack of progress on the whole modernisation programme.
Lord Dyson described the government's record on IT projects as "not exactly shining", and added: "We've just got to hope, otherwise we're just managing decline".
URL to article: https://www.legalfutures.co.uk/latest-news/dyson-condemns-desperate-moj-over-enhanced-court-fees
[1] Image: https://www.legalfutures.co.uk/wp-content/uploads/Lord-Dyson3.jpg
[2] not to double the cap: http://www.litigationfutures.com/news/government-decides-doubling-court-fee-cap-gives-green-light-general-increase


text:
Q: Give PHP access to coffee-script node module in OSX I've installed coffee-script module globally (with -g key). I can use it from terminal. But php can't do it with exec command. There is no output in exec command and no compiling.
In Windows i moved node_modules folder to Program Files instead /LocalRoaming, and then PHP can use coffee command. How to do it in OSX?
Coffee bin path is: /usr/local/lib/node_modules/coffee-script/bin/

A: exec() only returns the last line of the output - this may be blank. Pass the second and third params to it as references and var_dump their contents after running exec(). The third param will at least yield the exit code of the programme.
Failing that - give shell_exec() a try.


text:
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homeBNP Paribas Wealth Management | A Leading Private Bank
What prospects for 2022?
#Market Strategy — 07.01.2022
by Xavier Timmermans, Investment Strategist, BNP Paribas Fortis
First of all, we wish you a very Happy New Year, on a personal and investment level.
A positive performance in 2021
Three main sources of concern
Outlook for 2022
Following the double-digit returns on global markets for the third consecutive year, what can we expect from stock markets in 2022?
Global stock markets ended 2021 with double-digit gains for the third consecutive year.
In the wake of the first pandemic shock, monetary and fiscal stimuli immensely facilitated the recovery of economies. These favourable conditions contributed to a strong rebound in company earnings after the losses reported in 2020. In 2021, the MSCI World All Countries Index was up 20% in USD versus 14% in 2020 and 25% in 2019.
December ended on a relatively positive note, despite soaring inflation, prospects of a withdrawal of central bank stimulus measures and the staggering speed at which the Omicron variant was spreading.
In sharp contrast to these good performances, Hong Kong's Hang Seng Index fell 14% in 2021, penalised by Chinese tech stocks, with the Hang Seng Tech Index plummeting 48% from its February peak. Indeed the index suffered particularly from regulatory repression of the Chinese authorities and the threat of US delisting, which mainly hurt Chinese giants in the internet, technology and education sectors.
In 2021, Emerging Markets shed 5% in USD.
Commodities rose even more spectacularly than equities in 2021: +50% for the barrel of Brent and +33% for the Bloomberg Base Metals Spot Price Commodity Index (in dollars).
Since the end of November, investors have grappled with three main sources of concern: the human/economic impact of the Omicron variant, inflation plus the central banks' response, and the real estate situation in China.
Despite these ongoing concerns, the correction at the beginning of December was cancelled out in the last few days of the year. How can we explain this resilience?
The rapid spread of the Omicron variant remains a concern, as more restrictive health measures are put in place in a bid to prevent hospital saturation. That said, we believe that even in the worst-case scenario, medical progress should help to reduce the toll on lives and on the economy.
Potentially, we might have some very good news within two or three weeks if what we are seeing in South Africa and Scotland is confirmed, namely that this variant is less lethal, it is replacing more dangerous strains and is leading to herd immunity.
In the US, inflation has reached 6.8%, its highest level in 40 years. This is becoming a political problem. Nearly 40% of Americans do not own a property and have little or no stock market savings. Inflation is directly taking a bite out of their purchasing power. But the mid-term elections will take place in November and the Democrats risk losing their short majority.
Political pressure on the US Federal Reserve to curb inflation will therefore be significant. Good stock market performance is no longer a priority. In other words, we will have to live with a much more hawkish Fed (at least verbally) that will not be easy for investors. Jerome Powell's task of preserving the benefits of his monetary policy will be particularly difficult.
An important change is underway. Monetary policy is becoming more accommodative as China has cut the reserve requirement ratio (RRR) for banks as well as the one-year "loan prime rate", a small cut albeit very significant. In view of the very challenging situation in the Chinese property market currently, further support measures are expected in the near future. A more expansionary policy in China could contrast with the more restrictive policy in the US, favouring a recovery in Asia, which was heavily penalised in 2021.
For 2022, we do not expect a repeat of the last three years. Stock market performance should be more modest but still positive. There will be more volatility due to the slowing economy (which should however remain above trend growth) and less accommodative monetary policies, which will not (yet) become too restrictive.
Equities remain our preferred asset class. Earnings growth is set to be less spectacular than in 2021 due to rising labour costs and producer prices. However, earnings should continue to grow on the back of higher revenues and operating leverage.
Unfortunately, there is nothing to expect from government bonds, which will likely perform negatively as they did last year. Long-term yields remained abnormally low, especially when measured against inflation, despite the Fed's change of tone. We expect a slight rise in bond yields, but not sufficient to steal the thunder from equities.
Key data from 27/12/2021 to 31/12/2021
Index Close +/- Ytd 2021
Belgium: Bel-20 4310,15 1,07% 19,02%
Europe: Stoxx Europe 600 487,80 1,10% 22,25%
USA: S&P500 4766,18 0,85% 26,89%
Japan: Nikkei 28791,71 0,03% 4,91%
China: Shangai Composite 3639,78 0,60% 4,80%
Hong Kong: Hang Seng 23397,67 0,75% -14,08%
Euro/dollar 1,14 0,38% -7,06%
Brent oil 78,40 3,21% 51,09%
1822,39 0,77% -3,97%
Belgian 10-year rate 0,18
German 10-year rate -0,18
US 10-year rate 1,50
Refinitiv Datastream
The opinions given on this website are those of the authors and do not necessarily represent the position of BNP Paribas Wealth Management.


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The Cymbidium is a potted plant with a long shelf life produced from seedlings as well as cloned via meristem propagation. Since 1980, Japanese production of boat orchids has increased. Meticulously tailored cultivation techniques and a wide cultivar range are unique characteristics of Japanese Cymbidium.


Life went on, and things were changing on the domestic front. There was a guy named General Eisenhower running for president who promised to bring our boys home from Korea if he was elected. People had faith in him because he had commanded the troops who hit the beaches in Normandy in World War II. That operation marked the beginning of the end of that other war, and the voters believed he could, by gosh, do it again! And he did. To a kid, the winding down of the Korean War meant there were visible changes taking place, changes a young kid could see.
A man with the regal last name of Van Brunt was responsible for one of those changes in my own life. Blonde and Hollywood-handsome, he and his wife Helen and their kids were some of my family's best friends. Willard Van Brunt was my hero, because he had flown airplanes in World War II, and after the war he was a reservist in the Air Force. When Korea peaked in its utilization of modern day jets, he was activated to be a United States Air Force jet pilot flight instructor stationed at San Angelo, Texas. That was heady stuff to a ten-year-old.
My dad answered. He talked for a few minutes, and when he hung up he excitedly announced that Van Brunt, as we called him, was going to buzz Notrees at noon the next day. I didn't know exactly what buzz meant, but I was excited anyway because my parents were excited. I finished my homework and went to bed and slept the sleep of the young, and in the morning I did what I always did: I rode exactly one mile to school on the school bus with my brothers and sisters and many school mates to the little country school where I worked and waited for recess and the lunch hour.
Lunch hour was really important because it was our mother's belief that if at all possible, a child should have a hot lunch, and to that end she often picked us up in the family Oldsmobile and rushed us the mile back home for a lunch that she had prepared herself. Or, if Mom felt comfortable enough with the family funds, like she did that day, we would stop at the famous Cap Rock Caf� in Notrees, and we would get to order anything we wanted. I always ordered a hamburger. I was wired up tight waiting for the buzz. By now I was fully aware that it was going to be in an airplane, but I had no idea what it was going to be like, or if it was really going to happen.
It was the height of the busy lunch hour at the Cap Rock Caf� that day in Notrees, Texas, and I was around ten years old. I remember exactly where I was sitting and exactly what I was eating when the activity in the caf� full of oilfield workers stopped dead still when we heard a sound like a gigantic explosion.
Their first thought was of a gasoline refinery one half mile away, and their faces reflected dread and horror. But it was not my first thought, because in the midst of the shock and suddenly stilled voices as the jet roared back up into the sky, I dismounted my barstool in a rush and yelled out to everybody, "It's Van Brunt, it's Van Brunt!" and I raced to the front door of the caf�.
With eyes glued to the sight, we saw the airplane hook around at the top of the climb and start a steep dive back toward the caf�. Wide-eyed and mesmerized now, we saw the jet to our right, less than a mile away. It leveled out right over the highway in front of us, and in an eerie scene that our brains could hardly comprehend the jet seemed silent in its rush toward us.
As it approached at a dizzying speed, a strange buzzing sound preceded it, a sound made by trillions of molecules being rapidly pushed out ahead of the jet's path, and then, just as quickly, there was another brief silence before the jet's whooshing roar hit us with the delayed sound of jet exhaust. When the airplane blasted by us, it was so low to the ground that all of us awed spectators could see the two helmeted pilots and the oxygen masks covering most of their faces. Both men were looking down at us, seemingly right in the eyeball; I felt they could see me.
The sleek jet couldn't have been more than a hundred feet above the ground when it pulled up into another steep climb, and again, after more aileron rolls, it topped out high in the sky, leaving us engulfed in that delayed roar of jet exhaust and the smell of spent jet fuel. It was surely louder than the proverbial opening of the gates of hell.
Willard Van Brunt commenced another diving turn, and he came down right at us, right down the "main street," barely telephone-pole high, giving us one last breathtaking thrill as they streaked by us. That last pass filled just a second, a long second, frozen in time, down low at our level again, and we all knew the show was over by the way he climbed, without rolling.
I could not take my eyes off the airplane as it shrank to a speck in the sky, heading east, back to its base. Finally, and without my brain's permission, my eyes blinked, and the jet disappeared into the distance. It was all over in less than two minutes, but in reality it has lasted a lifetime. What a show!
Slightly dazed, we all slowly went back into the Cap Rock Caf� to talk about and contemplate what we had experienced. We knew we would never forget what we had just seen. It was a different little guy who climbed back up onto my barstool. Totally impressed, I wondered if I would ever in my life have a chance to do what I had just seen. I finished my hamburger--the hot lunch my mom wanted me to have--and then went back to school. My World War II mentality dimmed, and the dawn of my jet age had begun.
In 1967, fifteen years or so later at age 24, at Reese Air Force Base in Lubbock, Texas, and as a civilian flight instructor training air force students, I was given the privilege of taking two jet trainer flights in one day. You can bet that as I streaked upward and did aileron rolls in that twin engine jet airplane over the panhandle of Texas, I was thinking euphorically about the famous Cap Rock Caf� and the folks watching Willard Van Brunt as he blazed down main street and then back up high into the memorably blue west Texas skies.


Eagle Competition Vests are form fitting and will stretch. If you are used to wearing a loose fitting vest, Eagle 1 vests will feel much different. They are designed NOT to ride up on you while in the water. When you first zip the vest, it will feel quite tight, then loosen up once you are in the water.


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Practically all proprietors in Escondido will ultimately need to evict one of his Escondido occupants. Eviction Laws in Escondido means to use legal approaches to encourage a tenant to leave the landlord 's Escondido building if they will certainly not do so voluntarily.
There are lots of reasons a property owner may have to evict, including the Escondido tenant not paying rental fee or breaching his lease. Occasionally a Escondido landlord and tenant just could 't view eye to eye on various things such as repairs or late costs, and also the landlord longs for the Escondido tenant to leave yet the tenant will not go willingly, so the proprietor is compelled to begin the eviction treatment.
When a proprietor discovers himself in this type of circumstance in addition to wishes to file an eviction match to require the tenant to leave, it is vital to follow all pertinent eviction legislations exactly as well as fill in the different papers in addition to legal services forms appropriately in addition to precisely. If this is refrained appropriately, your eviction demand may be rejected and you will certainly have to start over once more, but if you do every little thing correctly and also verify your situation, the tenant in Escondido will be lawfully required to leave and you will have the full support of the neighborhood constable in removing him if he still chooses not to go.
To try to avoid the price and also headache of needing to evict a tenant, draw up every one of the scenarios or conditions that would trigger you to ask a tenant to leave and also include those in your lease arrangement so you will have a strong foundation based on breach of contract ought to you have to submit an eviction match. By authorizing the lease agreement with these specifications included, the tenant is consenting to all these terms and conditions when they authorize the lease.
Each property owner will have various requirements. Some could enable animals in addition to some may not. Some might be strict on the variety of owners in addition to some will not care. Criterion products are damaging the property or renters doing any kind of kind of criminal task on the rented out building such as medication use or sales. Unless it entails discrimination or other lawfully forbidden actions, each proprietor deserves to state "dos and don 'ts " for Escondido tenants renting his property.
When you have pertained to the conclusion that you have no alternative yet to evict a Escondido tenant law, congregate all the documents you will should supply evidence that the tenant has actually breached his lease. The lease contract is the most solitary vital document. You will likewise require other written papers you could have provided to the tenant, including letters you have created him cautioning him that his activities are unacceptable or notes you have actually made specificing any sort of dental warnings.
When you have come to the verdict that you have no choice however to evict a Escondido tenant law, collect together all of the paperwork you will certainly need to supply proof that the tenant has actually breached his lease. The lease arrangement is the most solitary vital document.
Make duplicates of any type of relevant terminated examinations if nonpayment of rental fee is a concern. If a tenant has actually participated in prohibited activity or tasks that produce troubles with neighbors, see to it you have any sort of applicable copies of cops records or notes or letters from neighbors, and so on.
You will certainly then have to ready an eviction notification Escondido which explains the reasons you are moving on with the eviction as well as give the tenant a due date whereby he should vacate the leased facilities and provide it to the tenant.
One kind of eviction notice is a California Notice to Vacate. This is the simplest kind of eviction notification in addition to applies when the tenant breaches the lease agreement somehow which has been adjusted forth in the lease contract such as nonpayment of rental fee or having additional occupants relocate.
You will certainly need to go to the court in your county to prepare for the eviction notification to be officially supplied (in legal terms and conditions, served) to the tenant. When you go to the court, you will certainly need to have numerous duplicates of your eviction notification as well as be readied to pay a little filing charge.
The region clerk may submit them as well as provide you 2 collections of certifications: one for you as well as one for the tenant. In most states the clerk will certainly give you a record called a Summons to serve after the tenant. A court date might likewise be evaluated that time to provide the tenant his right to say versus the eviction if he feels he has actually been wronged.
The next action is to serve the certifications which were offered to you by the notary to the tenant. Keep in mind that the files have to be personally offered on the tenant by placing them straight into his hands. If you prefer to not do this on your own, you can pay the county sheriff "s office or a private process-server to serve it on the tenant. In some scenarios it might likewise be provided by certified mail, yet in order for the service to be approved by the court using this approach, the tenant has to authorize for shipment, verifying that he did receive it.
A qualification of solution of the certifications on the tenant will certainly be located on the summons, astride the summons, or as its own file. Ensure that this has actually been properly loaded out as well as that the individual which offered the tenant, whether it was you, the constable 's deputy, or the personal process-server, has authorized it, then bring it to the county clerk to be submitted.
After that you will certainly require to go to court, if the tenant does not value the papers as well as voluntarily leave. Be well prepared! You must verify your claims in court with tangible evidence. When you are in court, provide your files as smoothly and logically as possible.
If you prevail in court, a Writ of Property will be released which continues the process of the eviction. A day will certainly be adjusted for the tenant to leave the rented facilities, and also you have to arrange for a sheriff 's deputy to be existing on that day in case the tenant still lingers in declining to leave or is tough.
Kindly note that each state has varying regulations on the number of days the tenant has just before he should leave the premises. Make certain you confirm this timeframe before you offer an eviction in addition to ready notice. It could postpone the eviction process and also you could have to start the whole process once again if you offer inappropriate paperwork.
When you have come to the conclusion that you have no option yet to evict a Escondido tenant law, compile with each other all of the documentation you will certainly require to give evidence that the tenant has breached his lease. You will certainly then require to ready an eviction notice Escondido which mentions the factors you are moving on with the eviction and also offer the tenant a deadline by which he should vacate the usinged properties and also supply it to the tenant.
You will need to go to the court in your region to arrange for the eviction notification to be formally supplied (in legal terms and conditions, served) to the tenant. A court date could also be adjusted at that time to provide the tenant his right to say versus the eviction if he feels he has been mistreated.
A date will certainly be established for the tenant to vacate the rented out facilities, and you must set up for a constable 's replacement to be present on that date in situation the tenant still lingers in refusing to leave or is tough.


text:
Homa chips in, wins in Napa after Willett's shocking 3-putt
Fortinet Champ (PGA)
Pos Name Score Thru
1 M. Homa -16 F
2 D. Willett -15 F
3 T. Montgomery -13 F
4t B. An -12 F
4t J. Lower -12 F
6t R. Fowler -11 F
6t N. Taylor -11 F
6t S. Theegala -11 F
9t H. English -10 F
9t D. Thompson -10 F
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(AP Photo/Eric Risberg)
By JANIE McCAULEY
NAPA, Calif. (AP) Max Homa knew he had no choice but to go for it on the par-5 18th hole if he wanted to defend his title at the Fortinet Championship. Trailing Danny Willett by a shot, he went for the green in two but ended up in a tough spot in a bunker short of the green. He blasted out but still wasn't on the putting surface.
Homa stayed aggressive, and this time it paid off, ramming his chip from 33 feet into the hole for a closing birdie. Still, all Willett needed to do was convert his own birdie from short range - and he didn't deliver.
Willett hit his 3-foot, 7-inch putt too hard. It grazed the lip and ran 4 feet, 8 inches by. Then his comebacker broke left, hit the lip and stayed out, too, completing a shocking collapse that made Homa the winner again in Napa.
"That was crazy. I still don't really know what happened," said Homa, a college star at California who now has three victories in the Golden State. "Just kind of one of those weekends you just had to hang around."
Homa high-fived his caddie when his chip shot hit the flagstick and dropped. Moments later, he was a five-time winner on the PGA Tour.
"Them things happen. Luckily we've been in a good position all week and then unfortunate things happen when you feel like you need them most," said Willett, who is winless in the United States since he took advantage of Jordan Spieth's collapse to win the 2016 Masters.
Willett laid up 65 yards short of the 18th green green, then stuffed his approach close enough that closing out the tournament should have been routine.
"It's a shame with how it finished but I'm pretty sure those are the only short putts we've missed all week. Just a shame to do it when I did. One of them things. At times you wish you could rewind time. We learn from it and move on," he said.
Homa had struggled with his putter over the weekend but didn't need it at the end.
"Today I hit it well, kept it around the hole where it needed to be, I just couldn't get the ball to go to its home," he said. "On 18 it decided to go home quickly, so that was quite a nice bonus."
Homa closed with a 4-under 66 for a total of 16-under 272 and now heads to Charlotte, North Carolina, as a captain's pick for the Presidents Cup with three wins in the past 12 months. Willett shot 69. Taylor Montgomery was alone in third at 13 under after a closing 64.
Homa's wife, Lacey, had no idea what he'd just done but hurried out to hug her husband. She is pregnant with their first child, a boy, due Nov. 2.
"I'm shocked right now," she said. "I didn't see what was happening."
The leaders had their tee times pushed up by nearly four hours in an effort to get the round in before the North course at Silverado Resort & Spa became completely unplayable. Greens that had been hard and fast earlier in the week from the sun and wind were suddenly quite the opposite, slow and soft from all the water.
Justin Lower held a one-stroke lead going into the final day while chasing his first title after years of struggles just to secure his tour card. The 33-year-old American wound up tied for fourth with Byeong Hun An at 12 under after shooting a 1-over 73.
Willett birdied three holes on the front nine to take a three-stroke lead, only to miss a short par putt on the par-5 ninth as Lower birdied to pull back within a stroke.
Homa and Willett began the day one shot back of Lower. All three players birdied the par-4 10th.
On the par-4 14th, Willett made a miraculous birdie. His tee shot landed behind a tree, and then he whipped the ball around it to the back side of the fringe before sinking a 5-foot putt.
On the front nine, Willett birdied Nos. 1, 4 and 8 - making a 7-footer for birdie on the par-4 eighth while Lower made bogey.
The 34-year-old Willett, from Sheffield, England, stayed loose, laughed with his caddie and smiled between holes in far from ideal conditions in California's famous wine country: wind and heavy rain the first three holes, a brief respite, then more rain. He regularly toweled off his clubs, wiped down his shoes before putting and took on and off his black sleeveless vest.
The weather made for an intimate gallery of umbrella-holding diehards willing to brave the elements.
"It's what I came to California for," Willett cracked with a grin in the early going of his final round.
More AP golf: https://apnews.com/hub/golf and https://twitter.com/AP-Sports


I hope you all made money in 2012 and I wish you a very profitable 2013. I made a 17% return in 2012, versus a personal target of 40%, and compared to the world's 300 most important hedge funds, my return is likely to rank in the top 30 (source HSBC – final week's report not yet in). For comparison, I made a 40% return in 2009 but made only the top 50 in hedge fund ranking that year due to the bumper returns on offer from a trend year. I made my lowest return of 15% in 2011, but conversely that made the top 15, as it was a more difficult year in the markets. So for me, it's important to measure both ways, and in doing so, I can declare 2012 a satisfactory year but not amazing.
I then bought back into equities in May 2012 on the oversold/overbearish selling exhaustion, and have largely sat on those positions since. I made additional purchases at the start of November with a longer term view (e.g. China at its cheapest p/e to date, Japan at ultra low p/b (since up 18%), Russia at ultra low p/e). I advised of all my trades on my site at the time of their action, and this can all be verified using the search functionality should you be new to the site.
I also added short treasuries in that May sell-off window. This is a smaller position compared to commodity and equity exposure, and has ended the year effectively flat like commodities. I have participated little in the currency markets this last year, and overall there have been no positions in any class that I have had to abandon and take a loss on. The bulk of my trades are open positions that are in profit.
My trading style is to attempt to call the global macro position for assets correctly, namely are we in secular bull or bear markets and are we in cyclical bull or bear markets, and be positioned accordingly. Within that I attempt to call turns, and buy on oversold/overbearish indicators, sell on overbought/overbullish indicators. Throughout 2012 I have deemed us to be in a secular commodities bull market and a cyclical equities bull market, as well as suggesting that we reached a secular treasury bond turn mid-year (from secular bull to secular bear). As we turn into 2013, we cannot definitively state that all those are true, but none of them have been proven false. I think they look good, and my profit snapshot is supportive of this. I have been looking for evidence of a cyclical equities top in H2 2012, but that evidence has been lacking, and so I enter 2013 with my stocks longs still in tact and will again be looking for that evidence coming to light in H1 2013. In short, I believe I have mainly called the strategic asset positioning correctly, but the biggest surprise of this last year, in my opinion, was the flat performance of commodities, as I was expecting their secular finale acceleration to begin and be a theme of the year.
That is still the shaping that I expect, and therefore commodities ought to begin that out-performance soon. Equities should go on to make some kind of topping range whilst internals deteriorate and give clues to a cyclical top.
Returning for a moment to 2009, we stepped back from financial system meltdown and acknowledged ultra cheap assets, to deliver a very bullish year for pro-risk that a lot of participants 'got'. In 2010, there was a mid-year retreat that had the hallmarks of a correction within an ongoing bull market, which most of those who I read 'got', for another year of bull returns. In 2011 however, action was more volatile and developments more confused, and I found the analysts that I read and respected at the time much more divided, with some getting it right and some getting it wrong. 2012 was similar to this. It was difficult to take the stance that ECRI were wrong in their recession call (but this now appears to be so), that H1 2012 concerns of a European sovereign default would not come true, and that, amongst others, Tiho's detailed reasoning for a global recession and stocks bear since mid-year was not the accurate picture – at least not yet. It has been a year of fluctuating and short-lived developments and I maintain this more confusing action of the last 2 years is because we are in a gradual transition period from secular bear to secular bull in equities and from secular bull to secular bear in commodities and bonds. Wouldn't we be glad of a trend year like 2008 (all down) or 2009 (all up), right? Well, I have some hope that this year will be a trend year for commodities: their final secular acceleration – so let's see.
As I have previously detailed, my view is that March 2009 was the secular equities bear nominal low, and that since then we have been in a period of gradual repair. From financial system meltdown to sovereign default fears (that's improvement), then from sovereign default fears to no natural growth (the European debt fear that was headline news in H1 2012 was very much wound down in H2 2012). I suggest that this year global growth will pick up and we will finally see the 'growthflation' that central banks have been keen to generate. Tightening (yields rising) and over- exuberance in commodity prices will then usher in the last equities cyclical bear before new secular bull market momentum. Of course problems and fears will still abound – the secular bull market will be built on a wall of worry – but they will gradually decrease with time.
I believe the most important model in 2013 will be the sunspots model, which should see solar activity reach a peak in H2 2013, biologically inspiring speculative behaviour and excitement in humans (potentially also through war and protest behaviours).
So here's to an exciting year. Thanks for all your comments and mails and links in 2012, I value your input. And to the silent majority: don't be shy in coming forward with a question or a view or a great find. Keep spreading the word guys – it's the year of the Solar. Happy New Year to you all.
John, Happy New Year! I am most bullish on "CAF", a (profitable) position we both are holding. You know, when so many pundits continue to call for a China Hard landing when it had already crashed into pieces (……measured by $SSEC which dropped roughly 2/3 since 2007), my contrarian instinct says Buy It and hold!
I hope Tom DeMark is right that it will rise 50% in the next 9 months. Do you have a particular China strategy to share with us?
Your patience to sit tight, allowing your profit to grow is awesome..Just brilliant.
In addition to owning CAF, I have added LFC and HAO last week.
China's 30 years of economic reform since Deng has brought significant progress to China. The recent (18th) People Congress targets the growth of the Middle Class in the next 30 years. I see the current set-back as a buy and hold opportunity while there are fear, lack of conviction and accusation of untrustworthy financial data.
I went to a Christmas function and a business man from Romania told me why the Chinese Government is giving next to zero interest rate loan to Chinese who want to start a business there. In my opinion, this sort of policy allows China to (deliberately) control the World economy in due time. I wonder what the next 30 60 or 90 years will bring.
China is to be bought and accumulated.
Thanks Greg. Something like that maybe with time.
I've checked in since the first few weeks of Amalgamator so it's been interesting to see how things have developed. Obviously, I don't always agree with you: sometimes to my detriment(I should have gone for it more on June 6);sometimes in my favour (PM's this year).
Either way I always enjoy your open minded, reasoned approach.
Good health and happiness to you and your family in 2013.
Cheers Will, same to you, and well done on your PMs call.
I still cannot feel a big change in the commodities I trade. Coffee, cocoa, sugar, cotton in volatile sideways to lowering ranges, wheat has broken down from 6 month sideways pattern, nat gas broke today below 3.40 – level that could be a good support in weekly chart, gold in a range that may last another 12 months…nothing right now, nothing soon.
I kind of agree. Takes a leap of faith to see commodities surging, so until then it's just theory. But last year's laggards have a better chance of being this year's stars, and both gold and oil went nowhere in 2012, along with a few agri commodities. I would suggest the backdrop is changing in their favour, with China's economy improving, the dollar declining, and some bearish extreme sentiment in the likes of gold, coffee.
Congratulations! Despite all the naysayers you stuck to your outlook and stocks did indeed go up – at least for the time being as you make clear in your post. Great call.
For 2013 do you favor China/Japan over the USA/Europe as a place to invest?
Thanks Jack. Leading indicator strength has rotated over particularly to China and Korea, so Asia as a whole should see a pick up in Q1. By p/e Russia and China still stand out as the cheapest (US somewhere in the middle). Japan has risen almost 20% in 2 months and Yen sentiment is extreme bearish, so I wouldn't be adding there at the moment.
Any ideas on natgas? It seems like the least bullish commodity but if the sunspot theories are correct then together with reversal to the mean could be a nice one. Perhaps a lot of bang for a small buck. I have been accumulating shares in XCO and CHK. Heads I win some. Tailes I win a lot.
I saw great value in natural gas in 2010 as it dipped to around 3.5, which was the long term rising lowest trend line together with historic extreme cheapness versus crude oil. I bought in, added more, and then waited for it to mean-revert, expecting the commodities secular bull finale to lift all commodities. I still expect that, but I am still waiting for my profits as it had a good – and overdue – year in 2012, but it still languishes sub 4. It was a good example of 'the markets can stay irrational longer than…" – sometimes it can take a long time for a value play to come good. I still think it will do well – even if it gets nowhere near its dizzy heights of 2005 or 2008 – and I still hold patiently. So I agree – but dependent on the commodities finale coming good.
A let the mighty reversal work his magic.
Rob, can You send me a link with this research ? or just give some name ?
grzegorz314: His research is here. http://armstrongeconomics.com/ I agree with John that it is hit and miss but he has done a lot of interesting research about financial history and I found it worthwhile reading.
I first tried my luck with a few shares in 2004. I gave it full time focus since 2008.
Is no the same context in a bullish market than in a bearish one; from 2004 to 2007 everything was calm and success, but from 2007 to 2009 is when you have to make hards decisitions.
It was the same from 1998 to 2002-3.
Prior that from 1966 to 1983.
And…the 90-100 years cycle tops like 1929-1835-1720.
I mean, John that a wide prespective is the clue for markets, i see you have it, but you can see that in 2010 you were in the point to miss all the profits of past years, as happens main people in 2007 or in 1998-2000.
The FED is lagging this mini-cycle from march09.
Any ideas on the research Armstrong has done? With a peak in 2015?
Second: Why do you always show the 60´s 70´s chart of the Sp500 and not the DOW Jones one? The Industrials is te historical chart that support the Historical charting, even before its creation, with UK economy recreations.
I have shown both, but I figure the leading US index in 2000 was the Nasdaq, 30 years prior the SP500 and 30 years prior the Dow Industrials.
I´m not agree with you, John, always the boss in the markets is the Dow Jones, the Industrials one, is the World Bell Tower of the Economy from more than 100 past years. The Industrials point the Cycle, until now.
You can see the differences in 1966-83 betw Sp500 and Industrials, and the 1906-23 and so in the past, but always the best reference is the Dow Jones.
If not, you can not evaluate the structure of the markets from the past.
Great post, John. Happy New Year to you and your family. Here's to 2013 being your most profitable year yet!
Thanks PimaCanyon! Same to you.
It's been a while since I last posted on here due to taking on a busy, new role in the Middle East. First and foremost, I would like to wish you and your lucky a family a wonderful 2013 and hope it brings you continuing health and prosperity.
My main point is that I think your work and contribution has been outstanding and this site of yours is always at the top of my favourites' list. The great thing about the web is that there are many different points of view being put across, beliefs being challenged continuously in, both friendly and aggressive approaches, and so the web can be a prickly place at times.
I have followed the sparring between Tiho and yourself (which has been educational, respectful and positive) and admired the both of you for sticking to your action plans and remaining with your trains of thought. There are many other sites out there including Anthony Tuleda's Change in Trend, yet SolarCycles is the one I come back to time and time again. Your opinions are simple and succinct, your writing even more so and you're never swayed by popular opinion and media hype.
To that Sir, I salute you. Congratulations to you on your 17% return in 2012 and fingers crossed that you surpass this return in the year that has presented itself. I think I speak for all when I say thank you for providing this site for all of us to continue learning, being entertained and hopefully, increasing our general prosperity.
P.S. Long Physical Silver and Gold :-).
Hi Jonathan, i´m glad to see you again here. We are very grateful to John´s work, is meritory.
the differents point of views are positive for all, open minds!
In my case only try to alert that is a danger ahead for long positions this year as the standar cycle of the Dow Jones goes as in the past.
No commnets about Anthony Tudela tricks, very embarassing place, take care.
I hope you're well. Like you, I'm nervous about the year ahead and I feel equities will remain strong for the first month or two before leveling off. Corporate earnings, in my opinion, will be under a lot of stress this year and the early signs are there fore all to see. This is evident all over the world. Corporations have no more streamlining to do so growth is now essential. I just don't know where it's going to come from though.
The bond markets are a problem but I'm expecting a switch into commodities rather than a switch in to equities as investors look for safe havens and capital growth. Governments are increasing their exposure to Gold all over the world and I so precious metals could offset a turbulent year ahead. I actually tend to think silver will have a very good year after one of relative stagnant performance. Time will tell of course but I continue to purchase physical silver every month as it looks decent value to me.
Please accept my New Years wishes of Health for You and those you love.
According to Korey Bauer, December 31st 2012 ans January 2, 2013 were consecutive 90% Up Volume Days..Only happened 6 times in history and 6 month after return = 18.90%.
Buy the dips or this time is different?


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As the wind violently howls outside my window the jolly Christmas song "Let it snow" plays in my mind. It is currently -4 degrees with a wind chill of -27 degrees and I'm again thinking about global warming! I had wished to get some more holiday shopping done but the sound of the wind ripping thru everything in its path has kept me inside the house. At first the sun light was peaking thru the windows and I thought to myself, "it can't be that bad outside..." but after a quick trip on the balcony, the weather put me in my place and proved otherwise. A 4' by 7' balcony 17 floors up isn't where you want to have Jack Frost nipping at your nose. 1 day in the house is giving me cabin fever...thank God for the internet and dish network...and my blackberry! I stumbled across a great new blog and think everyone should check it out. Go here to check it out. One of my favorite posts was a blog giving rules to life.
1. Spend Money on Experiences - So true. We get caught up in the excitement of shopping...dropping cash on the latest "it" item only to have it be a distant memory after a few months. Investing in a trip is a much better cause. The memories you make and feelings you have will last a lifetime.
2. Go with your gut - I don't think your gut will ever lead you down the wrong path. My Aunt always told me "your first thought is your Godly thought". I still find this to be very true today.
3. Love your flaws - Life is too short to waste time picking yourself apart. Love yourself completely, including every flaw. If you don't love yourself how can anyone else?
4. Crazy is contagious - The blog writer said it best, "Crazy is contagious. Stay far away. It's hard to keep crazy close without getting sucked into the vortex. First you hear about crazy, then you witness crazy, soon you are caught up in crazy and you are crazy."
I am obsessed with my blackberry. It is a wonderful device and thankfully it has a camera. While out and about in the city I often see things that serve as inspiration for blog ideas. As a result of cabin fever, here are some other random things on my mind.
Is it ever necessary to tail someone...especially with a centimeter of space between your bumpers? Yes, city drivers are aggressive, rude, and erratic...but if you're at a red light you need to take a big "woo-sa" and back off the other bumper of the car in front of you. I eyed this jeep around Ontario/Clark and it ridiculous how he kept creaping up on the cab in front of him. I was waiting for there to be an accident.
For all of my fellow vodka snobs I want to inform you that Stoli Elit (one of the best vodka out there) is available at Jewel. I found this lovely bottle on the shelves of the Southloop Jewel on Roosevelt and Wabash. Normally priced $59.99, it was on sale for $54.99. If you want to try something new this holiday season treat yourself and maybe some friends to this high end vodka. It'll leave you happy.
Everyone is entitled to their own hustle. Streetwise vendors are staples on the street corners around the city. While visiting my area Starbucks I was struck by the presence of the streetwise guy - - mainly because he was rocking a mink fur, electric blue leather gloves and a host of gold jewels. I found it a humorous but puzzling sight. I didn't want to treat him like an animal on display at the zoo so I tried to exert some discretion while snapping a photo. It's blurry...but you can get an idea for the type of swag he was showing while hawking his goods.


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