OPERATOR: Good afternoon, everyone. Thank you for standing by. Please continue holding, our conference will begin momentarily. Thank you all for standing by. Please continue holding. We will begin our conference momentarily.
OPERATOR good morning. Thank you for all standing by. Welcome to today's conference call. At this time, all lines are on listen only mode for today's conference. Until the question and answer portion of our call at which time you'll be prompted to press star 1 on your touch tone phone. Please limit yourself to one question and one follow-up during the Q and A portion of the call, please be sure to announce your name. Our conference is being recorded, if you have any objections you may disconnect at this time. I will now turn the conference over to your host Mrs. Kathy Harben. Ma'am you may proceed.
KATHY HARBEN: Thank you, Jill. Thank you all for joining us for the release of the CDC guideline for prescribing opioids for chronic pain. We're joined today by CDC Director by Dr.Tom Frieden. Dr.Debra Houry who is Director of CDC's National Center for Injury Prevention and Control, and Dr.Deborah Dowell, co-author of the guideline are here for the question and answer session. In addition, we welcome the Secretary Of Health And Human Services Sylvia Mathews Burwell for opening remarks. I'll now turn the call over to Dr.Frieden to introduce Secretary Burwell.
DR. FRIEDEN: Thank you and good afternoon. We're delighted that secretary Burwell could join us today. One year ago in march 2015 secretary Burwell announced HHS initiative to reduce the prescription opioid and heroin related overdose death and dependence. Secretary Burwell understands well the devastation that opioid abuse and overdose has caused for American families and communities and has helped to bring together stakeholders from across the country to focus on prevention, treatment and intervention. Secretary Burwell.
SECRETARY BURWELL: Thank you so much, Dr.Frieden. The opioid epidemic is one of the most pressing public health issues in the United States today. Last year, more Americans died from drug overdoses than car crashes. And these overdoses have hit families across our entire nation. Families who live on city blocks and families who live in rural towns. In my own home state of West Virginia I have seen firsthand and continue to see firsthand how substance use can devastate families and communities. Combatting the opioid epidemic is a national priority. That's why the President's budget requests more than $1 billion to fight opioid use disorder and overdose, and we look forward to working with the congress to secure this funding. It's why governors throughout the nation are working from common ground to end this crisis. And it's why public health leaders across the country are finding innovative ways to push back against these troubling statistics and what it means to people in their everyday lives. At HHS, we're helping to lead the nationwide effort by focusing on three priority areas. First, we want to make sure that naloxone is in the hands of first responders and anyone else who responds to an opioid overdose.
In November, the FDA approved a nasal form of Naloxone, one of the more innovative ways to get this treatment to the people who need it most. We're also expanding access to evidence-based treatments like medication -assisted treatment. A combination of behavioral therapy and counseling with medication to treat substance use disorders. And last week, we awarded $94 million to medication-assisted treatment in 271 health centers across the country. Third, what brings us here today is our commitment to equip health professionals with tools they need to fight this epidemic. We need to help primary care providers make the most informed prescribing decision. Balancing the need to manage their patient's chronic pain with the duty to curb dangerous prescribing practices. That's why CDC is releasing their guideline for prescribing opioids for chronic pain. We believe this guideline will help health care professionals provide safer and more effective care for patients dealing with chronic pain. And we also believe it will help these providers draw down the rates of opioid use disorder, overdose and sadly, ultimately death. We know this is a goal that we all share. Patients with chronic pain should have safe and effective pain management. And too many families have had to come to grips with the tragedy of opioid use disorder and overdose. The guideline CDC is releasing today will provide safer pain management while helping us reduce opioid abuse. It's an important step in our work to combat the opioid epidemic. With that, I'll turn it back to Dr.Frieden.
DR. FRIEDEN: Thank you so much, Secretary Burwell. It's become increasingly clear that opioids carry substantial risks, but only uncertain benefits, especially compared with other treatments for chronic pain. Today and every day this year, more than 40 Americans will die from a prescription opioid overdose in this country. Beginning treatment with an opioid is a momentous decision. And it should only be done with full understanding by both the clinician and the patient of the substantial risks and uncertain benefits involved. We know of no other medication that's routinely used for a nonfatal condition that kills patients so frequently. With nearly 250 million prescriptions written each year, it's so important that doctors understand that any one of those prescriptions could potentially end a patient's life. A study in 2015 found that 1 out of every 550 patients started on long-term opioid therapy for non-cancer pain died of an opioid-related cause, just a little over– within 21/2 years of the first prescription. Remarkably those who got the highest doses of opioids, more than 200 MMEs per day had a 1 in 32 chance of dying in just 21/2 years. And while some opioids potentially Buprenorphine and others may carry a slightly lower risk of dependence, almost all the opioids on the market are just as addictive as heroin. And while it's important that abuse deterrent formulations be made more widely available because those formulations are harder to melt down and then inject, they don't prevent opioid abuse or overdose when taken by mouth. The bottom line is that increased prescribing of opioids which has quadrupled since 1999 is fueling an epidemic that's now a blurring of the lines between prescription opioids and illicit opioids. I want to be clear that prescription opioids have an important place in pain management when the potential benefits outweigh the potential harm. Many Americans use prescription opioids for much needed relief from pain. And evidence support that opioids can be effective in the short term. They're important medications, for example, for patients after cancer treatment or getting end of life or palliative care. But we don't have evidence to show that opioids can control chronic pain effectively over the long term. And we do have evidence that other treatment such as exercise therapy, nonsteroidal inflammatory drugs and a variety of other treatments and modalities can be effective for chronic pain with far lower risks. That's why today CDC is releasing the CDC Guideline for Prescribing Opioids for Chronic Pain. To chart a safer, more effective course. The goal of the new guideline is to help providers improve patient care and safety and prevent opioid overdose. The guideline reflects the best available research to date and will refine the guidance as new science becomes available. But the ongoing impact of prescription overdoses and effect on American lives, families and communities means that we have to act now. The guideline was developed to support primary care clinicians who prescribe about half of all opioid pain medications in relieving patient's pain, preventing patient's suffering, and promoting patient's well-being. This guideline helps by offering a flexible tool. Not a one size fits all tool but a flexible tool to support informed clinical decision making, encourage improved communication between clinicians and patients and improve clinician confidence about when and how to use opioids to manage chronic pain. The guideline provides information about safer and effective options for pain management and encourages clinicians to work with other providers, including behavioral health specialists, pharmacists and pain management specialists. The guideline is intended to address chronic pain, not acute pain. But we recognize based on the feedback we got from doctors and others that long-term opioid use often begins with treatment of acute pain and the guideline suggests that clinicians prescribe the lowest effective dose of immediate release opioids when treating a patient with acute pain and not prescribe more than is needed. Three days or less will often be sufficient. More than seven days will rarely be needed for most acute pain syndromes.
The guideline is designed to help clinicians and patients together assess the risks and benefits of opioid use and identify the best treatment option. We work to develop a practical guideline with tools and resources, including a decision checklist, to help clinicians use the guideline every day. We want patients to understand the recommendations, so we created resources and materials for patients as well. The guideline has 12 recommendations based on three key principles. First, non-opioid therapy is preferred for chronic pain outside of active cancer, palliative and end of life care. Opioids should not be the first line treatment for chronic pain. They should only be used when their benefits are expected to outweigh their substantial risks. Second, when opioids are used start low and go slow. Start with the lowest possible effective dose and increase only gradually. Third, always use caution when prescribing opioids and monitor every patient closely. Clinicians can minimize the risk to patients by taking actions such as checking the state's prescription drug monitoring program or having a plan to taper opioids if the desired response is not achieved.
I want to spend a moment talking about the process of guideline production and preparation. CDC developed this guideline using a transparent, rigorous, scientific process. We obtained the best available evidence from anywhere in the published literature. We also involved more than 50 of the top experts in the world on various aspects of pain addiction and pain management to review the guidelines. We carefully read and considered more than 4,300 public comments, including letters from more than 160 professional, community and advocacy organizations and many individuals whose lives have been deeply touched by this issue. In the end, these are CDC guidelines. Written by CDC staff and CDC stands by them. In the feedback that we heard, we understood the importance of balancing the expected benefits and risks, and how challenging that can be. Primary care clinicians reported concerns about training and other modalities for pain management. Clinicians and patients need to carefully weigh the decision to start opioids and proceed only when there's a full understanding of the risks. And that the benefits are likely to outweigh the risks. Plainly stated, the risks of opioids are addictions and death and the benefits for chronic pain are often transient and generally unproven. In fact, some of the literature that was shared to us in the comment phase, outlined studies that suggests that individuals treated with opioids may actually experience more pain in the medium and long term than patients not treated with opioids because of potentiation of pain. Management of chronic pain is an art and a science. The science of pioids for chronic patient is clear. For the majority of patients there are effective alternatives to the known serious and all too often fatal risks of opioids.
KATHY HARBEN: Thank you, Dr.Frieden. Jill, we are now ready for questions.
>> Thank you, Mrs. Harben. Once again, if you'd like to ask a question, please press star 1 on your touch tone phone. Please be sure to release your line so you can record your name so that i may introduce you. Also a reminder, please limit yourself to one question and one follow-up. Our first question is from Melanie Saltzman with News Hour. Your line is open, ma'am.
MELANIE SALTZMAN: Hello, can you hear me?
DR. FRIEDEN: yes, we can.
MELANIE SALTZMAN: hi, thanks for taking my question. My question is with regards to the process. I know you just addressed that but I'd like to dive in more for a minute. Why was the process so complicated in being able to come up with a concrete, comprehensive set of guidelines? What went into that and why did it take more than just a week or two weeks to really get those concrete 12 points?
DR. FRIEDEN: i think there are several factors that go into the process. The first is that the evidence on treatment of chronic pain is not as robust as we would like. There are a limited number of studies that have looked at the effectiveness for long-term pain. And those studies have generally not found effective– positive outcomes in terms of improvement in functioning or reduction in pain in the long term. Also in the process, it's been very important that we involve a broad range of stakeholders so that we can get perspectives from patients, from families, from clinicians. And then accommodate and address the concerns that we have heard. So there's– there has been both the need to make decisions based on the best available science and also the need to have an inclusive process of getting a wide range of comments to inform the final guideline.
MELANIE SALTZMAN: and then i guess the follow-up would be, in terms of making sure these guidelines are actually implemented, not only something that physicians can go to, but in a way that you're making sure that they actually are looking at these guidelines, is there a plan for doing that? Those current practicing physicians. But also in med schools, looking at the future physicians in the United States and how they're being trained.
DR. FRIEDEN: Well, first, to be very clear we are not a regulatory agency. So these are guidelines. They are recommendations. States, the national governors' association, health care systems, insurers may look to these guidelines, when they implement policies within their own jurisdictions or institutions but what our role is to provide the best available science to try to improve the care of patients who are suffering from chronic pain which is a very challenging situation for patients to have to live with and a very challenging condition for physicians to treat.
DR. FRIEDEN: We also, i will say, did work with others to develop a checklist for prescribing opiates for chronic pain. This is for primary care providers. And this and other tools will be part of the rollout process to be able to empower physicians to have this information at their fingertips.
MELANIE SALTZMAN: So, it's a suggestion for the guidelines, but not something that's going to be a requirement for physicians to follow?
DR. FRIEDEN: CDC does not regulate the practice of medicine.
MELANIE SALTZMAN: okay. Thank you so much.
OPERATOR: the next question is from Dan Childs with ABC News. Your line is open.
DAN CHILDS: Thank you very much for taking my question. I have one question and a quick follow-up. The question I have is we have pharmaceutical companies essentially manufacturers being called out specifically in a JAMA editorial having to do with these new guidelines. My question is, what part, , did pharmaceutical companies play here, if any, as a stakeholder in developing these guidelines? and what is the responsibility going forward, seeing as there are many who believe that they hold a great deal of responsibility in terms of the expanded use of these drugs for those with chronic pain?
DR. FRIEDEN: So, we exercised very stringent conflict of interest policy, whereby we did not involve in the drafting of the guidelines anyone who had a conflict of interest with pharmaceutical industry or other actors in this topic. We certainly read and considered all comments received, regardless of where those were from, including some groups that are part of or associated with the pharmaceutical industry. I think we can take a step back and say that pain in general, and chronic pain specifically, is a very challenging condition to treat. And for many years, status of medical practice in the U.S.was such that pain was not adequately addressed. And there are still patients whose pain is not adequately addressed. The challenge is when we generalize that situation to chronic pain in which opioids are of unproven benefit, we can get into really big problems. Because these medicines are so addictive and they are so lethal. I think some of the things, the pharmaceutical industry has done include formulations which make it harder to melt down and shoot up these drugs. I do think it's important to be clear that these formulations which are referred to as abuse deterrent are no less addictive. And unfortunately, no medication has yet been discovered that can separate the pain relieving efficacy of an opioid from the addictive nature of an opioid. And that would be a really great thing, if a company can come up with that because then you would have an effective pain relief medication that is significantly less addictive than heroin. Right now, we don't have that. And in the interim, i think it will just be very important and one of the things we heard from physicians was they wanted guidelines that were clearly non-conflicted, and that's what these are.
DAN CHILDS: The one follow-up that I have, is there any clue as to what proportion of 250 million prescriptions per year are going to those with chronic pain? i.e., not those who are cancer patients or those who are taking them to palliative care.
DR. FRIEDEN: let me turn this over to Dr.Deborah Dowell. Dr. Dowell is the lead author of the guideline and spent an enormous amount of work probably understands the literature on this topic better than anyone alive..
DR.DEBORAH DOWELL: so, in answer to your question, the literature supports that a minority of patients receiving opioids are receiving them for chronic, for long-term use for chronic pain, about 5 percent. However, when you look at the amount prescribed in terms of days, duration, for a majority of amount of opioids prescribed, about 70 percent. They also account for a disproportionate– none of the adverse effects related to opioids. One study national VA. Sample found that more than 70 percent of patients dying of opioid-related overdose were prescribed opioid were being treated for chronic pain conditions. In addition, there's evidence patients who develop opioid use disorder, were prescribed opiods a proportionate amount of them are chronic pain.
DAN CHILDS: About 5% of patients accounting for 70% of these prescriptions?
DR.DEBORAH DOWELL: Yes, some studies have found that.
DR. FRIEDEN: And this is one of the reasons why we have also addressed use of opioids to treat acute pain. Because most of the treatment– most of the patients who go on to chronic pain syndrome, start with an acute pain situation. Next question, please.
OPERATOR: The next question is from Robert Lowes with Medscape medical news. Your line is open.
ROBERT LOWES: Thank you for taking my call. Dr.Frieden, there were strenuous objections to the initial set of 12 recommendations as regards to specific numbers on, for instance, you know, a dose threshold. 90 MME being something you should avoid. And the number of days that were suggested for the duration and several medical societies felt that they didn't want any specific numbers because there wasn't enough evidence. Yet, the final recommendations pretty much preserve what was in the initial ones in regards to these specific numbers. So what went into the thinking, you had objections to numbers that doctors felt might constrain them and weren't evidence-based.
DR. FRIEDEN: i will say we did get a lot of comments in. We took them all seriously. We found many of them helpful. And between the earlier released version and the final, there are a number of refinements in the approach. That includes the two areas that you mention, involving lowest effective dose and shortest duration. We have provided a range, rather than a fixed number I'll let Dr. Deb Houry who is the Director of The National Center for Injury Prevention And Control in which this work resides comment further. Dr. Houry.
DR. DEBORAH HOURY: Thank you. There were comments on both sides. We have a lot of organizations who actually thought we should have lower dosages or shorter durations. So there was a balance of both shorter and longer. With regards to the actual dosage, we tried to apply more nuances. You'll see that in the full document. At 50 MME we actually carefully reassess the patient's benefits and risks. At 90 MME, we say there's a clear cap but you should justify the decision. And then it talks about referring to a pain specialist. When you do look at a lot of the emerging evidence, though, there is evidence of increase overdose as the dose escalates. Providers did want a number in general to guide their practice. Again, this is guidelines not regulatory, so this will help physicians in their daily practices to determine what safe dosages. And this is about initiation of opioids for those doses. We feel strongly that you do not initiate an opioid naive patient on a high level of opioid because of the substantial risk of overdose. As Dr.Frieden mentioned, we did provide a range and that was modification we did after the feedback for the acute pain recommendation. We think it's important that physicians to always use the shortest course possible but did want to allow more flexibility in that number.
DR. FRIEDEN: Thank you. Next question.
OPERATOR: The next question is Randall Pearson with Reuters. Your line is open.
RANDALL PEARSON: Hi there, Dr. Frieden. I was just wondering your thoughts about common sense among the federal agencies, the FDA and CDC. You mentioned that the prescriptions have quadrupled since 1999, leading to 165,000 overdoses. But should the CDC and FDA exercised more common sense in recent years. Have you left the cows out the barn? When you might have been able to constrain the situation earlier. For example, Hydro, an extremely potent opioid was approved by the FDA fairly recently despite what we know about the heroin addictions throughout America and their links to opioids. Has the federal government really lapsed in trying to be more proactive earlier to prevent this situation from being at this incredible degree?
DR. FRIEDEN: Unfortunately, i think there's no quick fix for the opioid epidemic. We're seeing a situation in which a large number of people in this country are already addicted or dependent. And that involves both prescription opioids, and illicit opioids, heroin and illegally produced Fentanyl among other products. And the challenge really is turning around our approach to pain management. Understanding that the best treatment isn't always the one that provides the most immediate relief. It's the one that provides the best relief for the longest period of time. That's something that i think as a medical profession and as a society we had insufficient recognition of. And we're paying the price. Far too many families and individuals are suffering or dying for that reason. So, we can always look back and say something could have been done sooner or differently. Our focus right now is moving forward. What can we do to protect as many people as possible? And prevent as many overdoses, deaths and people who become dependent and addicted to opioids as possible going forward.
RANDALL PEARSON: Shouldn't there be more stringent requirements in the future at the FDA, since we have this flood of drugs in the market which we can't control? Should the FDA be a little more vigilant or restrictive itself in putting yet more products on the market?
TOM FRIEDEN: I think you'd have to address that question to the FDA. The FDA by law have to basically make decisions based on whether medications are safe and effective and equivalent to medications on the market. There may not be a regulatory method for them to do what you're suggesting, and whether that would be advisable or not I can't comment. Next question, please.
OPERATOR the next question from Mehmat Oz with "The Dr.Oz Show." Your line is open. Dr.Oz, your line is open for your question. Your line is open.
TOM FRIEDEN: shall we go on to the next question?
OPERATOR: Moving on to the next question. It's from Kimberly Leonard with "U.S. News and World Reports." Your line is open, ma'am.
KIMBERLY LEONARD: yes, hi, thank you for taking my call. One of the items here on the guidance talks about using a urine test to detect whether patients already have signs of opioids in them. And obviously that's to tell whether they might be selling them and not using them or if they already have it detected there. My question is this something that physician, are already doing, or is this something that's new? And if opioids are detected, would a doctor then have enough information to say we're not going to be prescribing this?
TOM FRIEDEN: So, I will turn this over to Dr.Dowell.
DR.DEBORAH DOWELL: This CDC guideline is certainly not the first guideline to recommend this. That being said, we did find surveys that many physicians do not use urine drug testing in making decisions about prescribing opioids. And in addition to that, a couple of studies have found that physicians misinterpret results on urine drug testing. Urine drug tests can't tell you everything; they can tell you whether in many situations whether a prescribed drug is present or whether other drugs are present. They can't tell you anything about the dose. And the guidelines does provide further interpretations for these tests.
KIMBERLY LEONARD: okay, thank you.
TOM FRIEDEN: Next question, please.
OPERATOR: the next question is from Mehmat Oz with "The Dr.Oz Show." Your line is open.
TOM FRIEDEN: If you're speaking, we can't hear you.
TOM FRIEDEN: Yes, go ahead.
MEHMAT OZ: oh, good. Sorry about that. For the average patient who hears all of this news, when they're offered an opiate by their physician, what would you recommend they push back on? How would they phrase and articulate their medicines to take an opiate?
TOM FRIEDEN: That's a great question, I'll startand i would ask Dr.Dowell to continue. I would first say, is this necessary, what are the alternatives, what are the risks, what's the dosage? And can you guarantee me that this is going to relieve my pain and not risk getting me addicted. Dr.Dowell.
DR.DEBORAH DOWELL: I would agree with that 100%. I think the important questions are, you know, is this necessary, what are the alternatives? What are the risks? What are the benefits? And how long do you anticipate that I'm going to be taking this? One more i would add is, what do we hope to accomplish? What should be our goals in using this medication and how are you going to know that we accomplish them.
DEB HOURY: And this is Deb Houry just to add, the first principle of our guidelines are about use non-pharmacological therapy and non-opiate pharmacological therapy. All of us speaking today are physicians who worked in the field. And many of us didn't have a lot experience of what are the non-opioid alternatives. I think patients need to ask their doctors what the non-opioid alternatives are and have a better understanding of how those can impact their pain directly.
MEHMAT OZ: As a quick follow up, Tom you articulate in your New England Journal piece about prescribing an opiate per person in America. What's the goal? There's a discrepancy from state to state that's quite dramatic? Any idea what you hope to see in three years, five years?
TOM FRIEDEN: Really what we hope to see is fewer deaths from opiates all sorts of opiates. Both legal and illegal. That's the bottom line here. What we also hope to see in a more immediate basis is that some of the higher and more dangerous doses of opiates will be used much less. I was really stunned at the study that shows that 1 out of 32 patients died in 21/2 years from the highest doses of opiates. So understanding these are really dangerous medications which carry the risk of addiction and death. And that we would at least begin to see that prescriptions that are written are safer, or less risky, at least. Ultimately, we want to see the number of deaths come down. It's just a horrific fact that we're seeing it continue to increase. It's one of the very few trends in this country where health is getting worse. It's one of the very few things where we're seeing increase in mortality rates; and we're seeing it across the entire lifespan – from neonatal abstinent syndrome to kids who get hooked on an opiate because of a sports injury and end up getting Hepatitis C or HIV because they switched to injecting drugs to elderly who have increased risk of falls because they're on opiates. It's a terrible problem. It's going to involve all of us getting into a more appropriate place when we think about managing pain.
OPERATOR: Our next question is from Charles Lane with "The Washington Post." Your line is open.
CHARLES LANE: Thank you. Listening to you speak about these prescription drugs, I'm just struck at the change in tone, the depiction of these as Dr.Frieden's own words as a dangerous quote/unquote drug. It's far, far from what we're being told about them 15 or 20 years ago when they came on the market. So, I'm wondering the following, a lot of people in the field believe there's pressure, has been pressure on physicians to prescribe these, because they would get bad reviews on Yelp or because the facilities that they work for would be thought of as neglecting pain, as the famous, you know, vital sign. How will these guidelines, and how should they affect that dynamic where there's been so much pressure on physicians, sort of when in doubt prescribe. How are you going to affect that dynamic?
TOM FRIEDEN: When i went to medical school we had exactly one lecture on pain. And in that lecture the professor said if you give an opiate to a patient in pain they will not get addicted. He was completely wrong. But a whole generation of physicians went through training hearing that. And also recognizing that pain was and continues to be undertreated in some situations. All of us have a role to play. I don't think doctors alone, I don't think patients alone, can get us to a better place. When we've interviewed patients, we've heard consistently that they're concerned about the addictiveness and danger of opiates. When we've interviewed doctors, we've heard that they're concerned that patients may be rating them poorly if they don't provide pain medications or opiates. And we know that sometimes, a few highly vocal patients may change the perception of a situation for a doctor. That's why we're emphasizing both the need to be careful with prescription of opiates and the need to scale up treatment of addiction which is a serious disease for which there are medications such as Buprenorphine and Methadone which do improve outcomes and that's part of this as well. I don't think there is a quick fix, but I do think the solution is going to involve more than just doctors and more than just patients to address the real concerns that people have about the use and risks of opiates. Next question.
OPERATOR: Next question is from Sabrina Tavernise with "The New York Times." Your line is open.
SABRINA TAVERNISE: Hi, thanks for taking the question. Dr.Frieden, I know these are your guidelines and nonbinding but it sort of sounds like you're saying in here and kind of the federal government is saying that the risks outweigh the benefits of these drugs for most patients. Is that– would you say that?
TOM FRIEDEN: I think, again, this is not a cookbook. Clinical care is both a science and an art. And there are some patients for whom currently on opiates or potentially in severe pain for whom they may be appropriate. But for the majority of patients, the risks will outweigh the benefits for chronic pain. For the vast majority of patients.
KATHY HARBEN: We have time for one more question.
OPERATOR: It comes from Sarah Karlin-Smith with Politico. Your line is open.
SARAH KARLIN-SMITH hi, is this Sarah. Thank you for taking the call. At the end of these guidelines, my question is directed to Secretary Burwell or someone at HHS if they are still on the call. You guys mentioned the need to work with other areas of federal government on policy that could make these guidelines more practical for doctors to follow. Are there any plans like for CMS or other agencies within the federal government to change how you guys cover non-opioid treatments to make it easy for physicians to offer patients non-opioid options?
TOM FRIEDEN: I don't know that others from HHS are on the call at present.. I know we've had a series of discussions with CMS and others parts of HHS about this issue. We've heard the concern from both physicians and patient groups, and we're encouraged by the progress that we've seen in a variety of insurance programs of expanding the scope of the non-pharmacological treatments provided. Dr.Houry, do you want to say anything about this?
DEB HOURY: I think these are just the next steps. I think by showing CDC's views, using the best available science on the need for non-opioids, the need for safe prescribing this will help inform a lot of future changes. And, as Dr. Frieden mentioned, we've been working closely with HHS agencies to really have a collaborative approach in making sure that we are able to provide this.
TOM FRIEDEN: I'll close the telebriefing with a final comment about the guideline and its potential to reduce the epidemic we're living through of opioid overdose deaths. The prescription overdose epidemic is doctor-driven. It can be reversed in part by doctor's actions. The guideline doesn't replace clinical judgment but it does provide a clear balance that has been missing. Prescription opioid overdose deaths can be prevented by improving prescribing practices. We can protect people from becoming addicted to opioids and clinicians are key to helping to reverse the epidemic. The management of chronic pain is both an art and a science. But the science of opioids for chronic pain is clear. For the vast majority of patients, the known, serious and all too often fatal risks far outweigh the unproven and transient benefits and there are safer alternatives. In medicine we take an oath to above all do no harm. And for chronic pain, a doctor has to go to a pretty high bar to see that the likelihood of doing harm will not be greater than the likelihood of doing good. At heart of the guidelines is a conversation between clinicians and patients about the best, safest treatment for chronic pain with a full understanding of risks and benefits. Thank you very much.
KATHY HARBEN: Thank you, Dr.Frieden. And also thank you to Dr.Houry and Dr.Dowell for joining us today. As well as Secretary Burwell. Thank you also, reporters, for follow-up questions, please call 404-639-3286. Or e-mail us@media@cdc.gov.
OPERATOR: that concludes today's conference. We thank you for participating. You may disconnect. And have a great rest of your day.


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During the 1914-18 conflict, three Battalions of Infantry were formed from Civil Servant volunteers drawn from across the Government Departments.
Long before WWI, the Civil Service had recognised the benefits of military service and actively encouraged its employees to join. Following the outbreak of war, Civil Servants from across the capital were eager to exchange pens for rifles and be directly involved in the fighting. The Civil Service Rifles lobbied the Prime Minister and supporters in the House of Lords arguing that replacements for their day jobs should be urgently found, exclaiming that, 'Civil servants are burning to do something for this country in this hour of need.' In parallel, the Regiment prepared itself through a programme of drill, rifle training, route marches and practice attacks in the streets and parks of central London.
In the pre-war years, approximately eighty per cent of the population was employed in manual labour. With its meritocratic system of advancement, the Civil Service offered social mobility to those seeking to enter a white-collar profession. As a result, members of the Civil Service Rifles were well-educated, self-disciplined and used to working within a hierarchical organisation. New recruits would always begin as privates, regardless of Civil Service grade, with officers being promoted from the ranks. Relationships between the ranks were friendly and respectful, which proved a significant factor in maintaining morale during WWI, sustaining them through the most appalling experiences and losses.
The 1st Battalion won twelve battle honours in France, including Loos, Vimy Ridge, Ypres and the Somme. Life in the trenches in France was typically desperate; writing from a waterlogged section of the line near Vermelles, Lt Roberts wrote: 'Mud up to your eyes, incessant shelling, unceasing rain… we had a hell of a time.' The 2nd Battalion won a further eleven battle honours in places as far-flung as France, the Balkans and the Middle East. Meanwhile, the 3rd Battalion remained in London to train reinforcements. These were required not only to replace the many casualties, but also the hundreds of members of the Civil Service Rifles who were given officer training and commissioned into other Units.
As with all Regiments, the Civil Service Rifles were accompanied by Army Chaplains, who provided pastoral support and spiritual guidance, whilst sharing the dangers and hardships of battle. The Reverend Edward Beattie served with the 1st Battalion and was awarded the Military Cross in France in 1918. It is therefore fitting that after the war, Rev Beattie helped dedicate the Civil Service Rifles memorial.
If you walk from this church just 20 minutes north along the river, you will find Somerset House, which was originally built for the Civil Service and became the Regiment's Headquarters and drill ground until its disbandment in 1921. There on the riverside terrace is a war memorial, designed by Sir Edwin Lutyens and unveiled by the then Prince of Wales, the Regiment's Honorary Colonel, in January 1924.
With acknowledgements to Jill Knight's book, 'The Civil Service Rifles in the Great War'.


Snap the idea together with Lego Cars Tokyo Pit Stop 8206 . It's 5.5" Height x 10.5" Length x 2" Width. It weighs somewhere around 0.47 lbs. To get the best price for this Car Lego set as well as other Legos, check out the link on this site.
Prepare your pit crew for the World Grand Prix! * Includes Luigi and Guido * Features Japanesestyle pit * Measures over 5"" (12cm) long and 4"" (10cm) tall * Cars all measures more than 2"" (5cm) long and 1"" (2cm) tall Time is running out to prepare for the worlds biggest race the World Grand Prix in Tokyo! Make sure that on race day, they will leave the other pit crews within the dust! Help Luigi and Guido to tuneup their skills with lots of practice.
Dimensions: Height: 5.5" Length: 10.5" Depth: 2"
Package Dim.: Height: 2" Length: 10.3" Depth: 5.6"


text:
The FCS can only come into effect if it is activated by the Australian Government when an institution fails. Once activated, the FCS will be administered by the Australian Prudential Regulation Authority (APRA).
The FCS was established by the Australian Parliament in 2008.
The objectives of the Financial Claims Scheme are to:
protect depositors of banks, building societies and credit unions incorporated in Australia, and policyholders of general insurers from potential loss due to the failure of these institutions
provide depositors with prompt access to their deposits that are protected under the FCS
support the stability of the Australian financial system.
APRA is a member of the International Association of Deposit Insurers, a global forum for deposit insurers to share knowledge and expertise.
Under the Financial Claims Scheme, deposits are protected up to a limit of $250,000 for each account holder at each bank, building society and credit union that is incorporated in Australia and authorised by APRA. See the list of banks, building societies and credit unions that are covered under the FCS.
Banks, building societies and credit unions are also collectively referred to as authorised deposit-taking institutions, or ADIs, and are licensed to operate (or authorised) by the Australian Prudential Regulation Authority (APRA).
To find out more, including the types of accounts that are protected under the FCS, how joint accounts are treated, and what happens when a bank, building society or credit union operates other banking businesses, go to the Banks, building societies and credit unions page and the Banking frequently asked questions.
If the FCS is activated by the Australian Government following the failure of a banking institution, APRA will endeavour to pay most account holders, or enable them to access, their FCS payments within seven calendar days.
If the Financial Claims Scheme is activated by the Australian Government, most claims made against a general insurer by their policyholders or people with valid claims against the insurer, are covered up to $5,000. Claims above $5,000 are also covered under the FCS for eligible policyholders and certain third parties.
In most cases, a claim can only be made against a failed insurer under the FCS if the insurance policy is issued by that insurer.
The FCS does not apply to life insurance companies or to private health insurers.
To find out more on how the Financial Claims Scheme works for general insurers see the General insurers page of this site.

redpajama_set_name: RedPajamaCommonCrawl


A 3/4 inch piece of plywood, which I found in my Stepdads garage already cut to the perfect size! Will be getting a new paint job as well to protect it from the elements.
Success!!! Candy was a wee bit leery of the new contraption, but with a piece of ham and some coaxing up she came!
Another hard day of work accomplished:). If you enjoy the blog please subscribe via email to receive updates of the adventure, or share on your favorite social site. Thanks!
Oh my. That looks like it was super hard. I am amazed that you got through it with the assistance of only two adult beverages. Looks to me like it would have taken at least six.


text:
Q: Yii2 Multiple Database Connection : Select database based on login user id, Runtime This is my scenario.
I have a list of all the Clinic using my application in a 'main' database. In the 'main', information about each clinic is in a table which also contains columns that for, database name, username and password for the DB. The schema structure is the same for each one.
All these clinics will use the single source code, which I am currently developing in Yii2. What I would need is at the time of login, automatically select the corresponding database, from that all the transaction, must be in the database.
I tried saving Database name in the session.
$db_name = "main";

if( isset($_SESSION['db']) ){
    $db_name = $_SESSION['db'];
}
$config = [
    'components' => [
        'db' => [
            'class' => 'yii\db\Connection',
            'dsn' => 'mysql:host=localhost;dbname='.$db_name,
            'username' => 'root',
            'password' => '',
            'charset' => 'utf8',
        ],
    ],
];

it don't  work i can't access the session in config/main.php .
I can't do the solution because all clinics have the same SERVER_NAME. Change DB connection Dynamically

A: If you have a 'main' database and then use the main db connection records for the second database:
It is best to configure db2 as a NULL db connection, then:
'db' => $db, // default...,
'db2' => [
    // Fill with null values
],

Yii::$app->db2->dsn= 'DSN';
Yii::$app->db2->username = 'username';
# password...

Also, first close the db2 connection. close() .Be sure to destroy
There is also a good way at this link. Dynamic database connection
OR Try the following:
'db2' => function () {
    if (!\Yii::$app->user->isGuest) {
        $db_name = \Yii::$app->user->getid();
    } else {
        $db_name = ..; params
    }

    return Yii::createObject([
        'class' => 'yii\db\Connection',
        'dsn' => 'mysql:host=localhost;dbname=' . $db_name,
        'username' => 'root',
        'password' => '',
        'charset' => 'utf8',
    ]);
},

then:
public static function getDb()
{
    return Yii::$app->userDb;
}

Of course, for db (default db), it may not work. But if tested .., be sure to close(), the previous connection/

A: We have a similar configuration, actually we have multiple instances, and an instance may have a main database, and one or more "child" databases.  The main database has a table that defines the child databases, just as yours also has.
I'm assuming the child databases are listed in a table called Children.
In the Model for Children we have some utility functions that I'll show lower down.
The tables in the child databases are given a model class that extends from class ChildActiveRecord extends \yii\db\ActiveRecord
Then any table in the child database uses
class SomeChildTable extends ChildActiveRecord
The key element in ChildActiveRecord is getDb which overrides the function defined in Yii's ActiveRecord class. getDb returns a database connection.
Class ChildActiveRecord extends \yii\db\ActiveRecord {
  public static function getDb()
  {
    $childDb = Children::getChild(); // usually set via Children->setChild()
    // Does a connection already exist? Return it:
    if(array_key_exists( $childDb, Yii::$app->params['dbs'])) {
        return Yii::$app->params['dbs'][ $childDb ];
    }
    $child = Children::getChildDetails();
    $connection = new \yii\db\Connection([
        'dsn' => 'mysql:host=localhost;dbname=' . $child->dbName,
        'username' => $child->username,
        'password' => $child->password,
        'charset' => 'utf8',
    ]);
    Yii::$app->params['dbs'][ $childb ] = $connection; // cache for re-use
    return $connection;
  }
}

In our case we have the database user and password in config files so they can be hidden from developers.
In the model class for the children table:
Class Children extends \yii\db\ActiveRecord{
 public function setChild()
{
    Yii::$app->params['childdb'] = $this->dbname;
}
/**
 * returns child db name
 *
 * @return string|null
 */
public static function getChild()
{
    if( ! array_key_exists( 'childdb', Yii::$app->params ) ) return null;
    return Yii::$app->params['childdb'];
}

/**
 * @return Children|null
 */
public static function getChildDetails()
{
    $childdb = self::getChild();
    if( ! $childdb ) return null;
    $child = self::findOne( ['dbname'=>$childdb]);
    return $child;
}

In your code, before you undertake any operations using the child database, you need to find the child record in the Children table e.g.
$child = Children::findOne([condition]);
then set the Child database:
$child->setChild();
After that you can use any table in the child database using normal Yii code.

redpajama_set_name: RedPajamaStackExchange


Our client is a well established Freight Forwarder.
All candidates must have ocean import/export experience with a Canadian Freight Forwarder.
They are looking for an experienced person to handle all aspects of Ocean Import/Export freight documentation and customer service.
Do you want to join a dynamic company with strong growth prospects?
We are looking for an Ocean import professional with 3 years or more experience in international import procedures.
Main tasks will consist of tracking/tracing of ocean shipments; preparing documentation and manifesting of import/export documentation for customs; costing and billing and communicating with Clients, Carriers and Agents.
Set up files based on pre-advise. Arrange trucker and warehouse requirements.
Receive documents from steamship or shipper.
Break down and distribute into files and calculate charges. Issue steamship release to warehouse, invoice shipments according to client rates. Close file, pass invoices.
Responsible for customer contacts, followups by phone/email.
Regular work with invoices, calculations of profit and commissions, tracking and correcting mistakes in supplier invoices.
Assure timely billing as per company policy.
Work according to project process.
Interact with international clients providing excellent customer service.
Escalate issues to next management level if required.
Contact shippers to gather documentation and shipment info, check. Understanding and working with De-consolidations.
Liaison with Steamship companies and Trucking firms.
Working with a computerized Tracking/Tracing system for monitoring the movement of ocean containers.
Proactive customer service to identify and resolve shipping problems.
3- 5 Years of Ocean Imports and Exports experience in Montreal in international freight forwarding.
Fluent communicator in English and French an asset.
Fast learner with a keen eye for detail; accurate and thorough; well organized.


This Marvellous Drug is Manufactured Under the Super Vision of Unani Pathy's Experts with the Herbs of High Quality & Fresh Herbs Which are Being in Practice Since Several Decades, Sharbat Jigar Khas Highly Effective in Hepatitis, Chronic Hepatitis, Chronic Constipation and Gastritis. it Enhances Appetite. Its Prolong Use Increases Red Blood Cells in Blood, There By It Makes Active & Life with Zeal. It Excrete Out Waste & Toxic Substances Through Urine and Faeces There By Results Healthy Kidney, Liver & Urinary Blader.
Dosage : 10-20 ML Twice a Day or as Directed By the Physician.


HAFIZABAD - The district administration has banned entry of 15 religious scholars in the district for maintaining peace and tranquility during Muharramul Haram. The banned scholars include Maulana Abdul Aziz of Lal Masjid Islamabad, Maulana Muhammad Ahmad Ludhianvi, Abdul Hameed Wattoo, Masood Nawaz Jhangvi, Aslam Alam Tariq, Maulana Muavia Azam Tariq, Maulana Muhammad Ilyas, Sibtain Shah, Aurangzeb, Maulana Abdul Rauf Yazdani, Allama Saeed Ahmad Asad, Maulana Naseem, Abbaz Rizvi, Maulana Asif Gilani. EX-DISTRICT NAZIM JOINS PTI: Former district nazim of Hafizabad Col (r) Ali Ahmad Awan has joined Pakistan Tehrik-i-Insaf.


text:
package net.savantly.sprout.starter.freemarker;

import java.util.ArrayList;
import java.util.Arrays;
import java.util.List;
import java.util.stream.Collectors;

import org.springframework.boot.autoconfigure.freemarker.FreeMarkerProperties;
import org.springframework.context.annotation.Bean;
import org.springframework.context.annotation.Configuration;
import org.springframework.context.annotation.Primary;
import org.springframework.web.servlet.ViewResolver;
import org.springframework.web.servlet.view.freemarker.FreeMarkerConfigurer;
import org.springframework.web.servlet.view.freemarker.FreeMarkerViewResolver;

import net.savantly.sprout.starter.template.TemplateRenderer;

@Configuration
public class FreemarkerConfiguration {

	private final List<String> defaultTemplatePaths = new ArrayList<String>();
	{
		defaultTemplatePaths.add("classpath:/templates");
		defaultTemplatePaths.add("classpath:/META-INF/templates");
		defaultTemplatePaths.add("classpath:/public/");
		defaultTemplatePaths.add("classpath:/static/");
		defaultTemplatePaths.add("classpath:/resources/");
		defaultTemplatePaths.add("classpath:/META-INF/public/");
		defaultTemplatePaths.add("classpath:/META-INF/static/");
		defaultTemplatePaths.add("classpath:/META-INF/resources/");
	}

	@Bean
	FreeMarkerConfigurer defaultFreeMarkerConfigurer(FreeMarkerProperties freeMarkerProps) {
		FreeMarkerConfigurer configurer = new FreeMarkerConfigurer();

		String[] paths = freeMarkerProps.getTemplateLoaderPath();
		List<String> pathsToAdd = new ArrayList<String>();
		pathsToAdd.addAll(defaultTemplatePaths);
		pathsToAdd.addAll(Arrays.stream(paths).collect(Collectors.toList()));

		configurer.setTemplateLoaderPaths(pathsToAdd.toArray(new String[pathsToAdd.size()]));

		return configurer;
	}

	// Also intercepts FreeMarker properties to ensure required paths are included
	@Bean("freeMarkerViewResolver")
	public ViewResolver viewResolver(FreeMarkerProperties freeMarkerProps) {

		FreeMarkerViewResolver resolver = new FreeMarkerViewResolver();
		resolver.setSuffix(".html");

		String[] paths = freeMarkerProps.getTemplateLoaderPath();
		List<String> pathsToAdd = new ArrayList<String>();
		pathsToAdd.addAll(defaultTemplatePaths);
		pathsToAdd.addAll(Arrays.stream(paths).collect(Collectors.toList()));

		freeMarkerProps.setTemplateLoaderPath(pathsToAdd.toArray(new String[pathsToAdd.size()]));
		freeMarkerProps.setCheckTemplateLocation(false);
		freeMarkerProps.setSuffix(".html");
		freeMarkerProps.applyToMvcViewResolver(resolver);

		return resolver;
	}

	@Bean
	@Primary
	public TemplateRenderer defaultTemplateRenderer(freemarker.template.Configuration freemarkerConfiguration) {
		return new FreemarkerRenderer(freemarkerConfiguration);
	}
}

redpajama_set_name: RedPajamaGithub


Probably one of the most frustrating responsibilities I have as a parish pastor is officiating at weddings. I would rather do a funeral than perform a wedding. It's not because I am filled with a great sense of morbidity. It's not that I delight in other people's suffering. Rather, it has to do with how receptive people are to ministry. At the time of death, people are much more receptive to facing the ultimate issues of life. They have a far greater sense of their need for the gospel. They have just experienced the limits of life and are primed to listen to the word of hope in Jesus Christ.


text:
What are the main elements of sampling?
Main elements of sampling : Following are main elements (essentials) of sampling:
A sample is the representative of all the characters of universe.
All units of sample must be independent of each other.
The number of items in the sample should be fairly adequate.
What is another word for sample?
Some common synonyms of sample are case, example, illustration, instance, and specimen.
What is antonyms give 5 examples?
Types of Antonyms Examples include: boy — girl, off — on, night — day, entrance — exit, exterior — interior, true — false, dead — alive, push — pull, pass — fail.
What is the definition and type of sampling?
Sampling is a process used in statistical analysis in which a predetermined number of observations are taken from a larger population. The methodology used to sample from a larger population depends on the type of analysis being performed, but it may include simple random sampling or systematic sampling.
What is purposive sampling in quantitative research?
Purposive sampling is an acceptable kind of sampling for special situations. It uses the judgment of an expert in selecting cases or it selects cases with a specific purpose in mind. Purposive sampling is used most often when a difficult-to-reach population needs to be measured.
What sample means?
A sample refers to a smaller, manageable version of a larger group. It is a subset containing the characteristics of a larger population. Samples are used in statistical testing when population sizes are too large for the test to include all possible members or observations.
What is the example of sample?
A sample is just a part of a population. For example, let's say your population was every American, and you wanted to find out how much the average person earns. Time and finances stop you from knocking on every door in America, so you choose to ask 1,000 random people. This one thousand people is your sample
What are the types of test?
Diagnostic Tests. These tests are used o diagnose how much you know and what you know.
Placement Tests. These tests are used to place students in the appropriate class or level.
Progress or Achievement Tests.
Proficiency Tests.
Internal Tests.
External Tests.
Objective Tests.
Subjective Tests.
When should purposive sampling be used?
The purposive sampling technique is a type of non-probability sampling that is most effective when one needs to study a certain cultural domain with knowledgeable experts within. Purposive sampling may also be used with both qualitative and quantitative re- search techniques.
Why is purposive sampling used in qualitative research?
Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research.
What is the purpose of sampling in research essay?
Sampling saves money by allowing researchers to gather the same answers from a sample that they would receive from the population. Non-random sampling is significantly cheaper than random sampling, because it lowers the cost associated with finding people and collecting data from them.
What is need of sampling?
Sampling is used in practice for a variety of reasons such as: Sampling can save time and money. A sample study is usually less expensive than a census study and produces results at a relatively faster speed. Sampling remains the only way when population contains infinitely many members.
What is data sampling?
What is data sampling? Data sampling is a common statistics technique that's used to analyze patterns and trends in a subset of data that's representative of a larger data set being examined. Sampling is used to determine how much data to collect and how often it should be collected
What is a sampling plan?
A sampling plan is a detailed outline of which measurements will be taken at what times, on which material, in what manner, and by whom. identify the parameters to be measured, the range of possible values, and the required resolution.
How do you do random sampling?
How to perform simple random sampling
Step 1: Define the population. Start by deciding on the population that you want to study.
Step 2: Decide on the sample size. Next, you need to decide how large your sample size will be.
Step 3: Randomly select your sample.
Step 4: Collect data from your sample.
What are samples in research?
In research terms a sample is a group of people, objects, or items that are taken from a larger population for measurement. The sample should be representative of the population to ensure that we can generalise the findings from the research sample to the population as a whole.
What are sampling methods in statistics?
Sampling methods are the ways to choose people from the population to be considered in a sample survey. Samples can be divided based on following criteria. Probability samples – In such samples, each population element has a known probability or chance of being chosen for the sample.
How do you do sampling in research?
Sampling Method in Research Methodology; How to Choose a Sampling Technique for Research. Hamed Taherdoost.
Clearly Define. Target Population.
Select Sampling. Frame.
Choose Sampling. Technique.
Determine. Sample Size.
Collect Data.
Assess. Response Rate.
What is another word for test?
assessment check
experiment analysis
evaluation investigation
inspection scrutiny
What is the difference between mean and sample mean?
Differences. "Mean" usually refers to the population mean. This is the mean of the entire population of a set. The mean of the sample group is called the sample mean
What is the meaning of test?
1a : a means of testing: such as. (1) : something (such as a series of questions or exercises) for measuring the skill, knowledge, intelligence, capacities, or aptitudes of an individual or group. (2) : a procedure, reaction, or reagent used to identify or characterize a substance or constituent.
What is the purpose of test?
Purpose of Standardized Tests
Tests results can be used to:
Employment Inform decisions on the hiring, placement and promotion of potential and current employees
Curriculum-based End-of-Course Testing Determine whether students have mastered the objectives of the course taken
What is the origin of test?
test (n.) late 14c., "small vessel used in assaying precious metals," from Old French test, from Latin testum "earthen pot," related to testa "piece of burned clay, earthen pot, shell" (see tete). Sense of "trial or examination to determine the correctness of something" is recorded from 1590s.
What are the methods of sampling?
Methods of sampling from a population
Simple random sampling. In this case each individual is chosen entirely by chance and each member of the population has an equal chance, or probability, of being selected.
Systematic sampling.
Stratified sampling.
Clustered sampling.
Convenience sampling.
Quota sampling.
Judgement (or Purposive) Sampling.
Snowball sampling.


WAKE UP CALL: Will Michael Vick find redemption in Philadelphia?
I often marvel at the hypocrisy that bubbles to the surface of American discourse and discussion when addressing issues of crime and punishment.
For example; there is a resounding chorus of "Just get over it…" that echoes through the blogosphere and other public forums of debate when the subject of slavery or the not-so-distant history of racial segregation is put on the table.
To many citizens, these crimes against humanity represent a past transgression that should be forgiven and forgotten by a people now rewarded with one of theirs calling the shots in the White House.
Memories of our African forefathers standing on Southern auction blocks being examined from tooth to toe before being sold to the highest bidder are just a manifestation of a different time and culture.
We are supposed to take the higher ground of forgiveness when confronted with the visceral images of burned, black bodies hanging from trees as throngs of white Americans smile and point at the result of their vigilante justice.
America expects redemption for its sins, yet seems reticent to offer the same to some of its own.
Michael Vick is one of America's own who is finding that redemption is harder to receive than snow in South Florida.
In December 2007, the highly skilled and highly compensated quarterback for the Atlanta Falcons was sentenced to 23 months in federal prison for his role, participation and complicity in dog fighting.
After 18 months of incarceration in Leavenworth, Kansas, Vick was released in May of this year. With his time served, the debate about his future began before he even emerged from the shadows of the penitentiary's concrete walls.
Animal Rights activists and associated trustees of morality waited and watched to see if the NFL would reinstate this transgressor of their ethical sensibilities, and in July of 2009, NFL commissioner Roger Goodell sanctioned Vick's conditional reinstatement.
Vociferous protests and threats to forego season tickets were but a few of the demonstrations of contempt directed at the football franchise that dared to offer redemption to a man who did the crime and served his time.
Somehow, in the minds of the moral crusaders who paraded their pit bulls in protest to the Vick signing, forgiveness for Vick is unthinkable, and thinking Vick can redeem himself is unforgivable.
Almost 20,000 wealthy Americans who opted to evade federal taxes by depositing their money in the Swiss bank UBS are eligible to avoid tax evasion prosecution by taking part in a voluntary disclosure program with the Internal Revenue Service, which will basically grant amnesty to any of the tax scofflaws who choose to participate. Sounds like a second chance to me, and from the IRS no less!
Clearly, America believes in second chances and redemption, but what I am trying to figure out is to whom it applies, and whether Michael Vick will be a beneficiary.
Though some of these Vick haters seem to have no problem throwing stones, they ought to realize that almost all of them live in glass houses.
Previous post THE GANTT REPORT: Black people are running!


text:
Are window cleaners in the UK exempt from drought orders?
This is a good question. So, we at WCM contacted DEFRA (Department for Environment Food and Rural Affairs)
DEFRA has policy responsibility for water resources in England.
This is their response:
Under the Water Resources Act 1991 and the Drought Direction 2011, an ordinary drought order may authorise a water undertaker to prohibit or limit the use of water for cleaning a window of a non-domestic building using a hosepipe other than for health or safety reasons.
The Drought Direction sets out the uses that could be restricted under a drought order.
http://archive.defra.gov.uk/environment/quality/water/resources/documents/droughtdirection2011.p df
Also, the use of water can be prohibited by water companies in England and Wales under their own powers in the Water Industry Act 1991 (as amended by the Flood and Water Management Act 2010) and the Water Use (Temporary Bans) Order 2010, if it thinks that it is experiencing, or may experience, a serious shortage of water for distribution. Under section 76(2)(i) of the Water Industry Act, the water undertaker may prohibit the use of water for cleaning walls, or windows, of domestic premises using a hosepipe. Under paragraph 12(2) of the Water Use (Temporary Bans) Order 2010, an exception is again made for using a hosepipe to clean walls or windows of domestic premises for health and safety reasons.
Under either of these measures, there is no restriction on the use of hand held water containers, not filled by hosepipe.
It is also worth noting that, prohibitions may be applied to specify uses or in specified cases or circumstances and may also be made subject to exceptions. Window cleaners should respond to water companies' notices of their plans to put in place restrictions with their views.
To find out the position of drought order exemptions for window cleaners in Northern Ireland and Scotland, a similar request should be sent to the Northern Ireland Executive and the Scottish Government respectively.
Incidentally – the Federation of Window Cleaners were fighting the corner for window cleaners back in 2007 when invites for views on a consultation document published by DEFRA and the Welsh Assembly Government on the modernization of the scope of hosepipe bans and drought orders which restrict or prohibit discretionary and non-essential uses of water.
Advice was given that to ban window cleaners from using water in WFP pole systems would be a health a safety risk.
Under the freedom of information act, WCM requested the documents of this consultation.
Consultations:
Consultation on proposed changes to powers to restrict non-essential uses of water (in 2007), including a summary of responses: http://webarchive.nationalarchives.gov.uk/20071204125941/http://www.defra.gov.uk/corporate/con sult/water-restrictions/index.htm
Consultation on the Draft Flood and Water Management Bill (included consultation on revised water company hosepipe ban powers), including a summary of responses: http://webarchive.nationalarchives.gov.uk/20100104180038/http://www.defra.gov.uk/corporate/con sult/flood-water-bill/index.htm
Many water companies are currently consulting, or have just completed consultation on their draft drought planning arrangements. The draft drought plan consultations are available on the water companies' websites.
If it is further clarification the FWC response was as follows:
Hello Lee,
Please see the attached PDF – page from South East Water, that states a Window Cleaning business is exempt from the hose pipe restriction…. similar to other Water Authorities…although Veolia Water initially stipulated WFP systems were restricted but have now stated that window cleaners who have invested into WFP systems prior to 15th March 2012 can continue using them until 4th July.
Note; the above information applies only during phase 1 or phase 2 of the drought conditions.
' In order to conserve water resources, window cleaners should use a mix of conventional window cleaning practices with buckets, squeegees and applicators as well as telescopic poles alongside the use of water-fed pole systems, alongside the objectives of avoiding work at height whenever possible'
Further information can be found on all Water Authority websites.
Window Cleaning News
, drought orders, magazine for professional window cleaners, Window Cleaning Magazine, Window cleaning news
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CCC203e Issues in Contemporary China provides students with a comprehensive analysis of social, political and economic challenges and issues facing China in the twenty-first century. Students will discuss some of the policies the Chinese government has implemented so far to address these issues and challenges, and assess the effectiveness of those policies.
Demonstrate in-depth understanding of contemporary Chinese history.


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Unfortunately if you have ever hired a contractor to perform home renovations, chances are he may have made promises he didn't keep. Or possibly shown up late consistently or provided shoddy workmanship? If so, then look no further - Six O Eight, Inc. is the apparent best choice for your next home project! Let us create the next look for you…experience the superior difference.
Copyright © 2014, Six O' Eight Renovations. All Rights Reserved.
Web Site Design by Design-Nectar.


The DA Tunnel Series is an Direct-to-Air thermoelectric assembly (TEA) that minimizes the number of airflow paths required to operate. It offers dependable, compact performance by cooling objects via convection. Heat is absorbed and dissipated through high density heat exchangers equipped with air ducted shrouds and brand name fans. The thermoelectric modules are custom designed to achieve a high coefficient of performance (COP) to minimize power consumption. Custom configurations are available, however, MOQ applies.


Retractable plastic and metal ball pen with a metallic barrel and soft rubber inserts in the grip. It has shiny chrome trim and a stylus for use with touch screens. Havana has a black TRENDS refill with 1200 metres of German manufactured DOKUMENTAL ink and a tungsten carbide ball for improved writing quality. Colours: Silver, Gunmetal, Matt White, Orange, Red, Bright Green, Dark Green, Light Blue, Dark Blue, Black. Dimension: Dia 11.5mm x L 140.5mm x 14mm (includes clip). Print Description: Positions D & E - 45mm x 7mm. Print Type: Pad Print. Packing: Loose packed or an optional presentation box or sleeve.


ADSL2+ broadband delivers Internet services over your phone line.
ADSL broadband is for people who can't yet access high-speed fibre or satellite services (e.g. National Broadband Network or NBN). It uses the copper telephone networks that have existed for decades in Australia.
Data allowances are the comparison point to watch for here. Many providers offer affordable unlimited plans, but if you're a light user you can save with a capped plan.
Info last updated 26 November 2018.
It can be hard to know which NBN plan to choose. We've designed a simple data usage tool designed to estimate how much data you'll need on average each month.
ADSL (Asymmetric Digital Subscriber Line) internet services work by sending data signals along the existing copper infrastructure that has been used for telephony services for decades now. Those copper lines have more bandwidth than is needed just for telephone calls, and it's those additional frequencies that are used for both ADSL and ADSL2+ connections.
The "A" in ADSL/2+ stands for Asymmetrical, because the ratio between download speeds and upload speeds on ADSL connections is always tilted towards downloads. That does largely follow the patterns of most Internet users, because you tend to consume more than you create.
ADSL/ADSL2+ has some significant limitations, including the quality of the copper lines between your home and the exchange that handles your Internet traffic; this is quite variable however depending on the life of the copper and its maintenance cycle. A more fixed and pressing problem for ADSL/2+ connections is the question of distance from that exchange. It can vary depending on line quality, but as a rough rule of thumb, ADSL services won't work at all beyond around 5km from an exchange, and the further out you go within the limit, the lower the available connection speeds will drop. That distance can be tricky to calculate exactly from the consumer end, because it's not a straight line, but instead also hinges on the lengths and quality of copper between your home and the exchange.
ADSL broadband relies on having a connection point at a telephone exchange within that 5km distance from the exchange as well. In some cases you may find that ADSL provisioning cannot take place due to a lack of connection points at a given exchange.
Because ADSL uses different parts of the available copper bandwidth, you do not have to run a regular landline service and pay line rental fees for that service if you don't use a landline phone regularly. These kinds of services disable access to voice frequencies to deliver a product most frequently referred to as "Naked" DSL.
ADSL connections in Australia are divided between connections that use the older ADSL standard, although these are becoming increasingly rare, and the faster ADSL2+ standard.
For the distance and quality related reasons above, ADSL/2+ speeds are always marketed as being "up to" approximations, because the distance between you and the exchange and then the ongoing issues of network congestion and end points on the Internet can radically affect your speeds. In typical terms, ADSL maxes out at around 8Mbps download and 384Kbps upload, while ADSL2+ connections can deliver download speeds of up to 24Mbps and upload speeds of up to 3Mbps. As noted, in effective real world use you're unlikely to see anywhere near those speeds unless you're very close to your exchange point.
Finally, it's worth noting that if you access your ADSL/ADSL2+ connection via Wi-Fi, you're likely to suffer a small speed penalty relative to the same connection used via a fixed Ethernet cable.
ADSL services are available across Australia wherever you're within radius of an exchange; most ISPs will request your address as a primary step to ascertain ADSL availability in your region. Most notably if you are in an area where fixed line (FTTP, FTTN or FTTB) NBN is installed you will find the copper decommissioned over time, meaning that ADSL services will no longer be available.
How can I compare ADSL plans?
ADSL plans are the most widespread in use in Australia while much of the country awaits the rollout of the NBN. As such, price competition is strong, with many ADSL providers offering bundles that include line rental or unlimited data provisions.
Will I need a new modem for ADSL?
With DSL connections, whether they're ADSL or ADSL2+ making up the majority of fixed line broadband connections in Australia, the odds are pretty good that your existing modem will work with ADSL services. That being said, if you jump up from ADSL to ADSL2+, you'll need an ADSL2+ compliant modem or modem router to take advantage of the additional speed on offer. That's only likely to be an issue if you've owned your existing modem for a very long period of time; any new ADSL modem router sold in Australia now will be fully ADSL2+ compliant.
If you're transitioning from a fixed line HFC cable service to ADSL you will however need a new modem to connect to ADSL services, as the modems supplied by Optus and Telstra for their HFC products are not ADSL compliant. Check with your ISP if they bundle a modem in with a service, as many do if you want to save a little money, although be aware that the modems and routers provided by ISPs are generally simple units, so if you want the fastest Wi-Fi performance you may find it a little lacking if you go down the bundled freebie route.
The range of bundling with DSL services can be quite wide, especially if you're prepared to sign up for a two year contract. On the hardware side over time this has encompassed everything from games consoles to included smartphones, but deals vary widely.
The other extra if you're looking at a plan with a strict data quota is whether or not your ISP has quota-free provisions for certain sites or types of content. Again this varies by ISP and affiliation, but as an example Telstra makes most of its own services (streaming NRL/AFL, BigPond Movies) quota free for its customers, while iiNet and Optus offer Netflix content quota-free. Some ISPs offer access to specific gaming servers as part of a package, while others will include additional online services such as web space or additional email inboxes with some plans.
I recently tried to transfer to Belong for my ADSL connection. That was almost a month ago. Istill have no connection and cannot fet in touch with them. Do you have any suggestions on who i should try instead?
If you wish to contact Belong to inquire about your existing plan with them, you may click this link to be routed to our review page for Belong and scroll to the bottom to see the contact details of the company. If you wish however to look into other providers, this page we are on offers a variety of providers that you may choose and what plans are most suitable to you. While we do not provide specific product recommendations, we can help guide you through the process of comparing options. Kindly review and compare your options on the table displaying the available providers. Once you have chosen a particular provider, you may then click on the "Go to site" button and you will be redirected to the provider's website where you can proceed with the application or get in touch with their representatives for further inquiries you may have.
Before applying, please ensure that you meet all the eligibility criteria and read through the details of the needed requirements as well as the relevant Product Disclosure Statements/Terms and Conditions when comparing your options before making a decision on whether it is right for you. If you are still under contract with Belong, it is still best to contact them before switching to another provider as this may incur fees for early disconnection. Hope this helps!
Just to give you a little background about NBN, once it becomes available in your area, your existing telecommunications networks will be replaced and upgraded. The upgrade to the National Broadband Network is actually compulsory once it's available and installed. This is the reason why Telstra have to shutdown your phone line. As for your internet connection with Belong, in time, it will still be switched to NBN. ADSL/2+ services delivered over the network will be switched off 18 months after the area goes live for NBN. Though you would receive warning from your provider and from nbn before the disconnection. I would suggest that you contact Belong if you still want to get services from them for your new NBN connection or discuss options available to you before your line and ADSL gets disconnected.
Meanwhile, you may like to read this article about how to switch to NBN and find this useful.
hi. im a little confused when it comes to this sort of stuff. iam currently living in a townhouse in a complex of 14. iam wanting to get home internet connection but am so confused on what to do and who to go with. i dont have a home phone line connection and never have since i have lived here, but there is a power point input in the kitchen wich has a phone line point, wich im gathering is where you would plug in a modem or phone connection right? so does that mean i can just plug a modem into that input and it will work or do i need to call up and pay for a phone line connection?? and then what is Naked adsl and would that be what i needed to go for?? arrrgh im so confused, can someone please help me or give me any sort of info and help on what my best options to go for would be? thankyou!!
If you really don't need a home phone, naked DSL offers a solution to this situation. Rather than charging you for a phone service you're not going to use, a naked DSL service strips out the telephone component and dedicates your copper phone line to Internet traffic. While this won't result in any increases in Internet speed since ADSL and phone data operate at different frequencies, it will save you money by not having to pay twice for a single copper line.
You may compare your options for naked DSL on this page. If you have already chosen a provider, you may directly call them to apply or you may visit their website.
Do the companies accept our modem if we have one? I have a Sagemcom (no idea about the model, because there are so many numbers and codes at its bottom). I'm quoting ADSL for now. Cheers!
Usually, internet providers allow you to use your own modem as it is a self-installation process. Now, if it is not working, you may call your current provider (not the provider who previously owns your modem), to see if there is incompatibility and see if they can fix it or you need to buy a new one.
I live in Mernda. Have been waiting for 12months to recieve a port at the exchange so I can get a phone line at my house.
Any idea how I can push this along or how far away NBN is from being installed in my area.
Slowing beginning to boil with frustration.
Sounds frustrating. I would recommend entering your full address in our NBN tracker.


This lovely single room is located in the heart of Ealing, There are ample Local amenities available such as Ealing Broadway Shopping Centre which is just a couple minutes away by walk , also many shops , restaurants and bars.
This room is in a lovely house with very welcoming house mates. The room is very Bright and airy. Local transport is but minutes away with links to central London, Hanger lane, Shepherds Bush and London Heathrow.


Today, on April 12, InformNapalm volunteer intelligence community presents its interactive database, mapping Russian aggression against Ukraine as well as Georgia and Syria. The searchable web site titled Russian Aggression is the summary of the findings collected by our volunteers over four years. More than 1700 OSINT investigations performed by InformNapalm have been systematized and divided into two groups: Russian weaponry found in Donbas, and the units of the Russian army taking part in the aggression against Ukraine and Syria, as well as in the occupation of Georgia.
The body of this database deals with the facts of the large-scale Russian invasion in Ukraine.
More than 1300 Russian servicemen from 89 units of the Russian army and other law enforcement and security of Russia, as well as 44 types of Russian weapons and equipment, which could not have been captured in combat, and were secretly brought to Donbas.
Images of the patches of military units and photos of equipment are clickable links to the texts of our investigations.
The Russian Aggression database will be useful to journalists and experts who are studying Russia's participation in the armed conflicts and hybrid wars. At the moment, the database is available in Ukrainian, English, Bulgarian and Russian.
InformNapalm Volunteers call on the editors of web sites and mass media outlets to write about the appearance of this database, put up a text or banner link to one of its language versions, share the news with friends and connections in social networks. We believe that this piece of systemic investigative data collected by our community will be of value not only to journalists and experts.
Every new lie of the Russian propaganda must be exposed with the light of evidence and facts. Let's write together the history of the fight against the aggressor and expose the committed hostilities to the international community at diplomatic meetings, on websites and internet forums. Thus we can contribute in stepping up political and media pressure on the Russian Federation. We invite you to join the peace enforcement effort!


With over fifteen years in the industry, Alexandra has held senior strategic and operational roles in both financial services and regulatory compliance.
Alexandra started her career as a graduate recruit to HSBC – covering all aspects of branch and retail banking. She rose through the ranks to become Deputy Regional Director SSM of Greater London Region, before leaving to join the Financial Ombudsman Service in 2012.
At the ombudsman service, Alexandra led on diverse casework areas including pensions, investments and jurisdiction. She was responsible for planning and directing different elements of the operation – overseeing various projects and initiatives including the rapid growth of the PPI casework management model; knowledge resource systems and management information reporting among others.
On joining Registry Trust in September 2017 as the Director of Operations, Alexandra has taken on responsibility for compliance, business development, contract management and complaints. Alexandra is also the Data Protection Officer.
Alexandra became interim CEO of Registry Trust from 1 March 2019.
I have worked as an office manager for more than 12 years having successfully established and efficiently managed responsibilities across a diverse range of functions. My experience at a specialised London law firm began with setting up the office from inception and managing its expansion as it grew into a prominent firm featured in the Legal 500.
I joined the senior management team at Registry Trust in January 2016 where I manage the human resources, finance and facilities team supporting the accounts, financial reporting, compliance and legislative requirements.
My career in computing started before the IBM PC appeared. Since then I have covered most aspects of IT and communications management and support with both small companies and large corporations including a main credit reference agency. I initially provided Registry Trust with consultancy for the development of Trust Online before moving into systems management full time in 2008. Registry Trust successfully partners with small, trustworthy responsive companies and we use comparable products to deliver IT services specific to our needs. We continually review and update the capabilities of our suppliers to ensure they provide robust, secure and dependable IT services and solutions that are up to date.
With over 25 years experience working in data solutions, 10 years with a credit reference agency at senior management level, I started the data exploration journey with Registry Trust in 2007. Since then we have built a clear understanding of the true value of the data on the Registers looking at the economic behaviour of consumers as individuals in the debt cycle. We now reach out not only to our existing clients but also new marketplaces sharing our knowledge and building relationships in ways not previously enjoyed at Registry Trust. Through our marketing, sales and account management programmes we continue to build our relationships in the markets we serve.
With 6 years' experience managing the technical support team at Registry Trust I have a background of working closely with our technical partners to deliver new software and introduce new procedures throughout the company. As operations manager since December 2013, I now manage the day to day business functions and the teams taking on the new challenges.


How old does my child have to be to begin music lessons at LHMC?
This depends on the age and maturity of the child. We suggest a student be 6 years of age to start Suzuki lessons. Other instruments such as guitar, woodwinds, drums, and strings are usually begun around the third grade. The goal at LHMC is to make sure your child has a positive experience, and we would rather hold one off that is too early and cause a negative, frustrating experience for the child.
All the time! It's never too late to learn to play an instrument, or pick up where you left off. All of our teachers are expressed in helping adults find success in their musical endeavors!
What if I don't see the instrument I'm interested in listed?
No problem! We have a network of highly qualified professionals with whom we can find you a teacher to provide lessons at LHMC.
What if my child has never played an instrument before?
LHMC is designed for beginners as well as advanced students, regardless of your child's previous musical experience. Our professional and skilled teaching staff will help nurture your child's love for music, and reach their fullest potential.
Do I need a piano at home to take lessons?
No. While it is ideal to have a piano at home you can begin lessons by using a digital piano to practice. If you are going to purchase a piano or digital piano please consult your teacher for guidance on the best option for you and your family.
How do I choose/purchase an instrument for my child?
Don't worry! Our teachers will gladly help you find the right size instrument that is best for your child.
How can I help my child get the most out of music lessons?
Make sure your child has their practice notebook. Read the teachers weekly instructions for practice, and encourage regular practice at home. One short practice every day is much more efficient than a marathon session right before the next lesson.
Keep in contact with your child's teacher. Make sure you establish contact by email or phone, and keep the teacher informed of your child's progress at home.
Observe a lesson! We strongly encourage parents to be present and involved in your child's musical education! Sitting in on a lesson may help you to help your child succeed at home.
How do I find out if the lessons are cancelled due to inclement weather?
In case of inclement weather Livingston Heights Music Center will closed at the discretion of the Director. If in doubt please call LHMC at (908) 963-5690.
When is the LHMC closed for holidays/breaks?
Please visit our "Calendar" page for our schedule!


Pasquale's Pizza Newport proudly sponsored The Spaghetti Eating Contest held at the Newport ItalianFest in June. A record crowd gathered to watch six local firemen compete, hands free, to eat a pound of spaghetti in record time!
Click here to watch a video of this fun event!
Getting ready to serve the spaghetti.
Vince chatting with Newport's finest.
WEAR THE MUSTACHE AND SAVE SOME CASH!
Check out this slide show of people who wore the 'stache !
Tell them Pasquale's sent you!


OMAHA, Neb. (AP) -- Gordmans Stores Inc.'s fourth-quarter profit fell 22 percent as higher costs offset better sales for the retailer.
The Omaha, Neb., company also said that the current fiscal year is off to a slow start, which sent its shares down 5 percent in after-hours trading Monday.
Gordmans earned $7.9 million, or 41 cents per share, for the quarter that ended Feb, 2. That compared with $10.2 million, or 53 cents per share, in the fourth quarter of the prior year. Total revenue increased 9 percent to $202.5 million.
Analysts polled by FactSet expected 37 cents per share on revenue of $202.8 million.
The company warned investors in January that it may be facing some difficulties as it lowered its outlook for the period, citing some unpopular merchandise and a seasonal drop in business.
President and CEO Jeff Gordman said Monday that the quarter's revenue gains were driven primarily by recently opened stores. Sales at stores open at least a year fell 4.1 percent. That is a key indicator of financial performance that strips away the impact of recently opened or closed stores.
The company was also weighed down by an increase in its selling, general and administrative expenses to $65.6 million from $58 million a year ago.
Gordman said the company was disappointed with its results, including a slow start to 2013. But it believes some recent changes, including its leadership team, will help drive sales gains in 2013. Gordmans named a new executive vice president and chief merchandising officer in February.
Gordmans operates 86 stores in 18 states.
Shares fell 52 cents, or 3.7 percent, to $13.70 in after-hours trading.


Rest in peace to myself.
Do not write stories about my epitaph.
Why do it? I never existed, I didn't really live.
С помощью иконки на правой боковой панели вы можете смотреть, слушать или купить онлайн the RIP музыкальный файл или компакт-диск.
Django DKZ перевод текстов песен авторское право является владельцем этой песни.
That briefly passed with the breeze and the wind.
My profile is hard like the profile of the world.
Who finds in it the grace of poetry?
It is a hostile wall around the orchard.
The landscape of life continues.
Towards a brand new day, full of light.
Another love is already awaiting you.
For all evils come for a good reason.
A friendly hand will give you warmth.
Like the moon loves the sun.
Heaven will open its doors!
Heaven will open its doors to you!
At last, you'll be back!


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See More: About Westchester
Welcome to Westchester County, New York — Your Destination for Business, Family and Fun
Westchester County is a great place to visit — or to hold your meeting, event, family reunion or wedding. From the majestic Hudson River to picturesque main streets, world-class shopping to historic homes and gardens, cutting-edge culinary innovation to scenic trails and natural beauty, we've got it all.
And with our strategic location bordering New York City — the first stop heading north into the Hudson Valley and offering easy access to New England — we're the perfect place to work, strategize or play.
Westchester County is made up of five geographical communities; each possessing unique qualities. We invite you to explore them all.
Explore the Westchester County Region
The mighty river awed Henry Hudson, who was convinced it would lead to the Pacific Ocean. Today it leads to historic homes, magnificent gardens and charming villages like Sleepy Hollow and Tarrytown. Look for riverfront dining, acclaimed accommodations and easy access by the Metro-North Railroad.
Kykuit: The Rockefeller Estate, and its sculpture garden. The famed manse is one of five sites, including a chapel with breath-taking stained-glass windows.
EagleFest, centered in Croton Point Park each February, where you'll track bald eagles as they soar over the river.
Ever Rest, the home/studio of Hudson River School painter Jasper Cropsey, plus a gallery of 15 works by this master artist.
MID-COUNTY
Balancing urban chic, suburban charm and rural beauty, this is the county's dynamic hub. At the center is White Plains, where you'll find upscale shopping at The Westchester mall. Look for world-class hotels (like the Ritz-Carlton New York, Westchester and Hilton), award-winning restaurants, music, theater and a lively nightlife.
The Westchester Knicks, an NBA Development League squad, offer up-close access to potential NBA stars at the Westchester County Center.
Hosted by Oscar-winner Jonathan Demme, the "Rarely Seen" series is just one of many movie samplers at the five-screen Jacob Burns Film Center.
The White Plains Performing Arts Center, an intimate theater with an eclectic mix of plays, music and original productions.
Who thought you could find such rural beauty so close to New York City? Discover miles of trails for hiking, biking or cross-country skiing. Look for the pristine 4,315-acre Ward Pound Ridge Reservation, golf courses, horse farms, and quaint, historic towns like Katonah and Bedford.
Grand Prix New York, where you'll take a thrilling go-kart ride around an indoor track. Plus there's bowling and plenty of fun activities for the whole family.
Pete Dye-designed Pound Ridge Golf Course, named to Golf Magazine's list of "U.S. Open-Worthy Public Courses."
Caramoor's annual summer Jazz Festival features more than a dozen nationally-known artists performing all afternoon and into the evening in a lush garden setting.
The County's eastern edge follows the Long Island Sound shore and combines urban settings, marinas and beaches, and historic neighborhoods. Look for village-style charm in Rye, a thriving restaurant scene in New Rochelle, and beautiful water views from Glen Island Park, all in an area easily accessible by car and train.
Playland Amusement Park, America's oldest amusement park, offers lots of old-fashioned fun — historic rides, a boardwalk, indoor skating and more.
Port Chester's Capitol Theatre, once host to Janis Joplin and other music luminaries, and now featuring top acts like Steely Dan and Ringo Starr.
New Roc City, with over one million square feet of family activities, from black-light bowling to a space shot ride.
Just north of New York City, this area is anchored by Yonkers, which features a revitalized downtown-waterfront with Hudson views and waterside dining at award-winning X2O Xaviars on the Hudson. Look for upscale enclaves like Bronxville, great shopping at Ridge Hill and historic sites like 18th-century Philipse Manor Hall.
Empire City Casino at Yonkers Raceway features 5,300 slot machines, electronic table games, and the excitement of year-round harness racing.
Legoland® Discovery Center Westchester, with everything from a Star Wars mini-land to 4D movie fun to a master class in Lego building.
The "Bookstore," a walk-through sculpture-comic artwork by famed installation artist Red Grooms, at the Hudson River Museum.
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148 Martine Ave., White Plains, New York 10601
Tel: +1 (914) 995-8500 or +1 (800) 833-9282
E-mail: info@visitwestchesterny.com