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Gem Limousine Continues to Shine
Published: 2017, October 11
After four decades in business, this New Jersey operation is run by three generations of family.
With three recently acquired limousines in her New Jersey driveway, Barbara Chirico sat at her kitchen table, dictionary in hand, and tried to find the perfect name for her burgeoning limousine company. Entering the field was a bold decision for someone who had never even ridden in a stretch, but Chirico was looking for a career to fill the time as her daughter Deanna entered kindergarten. The new operator thumbed through the book's pages, searching for a word that was short, catchy, and could be visualized by a simple logo. Before long, she came to the "G" section—and Gem Limousine Service was born.
Flash-forward 41 years, and that initial fleet of three Cadillac Formals—in actuality, two, since one was only used for parts—has long been supplanted with a lot of 100 diverse vehicles, ranging from sedans to minibuses. Moreover, Gem has flourished as a true family-run organization. Deanna Gulino, the kindergartner who inspired mom to enter the industry, now serves as the company's CEO alongside her husband Joe Gulino, who is president. Their son Joe Jr. (Joey) is Gem's director of strategic partnerships, and daughter Nicole is director of finance. With three generations active in the organization, Gem is considered a leader in the greater New Jersey/New York area marketplace, and the lady at the helm is recognized as an industry legend. And while Gem now operates out of a 17,000-square-foot facility in Woodbridge, N.J., just across the river from New York City, it's a considerably different environment than the company's early days.
"We had a small house in Linden, New Jersey, with only five rooms," shares Barbara. "And I worked out of that home for 15 years. We parked cars in the driveway and in the street. The kitchen and an extra bedroom became the Gem headquarters. Drivers were in and out at all hours of the night. While I was in the house, I had two-way radios that would be next to the bed and even the shower."
Barbara recalls those initial days as an operator as a "grind," and would often seek help from family and friends. Deanna was taught to fold and file invoices, and Barbara's best friend Elsie Pepe would come over to help wash cars and answer the phone. She was with the company for 30 years as Barbara's "right-hand woman," until her passing nearly a decade ago. Meanwhile, the rookie owner was pounding the pavement to look for retail clients for proms, weddings, and funerals. "Honestly, I wasn't sure how long I'd be able to continue," she confesses. However, a random but fortuitous encounter at a Jersey diner two years after starting the company would change the course of Gem's business model.
A few of Gem's chauffeurs in front of MetLife Stadium "I had a part-time driver who was also a fireman. After his shift, he went to the diner to eat around 3 a.m. This night, he overheard a conversation between two women in the booth behind him. One of them was fretting about her job because the limousine hadn't shown up to pick up her boss. After an introduction and a quick chat, he made an appointment to see her in the office—which happened to be at a Fortune 100 pharmaceutical company. We came to realize that the area corporations needed limousine service, which ultimately became a huge turning point for Gem. To this day, we still are contracted with them. It was a struggle until we stumbled into the corporate side."
Back in the late '70s and early '80s, Barbara faced more than the typical trials and tribulations of the nascent limousine company owner—that is, finding new business, buying vehicles, hiring staff—but she also had to deal with the difficulties of being a woman in an overwhelmingly male industry. "As a female operator in those days, there were a lot of people who wouldn't lend me money. Fortunately, Jack Schwartz from Gaines Leasing believed in me and leased me a used limo. To this day, I owe him credit for giving me a shot. Through him, I met Bruce Cirlin (now with Complete Fleet Livery Sales), who is still a friend we do business with."
Barbara is also quick to mention the importance of new business owners getting involved in industry associations. In 1977, she joined the Private Livery Association, which was mostly made up of N.J. funeral companies. "Back then, funeral companies were starting to get into sedan work. I learned a lot from them, and the association got me networking. I felt I was all alone on an island in an industry I knew nothing about. Later, the New Jersey Limousine Association started to organize networking, with great people who were willing to talk and share experiences, and establish a benchmark. It really helped my company keep growing."
"We came to realize that the area corporations needed limousine service, which ultimately became a huge turning point for Gem."
– Barbara Chirico, Founder/Chairwoman of Gem Limousine
Chirico continued her devotion to industry associations. In 1998, she became a director of the NLA, eventually becoming president in 2001. Barbara also held the position of treasurer with the Limousine Association of New Jersey. Recently her years of constant service to the association were recognized with a lifetime achievement award.
After cementing its place in the industry, Gem enjoyed a steady period of growth still operating out of Barbara's home. Eventually, though, she realized it was time for a change, and it was none other than a prom that opened her eyes. "I always felt bad that Deanna had to grow up in that atmosphere, with drivers coming in and out of the house at all hours. She was trying to live a normal life of a kid. When she was a teenager, Deanna was getting dressed to go to her prom while the phones were ringing and drivers were in and out. I finally said to myself 'I have to get out of the house.' She left for the prom, and I cried because it just wasn't fair to her. At the time, I was running 18 cars out of my home, and we knew it was time to look for a small office building—which we found in Linden."
Members of Gem's staff (L to R): Kevin Boughton, Kathleen Tuccillo, Alyse Stauffer, Jackie Sue Sperber, and Jason Martinez With Deanna playing such an important role in the development of the company, it should come as no surprise that she would eventually find her way into her mom's business; however, Barbara insisted that she work for another company first.
"I worked for my mom part-time when I was a kid," says Deanna. "I would go out and sunbathe during breaks. I considered entering the biz out of high school, but she wanted me to join the corporate world to get some knowledge and experience. So right out of high school, I was recruited by a huge pharmaceutical firm."
But after she married, juggling work and family, corporate changes threw a wrench in the mix. "I had been there five years and had a 2-year-old when the company announced they were moving to a new location. They offered to pay to relocate us, but at the time, my husband owned a popular local bar and restaurant. The commute would have been very difficult, and I didn't know what to do."
Leave it to Mom to come to the rescue: "She looked at me and said, 'Would you like to come into the business?' At that point, a lightbulb went off."
Deanna started in 1992 as a reservationist, ultimately learning every aspect of the business. Eventually, she went into accounting and handled the books, payroll, and payables—while offering her mother some much needed family support. "I truly believe that if I didn't come in, I don't know how much longer she would have been able to continue on her own."
With the next generation recruited into the company, it was only a matter of time before Barbara looked to add more familiar, or more accurately, familial, faces into the fold. Joe and Deanna Gulino were high-school sweethearts—he was her date for the aforementioned, fateful prom—and they had married in 1990. Not long after Deanna joined Gem, her husband decided to dip his toe in the water, too.
"I'm a blue-collar, hands-on type of guy. I like getting my hands dirty."
– Joe Gulino, President of Gem Limousine
"I was running a successful sports bar that my brother and I bought out from our parents," says Joe. "Barbara asked me if I'd consider a career change. She recognized my work ethic, and thought I might be a good fit. I took a leave-of-absence and started as a chauffeur in 1997."
"And he hated it," laughs Deanna.
"It was very hard with three small children to wake up at 3:30 a.m., work 12-hour shifts six days a week, get home at 8, and clean the car and my suits. But Barbara said, 'you have to trust me; you have to understand what the drivers are feeling and what the clients need.' So, I did it for 24 months."
While Joe was driving, he realized he was in an ideal place where he could pay close attention to the needs of his clients as well as those of their companies. After his morning runs were complete, he would literally knock on office doors with brochures in hand. "I would go to the top floor of mixed-use office buildings and drop off business cards one floor at a time."
After his tenure as a chauffeur, Joe started dispatching during both day and night shifts. By taking on as many roles as possible, it allowed him to get to know the nuts and bolts of the operation. "I'm a blue-collar, hands-on type of guy. I like getting my hands dirty. When I was in the restaurant biz, I did everything there, too," he says.
L to R: Dispatch Manager Anthony Wright along with dispatchers Tim Trenery, Karan Randhawa, and Adam Izquierdo After learning the ropes in dispatch and sales, Joe next tackled putting together a nationwide affiliate network for Gem, inspired by a visit from a competitor during a period of economic downturn. "After 9/11, the CEO of a large competitor made an offer to buy us out. He looked in my eyes and said, 'How do you expect to compete against companies like mine?' He really scared me, but I turned my fright into determination. He lit a fire, and it was the best thing that ever happened to me."
Soon, he was able to sell his new affiliate program to Gem clients, for which Joe takes a great deal of pride. "Gem Limousine Worldwide, our affiliate side, represents 40 percent of our gross sales. It allowed me to put my stamp on the organization, and it was gratifying for me."
"He went from being a chauffeur to president of the company, and he has a true passion for the business," Deanna proudly says.
In May 2011, the third generation of Gem entered the field after Joe and Deanna's son Joey graduated from Monmouth University. He jumped right into the business, building the operation's website and digital presence in addition to creating presentations and RFPs.
"He knew what he was getting into," says Joe. "He watched us work. We had babysitters caring for him after school while we both worked full-time. Unfortunately, we talked a lot of shop at the kitchen table. We didn't have a traditional family life."
"Joey has goals and ambitions for the company that includes a lot of technology," says Barbara.
Joey's wife Lauren also has an role in the company as director of global business development. Her father-in-law Joe calls her an "affiliate manager on steroids" who has the respect of all the reservation agents in the company. Furthermore, Joe and Deanna's middle child Nicole, a recent Monmouth University graduate, now serves as director of finance. She has plenty on her plate planning her wedding to fiance Kevin Stankewicz this December.
"You need to care about your employees. You need to be honest and treat people fairly, no matter what position they have in the company." – Barbara Chirico
"She has always wanted to come into the family business," beams Deanna. "She told me that she wants to take my job!" The Gulinos are currently empty-nesters as their youngest daughter Gina is studying business administration at college, and will soon be the family's third child with a business degree.
But there are more involved in the company than the Chirico/Gulino clan. A key factor in their corporate culture is that each member of the team is part of an extended family. Employees are labeled as "The Gem Family" and Barbara, Deanna, and Joe make sure that everyone on staff is treated with the same level of respect.
"You need to care about your employees," says Barbara. "You need to be honest and treat people fairly, no matter what position they have in the company."
"We'd never ask anyone to do something we wouldn't do ourselves," adds Gulino.
In 2008, the "Gems" bought the property next to their headquarters that included a well-known N.Y. style pizzeria Strawberry's Pub & Pizza Case in point: "To clear my head at lunch, I go into the parking lot and blow leaves around," says Joe. "My car washers look at me, and say 'this guy doesn't stop.' But they respect me for it. I'll pick up a brush just to talk to them and break up the day. I connect with them. The secret of the business is connecting with your team."
The Gem team includes employees that have been with the company for more than 20 years. Mechanic Sandor Lech has been with them since 1990, and Barbara says that he takes pride in each and every one of the vehicles as if they were his own. "Our drivers are more fearful of him than Joe," she jokes. "He's on them about keeping the vehicles clean and regular oil changes. He's a great asset to the company."
Another employee they are quick to recognize is Gem's Executive Account Manager Worldwide Groups & Events Cindy Chase. She was hired to "fill in" for Deanna during her first maternity leave in 1992, and is still here today. Other longtime staff are Anthony Wright, dispatch manager, who supervises four different dispatch teams; Ian Reilly, manager of chauffeur training and operations; Ed Walch, vice president of client relations; and Kathleen Tuccillo, manager of finance, who streamlines all processes within the finance department.
The upper management of the company values each member of the 140-plus Gem family, which includes 40 office staff and more than 100 chauffeurs. But that doesn't even include the 30 people that work at Strawberry's.
Strawberry's...?
Diversification in the chauffeured ground transportation industry is certainly not uncommon. Many operators have expanded their business to include DMCs and even bridal shops or gas stations. However, in 2008, eight years after Barbara made the decision to build Gem's own facility, the company had already outgrown its parking area and was still expanding. Unfortunately, she found herself butting heads with the owner of the neighboring property.
"The properties included a successful pizza parlor, warehouse, and parking lot, but the owner wouldn't separate the lot from the building. So we looked, but it was less expensive to buy the two properties than it was to move." Thus, Gem became the owner of Strawberry's Pub & Pizza.
L to R: Joe Gulino, Gina Gulino, Barbara Chirico, Lauren Gulino, Joe Gulino Jr., Deanna Gulino, and Nicole Gulino "With my background, it wasn't strange or foreign to own a restaurant," says Joe. "This was a good opportunity, but it was scary because it was a whole other business and team. The staff there made it work. They had a great team in place, so we kept everyone on."
"We love them," says Gulino, "and they love us. People come in for our New York-style pizza and to see the people who work there."
The gamble fully paid off. After an 11-month period of renovating the building, Strawberry's reopened in 2013, ultimately growing profits by a full 100 percent. "It's become an institution," says Joe. "We all have our hands in that part of the business. Joey handles every aspect of running the restaurant, and Gina and Nicole work shifts bartending and serving." With three generations active in the business, it's only natural that the family would continually be clashing over ideas and business practices, right?
"Even though Joe and I have offices next door to each other, there are days when we never even see each other," admits Deanna. "You'd think the kids would get tired of us, but the kick of it is that after work, we frequently get together for dinner. We see each other almost every weekend, too."
In reality, it's the family aspect of the business that they find most rewarding. Amidst the challenges of regulations, pricing, and dealing with the insane volume of traffic in North Jersey, the family takes comfort in having each other close. Although Barbara is semi-retired and spends her winters in Florida, Deanna says it's still a thrill having her mother in the business.
And for Barbara her greatest reward, after 40 years of business, is equally simple.
"The best thing for me is having my kids and grandchildren here; every morning they come into my office and give me a kiss. What could be better than that? Life is good." [CD1017]


Leading up to The Last Jedi's arrival, Supreme Leader Snoke quickly became a point of fixation among the Star Wars faithful.
And it all revolved around one question: who is Snoke, exactly? We know he's not a Sith Lord, as that bloodline died out with Vader. Andy Serkis' glowering baddie is still very much in tune with the Force, though, as evidenced by his ability to grapple his subordinates (read: General Hux) from the other side of the galaxy.
However, even after The Last Jedi's release, that million-dollar question remains, as Rian Johnson refrained from divulging any firm details about Snoke's backstory before he was unceremoniously killed off during the film's mesmerizing Throne Room scene.
It's a somewhat anticlimactic end for the former Supreme Leader, but during a recent Q&A with BAFTA (via Cinema Blend), Johnson once again explained his handling of Snoke's demise.
In this particular story, it's much more like the original trilogy, where with Snoke if you think about the actual scenes, if suddenly I had paused one of the scenes to give a 30 second monologue about who he was, it would have kind of stopped the scene in its tracks, I realized.
Even though it could have been interesting, something that fans were interested in, as storytellers, we have to kind of serve what the scenes need to be. It was a tough thing, even though I knew some fans were interested in it I also knew it wasn't something that dramatically had a place in this movie.
Hopefully it can be addressed elsewhere or even J.J. may address it in the next movie. But it's not something that's particularly interesting to Rey, so we kind of had to follow through.
"The Supreme Leader is dead; long live the Supreme Leader." Star Wars: The Last Jedi initially premiered on December 15th, and ever since, Rian Johnson's tour-de-force has cemented its place in box office history. It's now the 12th highest-grossing release of all-time (not adjusted for inflation), and is expected to finish its theatrical run in the ballpark of $1.6 billion.


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Le golfe d'Antalya (en ) est un golfe du nord du bassin Levantin (mer Méditerranée), situé plus précisément au large de la ville d'Antalya, au sud de la province d'Antalya, en Turquie.

Une partie de la riviera turque s'y trouve.

Antalya
Antalya

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Liberty special election set for Tuesday
LIBERTY — Voters in Liberty will go to the polls to pick the newest city council member during a special election on Tuesday, March 6.
The Liberty City Council Ward 4 seat became vacant when councilman Brian Petersen was elected mayor last year.
There will be no names on the ballot when voters take to the polls, as no candidates filed for the seat during the initial filing
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What is Luxury ? Victoria & Albert museum, until 25th September 2015
The Second Space Travellers Watch is one of George Daniel's most well-known pieces. Image taken by Frances Spiegel with permission of the V&A, all rights reserved. Courtesy V&A Frances Spiegel , with thanks.
V&A Exhibition What is luxury ?The museum examines how perceptions have altered through the ages. Second Space Traveller Watch, George Daniels. photo courtesy Apollo magazine
V&A Exhibition What is luxury ? The museum examines how perceptions have altered through the ages. Second Space Traveller Watch George Daniels. photo courtesy Apollo magazine
Cartier launches Etourdissant Haute Joaillerie collection Autumn 2015
Cartier launches their ETOURDISSANT Haute Joaillerie collection Autumn 2015. Images courtesy CARTIER with thanks.
LUMIERE DU JOUR. CARTIER ETOURDISSANT COLLECTION 2015. Images courtesy CARTIER with thanks.
HILLARY CLINTON's FUNDRAISER. "The deck is stacked" Exclusive Daily Mail Feature. Courtesy Daily Mail LAURA COLLINS FOR DAILY MAIL.COM article published 24th August 2015.
EXCLUSIVE: A Maserati, a Ferrari, a Bentley, a Porsche (and supermodel Christie Brinkley) – the VERY one per cent turn out to raise funds for Hillary Clinton's efforts to 'shuffle the pack'
Exclusive Daily Mail Online pictures reveal how supermodel, 61, was guest at elite fundraiser in the Hamptons, NY
Donors arrived in expensive cars including Maserati, Ferrari Spirder, Porsche, Jaguar XKR and Bentley convertibles. Exclusive Daily Mail Online pics show guests arriving at the Water Mill, Long Island home of Selma & Artie Rabin who hosted a fundraiser for Mrs Clinton, on saturday evening.
Before the fundraiser Clinton tweeted: 'When you see that you've got CEOs making 300x what the average worker is making, you know the deck is stacked'
Democratic front runner is in $50,000 a week vacation rental but will campaign in Cleveland, Ohio, this week Rabin is an apparel company magnate & the co-owner of the Brooklyn Nets basket ball team.
By LAURA COLLINS FOR DAILYMAIL.COM
PUBLISHED: 21:43 GMT, 24 August 2015 | UPDATED: 01:02 GMT, 25 August 2015
Read more: http://www.dailymail.co.uk/news/article-3209466/Christie-Brinkley-Maserati-Ferrari-Bentley-Porsche-supermodel-one-cent-turnout-raise-funds-Hillary-Clinton-s-efforts-shuffle-pack.html#ixzz3k1CQnB69
Follow us: @MailOnline on Twitter | DailyMail on Facebook EXCLUSIVE DAILY MAIL. THIS FEATURE COURTESY DAILY MAIL. WITH THANKS. COPYRIGHT DAILY MAIL & PHOTOS MACFARLANES.
Hillary Clinton has announced her intention to 'shuffle the pack' to help the beleaguered middle classes but when it comes to Hillary Clinton's own fundraising efforts the deck seems pretty firmly stacked in favour of the rich and powerful.
These exclusive pictures taken by Daily Mail Online show guests arriving at the Water Mill, Long Island home of Selma and Artie Rabin who hosted a fundraiser for Mrs Clinton on Saturday evening. Rabin is an apparel company magnate and the co-owner of the Brooklyn Nets basketball team.
Mrs Clinton arrived first with her entourage in a blacked out SUV that turned out to be by far the most modest car of the day.
While some guests opted for a limousine drop off, a Maserati, a Bentley, a vintage Mercedes worth $150,000, a Jaguar and a Porsche were among the impressive array of luxury cars to roll up at the Rabins' imposing home. Photo Macfarlanes for MailOnline.com
Read more: http://www.dailymail.co.uk/news/article-3209466/Christie-Brinkley-Maserati-Ferrari-Bentley-Porsche-supermodel-one-cent-turnout-raise-funds-Hillary-Clinton-s-efforts-shuffle-pack.html#ixzz3k1FgAHhi
PARIS ETOILE PARC MONCEAU PIED-A-TERRE FOR SALE
ETOILE MONCEAU
Price: €1 050 000
Size: 105 m2
Area: ETOILE
Quarterly Building Fees: €788
Property Tax: €3 213
For sale in the 17th arrondissement near the Parc de Monceau, one of Paris' most celebrated parks, on the first floor of a century-old cut-stone building with elevator, this 105 m2 (1,130 sq. ft.) apartment on avenue de Villiers is replete with classic features such as parquet floors, marble fireplaces with gilded mirrors above, high ceilings with plaster molding, a sitting room, and French doors that open onto a small balcony with wrought-iron railing. Features include a fully equipped separate kitchen with a dining area, laundry with washer and dryer, and a guest lavatory that opens off the commodious entry hall. The salon and master bedroom suite are especially spacious. The apartment was recently repainted and several appliances, including a gas heat and hot water system, were updated. Double-paned and metal shutters keep down heating costs and reduce exterior noise. Thanks to its northern and western exposure the apartment is filled with natural light. The lobby and elevator were recently updated, and the façade was cleaned in 2012. The location is especially convenient for daily needs, with a public garage across the street, the Villiers Métro station nearby, and rue de Levis, which has one of Paris' best-known open-air markets, a brief walk. Furnishings may be acquired at extra cost for turnkey occupancy. Please contact us today for your private viewing. Information and visits 7/7 at +336.72.30.25.64 with Susie HOLLANDS (Reference EMPSU445). IMAGE AND INFO COURTESY SUSIE HOLLANDS VINGTPARIS
Irina Kolesnikova. St Petersburgh Ballet Theatre at the London Coliseum. August 2015.
The renowned St Petersburg Ballet Theatre continues its 2015 international tour with its London Coliseum season.
Internationally acclaimed Irina Kolesnikova brings together guest artists of the Mariinsky Theatre, the Bolshoi Theatre and the Royal Ballet's own Vadim Muntagirov in a spell-binding production of Swan Lake.
Surely the most famous and beautiful of all classical ballets, Swan Lake is the classic love story between Prince Siegfried and the Swan Princess Odette. From the iconic lakeside 'white act' to the visually stunning palace ballroom, this is the story of lovers divided by the villainous sorcerer Rothbart and true love conquering all.
Classical ballet at its best, wrapped in Tchaikovsky's glorious and unforgettable music, this full-length ballet is accompanied by The St Petersburg Ballet Orchestra.
With lavish costumes, beautiful sets and a company of 55, this magnificent production is not to be missed. Courtesy The London Coliseum The Marinsky Theatre & the St Petersburgh Ballet
Beyonce lands Vogue cover September 2015. Beyonce stuns Cannes red carpet arrival……photo courtesy Timothy A. Clary. AFP/GETTY IMAGES
Beyonce! Lands Vogue magazine cover for September 2015 . Vogue photo shoot includes great pics & to die for wicked dresses inside. This glam image from Cannes Film Festival red carpet look stuns the crowds. Photo TIMOTHY A.CLARY. courtesy AFP/GETTY IMAGES.
Paris flat with terrace for sale in the hip Republic Arrondissement.
This luxuriously appointed 936 sq. ft. 4-room apartment on an upper floor in a Haussmannian building benefits from a superb 355 sa. ft. south-facing terrace overlooking a peaceful street. It includes an entry, a superb living room opening onto the terrace and with a top-quality Italian-manufactured kitchen (state-of-the-art-appliances), a wine cellar, 3 bedrooms, and a Carrara marble tiled bathroom and shower room. With walk-in closets and ample storage space. The property also benefits from a Bose sound system both inside and outside, a water softerner, underfloor heating and air conditioning. Sold with a maid's bedroom and a cellar. Country : France Area : Ile-de-France Surface : 87m² Rooms : 4 Reference : 1072 Prix : 1,480,000 €
DUE CENTO 27


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Thievery Corporation Tickets
No concerts
when new Thievery Corporation events are added in your area.
'It Takes A Thief' is the tagline for the Washington, D.C. based duo consisting of Rob Garza and Eric Hilton. Of course the pair have a little help from the their friends, including Rob Myers, Frank 'Booty Lock' Mitchell, Jeff Franca and Ashish Vyas. And with a group like that, they're bound to make some noise.
The thing that makes Thievery Corporation stand out is an eclectic style that mixes elements of acid jazz, dub, Indian Classical, Brazilian, Middle Eastern and reggae music. Formed in the summer of 1995, Garza and Hilton had a mutual love of music and the club life. The two decided to combine various sounds in the studio to see what the end result would sound like, and born of that project was the Eighteenth Street Music Lounge record label.
Thievery Corporation's debut came with "Sounds from the Thievery Hi-Fi," and they managed an even higher profile with follow-up albums like "The Mirror Conspiracy," "The Richest Man in Babylon," and "The Cosmic Game." Their fifth studio album, "Radio Retaliation," earned a Grammy nomination in 2008, and the following year they opened for Sir Paul McCartney at FedEdField in Landover, Maryland.
The group's latest effort, "Culture of Fear," came in 2011. They continue to draw attention for use of lyrics throughout their career that includes English, French, Hindi, Persian, Portuguese, Romanian and more. Their substantial body of work has a true global influence, which the band continues to showcase on tour today via a 'carnival-esque' atmosphere. Catch them today!
Frequently Asked Questions About Thievery Corporation Ticket Prices and Tour Information
Is Thievery Corporation touring?
See above for all scheduled Thievery Corporation concert dates and click "favorite" at the top of the page to get Thievery Corporation tour updates and discover similar events.
How much are Thievery Corporation tickets?
Thievery Corporation tickets on the secondary market can vary depending on a number of factors. Typically, Thievery Corporation tickets can be found for as low as $77.00, with an average price of $108.00.
How to get cheap Thievery Corporation tickets?
If you're looking for cheap Thievery Corporation tickets, tickets can be found for as low as $77.00. Additionally, once you click on your preferred event date, use the "sort by price" button located in the top left hand corner of the event page to sort all available Thievery Corporation tickets by cheapest tickets available.
Who's opening for Thievery Corporation?
No known opener or special guest will accompany Thievery Corporation.
How long are Thievery Corporation concerts?
Most concerts last about 2-3 hours but can run shorter or longer depending on the artist, opening acts, encore, etc. Thievery Corporation concerts typically last 1.75 hours.
What's Thievery Corporation's setlist?
While setlists can vary between venues, Thievery Corporation will likely play the following songs on tour:
True Sons of Zion
Voyage Libre
Until the Morning
Ghetto Matrix
Amerimacka
The Heart's a Lonely Hunter
Fight to Survive
Warning Shots
Road Block
Sweet Tides
Lebanese Blonde
Are there age restrictions for Thievery Corporation concerts?
Generally if you are under 18, you may have to be accompanied by an adult. Some artists and venues may be unsuitable for certain ages and the age requirements will be listed next to the event above. Currently, Thievery Corporation concerts have 16+ restrictions, for one or more shows.
Thievery Corporation Ticket Prices
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In 2005, a Japanese company called Oji Paper took over a project to plant 50,000 hectares of mainly eucalyptus plantations in central Laos. The following year, as part of his research in Laos, a Canadian researcher took a series of photographs of forests cleared by Oji's bulldozers. Now, Oji Paper wants to get REDD funding for its plantations in Laos.
The timing could not be better. Just as the UN climate negotiations start in Cancun, Oji Paper is demonstrating one of the most serious problems with the international discussions relating to REDD: the failure to differentiate between forests and plantations. Oji is also demonstrating how corporations can benefit from REDD while their operations have serious impacts on local livelihoods.
Oji Paper started another plantation project in Southern Laos earlier this year, covering a total of 30,000 hectares. The feasibility study, which starts this month and runs until March 2011, will look into potential REDD funding for Oji Paper's plantations in central and southern Laos. The study is commissioned by Japan's Ministry of Economy, Trade and Industry. It is supposed to develop, "the methods to measure, present and evaluate effectiveness of plantation projects in CO2 absorption and effectiveness of countermeasures against deforestation and forest degradation in reducing CO2 emissions," according to an Oji Paper press release.
Oji Paper plans to export wood chips from its plantations in Laos to feed its ever-expanding pulp and paper operations. It will be interesting to see how the feasibility study takes into account the fact that Oji Paper's plantations will not store carbon for any length of time, but will be chipped, transported by road and sea and manufactured into paper. After use, much of this paper will be disposed of in landfills where it will rot and produce methane.
Oji Paper is one of the largest paper companies in the world, with a total of 240,000 hectares of plantations in Laos, Vietnam, China, Indonesia, Australia, New Zealand, Canada and Brazil. The company is planning a REDD programme and intends to apply the results of its feasibility study in Laos to its other plantations.
Oji's concession area in central Laos covers a total area of 154,000 hectares, of which a total of 50,000 hectares is to planted. More than 55,000 people live inside this concession area.
If the company responsible for this destruction can now claim to be reducing emissions from deforestation and forest degradation, then the concept of REDD has become intellectually and morally bankrupt.
A version of this article was published in World Rainforest Movement's Bulletin 160, November 2010.
 ^^ Thanks to Mekong Watch for the translation from Japanese.
Ban Phone Thong, Pakkading District. March 22, 2006.
Ban Dan Hi, Hinboun District. June 22, 2006.
Oji-LPFL forest-land clearing, Ban Pak Veng (in the background are the mountains of the Phou Hinboun National Biodiversity Conservation Area).
"If the villagers cut the big forest like this, we would go to jail." January 2006, Ban Pak Veng.
Forest-land areas cleared by bulldozer, 2006, Ban Pak Veng.
Tractor-cleared secondary forests, Ban Pak Veng.
Its a pity to see these distructions made by companies in the forests in Laos. However similar to AR CDM, i guess large scale companies will try to get the maximum benefit from REDD+ too, thus ignoring the benefit sharing aspects…..
@Chanthapone (#2) – I'm not sure I've understood what you are saying. It appears that you are supporting what Oji Paper is doing, because it is better than doing nothing.
That appears to be an argument in favour of bulldozing villagers' fields and forests, replacing them with monoculture tree plantations, severely impacting local people's livelihoods and their environment and increasing greenhouse gas emissions in the process. Then rewarding, Oji Paper, the company responsible by handing over carbon credits for the non-existent reductions in emissions. Oji Paper could then sell the carbon credits, allowing greenhouse gas emissions to continue somewhere else, resulting in an even larger increase in greenhouse gas emissions.
I'm sorry if I'm missing the point, but which part of this is better than doing nothing? And why is doing nothing the only alternative that you put forward to the destruction carried out by Oji Paper?
METI's projects aim to build a new framework through bilateral and multilateral agreements to appropriately evaluate Japan's technologies and products to decrease and absorb global warming gas. The projects will look at present technologies and the technologies which have not yet been recognized internationally in the current Clean Development Mechanism.
– Developing the methods to measure, present and evaluate effectiveness of plantation projects in CO2 absorption and effectiveness of countermeasures against deforestation and forest degradation in reducing CO2 emission.
– Evaluating economic impacts of the plantation project on the area, including the project's effectiveness in making social contributions and creating employment in the local communities.
– Evaluating effectiveness of measures such as preservation of the biodiversity.
– Calculating the expected CO2 credits.
– Building a programme for the CO2 credits transfer through bilateral agreements.
If a new programme for REDD+ is established, CO2 absorption promoted by the plantation projects and CO2 emission reduced through countermeasures against deforestation and forest degradation will be recognised more broadly and receive a higher appraisal. The Oji Paper Group currently holds 240,000 ha plantation in 13 projects in 8 countries and is promoting sustainable use of forest resources. The company plans to apply the new scheme to the plantation projects in other areas.
REDD stands for "reducing emission from deforestation and forest degradation in developing countries." In addition to this goal, REDD+ seeks to enhance forest carbon stocks by such means as plantation and forest preservation.


"Many folks were just minding their own business on Saturday, trying to watch some college football," begins Beiler "when this ad interrupted their lives. And not in a bad way at all." The ad was a new Perfect Bacon Bowl commercial (see below) and the ears of many viewers perked up at the sound.
"It sounds for all the world like mid-70s Queen, complete with Freddie Mercury. I mean, that is uncanny," Beiler declares. The creator of the jingle, Rick Altizer, actually asked a frontman for a Queen cover band, Queen Extravaganza, to sing the Perfect Bacon Bowl jingle. It's an "homage to an iconic band" Beiler says.
The ad caused a lot of social media buzz. Many people declared their appreciation of the commercial, and the Perfect Bacon Bowl!
This entry was posted in Scott Boilen in the News and tagged Allstar Products Group, Bacon Bowl, Scott Boilen, Washington Post on December 22, 2014 by ScottBoilen.
In a recent Market Watch article, Charles Passy discusses bacon sales, the "bacon boom" and Allstar's popular Bacon Bowl. Allstar CEO, Scott Boilen, says he reflected on the boom of sales occurring with bacon and consider the crowded bacon marketplace before introducing the Bacon Bowl – a simple device that runs strips of bacon into an edible shell.
Scott Boilen decided he couldn't resist the invention and in late 2013 Allstar Products Group launched a series of Bacon Bowl infomercials. "In a brief period, Scott Boilen's New York-based company has sold more than two million units of the $10.99 bacon cooker, making the Bowl a success story potentially on par with the Snuggie, to name Boilen's biggest "As Seen on TV" hit.
This entry was posted in Scott Boilen in the News and tagged Allstar Products Group, bacon boom, Bacon Bowl, bacon sales, CEO, MarketWatch, Scott Boilen on August 11, 2014 by ScottBoilen.


text:
package com.palantir.atlasdb.transaction.knowledge;

import com.palantir.atlasdb.internalschema.InternalSchemaInstallConfig;
import com.palantir.atlasdb.keyvalue.api.KeyValueService;
import com.palantir.atlasdb.sweep.queue.LastSeenCommitTsLoader;
import com.palantir.tritium.metrics.registry.TaggedMetricRegistry;
import java.util.function.BooleanSupplier;
import java.util.function.Supplier;
import org.immutables.value.Value;

@Value.Immutable
public interface TransactionKnowledgeComponents {
    KnownConcludedTransactions concluded();

    KnownAbandonedTransactions abandoned();

    Supplier<Long> lastSeenCommitSupplier();

    static TransactionKnowledgeComponents createForTests(KeyValueService kvs, TaggedMetricRegistry metricRegistry) {
        return create(kvs, metricRegistry, InternalSchemaInstallConfig.getDefault(), () -> true);
    }

    static TransactionKnowledgeComponents create(
            KeyValueService kvs,
            TaggedMetricRegistry metricRegistry,
            InternalSchemaInstallConfig config,
            BooleanSupplier isInitialized) {
        LastSeenCommitTsLoader lastSeenCommitTsLoader = new LastSeenCommitTsLoader(kvs, isInitialized);
        return ImmutableTransactionKnowledgeComponents.builder()
                .concluded(KnownConcludedTransactionsImpl.create(
                        KnownConcludedTransactionsStore.create(kvs), metricRegistry))
                .abandoned(KnownAbandonedTransactionsImpl.create(
                        KnownConcludedTransactionsImpl.create(
                                KnownConcludedTransactionsStore.create(kvs), metricRegistry),
                        new AbandonedTimestampStoreImpl(kvs),
                        metricRegistry,
                        config))
                .lastSeenCommitSupplier(lastSeenCommitTsLoader::getLastSeenCommitTs)
                .build();
    }
}

redpajama_set_name: RedPajamaGithub


This post is taken from Dhananjay Kumar.
We build a single page app instead of a standard MVC app to avoid re-rendering pages and performance issues. Also SPAs can provide a rich, desktop-like environment. But what to choose ..?
Update: 5/1/2014 – Customer View & customerController.js has been updated to toggle styles by manipulating the DOM through the ViewModel with ng-show to adhere and stay consistent with AngularJS best practices.
Update: 5/14/2014 – Added section "Animating our View Swapping", to elaborate on adding animation to the "ng-view" swapping process.
With AngularJS and ASP.NET MVC, we now have an MVC pattern and architecture for both on the client and server. What do we do and/or how do we approach this? Well one can argue we don't use any of the MVC architecture on the server and build out a full-fledged AngularJS front-end application and only use make async calls to Web API for all things that absolutely need to be on the server e.g. CRUD, workflows, business logic, etc.
It's important to note that in the Angular, we're not looking up elements by a selector and then directly manipulating the HTML. Instead, we're declaring where the variables should be attached and then Angular takes care of the plumbing for us.
The angular way of developing applications dictates that we take care of the data and angular will take care of the DOM manipulation.


This semester we will tackle the question of social change — namely, by popping the hood of a few social change "vehicles" (i.e. organized efforts pursuing some positive social and/or environmental impact) and troubleshooting their different methods, models, strategies, ways of operating, and sets of assumptions in relation to social change and how it is believed to work. In collaboration with our community partners, each embodying a different "theory of change" — in our case, local organizations embroiled in the politics of Vermont's energy and climate goals — we will explore how practitioners of social change conceive of social change: what it is, what it looks like, how it happens, what their role is in it, and how to do it.
WHAT ARE THEORIES OF CHANGE?
Typically, a "theory of change" (TOC) outlines key beliefs, assumptions, and hypotheses about how social change is thought to occur. These are often depicted through narrative and causal chain diagrams portraying, step-by-step, how a given group envisions and intends to enact change. To say that opinions differ on such matters would be a comic understatement. As such, we will engage a range of intellectual traditions, political orientations, and strategic outlooks regarding social change through in-class discussion, targeted course readings, and two short assignments.
TOCs are not only practical tools for strategic planning. They can also serve as valuable entry points for understanding pivotal tensions at the heart of the environmental movement: longstanding debates between reformers and revolutionaries, insiders and outsiders, progressives and radicals, pragmatists and idealists. By foregrounding underlying beliefs about social change — essentially, making us 'show our political work' — the process of TOC formulation forces us to have conversations about, and thereby directly confront and reckon with, fundamental questions about the nature of power, social struggle, and where we stand in relation to the established political-economic order. By design, TOCs render these questions uniquely and unavoidably explicit. Viewed in this way, TOCs offer revealing glimpses into how environmentalists are wrestling with the political meaning of the current moment and what can, and should, be done about it.
We do not need to tell you by this point in your studies that these questions are not merely an interesting intellectual exercise. Given the severity and time-sensitive nature of the climate crisis, getting our "theories of change" right, their characterizations of what we are now confronting, and their claims about how we are supposed to get from Point A to Point B, have never had higher stakes. Moreover, don't let the word "theory" give you the wrong impression. This kind of work is inherently messy and personally involving — it is as much an art as it is a science. A major goal for this class is to give you some exposure to this reality as you learn how your partners contend with the everyday dilemmas, power structures, entrenched inertias, dynamic relationships, idiosyncratic personalities, emotional rigours, rambunctiousness, and occasional windows of opportunity that all combine in different ways to define the terrain of social change-driven work.
Working together with your partners — with humility, with respect, and with all the knowledge, skills, experience, analytical intuitions, creativity, compassion and courage you can muster, and which you have spent so many days and nights cultivating through your studies at Middlebury — you will endeavour to think through, carefully and systematically, how we are to thread the needle at this critical juncture before the wind picks up. So, tell us: how exactly are we going to get from "here" to "there"?
In this course, students will work in small groups with one of a variety of partners and organizations to complete a semester-long, community-engaged project. Project themes vary by term and typically focus on local and regional environmental issues that have broader application. Projects rely on students' creativity, interdisciplinary perspectives, skills, and knowledge developed through their previous work. The project is guided by a faculty member and carried out with a high degree of independence by students. Students will prepare for and direct their project through readings and discussion, independent research, collaboration with project partners, and consultation with external experts. The course may also include workshops focused on developing key skills (e.g. interviewing, public speaking, video editing). The project culminates in a public presentation of students' final products.
In Fall 2018, I will be taking the helm of this capstone course for Environmental Studies at Middlebury and will be structuring it loosely around themes explored through my ongoing research into "Theories of Change." The permanent homepage for ENVS 401 can be found here.


Many English words are imitative of the sounds they describe and are thus onomatopoeic. This is true of a large group of English words ending in -ash, which mimic the sounds they describe and have similar meanings to each other. Words ending in -ash tend to denote forceful collision or its smashed-up after-effects. Hence, after a bash or a crash, what is left may be only a squashed or shattered mash fit for the trash. There is an intrinsic violence and commotion to most of the words which end in the -ash cluster. These actions occur at speed and may well turn out to be slapdash or extremely rash. First, let's look at some of the verbs.
Words with the -ash ending are not usually well-controlled or planned - they are flung together, all mixed up, and form a bit of a mish-mash. As might be expected by such a hurried, bungled approach, you might end up making a hash of whatever you are attempting and the results just won't wash, or stand up to scrutiny. This may cause your hopes to be dashed and because of your rash promises, there could well be a backlash, with your words being described as preposterous or balderdash. Linguists assert that the word balderdash comes from just such a thrown together combination, in this case a jumbled up mix of liquids that was sold cheaply in medieval England. Wine was mixed with beer or water, or else beer was combined with milk or water and the resulting concoction was known as balderdash, possibly through association with Danish balder "noisy clatter" or Swedish bullersten "noisy stone"and the word dash, which is still used when ingredients are tossed into drinks. Balderdash later acquired the meaning of "nonsensical speech or writing", which seems appropriate given the unappealing nature of the drink it first described.
The word mash was masc in Old English and can be traced back to a Proto-Indo-European root *meik- "mix", which is also the source of Old English meox "dung, filth". Masc meant "unfermented malt sap" and was originally used only for brewer's mash before later acquiring the more general meaning of "soft mixture". Many of the other -ash nouns, such as hash, brash and even ash itself also refer to mixtures and soft remains. A related group of words ends in an -ush cluster, but these tend to be mushier and with more of a liquid content, as we wil see in a later post. Mash has cognates in other Indo-European languages with German Maische, Swedish mäsk, Lithuanian misa and Spanish mezcla. The jumbled up, hastily mixed together idea of -ash is also a feature of the Slavic word kaša/каша, which means "porridge" "mash" and "mess" in Serbian, Croatian, Slovak and Bulgarian among others.
Scottish and Northern English dialects seem particularly fond of the -ash cluster, as many -ash words survive here that are no longer used or have never been used in Standard English. These include the verb fash "bother, annoy, trouble", from Old French fascher (Modern French fâcher); pash "head" and also "fight with fists" - in recent years pash has become an abbreviation for "passion" and is used in the UK as a verb meaning "snog"; snash "abuse, insolent speech"; plash "splash through water", "puddle" and stramash "uproar, disturbance, racket". There are probably similar examples, but I waddn't fash to find them. Possibly a grave mistake as such lethargy may have serious consequences as outlined in the County Durham folk song The Lambton Worm, later regaled by my mother to her totally incredulous daughters-in-law.
After your crash course in -ash, here is a quiz to finish. Have a bash!
2. And which of these terms also means "nonsense"?
3. Which of these is a sudden local flood?
5. Which -ash is a strong, negative reaction?
6. The adjective brash means "over-assertive, rude", but what does the noun brash mean?
7. When we reuse old ideas or material and don't make any real improvements, what do we produce?
8. Where do revellers go when they intend to have a few drinks?
9. If you are disparaging and insulting an opponent or an enemy, what are doing?
10. What type of primitive agricultural technique involves cutting down trees and burning plants and forests to create fields?
11. Which -ash is a secret hiding place?
12. What do we call the type of injury suffered when there is a sudden jerking of the head, as happens as a result of a car crash?
I hope you enjoyed the blog post, but now I'm afraid I must dash! See you next time!


text:
Fedora Unity is a community project to build comprehensive and concise websites and content that provide Fedora users and contributors with quality information.

All submissions to the project are covered by the Open Publication License (with no options) unless otherwise noted in order to allow submission to the Fedora Documentation Project.

Re-spins
The Fedora Unity project produces ISO images for i386 and x86_64 architectures that are available as Jigdo downloads, containing slipstreamed installation media.

Last release: Fedora 12 Re-spins-20100303 released, March 19, 2010. These Re-Spin ISOs are based on the officially released Fedora 12 installation media and include all updates released as of March 3, 2010.

See also
List of remastering software

References

External links
 https://web.archive.org/web/20070218131800/http://fedoraunity.org/
 http://fedoraproject.org/wiki/
 http://torrent.fedoraunity.org/

Fedora Project
Year of establishment missing
Open Publication License-licensed works


How much agricultural produce does the UK consume in real time?
The changing numbers, here below, represent the consumption in real time, since you've been on this page!
Just seeing the sheer volume of real time consumption of agricultural produce, it becomes very clear that mechanization in agriculture and crop rotation are key to be successful.
Farmmachinerylocator.co.uk is a specialist agricultural equipment site in the UK, where users can search for all types of farm equipment for sale. The most popular search on the site is for tractors for sale in the UK which typically return more than 1,000 tractors advertised by sellers across the UK.
At harvest time, the popularity of the combines for sale, in the UK, search term increases, as you would expect. Published by Focus Business Media alongside the website is the fortnightly national classified advertising magazine, Farm Machinery Locator.


The U.S.A. International Black Belt Hall of Fame Induction Ring!
The ring represents world-class success for all martial artists. It is the ultimate in personalized jeweler's. The XXL double rail stadium based championship sized ring is made of Celestrium (jeweler's stainless steel that does not tarnish). The ring is topped with a brilliant Fire Blue Spinel gemstone. Each ring is personlized with the individual's name and /or title along with the America Eagle and the EUSAIMAA logo with your specific year of induction. The ladies inductee pendant is designed exactly as the top of the men's ring to be worn with the silver necklace provided or one of your own.
by ordering this ring today!
for information on how to order yours!


Unsuspecting hungover rival spotted on a sun lounger.
Watch five unruly Middlesbrough fans, said to be on holiday, creep up on an unsuspecting Newcastle supporter and throw him in the pool he was lounging beside, apparently snoozing off a hangover.
The sniggering group team up to tip the seemingly oblivious Newcastle fan's sun lounger over and run off laughing as the man crashes into the water face first.
I presumed he could swim or did he just drown?


text:
Q: Prove that $f(x,y) = 1/(x^2 + y^2)$ has limit $\infty$at $(0,0)$ The question is: "prove that function $f(x,y) = $ $1 \over (x^2 + y^2)$ have limit $\infty$ in point $[0,0]$.
This is pretty standard question, and even my book answers it immediately afterwards, but it answer begins with "A is any number from $\mathbb R$, let's assume that $\delta = $ $1 \over \sqrt (2|A|)$, so it doesn't give me any strategy to look for the right $\delta$, except for "lucky guess". How do I find $\delta$ here without first guessing it and than proving that my guess was indeed right?

A: To reach a useful guess, note that, for every positive $\delta$, $$\|(x,y)-(0,0)\|\leqslant\delta,\ (x,y)\ne(0,0)\implies f(x,y)\geqslant\frac1{\delta^2}.$$

redpajama_set_name: RedPajamaStackExchange


text:
Celebrating 90 Years of Independent Bookselling
Browse Bestsellers
The Penguin Team
Store Hours & Info
Moving Forward by Jerry Veshio
Pancho Rabbit and the Coyote: A Migrant's Tale (Hardcover)
An allegorical picture book about the hardships and struggles of immigration from award-winning picture book creator Duncan Tonatiuh
A Pura Belpré Author and Illustrator Honor Book and ALA/ALSC Notable Children's Book!
A young rabbit named Pancho eagerly awaits his papa's return. Papa Rabbit left two years ago to travel far away north to find work in the great carrot and lettuce fields to earn money for his family. When Papa does not return home on the designated day, Pancho sets out to find him. He packs Papa's favorite meal—mole, rice and beans, a heap of still-warm tortillas, and a jug full of fresh aguamiel—and heads north. He soon meets a coyote, who offers to help Pancho in exchange for some of Papa's favorite foods. They travel together until the food is gone and the coyote decides he is still hungry . . . for Pancho!
Award-winning author and illustrator Duncan Tonatiuh brings to light the hardship and struggles facing families who seek to make better lives for themselves and their children by illegally crossing the borders.
Duncan Tonatiuh was born in Mexico City and grew up in San Miguel de Allende. His books have received many awards over the years. He currently lives in San Miguel with his wife and children but travels to the US often.
** STARRED REVIEW **
"Tonatiuh's great strength is in the text. No word is wasted, as each emotion is clearly and poignantly expressed. The rabbits' future is unknown, but their love and faith in each other sustains them through it all. Accessible for young readers, who may be drawn to it as they would a classic fable; perfect for mature readers and the classroom, where its layers of truth and meaning can be peeled back to be examined and discussed. An incandescent, humane and terribly necessary addition to the immigrant-story shelf."
— Kirkus Reviews
STARRED REVIEW
"In both prose and art, Tonatiuh expertly balances folkloric elements with stark, modern realities; Pancho Rabbit's trip has the feel of a classic fable or fairy tale, with the untrustworthy coyote demanding more and more of him."
— Publishers Weekly
"The book shows the fragility of making a living, the desperation that many migrants experience, and the deep family ties that bind the characters. Classrooms studying the migrant experience will find plenty to discuss here."
— School Library Journal
"This will spark strong responses and needed discussion."
"Tonatiuh is so careful in weaving his allegory that his empathetic contemporary tale feels like age-old folklore, with simple but compelling text and a step-by-step escalation of the story through gripping, kid-understandable challenges."
— The Bulletin of the Center for Children's Books
Publisher: Abrams Books for Young Readers
Publication Date: May 7th, 2013
Juvenile Fiction / Social Themes / Emigration & Immigration
Juvenile Fiction / Animals / Rabbits
Juvenile Fiction / Family
Kobo eBook (May 7th, 2013): $16.15
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text:
Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial
Paul A Jennings1,2,3,
Peter Cameron2,
Stephen Bernard2,3,4,
Tony Walker3,
Damien Jolley2,
Mark Fitzgerald3,4,
Kevin Masci3
1Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
3Ambulance Victoria, Melbourne, Victoria, Australia
4The Alfred Hospital, Melbourne, Victoria, Australia
Correspondence to Dr Paul A Jennings, Department of Community Emergency Health and Paramedic Practice, Monash University, Level 5, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia; paul.jennings{at}monash.edu
Introduction Improved early pain control may affect the longer-term prevalence of persistent pain. In a previous randomised, controlled trial, we found that the administration of ketamine on hospital arrival decreased pain scores to a greater extent than morphine alone in patients with prehospital traumatic pain. In this follow-up study, we sought to determine the prevalence of persistent pain and whether there were differences in patients who received ketamine or morphine.
Methods This study was a long-term follow-up study of the prehospital, prospective, randomised, controlled, open-label study comparing ketamine with morphine in patients with trauma and a verbal pain score of >5 after 5 mg intravenous morphine. Patients were followed-up by telephone 6–12 months after enrolment, and a questionnaire including the SF-36 (V.2) health-related quality of life survey and the Verbal Numerical Rating Scale for pain was administered.
Results A total of 97/135 (72%) patients were able to be followed-up 6–12 months after enrolment between July 2008 and July 2010. Overall, 44/97 (45%) participants reported persistent pain related to their injury, with 3/97 (3%) reporting persistent severe pain. The prevalence of persistent pain was the same between study groups (22/50 (44%) for the ketamine group vs 22/47 (46%) for the morphine group). There was no difference in the SF-36 scores between study arms.
Conclusions There is a high incidence of persistent pain after traumatic injury, even in patients with relatively minor severity of injury. Although decreased pain scores at hospital arrival are achieved with ketamine compared with morphine, this difference does not affect the prevalence of persistent pain or health-related quality of life 6 months after injury. Further larger studies are required to confirm this finding.
Trial Registration Number Australian and New Zealand Clinical Trials Registry (ACTRN12607000441415).
emergency ambulance systems
analgesia/pain control
http://dx.doi.org/10.1136/emermed-2013-202862
Acute pain is a common presentation to healthcare clinicians,1–4 and is a significant contributor to disability many months, or years, after injury. The effective management of pain is obviously of critical importance in the short term, yet the effectiveness of early pain management may also be associated with the likelihood of persistent pain syndromes and the pain-related anxiety and distress that follow.5–8 One of the theories postulated for the progression of acute to persistent pain is central sensitisation, whereby nociceptive neurons increase their response to non-painful stimuli, develop spontaneous activity, and broaden the area of the body that is involved with the pain over time.9 Persistent pain significantly affects people's physical and mental health,5–8 and can delay functional recovery after traumatic injury.10 ,11 The prevalence of persistent pain after injury has been reported to be 11–67%,12–15 and it adversely affects health-related quality of life.
Most acute traumatic pain management studies focus on efficient reduction of pain during the episode of care, but few studies follow patients over the medium to long term after injury. The aim of this study was to determine the prevalence of persistent pain and self-reported health-related quality of life outcomes 6–12 months after injury and enrolment in a prospective randomised controlled study that compared the effectiveness of morphine with morphine and ketamine in patients with moderate to severe traumatic pain before arrival at hospital.
The setting and study design of the morphine and ketamine versus morphine alone randomised controlled trial has been previously described.16 Briefly, patients with trauma and a verbal pain score of >5 after 5 mg intravenous morphine were eligible for enrolment. Those with any of the following were excluded: known allergy to ketamine hydrochloride or morphine sulfate, pregnant or lactating women, ischaemic chest pain, acute pulmonary oedema, and/or severe hypertension (systolic blood pressure >180 mm Hg), head injury with history of loss of consciousness or Glasgow Coma Score <15, no venous access available, or presumed intoxication with alcohol or illicit substance. Patients allocated to ketamine received a bolus of 20 mg followed by 10 mg every 3 min. Patients allocated to morphine alone received up to 5 mg intravenously every 5 min until pain free (standard care). Pain scores were measured at baseline and at hospital arrival.
Patients were then followed-up via a telephone interview 6–12 months after enrolment into the study. Two instruments were administered to participants enrolled in this study to measure both the presence of persistent pain and health-related quality of life: the Short Form 36 V.2 Health Survey (SF-36; QualityMetric, Lincoln, Rhode Island , USA)17 and a global pain numerical rating score. The SF-36 was divided into two aggregate summary measures: the Physical Component Summary (PCS) and the Mental Component Summary (MCS).17 The global pain measure used the Verbal Numerical Rating Scale (VNRS)18 and reported the patient's self-rated current pain at the time of the interview. Patients were asked to rate their current pain intensity using an 11 point scale 0–10 (0 being 'no pain' and 10 being 'worst pain ever experienced').
Participants were eligible if they had been recruited for the ketamine study.16 Each participant was contacted by telephone 1 month after enrolment to obtain consent for access to their medical record from the receiving hospital and for a follow-up telephone call for the purpose of conducting the questionnaire. Participants were contacted via the landline or mobile phone number recorded on the case report form at the time of enrolment. If the participant was not contactable via the phone numbers provided at enrolment (ie, phone numbers disconnected, not responding to messages left on answering machines, no answer, and wrong numbers) after at least five attempts, additional sources were used to identify current contact details. These sources included the Whitepages, the patient's medical discharge summary (where available), and the ambulance service patient database. The telephone interview took ∼20 min to complete, and each participant was offered the opportunity to ask questions about the study and their participation. Several trained interviewers conducted the telephone interviews, and each was blinded to the trial arm allocation of the participant at the time of the interview. Owing to the method of SF-36 administration (telephone interview), there were no missing data. Only one person contacted for follow-up interview refused to take part in the SF-36.
The sample size calculation has been provided previously,16 and was powered to detect a difference in the primary outcome measure (change in VNRS score), not the secondary outcome measures, which include the long-term outcomes. Transformation of raw scores was performed using Stata V.11 using the published Australian and New Zealand population norms.19 The baseline characteristics and SF-36 summary and scale scores were compared using the two-sample t test for continuous variables. The global pain scale scores were compared using the two-sample Wilcoxon rank-sum test, as these data were not normally distributed. Treatment effects were tested at a two-sided significance level of 0.05.
A total of 136 participants with moderate to severe traumatic pain were enrolled between December 2007 and July 2010 (a 30-month period). Follow-up of participants continued until December 2010. One person withdrew consent to participate in the trial, leaving 135 participants eligible for analysis. Sixty-five (48%) participants were randomly assigned to the morphine-only group (M group) and 70 (52%) to the ketamine plus morphine group (K+M group). The baseline characteristics were similar between the two groups and are shown in table 1.
Demographic data and injury characteristics of patients
Study participants could be followed-up in 72% of cases (97/135). Thirty-seven participants (27%) were unable to be contacted by phone, and one participant (1%) refused to participate in the interview. Of those who were available for follow-up, 48% (47/97) had been enrolled in the ketamine arm and 52% (50/97) in the morphine arm.
Responders vs non-responders
Non-responders and responders were very similar with respect to all characteristics, except that non-responders were less likely to be male (50% vs 66%) and were slightly more severely injured (mean Injury Severity Score 6.2 vs 4.0).
Outcomes at follow-up
Table 2 summarises PCS and MCS scores of the 97 participants who were followed-up by participant characteristic.
Physical Component Summary (PCS) score and Mental Component Summary (MCS) score by participant characteristic
The overall mean PCS and MCS summary measure scores were the same for the two study groups (table 3).
Summary measures by study group
Overall, 45% (44/97) of participants reported persistent pain related to their injury, with 3% (3/97) reporting persistent severe (VNRS >7) pain. The prevalence of persistent pain was approximately the same in the two study groups (K+M group: 44% (22/50); M group: 46% (22/47)). The self-reported global median pain score at follow-up was no different between the K+M group (0 (IQR 0–2)) and the M group (0 (IQR 0–3)) (Wilcoxon p value=0.44).
There was no clinically significant difference in the long-term follow-up between study groups with respect to the summary or global pain score. Even so, this study is important, as it provides information about the long-term evaluation of management of acute pain. Most studies focus only on the immediate effect of the intervention.
There was no difference in the median self-reported global pain scale between the two study groups; however, 45% of participants reported persistent pain as a result of their injury. This finding is particularly important given the relatively minor nature of the injuries sustained, most being isolated musculoskeletal trauma. Early, effective pain management is important for several reasons. First, pain relief after injury is important for humanitarian reasons. Perhaps of equal, or arguably more, importance, earlier and more effective treatment of acute pain may reduce or even terminate the progression from acute to persistent pain.10 ,13 Effective pain management in both the emergency medical services (EMS) and emergency department setting may play a role in reducing the likelihood of chronic pain syndromes and pain-related anxiety and distress after the acute phase.5–8 The phenomenon of the progression of acute pain to chronic pain syndromes is also seen in surgery, where there is strong evidence that some early anaesthetic/analgesic interventions reduce the incidence of chronic pain after surgery.20 Furthermore, persistent pain is a substantial contributor to the burden of disease after injury, significantly impacting on people's physical and mental health,5–8 and can delay functional recovery after traumatic injury.10 ,11
Future pain management research should also aim to follow participants over time to evaluate the effect the interventions have on long-term physical and mental health outcomes and the association of acute pain characteristics and management with the development of persistent pain.
A limitation to the analysis of long-term global pain and quality of life of the participants in this study was the loss to follow-up. Follow-up was possible in 72% (97/135) of participants, and it is possible that the inability to locate all study participants may affect the validity of the study's secondary end point—long-term health-related outcome. There was, however, little difference in the characteristics profile of those who responded and those who did not respond. Furthermore, the number of patients included in this phase of the study was moderate, and therefore the power to identify a difference between groups, if one exists, may have been limited. We did not have the 'time to treatment' interval available to us, and we feel that this may have been an important covariate and should be collected and considered for future studies in this area.
Finally, it was not possible to interview all study participants at the same time period after their enrolment. While it was intended to conduct interviews 6 months after enrolment, a number of participants were unable to be contacted until up to 12 months after recruitment.
There is a high incidence of persistent pain after traumatic injury, even in patients with relatively minor severity of injury. There was no difference in persistent pain prevalence, global median pain intensity or SF-36 summary measures in this prehospital trauma cohort. We feel this study, despite being moderate in size, provides valuable information for researchers aiming to undertake further, larger-scale research in this area of persistent pain mechanisms and aetiology. Furthermore, clinical trials that examine acute pain management interventions should include in their study design medium- to long-term follow-up of health-related quality of life and prevalence of persistent pain.
The authors would like to acknowledge the contribution of the paramedics from Ambulance Victoria who assisted by enrolling participants and the submission of data.
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. Acute pain management: scientific evidence. 3rd edn. Australian and New Zealand College of Anaethetists and Faculty of Pain Medicine, 2010.
Contributors PAJ, PC, and SB conceived the study, and PAJ, PC, SB, TW, MF and KM designed the trial. PAJ obtained research funding through a TAC research fellowship. PAJ, PC, SB, TW and KM supervised the conduct of the trial and data collection. PAJ undertook recruitment of participating sites and patients and managed the data, including quality control. DJ provided statistical advice and analysed the data. TW chaired the trial steering committee. PAJ drafted the manuscript, and all authors contributed substantially to its revision. PAJ takes responsibility for the paper as a whole.
Funding Transport Accident Commission (TAC) Health Research Fellowship.
Ethics approval Monash University Human Research Ethics Committee, Melbourne, Australia.
Guide to the design and review of emergency research when it is proposed that consent and consultation be waived
Hugh Davies Haleema Shakur Andrew Padkin Ian Roberts Anne-Marie Slowther Gavin D Perkins
Emergency Medicine Journal 2014; 31 794-795 Published Online First: 31 Jul 2014. doi: 10.1136/emermed-2014-203675


text:
Straight Up Conversation: New Florida Commissioner Tony Bennett
Opinion Blog
Rick Hess Straight Up
Education policy maven Rick Hess of the American Enterprise Institute think tank offers straight talk on matters of policy, politics, research, and reform.
By Rick Hess — December 14, 2012 5 min read
Rick Hess
Opinion Contributor, Education Week
Rick Hess is a resident scholar at the American Enterprise Institute and the director of the think tank's Education Policy Studies.
The alternative headline here would've been, "Denver Got P. Manning, Florida Gets T. Bennett." After all, it's been a tough year for Indiana; they keep shipping homegrown stars elsewhere. This spring, the Indianapolis Colts cut ties with all-world quarterback Peyton Manning, with the Denver Broncos outbidding several other franchises for his services. Last month, Indiana's voters turned out an iconic school reformer, state superintendent Tony Bennett, setting off another, though less glamorous, scrum. Indiana's loss turned out to be Florida's gain, as the State Board voted unanimously Wednesday to select Bennett as Florida's new education commissioner.
Bennett moves to a big state with an outsized reputation when it comes to education reform, but one that's been struggling to keep a strong state commissioner in place amidst concerns about politics and relations with the governor and the State Board of Education. Florida is also wrestling to implement Senate Bill 736, the nation's most radical effort to overhaul teacher evaluation, tenure, and pay. It's going to be messy because, while 736 got some big things right, it also got some big things really wrong. Florida is also where school reform icon Jeb Bush built his reputation and based his massively influential foundation, and it's no secret that Bush and Bennett are close. That only strengthens Bennett's hand. All in all, a coup for Florida, a great move for Bennett, and a situation that's going to be well worth watching. Yesterday, I chatted with Bennett about the move.
Rick Hess: So how did this whole thing come about?
Tony Bennett: I had read that Florida extended their search for a new commissioner after the election. I got in touch with their board chair, Gary Chartrand, he put me in touch with the search firm, and we took it from there. It took maybe four weeks from start to finish.
RH: When do you start the new job, and what are you doing to get up to speed?
TB: I'll start January 14th. I'll walk out of Indiana on Friday, January 11th, and I'll be in Florida and ready to go on Monday, the 14th. As for getting prepared, I'll be spending some time with [interim commissioner] Pam Stewart and her current staff, just trying to learn about various issues. I'm bringing in at least four people [from Indiana], who are going to help me get my arms wrapped around staffing, strategic initiatives, and how we transfer in.
RH: What most appealed to you about the new opportunity?
TB: You know, I loved doing the job I did [being state chief in Indiana]. I had a real dilemma as to whether I wanted to stay in Indiana and do something other than what I was doing, or if I was open to doing the job I love somewhere else. Florida has a rich history doing the same kinds of things we accomplished in Indiana. There is also an incredible openness among educators around these things in Florida. I'm confident we can have a big impact not only for Florida's kids, but also on the national education landscape. All that helped convince me to make the move.
RH: What gave you pause as you looked at Florida?
TB: Nothing, really. I have a close relationship with [former Florida commissioner] Eric [Smith], so I knew a lot of the context first-hand. I had a thorough understanding of how Governor Scott wants to use education for economic development and my conversations with the Board were incredible. The interview went well, and it was clear that this is where we wanted to be. When they called and said, "We want you," there was never a hesitation. I didn't have to stop and say, "Let's think about it." My wife and I had already discussed it and we decided that, if they wanted me, this is where we wanted to be.
RH: What's your take on some of the murmurs that the political situation is tough, that Florida has burned through two commissioners in Eric Smith and Gerard Robinson, and that it seems like it's a tough state to lead nowadays?
TB: Well, and I don't intend for any of this to come off as a criticism, Eric got caught up in the change of administration. As for Gerard, one of the things I bring to the table is four years of a strong, well-established record managing a state agency. That's experience you can't put a price on. I also have the experience and skills to make a smooth transition. The reason Florida is such an intriguing and exciting opportunity is that you have a governor that is firmly invested in using education for economic development, and then you have Jeb Bush and the Foundation [for Excellence in Education]. A commissioner who is able to bring those forces together can do big things for Florida. And that's a challenge I look forward to.
RH: What are some of the key challenges ahead for Florida?
TB: Common Core implementation is a huge piece. There is a much more universal acceptance of the Common Core in Florida than there was in Indiana. It's the implementation that is going to be very important. We really want to make sure that Florida is very intentional about continuing to lead the country - and we're going to work with the board, legislature, and governor to identify the next steps of reform. When I was in Florida [earlier this week], Governor Scott told me to address two things when we spoke to educators and administrators: Common Core implementation and SB 736. Those are going to be out front.
RH: Obviously, implementing SB 736, the big teacher bill, has been the subject of much angst. How will you think about moving forward there?
TB: Senate Bill 736 has created some challenges, but also some opportunities. It has and will continue to bring into focus how we think about the obstacles, the capacity challenges at the district level, and whether we need to make tweaks to the legislation. When I met with administrators and teachers the other day, I said nothing is off the table in terms of 736. We want to make sure this is an effective, efficient, fair, measure of teacher effectiveness. One thing I've been clear about is that I will not try to make Florida into Indiana, but I will bring the insight about what has worked there and combine it with what has historically worked well in Florida.
RH: What's the biggest lesson you learned from your experience in Indiana?
TB: This is something I wrestle with all the time. In Indiana, we moved very quickly. We did in four years what Florida did in eight or ten years. And I keep asking myself, is there anything we could have done differently and still got it all done? If I were to do all of those things over a longer period, I would have approached them differently when it came to how we sold the reforms and brought the education community on board. We didn't communicate with educators like we needed to. We did a good job explaining how the reforms were good for kids, but a poor job saying why they were also good for schools and educators. But we had a window of opportunity to do very big things in Indiana and we got them done. Now, Florida's a different situation, and we're going to work hard to do better when it comes to communicating with educators.
The opinions expressed in Rick Hess Straight Up are strictly those of the author(s) and do not reflect the opinions or endorsement of Editorial Projects in Education, or any of its publications.
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