text:
General practitioners' perspectives on management of early-stage chronic kidney disease: a focus group study
Carola van Dipten ORCID: orcid.org/0000-0002-0529-60881,
Saskia van Berkel1,
Wim J. C. de Grauw1,
Nynke D. Scherpbier-de Haan1,
Bouke Brongers1,
Karel van Spaendonck1,
Jack F. M. Wetzels2,
Willem J. J. Assendelft1 &
Marianne K. Dees1
Guideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners' (GPs') perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care.
Qualitative focus group study with 27 GPs in the Netherlands. Three analysts open-coded and comparatively analysed the data. Mind-mapping sessions were performed after data-saturation.
Five themes emerged: defining CKD, knowledge and awareness, patient-physician interaction, organisation of CKD care and value of the guideline. A key finding was the abstractness of the CKD concept. The GPs expressed various perspectives about defining CKD and interpreting estimated glomerular filtration rates. Views about clinical relevance influenced the decision-making, although factual knowledge seems lacking. Striving to inform well enough without creating anxiety and to explain suitably for the intellectual ability of the patient caused tension in the patient-physician interaction. Integration with cardiovascular disease-management programmes was mentioned as a way of implementing CKD care in the future. The guideline was perceived as a rough guide rather than a leading document.
CKD is perceived as an abstract rather than a clinical concept. Abstractness plays a role in all formulated themes. Management of CKD patients in primary care is complex and is influenced by physician-bound considerations related to individual knowledge and perception of the importance of CKD. Strategies are needed to improve GPs' understanding of the concept of CKD by education, a holistic approach to guidelines, and integration of CKD care into cardiovascular programmes.
Chronic kidney disease (CKD) is an important healthcare problem. The estimated prevalence in the Netherlands is 12% [1], which is similar to the prevalence in the US and the UK (13%) [2, 3]. CKD causes substantial morbidity and mortality, mainly related to increased cardiovascular risk [4,5,6]. It is expected that the number of CKD patients will increase due to aging of the population and increased prevalence of diabetes and hypertension [5, 7].
Most early-stage CKD patients receive care from general practitioners (GPs). Several international guidelines have been developed to improve the quality of care in primary care [8, 9]. In the Netherlands GPs function as gatekeepers and are supported by nurse practitioners in the area of chronic diseases. The Dutch interdisciplinary guideline for CKD (DIG-CKD) [10] for family practice and nephrology provides recommendations for GPs about the identification and management of CKD and serves as a guide for shared care with nephrologists [10]. This guideline was introduced in 2009. It is very similar to the NICE guideline for CKD, is distributed by the Dutch College of General Practitioners and freely available, in print and online.
Despite guideline recommendations, a number of quantitative studies indicate substantial deficiencies in the quality of care delivered, including CKD recognition and monitoring as well as reaching blood pressure targets [11,12,13]. Several barriers for implementation of CKD management have already been described; objections to the label CKD because of fear, stigmatisation and physiological decrease of kidney function; lack of time; low expectations of management; and guideline familiarity [14,15,16]. A commonly mentioned solution is education, but GPs who participated in a recent Dutch CKD trial in which they received extra education on CKD management, had difficulties implementing the guideline recommendations [17]. In order to improve the implementation of CKD care, it is important to know GPs' underlying thoughts and beliefs about CKD and the implementation of the guideline. The present study therefore aims to explore the perspectives of GPs who were familiar with the guideline on CKD management in daily practice. We also examined the applicability of the national interdisciplinary guideline.
Given the explorative character of the research aim, we considered a qualitative approach to be the most appropriate. We selected a focus group design because perspectives are more likely to be revealed by interaction and discussion with peers. Grounded theory was used as a theoretical framework [18]. We used the consolidated criteria for reporting qualitative health research (COREQ) as a reporting structure [19]. Besides adjustment of the topic list, we made no further modifications of the methods during the study.
Selection of participants
Four focus group interviews were conducted with 27 Dutch GPs. We recruited (by phone and e-mail) from practices that had participated in the CONTACT study (Consultation Of Nephrology by Telenephrology Allows optimal Chronic kidney disease Treatment in primary care) [20]. These GPs were definitely informed about the guideline. We assumed they used the guide in daily practice, thus being able to provide knowledge about the perspectives of implementation of CKD management. In the Netherlands, GPs are responsible for providing and implementing CKD care. Although Dutch nurse practitioners (NPs) are involved in care programmes for diabetes and cardiovascular disease, their involvement in CKD care is minor. We therefore recruited only GPs. Two GPs were not involved in the CONTACT trial study. They participated because two participants in focus group 4 cancelled at the last minute. They were involved in scientific research and familiar with the guideline.
A purposive stepwise sampling strategy [21] was applied to ensure heterogeneity for gender, age, urbanization, and experience in general practice (Table 1). Sampling, data collection and analysis occurred iteratively. Practice and personal data were collected prior to the interviews. All GPs consented to participation, and they were assured that anonymity and confidentially was guaranteed. No patient data were used.
Table 1 Participant characteristics
Before starting, a topic list (Additional file 1) was created by reviewing relevant literature and in consultation with the research team and two CKD-patients of the Dutch Kidney Foundation. A senior psychologist (KvS) with extensive experience in medical healthcare and chairing focus group studies moderated the focus groups. Either one of the two investigators (CD or SB), both GP trainees, PhD students and trained in qualitative research, and a research intern (BB) observed the focus groups and noted non-verbal communication and details about group interaction. The sessions lasted 120 min each. After each focus group, the investigator and Chair discussed observations made during the sessions and adjusted the topic list for each following focus group, in discussion with the research team. All focus group discussions were audio-taped and transcribed verbatim. In the analysis of the fourth focus group, no new codes or concepts were found. We decided that saturation had been reached at that moment.
The transcripts were analysed with the constant comparative analysis method [21] and with the aid of a computer program (Atlas.ti version: 7.1.5). Analyses started after the first focus group interview. The analysts (SB and BB) independently used open and inductive coding. They discussed and merged codes after each focus group. In the case of disagreement, members of the peer group (MD and WG) were consulted. A consensus code list arose, which was used to code the second transcript. New codes were added and discussed as described after each next coded transcript. After three focus group sessions, another researcher (CD) became involved as SB left the research project. This researcher coded all transcripts as a third coder. The research intern (BB) and the second researcher (CD) independently coded the fourth session. After saturation was reached, the codes were sorted into categories and themes. It took five consensus meetings in which members of the research group (CD, SB, BB, MD, NS, and WG) participated to construct the final thematic map. For a detailed description of the analysis process, see Additional file 2. A native-English speaker translated the illustrative quotes.
Four focus group interviews were conducted between November 2014 and March 2016. A total of 147 GPs were invited to participate, of whom 71 responded. Forty-one GPs were interested in participating, while 30 GPs declined, mostly due to lack of time. Altogether, 27 GPs were included by purposive sampling, and 5 to 8 GPs participated in each session. Table 1 presents the characteristics of the participants.
Five main themes emerged: 1) defining CKD, 2) knowledge and awareness, 3) patient-physician interaction, 4) organisation of CKD care, and 5) value of the guideline. For a detailed description of codes, categories and themes, see Additional file 3.
Defining CKD
CKD was experienced as a difficult and abstract concept. CKD seems intangible. The diagnosis is not a clinical one, but is merely based upon laboratory findings without patient complaints and- in the view of participants- in some cases without clinical consequences. The participants struggled to interpret the eGFR values due to eGFR fluctuations and strict cut-off points. Age and physiology were considered relevant to interpret eGFR values, but also whether to label patients with the CKD diagnosis. Participants felt that there was no fixed definition of CKD. Furthermore, whether CKD is a disease on its own or a risk factor for cardiovascular disease, like hypertension, was discussed.
"The initial question was what is your picture of chronic kidney damage, and honestly, that picture is just a check mark in a row of risk factors." (FG1, man, 60-70y)
Knowledge and awareness
Professional competence
Educational gaps in the contents of the guideline and about proteinuria were reported. Nevertheless, there was a shared feeling that awareness of CKD has improved due to increased monitoring of diabetes and cardiovascular disease and the introduction of the DIG-CKD. The recurrent use of the guideline appeared to facilitate a learning curve so that managing CKD patients became easier. This reduced the urge to consult or refer to a nephrologist.
"Yes, at a certain point you know what the nephrologist will say. If I have heard it a few times, then I think: ok, that's the next step that I can take with this patient." (FG2, woman, 50-60y)
Perception of the importance of CKD
Due to insufficient knowledge about the clinical consequences of CKD, treatment and adherence to the guideline were trivialised. There was scepticism concerning health profit for patients if GPs would fully adhered to the guideline. GPs' decision making was influenced by expectations about poor prognosis and quality of life.
"I think it's a difficult problem ... a lot of medication, that influences kidney function. But then I think I'd rather have poor kidney function than be a patient who is extremely short of breath." (FG4, woman, 50-60y)
Patient-physician interaction
Informing patients
It appeared difficult to find the best approach for informing patients. The major concern was to inform enough without creating anxiety. Both straightforward communication and metaphors were used to explain the CKD diagnosis.
"…That there is a kind of rinsing machine in your body that keeps your blood clean, I say then. And if that machine doesn't work well, then your blood gets poisoned." (FG1, man, 60-70y)
Striving to adequately inform patients without creating unnecessary anxiety and to ensure the explanations and education was tailored to the patients educational level was found difficult. The right moment to inform patients and a lack of information material were also discussed.
The GPs felt the urge to empower patients in managing their CKD, but struggled to provide methods to increase patients health literacy. GPs felt that patients should especially take preventive measures, but they also had doubts about the efficacy of self-management. They felt that gaining patients' compliance would require time-consuming explanations. Especially in the case of co-morbidity, the balance between energy spent on self-management and the return it would generate worked out negatively.
"Yes, but that is in the whole of chronic care, it is certainly very difficult because people with kidney function disorders, even not considering age, so often have other problems with smoking, blood pressure, weight, etc." (FG4, man, 40-50y)
Organisation of CKD care
There was not always consensus regarding GPs' policies within the practices, though the participants agreed about the importance of congruence of CKD care. The presence of alignments about task delegation to the nurse practitioner varied. There was discussion about the future implementation of CKD care.
"They usually come into the picture through the annual blood test in chronic-disease management programmes, so that you have already checked them in connection with other disorders." (FG1, man, 40-50y)
Primary-secondary care interface
The accessibility of nephrologists and the transfer of medical information needs improvement. The participants found it instructive to consult a nephrologist. The preferred method of contacting nephrologists (teleconsultation or by phone) differed.
"Formerly, specialist were easy to reach, now you get lost in the logistics of the hospital." (FG3, man 50-60y)
The views towards nephrologists varied and were mainly based on previous experiences in contact and communication with them. Some had doubts about the added value of nephrologists' involvement. Losing control over patients' treatment after referral to a specialist was difficult for the GPs. They considered that other aspects should be taken into account, influencing how aggressively patients should be treated. GPs also experienced one-way communication and held the opinion that nephrologists do not involve GPs enough.
"I always find it sad when people land at the nephrologists' and have a blood pressure that is 2 mmHg too high. Then they have to come back three times. While I think: yeah right, boys, yeah. " (FG3, man, 50-60y)
Value of the guideline
Accepting the recommendations of the existing interdisciplinary guideline induced a sense of safety. The guideline was used by the GPs to reduce knowledge gaps, resulting in a learning curve. The shared opinion was that the guideline created more awareness for CKD and improved the quality of care for patients.
The GPs found treatment and referral criteria in the interdisciplinary CKD guideline too strict and precise, which made following the guideline time consuming. Furthermore, a feeling of medicalization of CKD patients was mentioned.
"What is the use of medicalising someone of great age with everything?" (FG4, woman, 40-50y)
Advice for improvements
According to the GPs more attention should be paid to the context of CKD patients and to how to interpret laboratory and clinical findings, while at the same moment taking the context of the patient into account. More advice about how to enlarge patient empowerment would be helpful.
Summary of main findings
Perception of CKD as an abstract concept is a key finding in this study. The perceived abstract CKD concept seems to play a role in all formulated themes. It influences the GPs' experienced confidence on CKD knowledge. Clinical relevance also seems to be lacking, and there is scepticism concerning treatment benefits for patients. GPs act at their own discretion, taking into account patients' age, prognosis and quality of life. The interdisciplinary guideline is therefore seen as a rough guide rather than leading. The abstractness of the CKD concept forms an obstacle in conveying the CKD concept to patients.
Previous findings like educational gaps, guideline familiarity, tensions surrounding ICPC (international classification of primary care) labeling and physiology are in line with our study results [14,15,16, 22,23,24]. However, the importance of the perceived abstractness of the CKD concept, which in our study was a key finding, has never been highlighted as a central theme, causing difficulties for GPs in managing CKD. Since our findings are based on a study of trained GPs with special interest in CKD we presume that CKD as a concept will be even more difficult for other GPs who have not been trained in CKD explicitly. We indentified several factors that contribute to the abstractness of the CKD concept. Of these factors, renal aging, a diagnosis based on eGFRs and the tension between disease and risk factors have been earlier discussed in studies of Crinson and Simmonds [14, 22]. In our study, another aspect of the abstractness of CKD appeared to be the struggle to interpret eGFRs (i.e. fluctuating eGFRs, eGFR versus severity of CKD). This is a new and fascinating insight, which raises the question of how the interpretation of an eGFR value differs from the interpretation of a blood glucose level. Both a CKD diagnosis and a diabetes diagnosis are laboratory based, have strict cut-off points, and have no symptoms in an early stage. Despite these similarities, diabetes management is well integrated in daily practice in primary care while CKD management is not. In the knowledge that CKD provides as much risk of cardiovascular disease as diabetes does [25], this is a remarkable difference.
We have seen that extra education for the GPs in our previous study did not meet their needs in interpreting and managing CKD [20]. We hypothesise that educational interventions should be even more intense, as Pang found in a study in which GPs perceived an increase in knowledge after interventions during which they were personally mentored by nephrologists [26].
GPs prefer to make CKD patients partners in care, but they encounter several barriers. Patient empowerment is time-consuming, and GPs have doubts about the efficacy of self-management. If patient empowerment is recommended in guidelines, attention should be paid to these barriers.
The heterogeneity of the participants supported the generalisability of the findings. Internal validity was established through independent coding in triplicate, the use of Atlas.ti and the mind-mapping sessions with the research team in which additional perspectives and interpretation of analysis and findings were discussed. Analysis by three analysts and similar findings from previous other studies helped to triangulate the findings. The rigor of the data is supported by the iterative approach of the focus group and the interim data analysis. Some limitations should be considered. The focus groups were performed in Dutch, so that representative quotations needed translation. This may have caused loss of nuance, which we tried to limit through translation by a native-English speaker. The moderator was a psychologist, which could be a restriction regarding in-depth interviewing in the medical field. Another possible limitation is that most recruited GPs were previous participants in the CONTACT study. This might be related to a special interest in the research theme, possibly influenced their knowledge of and commitment to the subject. However, GPs who are not familiar with the subject may have even more difficulties with CKD care while they have insufficient knowledge about the guideline to provide answers to the research question. In order to avoid analysis bias as much as possible, the research team members differed in profession, age, experience regarding CKD care, and experience as a GP. Some had been involved in previous research on CKD (including the trial), but others had no specific experience in CKD research when the focus group study was performed. All researchers were GPs (in training). These background factors may have influenced our findings, but we can't indicate the direction of a possible bias.
Implications for practice
Our study provides insight into the perspectives of GPs concerning early-stage CKD management and could give input for future quality-improvement interventions. A major direction should be to improve GPs' understanding of the clinical concept of CKD. This could be done by education, which should also focus on clinical relevance, prognostic value of CKD, proteinuria and the interpretation of eGFRs in relation to age and comorbidity. Instructions on how to give a suitable explanation of the CKD diagnosis to patients might as well be part of GPs' education.
Our opinion is that embedding CKD care in an integrated care programme of all cardiovascular risk factors, including CKD, hypertension and diabetes, may support GPs and patients to maintain an overview. For those who were not diagnosed with diabetes or cardiovascular disease, a comparable care program provides the best chance of creating awareness and improving the quality of care for CKD patients. The tension between disease-specific guidelines and the holistic care preferred by GPs is - besides the abstract concept of CKD - perhaps the most important implementation barrier. GPs wish to maintain a patient-centred approach in providing high-quality CKD care, deviating from guideline recommendations when necessary.
This paper shows that care for patients with chronic kidney disease in primary care is a complex interplay of an abstract concept and physician-bound considerations. Difficulty interpreting the concept of CKD and doubts about the clinical relevance of CKD in the light of the patient's personal situation are the main reasons for deviating from guideline recommendations. Quality improvement strategies should focus on education of GPs in CKD-specific knowledge, especially in judging CKD relevance and GP-patient communication. Guidelines should include more guidance in eGFR interpretation, clinical consequences, and suggestions for tailoring interventions to the personal context of the individual patient. GPs feel there is tension between personalised healthcare and CKD-specific guidelines.
CKD:
Consultation of nephrology by telenephrology allows optimal chronic kidney disease Treatment in primary care
COREQ:
COnsolidated criteria for REporting Qualitative health research
DIG-CKD:
Dutch interdisciplinary guideline for chronic kidney disease
eGFR:
FG:
KDIGO:
Kidney disease: improving global outcomes
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Participating general practitioners.
Lea Peters, research assistant.
Dutch kidney foundation for financial support.
The Dutch Kidney Foundation funded the study. Grant no. 13A4D302.
The funder agreed with the researchers' study design, but had no direct influence on the data collection, analysis, interpretation and reporting of the project.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Please note that the interviewees were Dutch CKD patients, so the data is in Dutch as well. The Radboud University Medical Center had his own integral quality system scientific research named PaNaMa. PaNaMa contains project information, patient inclusion, research files etcetera. This system is internally viewable.
Department of Primary and Community Care, Radboud University Medical Center, PO Box 9101, 6500 HB, Postal Route 117, Nijmegen, The Netherlands
Carola van Dipten, Saskia van Berkel, Wim J. C. de Grauw, Nynke D. Scherpbier-de Haan, Bouke Brongers, Karel van Spaendonck, Willem J. J. Assendelft & Marianne K. Dees
Department of Nephrology, Radboud University Medical Center, PO Box 9101, 6500 HB, Postal Route 464, Nijmegen, The Netherlands
Jack F. M. Wetzels
Carola van Dipten
Saskia van Berkel
Wim J. C. de Grauw
Nynke D. Scherpbier-de Haan
Bouke Brongers
Karel van Spaendonck
Willem J. J. Assendelft
Marianne K. Dees
All authors read and approved the final manuscript. CD: organised focus groups, coded, analysed and wrote the article. SB: organised focus groups, coded and analysed. WG: was consulted in case of disagreement (between CD, SB, BB), participated in the mind map sessions and in the writing process. NS: submitted an application, participated in the mind map sessions and in the writing process. BB: transcribed, coded and analysed. KS: chaired the focus groups and participated in the writing process. JW: involved in the design of the study, involved in the supervision of the PhD and participated in the writing process. WA: involved in the design of the study, involved in the supervision of the PhD and participated in the writing process. MD: was consulted in case of disagreement (between CD, SB, BB), participated in the mind map sessions and in the writing process.
Correspondence to Carola van Dipten.
Ethical approval for this study was not required according to the accredited Medical Research Ethics Committee of Arnhem/Nijmegen, registration number 2014–1319.
All participants signed informed consent before executing of the study, in which they gave permission for using their quotes and demographics in a scientific publication.
The authors declare that they have no financial or non-financial competing interests.
Topic list. A list of relevant topics concerning CKD management which was constructed before start of the study to ensure all research items were covered and discussed in the focus groups. (DOCX 19 kb)
Analysis details. A detailed description of the iterative process of data collection and analysis. (DOCX 14 kb)
Codes, Categories and Themes. A detailed table with codes and their description, from which categories and themes originated. (DOCX 37 kb)
van Dipten, C., van Berkel, S., de Grauw, W.J.C. et al. General practitioners' perspectives on management of early-stage chronic kidney disease: a focus group study. BMC Fam Pract 19, 81 (2018). https://doi.org/10.1186/s12875-018-0736-3


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Gold nugget. Stock photo from Pixabay
German court rules term 'gold nugget' hate speech against migrants
The German district court in Bremen has dismissed the complaint of a Facebook user who had been banned because of the use of the term "gold nugget" for asylum seekers.
Published: June 23, 2019, 1:40 pm
"It is known by the court that supporters of the right-wing scene refer refugees as 'gold nuggets'," the Redaktionsnetzwerk Deutschland reported on the court's verdict.
Facebook had blocked the user from Bremen in August 2018 for 30 days, because he had commented on the murder of a German doctor in Offenburg by a Somali asylum seeker. The doctor and his medical assistant was stabbed by the migrant. The doctor died shortly after the attack, and the woman was seriously injured.
The police searched for the perpetrator by deploying a helicopter squadron, the dog squadron and forces of the Federal Police. In just over an hour, the 26-year-old asylum seeker from Somalia was arrested.
The banned Facebook poster said: "Well, therefore a 'man' … stabbing… gold nuggets …?" He had expressed his anger at the recommendation of the Press Council not to mention the ethnic origin of suspects.
The judges agreed with Facebook's assessment that this was a case of "hate speech". The user's contribution was likened to an "attack on a group of people" because it linked all asylum seekers with the murder.
The term "gold nuggets" as a synonym for asylum seekers refers back to a quote from the former SPD Chancellor candidate Martin Schulz. He said in 2016, "What refugees bring us is more valuable than gold. It is the unwavering faith in the dream of Europe."
Meanwhile in Osnabrück, the police arrested a 33-year-old asylum seeker from Lebanon, who wanted to blow himself up in Berlin. The violent perpetrator, known to law enforcement, had announced that he wanted to die in martyrdom in Germany, said Lower Saxony's Interior Minister Boris Pistorius (SPD) on Friday morning in the state parliament, according to NDR.
Pistorius said the man had already been arrested on Wednesday. He had threatened to harm his family. "He was considered a high-risk case of domestic violence and was released from custody in February."
The suspect was initially held in preventative detention for 14 days. The new Lower Saxony Police Law, adopted in May, allows such measures to be taken to combat terrorism.
The suspect is currently not considered an Islamist threat because it has not yet been established whether he had acted for political or religious reasons, according to police sources.
The state of Lower Saxony is currently trying to obtain replacement papers for the asylum seeker in order to deport him. If that does not succeed, there must be another court date set in Germany.
RL, Vallentuna
Go to Hell Germany !! The county is destroyed
Germany has not been a independent State since the nsdap lost the war for global freedom
Germans thought they would find more cheap bank accounts for their factories….
The 2 groups you go to jail for speaking the truth, moslims and ((())). It speaks volumes on who is in (((charge)))

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A: In the main index page add error_reporting(E_ALL);. I recommend you remove this once you are ready to publish the website.

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A: Just add this line ini_set('display_errors', true); somewhere in your controller before you called the library or in the beginning of the library and everything should work.

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Чуперно́сів — село в Україні, у Перемишлянській міській об'єднаній територіальній громаді Львівському районі Львівської області. Населення становить 226 осіб.

Географія
Через село тече річка Дихтарка, ліва притока Погоблиці.

Історія
У 1552 році власником села був Єжи Свірзький, у 1711 році — львівські фрацисканці.

У 1927 році в селі мешкало 337 осіб. Найбільшим землевласником в селі був І. Вибрановський, у власності якого було 315 га землі.

Галерея

Примітки

Посилання

Села Львівської області

redpajama_set_name: RedPajamaWikipedia


Enhanced heavy-duty industrial slides with high reliability and high load capacity support 60" wide drawers with slide lengths up to 36". Well-suited for fire trucks and emergency vehicles, RVs, coaches, service vehicles, trucks, and also ATM manufacturers.
For use in medium-duty industrial drawers or trays, or electronic enclosure applications.


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Christopher Glanz
Stories By Christopher Glanz
Top 10 Diss Tracks in the History of Rap
By Christopher GlanzMarch 5, 2019
There are more than one reason why Hip Hop is the most popular genre of music...
Top 10 Ways that All-You-Can-Eat Buffets Make Money
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Pretty much everyone reading this has eaten at a buffet at some point in their lives....
The Untold Truth of Taco Bell
By Christopher GlanzNovember 21, 2018
When it comes to Mexican food in the fast-food arena, there is one king, Taco Bell....
10 Ways Amazon Controls Your Life
By Christopher GlanzSeptember 19, 2018
Amazon used to just be an online book store, but the only thing that Amazon then...
Top 10 Tower Defense Games
By Christopher GlanzMarch 17, 2018
Tower Defense games have been around since the dawn of gaming, with games like Space Invaders...
Another Top 25 Movie Posters for 2018
By Christopher GlanzFebruary 10, 2018
We live in a day and age where we can watch movie trailers basically at any...
Top 25 Twitter Reactions to the Disney/Fox News!
By Christopher GlanzJanuary 5, 2018
It's Official! Nerds of the world rejoiced this morning as it was announced that Disney has...
Top 15 Crypto Currencies!
Cryptocurrencies are a relatively recent product and phenomenon that replaces physical money (and it's intrinsic value)...
25 Times Gordon Ramsay Savagely Roasted People On Twitter
By Christopher GlanzDecember 5, 2017
Celebrity Chef Gordon Ramsay is almost as well known for his temper and use of foul...
Top 15 Harry Potter Little Known Facts
The Harry Potter universe is one of the most extensive fictional worlds ever created. The exclusive...


How can I change the frequency of emails sent from My Ladyboy Date?
What is not allowed to do on My Ladyboy Date?
Joining My Ladyboy Date is easy. Complete the sign up form and you will receive a confirmation email with a link to follow to complete your registration. This will help confirm that you gave a real email address and that you will be able to receive emails from us. Your account will be activated and ready to use after this process.
What you need to do: go to your Spam Folder, look for an email from "My Ladyboy Date" with the subject "Activate your account", then select if and mark it as "not a spam". To make sure you well get our emails in the future, you can also add noreply@myladyboydate.com to your list of contacts.
On My Ladyboy Date, it's free to create your profile, review your matches and browse all the other profiles and photos. Your profile will remain active as long as you wish, for free.
If you want to leave My Ladyboy Date but keep your profile and photos intact, you can temporarily deactivate your account. There is no difference regarding other members between deleting or deactivating your account, the only difference is that you can recover your profile at any time when you come back. You just have to log in with your email address and password, and your account will be re-activated instantly.
We designed community guidelines to ensure every member can enjoy My Ladyboy Date safely and responsibly. We invite you to familiarise yourself with them to make sure you won't do anything bad.
In the event that a member is harassing you, spamming, asking for / offering money, or otherwise making My Ladyboy Date a bad place to be, there are "Report" buttons on every profile page, and on every conversation page. Doing so is confidential and our moderation team will deal with this quickly.
This is the million-dollar question. You cannot! But you can be wise and avoid newbie pitfalls. We have advance technology to automatically spot scammers, fakers, duplicate accounts and so forth. Our moderation team works every day reviewing profiles, photos and making My Ladyboy Date the safest place possible for dating transgender women. But it cannot be perfect. Online dating is a wonderful way to find love, but it has risks, you must be aware of them and must be smart.
As a rule of thumb: NEVER send money to somebody you met online, whatever the reason. If a member asks for money, report to us and we will ban him/her right away. If you report to us after sending money, then we will ban both of you. The reason is simple: if nobody ever sends money, then nobody asks for it. Members who send money online are creating a market for scammers and we don't want those members on our site. However, if a member asks for money and you don't send any, we will be happy that you reported this member and will thank you for making My Ladyboy Date a better place.


Football legend David Beckham has partnered with L'Oréal to launch House 99, a 13 piece grooming line which includes hair products and moisturisers. The launch is a partnership with the dominant international beauty business -L'Oréal, which has a track record in the male skincare market with L'Oréal Men Expert.
Beckham has dabbled in the men's grooming arena before with his range of fragrances. I haven't been a huge fan of those. It will be interesting to see what the full line-up includes and how focussed it will be on anti-ageing and beards. The brand is said to be inspired by British barber shops as well as Beckham's own favourite products, featuring skincare, haircare, bodycare and grooming, ranging from the Bold Statement Tattoo Body Moisturizer to the Softer Touch Beard Oil. Quinoa and spirulina are at the heart of the formulas, chosen specifically by Beckham for their reputation as health-boosting ingredients. I'm guessing from some of the imagery available that it will address shaving, beards and skin with 13 products.
Beckham commented 'I'm so excited to finally share House 99 with everyone around the world. For me, grooming is not only about how you look, but how you feel. It's about being comfortable, trying new things and shaping your next look. I created House 99 to give people the inspiration as well as the right products to experiment and feel completely at home doing so'.
House 99 will launch exclusively at Harvey Nichols in the UK on February 1 2018, rolling out to other British retailers and 19 countries worldwide from March 1.


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Media Release | 61 New Affordable…
Media Release | 61 New Affordable Homes on the way for Pemberton, B.C.
61 New Affordable Homes on the way for Pemberton, B.C.
Pemberton, BC – BC Housing has approved an application to the Community Housing Fund (CHF) submitted by Sea to Sky Community Services (SSCS) in partnership with the Village of Pemberton (the Village), offering 61 new affordable housing units available to community members living in the Village of Pemberton and surrounding areas.
Affordable housing has been a priority in the Village of Pemberton's community plan for over a decade. Similar to other communities in the Sea to Sky region, Pemberton is experiencing increased population growth, upward pressure on housing prices and limited supply of affordable rental opportunities. In 2019, the Village Council formally added Affordable Housing as a Strategic Priority and since that time have completed an Affordable Housing Revised Background Report, an Age-Friendly Affordable Housing Needs Assessment, and an Age-Friendly Affordable Housing Action Plan and Work Program. The Village has begun public engagement on options for facilitating more affordable housing by way of an information session and survey, with results to be presented in the near future.
This new project will provide housing to families, seniors and persons with disabilities. The proposed location on Harrow Rd., will offer 32 units allocated to independent families, comprised of eight (8) 3-bedroom units and twenty-four (24) 2-bedoom units, and 29 units allocated to independent seniors and persons with disabilities (1-bedroom units). The latter will also include eight (8) dedicated accessible units for persons with disabilities.
When asked about the project, Executive Director Jaye Russell stated, "We are thrilled with the news. Funding from BC Housing will provide much needed safe and affordable housing to individuals and families that need it the most. We are pleased to partner with the Village of Pemberton and look forward to engaging the community in the months ahead."
"The Village of Pemberton is ecstatic that this proposal has been approved to proceed. In 2019, Village of Pemberton Council identified Affordable Housing is a Strategic Priority and have been working to encourage and enable this type of development. With the announcement of this funding, and our partnership with Sea to Sky Community Services, this will allow us to deliver affordable housing options for up to 60 Pemberton families or individuals while improving social stability and equity in the Pemberton community," said Mike Richman, Village of Pemberton Mayor.
More information will follow as the project requires an amendment to the Official Community Plan (OCP) and Zoning Bylaw in order to proceed. Community consultation on the OCP and Zoning Bylaw amendments will provide the public and key stakeholders the opportunity to view concept drawings and "have their say". Project success will rely heavily on community and neighborhood support and engagement.
About Sea to Sky Community Services
With compassion, respect and care, SSCS provides high quality programs throughout our region to enhance the lives of residents at every age and stage of life. To do this, we offer affordable housing for low to moderate income earners, early childhood care and education, social supports and mental health services. The organization's main activities encompass six different service delivery areas which are the core structure of our programs and services. These areas are Affordable Housing, Youth, Community Living, Adults and Families, Children and Childcare Services. The activities in these core areas include youth at risk programs and support; children and family support programs including childcare; employment, life skills, and housing services for adults with developmental disabilities; food security through food banks; crisis support and intervention; mental health support through counselling and referral services.
Pemberton is one of the most desirable communities in BC and home to family farms, fresh outdoor adventures and stunning vistas. With over 2500 residents and just 30 km from Whistler, Pemberton prides itself on its creative and collaborative approach with the business community, local volunteer groups, neighbouring communities and key business and tourism partners such as Tourism Pemberton and the Pemberton & District Chamber of Commerce. Pemberton's mild winters, warm summers and unique pioneer heritage provide an ideal place to enjoy arts, culture, history, recreation, dining, shopping and comfortable lodging.
Lindsay Leathem (she/her/hers)
Manager, Communications and Marketing
Sea to Sky Community Services | sscs.ca
604 892 5796 ext.279
Lindsay.leathem@sscs.ca
Vinka Hutchinson
Communications and Grant Coordinator
vhutchinson@pemberton.ca
VIEW FULL MEDIA RELEASE
VIEW AFFORDABLE HOUSING UPDATE


At Under Armour Connected Fitness® we start with the customer, and that means that we believe the best solutions arise from a thorough understanding of customer wants, needs, and behaviors. In addition to the raw data we can analyze via our app platforms, we inform and inspire our work through qualitative research methods. As customer research is core to our process, we create solutions that are informed, validated, and in turn resonate with our customers. We neither define nor design from a distance.
Through our design, product, and engineering teams, we employ a mix of new and tried-and-true methods, and are happy to do so in a 'guerilla' style—scrappy, impromptu, quick, and self-sufficient. We get results, we iterate, and we move quickly. In addition, our dedicated Customer Happiness teams are an excellent source for gathering additional structured insights from customers.
once the product is launched (customer feedback), resulting in iterative product improvements.
Foundational Research helps to answer the question,"What is the correct product/feature to design?". It highlights behaviors that provide a good indicator of customer needs. It can provide insight and inspiration into the direction of future product opportunities.
Typically in the Define phase.
Generative Research is employed to generate new ideas, refine existing ones, and to zero in on a set of core functionalities about a product. Methods can include user testing, and co-designing exercises with target customers.
Typically in the Design phase.
Typically in the Deploy phase.
To learn about our customer wants, needs, and behaviors, we employ several techniques, one of which is customer surveys. In tandem with in-person contextual interviews, examining app usage data, and other research techniques, Customer Surveys are an excellent tool to generate insights from real customers through conversation and observation.
Customer surveys sit on a continuum somewhere between app usage data and in-person interviews.
Avoid marking every question as "required". This enables your respondents to skip questions they do not want to or can not answer.
Surveys are good for certain situations. When it comes to understanding user behavior, needs, wants, frustrations, and preferences, it's best to use surveys in tandem with other research techniques. Each research tool helps you see a portion of the whole picture.
Generate a prototype using high-fidelity designs (InVision).
Let the user hold the phone like they normally would. Take notes of organic reactions and comments. Avoid aiding or helping (i.e. don't say "there's more down below if you scroll") and if they ask questions, instead of immediately answering, try and understand why they are asking it and what they would do if there wasn't anyone around to ask.
Take pictures, transcribe notes, spot trends, make conclusions and takeaways. Generate a report.
Iterate on designs based on feedback. Test again as needed.
Note-taking, photography, and video are musts and can be massive aides when observing participants in their environments. There are many subtleties captured that can provide deep insight into customer behaviors.
Our Customer Happiness team is on the front lines of listening and responding to customer feedback emails. Much of the feedback is in the form of feature requests. The Customer Happiness team have created a system to track and rank common feature requests using a JIRA ticketing system. This allows product teams to address the most commonly reported issues from customers using our apps.
User Panels give our employees the chance to engage directly with our customers – and vice versa. Much like surveys, they allow for a dialogue and deeper dive into specific uses and areas of our products.
The Panels are conducted as a free flowing conversation, with a moderator guiding the conversation from topic to topic. Interacting with customers and hearing how they articulate their experiences with the products in real-time is invaluable.
Spending an afternoon putting your designs in front of coworkers can help identify potentially larger design and functional issues before the feature goes into production.
Pros: They are quick – typically a hallway test can be setup and completed within a day.
Cons: Contextual authenticity – lacks the real-world insight, even though the participants are valid users of the product.
Even before the sessions begin, you can uncover issues simply by organizing the test. As you lay out screens and prepare questions and tasks, you might find obvious oversights, such as a transition from one screen to the next being too abrupt, or a flow feeling disjointed. For example, while working on a release for UA Record, we encountered a challenging scrolling experience that would not have been uncovered by static comps alone. We discovered this while building the prototype to test, and immediately took note of the issue as something that needed to be addressed.
Recruit coworkers who are as far-removed from the feature being developed as possible, yet who represent your target audience as closely as possible. It can be tricky to find valid candidates, but there are ways you can approach the test session with participants on the fringes that will yield specific insights. For example, one of our Customer Happiness agents loves volunteering for Hallway Tests. Our approach with the agent is to identify areas that might lead a user to contact support for help, and to focus on reducing those pain points as much as possible, or provide a way for the user to solve the issue themselves. This can include anything from the terminology used to ability to complete a given task.
Given the fast-paced set-up and execution of hallway tests, it might be hard to recruit a large number of participants. This is OK! If you only get 3 people to look at your designs, you'll be able to identify trends – even if that "trend" shows each participant has a completely different reaction to something. Better than that is when they all have the exact same reaction to something – which is a strong indicator that it needs to be addressed.
Always schedule the first and second test with a large enough break between them to fix any issues with the test itself. Consider the first session the "test of the test". Aim for a task-based structure, but be prepared to go off-script if necessary. And allow time for some open-ended discussion at the end.
Customer Research yields fascinating and insightful conversations, that lead to product improvements, and even innovation. Understanding customer context, needs, and behaviors is critical to our success as our company transforms from product-led to consumer-led. Data and insights derived from research can help inform improvements to the product experience across the product development life cycle. Engaging with consumers in meaningful ways as we design our products will lead to more meaningful customer engagement with the finished product. And continuing to listen to customers post launch allows us to iterative and improve based on real behaviors.
© Copyright 2019, Under Armour Inc.
Disclaimer: The views and opinions expressed in the individual articles published herein are those of the authors and do not necessarily reflect an official policy or position of Under Armour, Inc.; Under Armour, Inc. does not endorse, recommend or support any specific products or services and shall be considered in no way affiliated to the products and/or services discussed by the articles authors.


In order to facilitate research projects and prepare grounds for prevention and control of noncommunicable diseases, NCD research center avidly follows the scientific path through potentiating local researchers and developing international collaborations. While focusing on publishing state of the art research articles and applicable knowledge, we eagerly seek society's contribution toward enhancing public health and reducing NCD burden.
This research center is determined to produce reliable and applicable evidence to eventually become an influential center in the field of NCDs. With the available efficient human resources and relying upon ethical issues, humanistic values and new technology, we are determined to establish a center of excellence to finally become an WHO collaborating center.


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Durkeetown Baptist Church: Fort Edward, NY
Times and Locations
Staff/Leadership
KidMission
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MOPs at Durkeetown
What is MOPS?
Here at MOPS, we gather and support moms. We believe in the simple but revolutionary idea that remarkable things happen when moms come together, face to face. That's why we rally women to come together in their own neighborhoods and help each other through this thing called motherhood, one gathering at a time.
Our acronym stands for "Mothers of Preschoolers" because we began in 1973 when a group of moms of young children banded together to share their lives and parenting journeys. Over the past forty-five years, MOPS has expanded our reach to include moms with older kids, partnering with churches and organizations worldwide to equip and encourage moms in more than 60 countries.
If you are expecting or have an infant, toddler or preschooler: Try one of our traditional MOPS groups. Every group offers its own unique feel, so try more than one to see which fits you best. Many groups offer childcare, so you can get a chance to connect with moms, face to face, while your kids are safe and making friends, too.
At Durkeetown, our MOPs group meets at regularly scheduled times and is directed by Bekkah Herrick (mother of 3). They usually meet on Sundays at about 5pm with baby/child-sitting provided for your convenience. See the website calendar for upcoming dates and themes.
©2010 Durkeetown Baptist: Fort Edward, New York
Email: office@durkeetown.org
durkeetown baptist church
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Japan warns China making new platform in East China Sea
July 12, 2015 — 3.11pm
Latest updates on the South China Sea dispute
South China Sea dispute: what you need to know
Tokyo: China has been constructing a new offshore platform near the median line between its shoreline and that of Japan in the East China Sea, where China is developing gas fields, according to the Japanese government.
At a Friday meeting of the House of Representatives' special committee on security legislation, Japanese Defence Minister Gen Nakatani said the move could become a security concern.
Chinese President Xi Jinping, right, shakes hands with Japanese Prime Minister Shinzo Abe in Jakarta in April. Credit:Kyodo News/AP
China "could install a radar system on the platform, or use it as an operating base for helicopters or drones conducting air patrols", he said.
China has been reclaiming rock reefs in the Spratly Islands in the South China Sea to build an airfield and communications facilities, so this latest discovery could indicate progress toward creating a militarised base in the East China Sea.
The Japanese government is regularly monitoring this area of the sea via air patrols by the Self-Defence Forces (SDF) and Coast Guard, though it did not offer information on how many new platforms are being built, their locations, their scale or other details. It became evident in June 2013 that China was building an offshore platform in the area.
The Japanese government demanded that construction be stopped, but it appears that more work has been done.
Japanese Prime Minister Shinzo Abe said in Friday's lower house special committee meeting: "I strongly object to (China) repeatedly going ahead with unilateral development."
In November 2013, China declared an air defence identification zone (ADIZ) in the East China Sea, though it cannot completely cover this area with radar from the Chinese mainland.
"If radar was installed on the platform, it would supplement the (ADIZ)," Mr Nakatani told the committee. "It would improve China's capacity for surveillance and warning, which could give them a better idea of the SDF's activities."
The boundary between Japan and China in the East China Sea is not clearly demarcated. The area where the platform is being built is on China's side of a line that runs midway between the two nations' shores.
In 2004, it came to light that China was unilaterally developing four gas fields in this area, at Shirakaba (Chinese name: Chunxiao), Kashi (Tianwaitian), Asunaro (Longjing) and Kusunoki (Duanqiao).
The Japanese and Chinese governments in June 2008 agreed to establish a joint development region for sea areas that straddle the midline, and to cooperate on developing the Shirakaba gas field, which sits on the midline.
Talks over how to deal with the other three fields have been ongoing, but little progress has been made.
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At this point in the summer, we've covered swimsuit trends a good deal. We've shown you just how chic wearing a belt over your swimsuit can be, which are the best swimsuit trends for shorter girls, and even tested out our favorite swim brands so you can see what they look like IRL. But before the summer starts winding down, there's one more place you have to shop for swimsuits: Amazon.
The biggest swim trends of summer 2018 are actually blowing up right now on the retailer's site—all of them for under $30. So whether you're shopping last-minute for that August vacation and realize you don't have as many cute swimsuits as you thought or you're just looking for a fun new suit to add to your collection, look no further. From retro high-cut suits to pretty smocking and chic leopard print, shop the best Amazon swimsuits below.
Available in sizes XL to XXXXL.
Next up, see which three lingerie trends are blowing up on the retailer right now.


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New Release – HIS TRUE QUEEN by Jodi Ellen Malpas
Leave a comment August 7, 2018 beneaththecoversblog
His True Queen by Jodi Ellen Malpas
Series: Smoke & Mirrors Duology Book 2
Publication Date: August 7, 2018
A beautiful, defiant princess.
A renowned, sinfully gorgeous Hollywood actor.
A love affair that is sure to rock the British Monarchy…and the world.
Their love affair began intensely and passionately. Princess Adeline and Josh Jameson knew any future together was impossible—her status as a princess and his standing as a Hollywood heartthrob dictated that. But the heights of pleasure they could take each other to were wildly unanticipated by them both.
Josh's absolute disregard for Adeline's status quickly drew her into his hedonistic world. And her perfectly worn mask and false façade captivated Josh to the point of obsession.
The boundaries became blurred. The physical became emotional. Their hearts became entwined.
But a cruel turn of events rips their worlds apart and Adeline is more bound than ever by the protocol and expectations her title commands. The army of royal advisors who guard the secrets and scandals of the Monarchy will go to unthinkable lengths to keep the smoke and mirrors in place…and Josh away from Adeline. She knows the power she possesses comes with agonizing sacrifices. Walking away from Josh devastates her…but it keeps him safe from the corrupt institution that has ruled her life.
Yet Josh refuses to lose the woman who has consumed him so completely, distorted his boundaries, and stripped him of all sensibility.
Will the power of the British Monarchy triumph? Or will Adeline and Josh's fierce love for each other change the course of history?
Purchase today!
Amazon US | Amazon UK | iBooks | B&N | Kobo
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Read The Controversial Princess (Smoke & Mirrors Duology #1) today!
Amazon US | Amazon UK | Amazon CA | iBooks | B&N | Kobo
Jodi Ellen Malpas wrote her debut series, The This Man Trilogy, in secret, worried about what people might think if they knew what her imagination was capable of. She was shocked herself. But she finally found the courage to unleash her creative streak and self-published THIS MAN – the first book of the This Man Trilogy – in October 2012. She took a chance on the story with a hero who soon became one of modern day fictions most prolific alpha male characters. Jesse Ward – also affectionately known as The Lord of The Manor, sparked incredible reactions from women across the globe and catapulted Jodi into the world of women's fiction.
Jodi went on to self-publish the second book in the trilogy, Beneath This Man in Jan 2013, just before Grand Central Publishing, part of the Hachette Book Group, picked up the popular trilogy and the unknown Jodi. The third book of the trilogy, This Man Confessed, took Jodi to the top of the bestsellers lists, earning her the proud title of #1 New York Times Bestselling Author. This Man has since been voted one of the top romance novels of all time.
With so much love, enthusiasm and a thirst for her words from her readers, Jodi suddenly wasn't afraid of her imagination anymore. She went on to write The One Night Trilogy with the delectable and mysterious Miller Hart, and stole the hearts of her readers once again. Her first stand-alone novel, THE PROTECTOR, released in September 2016 and has since been nominated for a Reviewers' Choice Best Book Award. Jodi's next stand-alone novel. THE FORBIDDEN, is set for release in August 2017.
All seven of her published novels have hit the New York Times best sellers list – as well as the Sunday Times list and various international best seller lists. Her work is now published in over 24 languages across the world.
Jodi was born and raised in the Midlands town of Northampton, England, where she lives with her two boys and a beagle. She is a self-professed daydreamer, a mojito addict, is famous for her obsession with Converse, and has a terrible weak spot for Alpha Males. Writing powerful love stories and creating addictive characters has become her passion – a passion she now shares with her devoted readers.
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This volume features a complete set of problems, hints, and solutions based on Stanford University's well-known competitive examination in mathematics. It offers high school and college students an excellent mathematics workbook of rigorous problems that will assist in developing and cultivating their logic and probability skills.These 20 sets of intriguing problems test originality and insight rather than routine competence. They involve theorizing and verifying mathematical facts; examining the results of general statements; discovering that highly plausible conjectures can be incorrect; solving sequences of subproblems to reveal theory construction; and recognizing "red herrings," in which obvious relationships among the data prove irrelevant to solutions. Hints for each problem appear in a separate section, and a final section features solutions that outline the appropriate procedures.Ideal for teachers seeking challenging practice math problems for their gifted students, this book will also help students prepare for mathematics, science, and engineering programs. Mathematics buffs of all ages will also find it a source of captivating challenges.
Reprint of the Teachers College Press, New York, 1974 edition.


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Riddick was thrown out of a moving car back in 2015 by Rescue Dogs Rock NYC. He was soon put up for adoption after we healed completely. Soon, Bryan Junior and his wife found him out through Facebook and immediately knew they wanted her. So, they rescued her in August 2015 and she was almost immediately a very important member of the family.
The next year, the Juniors had a baby boy and named them Dawson. As soon as Dawson came home, Riddick and her pit bull dog sister, Cambria, were entirely obsessed with him.
And it's the same from Dawson's side as well! He loves climbing all over them and cuddling with them. He likes feeding them too!
Unfortunately, Dawson recently caught the flu, which was his first time being very sick. He had a fever and he was just miserable, not wanting to do anything the entire day. He didn't even want to interact with anyone, except one exception—Riddick.
Riddick, too, was the only one who wanted to be there for Dawson during the time he was flu-ridden. Riddick is always there for Dawson and their parents happily watch him being sweet and protective towards his little brother.
And, with the help of Riddick's selfless comfort, Dawson began feeling better soon. And within no time, he was back to normal, running around with his two best friends in the world. And, without a doubt, Riddick is still always there right beside him, protecting him from any kind of harm.


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David Patrick Kelly (born January 23, 1951) is an American actor, musician and lyricist who has appeared in numerous films and television series. He is best known for his role as the main antagonist Luther in the cult film The Warriors (1979). Kelly is also known for his collaborations with Spike Lee, in the films Malcolm X (1992), Crooklyn (1994), and Chi-Raq (2015), and with David Lynch, appearing in Wild at Heart (1990) as well as Twin Peaks (1990–91) and its 2017 revival.

Kelly's other credits include roles in 48 Hrs. (1982), Commando (1985), The Crow (1994), The Funeral and Last Man Standing (both 1996), The Longest Yard (2005), as President Harry S. Truman in Flags of Our Fathers (2006), and a recurring role in The Blacklist (2015).

Early life
Kelly was born in Detroit, Michigan to Margaret Elizabeth (Murphy) and Robert Corby Kelly, an accountant. His father received a Bronze Star Medal for service during the Battle of the Bulge in World War II. His grandfather, Daniel Murphy, was from Lisnashearshane, Duhallow, County Cork, Ireland. His great-grand-uncle was Father William Corby, chaplain of the Irish Brigade at the Battle of Gettysburg. As detailed in Corby's book, Memoir of Chaplain Life: 3 Years With the Irish Brigade, Father Corby eventually became president of the University of Notre Dame.

Kelly was given a mandolin on Saint Patrick's Day 1964 by his mother and considers that to have been the greatest influence on his artistic life.

As an undergraduate student, Kelly wrote the lyrics and music for four musicals produced in Detroit. These four productions were Lysistrata (by Aristophanes), The World from My Window (based on a book of children's poems), a project based on Gulliver's Travels (in the land of horses) and Home for Silent Clowns, a mime show with songs.

Kelly graduated cum laude with a Bachelor of Fine Arts from the University of Detroit, and was a student of Marcel Marceau and Mira Rostova.

Career

Film
In his debut role of Luther in the 1979 cult film The Warriors, Kelly screeches the famous line, "Warriors... come out to play-ee-ay!", which he improvised while clanging three empty beer bottles together. In the 1982 film 48 Hrs., starring Nick Nolte and Eddie Murphy, director Walter Hill rewrote a role for Kelly and again named the character "Luther".

Kelly's film credits include Commando (1985, as Sully), The Crow, Crooklyn, Hammett, Wild at Heart, Dreamscape, The Adventures of Ford Fairlane, Last Man Standing, Songcatcher, K-PAX, The Longest Yard', Flags of Our Fathers, John Wick (reprising his role as Charlie in John Wick: Chapter Two), and Chi-Raq. He appeared in the 1996 video game Ripper.

Television
Kelly's television guest appearances include Twin Peaks, Miami Vice, Moonlighting, Spenser: For Hire, Ghostwriter, Third Watch, Hack, Kidnapped, Law & Order, Law & Order: Criminal Intent, Law & Order: Special Victims Unit, Gossip Girl, Louie, Blue Bloods, The Blacklist, and Feed the Beast.

Stage
He performed in a few off-off-Broadway theater productions during the 1970s and 1980s. These included Wilford Leach's C.O.R.F.A.X. (Don't Ask), produced at La MaMa Experimental Theatre Club in 1975, and Ireneusz Iredyński's An Altar to Himself, as adapted by Michal Kobialka and Liz Diamond and directed by Virlana Tkacz at La MaMa in 1989. He also appeared in the April 1974 production of Mr. Jello, written and directed by George Birimisa, and then performed a song for which he wrote the music from Mr. Jello, at a benefit hosted by La MaMa to honor H.M. Koutoukas, called "For the Benefit of Harry", also in 1974. In 1976, he performed in La MaMa's "Cracker Club Country Fair Gala" in segments from Paul Foster's Silver Queen and Leonard Melfi's Horse Opera.

Kelly originated the role of Da in Once on Broadway, which was awarded the 2012 Tony Award for Best Musical. In 1998, he played Feste in the Lincoln Center production of Twelfth Night.

Kelly has frequently appeared at the Hartford Stage Company in Hartford, Connecticut, starring in the title roles in Georg Büchner's Woyzeck and Molière's Tartuffe. He played Iago in Othello and Hoss in Sam Shepard's Tooth Of Crime. At the American Repertory Theater in Cambridge, Massachusetts, he played the title role in Luigi Pirandello's Enrico IV and starred in an adaption of the Yuan dynasty classic Snow in June.

He has appeared in four plays by avant-garde playwright Richard Foreman: Pearls for Pigs, The Mind King, Film Is Evil/Radio Is Good, and The Cure.Theater listings compiled by Ruth Gilbert (January 6, 1992). New York,  p. 74. In 2015, he appeared as Michaud, alongside Keira Knightley, in the Roundabout Theatre Company's production of Helen Edmundson's adaptation of Thérèse Raquin in the Studio 54 space.

In 2022, Kelly played the Narrator and the Mysterious Man in Sondheim's Into the Woods at Encores! and later at the St. James Theatre on Broadway and on the 2023 national tour.

Music
As a composer and musician, Kelly participated in New York's rock and cabaret scene, playing such venues as Max's Kansas City, Reno Sweeney's, CBGB, and The Lower Manhattan Ocean Club. He wrote the music for the titular song of George Birimisa's Mr. Jello, which was produced at La MaMa in 1974.

In May 2008, he released an album of his original music titled David Patrick Kelly: Rip Van Boy Man, which contained new songs and live recordings from his club days in 1975.

Awards
Kelly played Dropshadow in David Lynch's film Wild At Heart, which won the Palme d'Or at Cannes in 1990. Kelly sang and played mandolin on the Grammy Award-winning soundtrack for the musical Once. He received a Connecticut Critics Circle Award for his performance in Tartuffe at Hartford Stage, and was nominated for a Lucille Lortel Award for his performance in Nathan Louis Jackson's When I Come To Die'' at LCT3 in Manhattan. In 1998, Kelly received an Obie Award for sustained excellence for his theater work in classics, new plays, and the avant-garde.

Personal life
Kelly married theater actress and writer Juliana Francis at St. Mark's Church in-the-Bowery in Manhattan on August 14, 2005. They have a daughter named Margarethe Jane Kelly born in 2008.

Acting credits

Film

Television

Video games

Theatre

References

External links

 Kelly's page on La MaMa Archives Digital Collections

1951 births
American male film actors
American male television actors
American male stage actors
American people of Irish descent
Living people
Male actors from Detroit
University of Detroit Mercy alumni


The Tutorial is an unofficial "game" for Minetest which teaches the basic gameplay of Minetest in a nice castle. The goal is to complete all the lessons and win the golden cup.
The tutorial concentrates on basic singleplayer gameplay and does not focus on any particular game for Minetest. Most of the lessons apply to multiplayer as well. This article will guide you how to install and start the tutorial.
The tutorial is not shipped together with Minetest and must be downloaded separately.
Windows: into the games sub-folder inside the folder in which you have installed Minetest. It is the directory containing the directories (not neccessarily exhaustive list) bin (which in turn contains minetest.exe), builtin, client, doc, fonts, games, locale, mods and textures.
If the "games" directory does not exist, create it.
From this point on, the tutorial should guide you through the game.
This page was last modified on 12 March 2019, at 07:17.
This page has been accessed 47,802 times.


I used to wonder why anyone would pay for food on a cruise ship when you can get all the food you want and then some at no extra charge. The dining room serves multi-course meals and there's always a buffet. Cruise ships also offer room service, often for free. But they also all have at least one eatery that has a surcharge, often more than one.
The waiter brought us each an extra appetizer before the ones we ordered.
On my most recent cruise on Holland America's Westerdam, I had the opportunity to experience the regular dinner service at the Pinnacle Grill, their fancy restaurant. The dinner there is definitely worth the extra charge, but those wishing to spend less money to try the food there can make reservations for lunch instead. It is a different menu for lunch than for dinner though.
We had great service with two waiters for our party of five. The menu had lobster available in several dishes, including lobster macaroni & cheese. The first course had a variety of soup and salad options for the appetizer. We all chose something different and everyone liked what they got. Certain menu items include some tableside preparation.
For the main course, my sister ordered the lamb kabob. This the waiters brought to the table with a cart where they flambéd it tableside before moving the food from the skewer to a plate and serving it. My father's baked Alaska came to the table in a similar manner. It kind of provides a bit of a show with the meal when they do that.
Our dessert had a bit of a delay, so in the meantime they served a dish of homemade truffles in several varieties, all very rich and delicious. The dish of truffles alone would have made an excellent dessert, and had more than enough for everyone.
I expected a small cake with a molten center when I ordered the chocolate lava volcano, but instead got a large pot of melty chocolate goodness. More than I could eat following such an excellent meal.
I ordered soup for my starter, and a stuffed chicken breast for the main course. They also added a small bowl of the lobster macaroni since I had inquired about that, as lobster and macaroni and cheese aren't normally things people put together. They worked well together though, it tasted quite good. My dad tried the broiled lobster tail, which he liked quite well. I probably would have ordered the lobster too except we had just had lobster the night before at the formal night dinner in the dining room. They cook it differently at the Pinnacle Grill though.
It's not just the food at the pay-extra eateries that make for a special dinner, it's the service and the extra little things included with the delivery and the whole ambiance of the venue that make the experience worth the extra charge.
This entry was posted in Cruise Food, Shipboard Life, Westerdam and tagged cruise food, Holland America, photos, Pinnacle Grill, travel, Westerdam. Bookmark the permalink.
So this landlubber has a question: from the picture it seems that vessel when its sailing with all its passengers is easily the size of a town. When you're out there on the open seas, do you ever feel the motion of the ship? The last thing I'd want to feel is sea sick while fine dining. I'm funny that way.
Normally the seas where these ships sail are calm enough not to feel motion on such large vessels, but if it gets stormy enough they will rock. There's been a few times when everyone looked like drunks staggering down the halls due to the motion of the ship on a couple of our cruises. My cousin who is very motion sensitive (enough to get ill on a plane with no turbulence) was always aware of just the normal forward motion of the ship as it sailed from place to place, but most people don't notice it.
Say no more. I'm already reaching for the Dramamine.
Hahaha, I bring Dramamine because I have a history of motion sickness. I've taken it on occasion as a preventative when the seas were rough, but never actually had a motion sickness problem on a cruise so far.
The food looks delicious. That is a very good tip you mentioned about trying a fancier restaurant at lunchtime. I've found that is a great way to try food at finer dining establishments even back on land. Even though the menus between lunch and dinner are different, often the flavor profiles and ingredients for the lunch and dinner menus are similar. So you still get a good meal. And yes, the prices at lunch time are much more in line with more casual dining restaurants in the area.
Great post, although now I'm hungry again after reading this!
Food is something I always look forward to on cruises. That's a good point about saving money trying the fancier places at lunchtime on land as well as at sea.
why pay go to the lido or main dinig rm. DAH!
You don't actually have to pay to go to the Lido or the main dining room. They're included with the cruise.
Yum! this is making me so hungry!
I did the pay extra sushi place on my Alaskan cruise. It was well worth the $15 price, the amount of sushi I ate probably would have cost me $100 at home. I just kept ordering until I couldn't eat any more.
The pay-extra places do seem to be worth the extra money. The sushi you are talking about was on the Norwegian Sun. Norwegian does seem to have quite a variety of pay-extra places.


Valid at Highland Woods only. Valid Monday-Thursday anytime, Friday-Sunday after 1pm. Not Valid during leagues, holidays, or outings. Valid through 5/31/15. Cannot guarantee Christmas day delivery on orders placed after December 20th.


Ernie's incredible imagination is alarming his parents and they go to the doctor in search of a cure. Once they're there, they discover Ernie's 'illucinations' are more powerful than they realized as everything that Ernie imagines – from secret agents to a boxing granny – has the disconcerting habit of turning into reality.
Ernie's Incredible Illucinations by Alan Ayckbourn is brought kicking and screaming to the Clongowes stage by the talented and energetic thespians of the Third Line. Appropriately, the drama is a weird and wonderful journey into the imaginings of a young boy with an overactive imagination – a dreamer with a difference. The cast has been preparing for it under the guidance of Ms Jane O'Loughlin, and Mr William O'Sullivan and are all set to knock your socks off.
The Clongowes – oops – Ridley Road School Orchestra are at the European Festival of Youth in Moscow, just hours away from playing the most important performance of their lives. There is only one problem; their instruments seem to be missing! Tension mounts as the orchestra arrives at the concert hall, where the only person willing to help them is a Russian cleaner with a broom for a guitar and an interest in all things rock.
The Clongowes premiere of The Musicians brings together two exciting talents: writer (and Academy Award nominee) Patrick Marber and director Tom Carroll, fresh from his recent successes with Macbeth Unlimited and Conversations on a Homecoming (both 2016).
Can the orchestra overcome their differences and perform the concert of their lives? A lively and humorous production for anyone who has ever played air-trombone. (Any comparisons with the upcoming Clongowes Orchestra Trip are almost certainly coincidental – it says here…).
Both plays will be brought to the stage in Clongowes for two nights only on Thursday 30th and Friday 31st March at 19.00 in the Music Performing area.
The smell of the greasepaint, the roar of the crowd.


text:
Q: Get the child of an HTML element by its XPath I have a really simple ask, i have a div in a html page that i can acces by his XPath which is : //div[2]/div/div[2]/div[2]/div[2].
I want a XPath that would give all the child of this div but i can't find it.
I need to get the element with the findElements method of Selenium, but what i've tested does not work:
My HTML code looks like this :

    <input/>

And the XPath I want to use like this :
//div[2]/div/div[2]/div[2]/div[2]/child

And my Java Selenium script like this :
List<WebElement> listElement = driver.findElements(By.xpath(xpath));

for(WebElement element : listElement) {
    System.out.println(element.getAttribute("id"));
}

What XPath should I put to get the child of the div?
EDIT 1: I did use the * and it's working, but when i count the number of element it prints me 6. Does the * consider the children of his children as his own children ??

A: If the div in the HTML fragment in your question is located at
//div[2]/div/div[2]/div[2]/div[2]

then the input child element would be here:
//div[2]/div/div[2]/div[2]/div[2]/input

and all of the children elements would be here:
//div[2]/div/div[2]/div[2]/div[2]/*

Update:

EDIT 1: I did use the * and it's working, but when i count the number
  of element it prints me 6. Does the * consider the children of his
  children as his own children ??

No, div/* selects only the immediate children elements of the parent div.
If you're being surprised by a greater number of children than expected, it may be that the base XPath is selecting multiple elements, and you're then selecting the children of more than just the targeted div element.

Update 2:
If you cannot post a MCVE, and you're still puzzled about the number of children returned by,
//div[2]/div/div[2]/div[2]/div[2]/*

try challenging yourself on the XPath you've provided as the base:
//div[2]/div/div[2]/div[2]/div[2]/

First, try
//div[2]

Does it really select the single div as you expect?
Then try
//div[2]/div

Again, see if this one really selects the single div you expect.
Continue in this manner until you get to a place where the reality of the selected elements deviates from your expectations.  There your answer will be obvious, or your have a more specific question to ask.
Without seeing your XML/HTML, this is about as good as the advice can get.

A: List<WebElement> childs = driver.findElements(By.xpath("//div[2]/div/div[2]/div[2]/div[2]/*"));

In that case selenium searchs for all child elements from path div[2]/div/div[2]/div[2]/div[2]/ and set them in list collection as WebElement object.


We take our lawns seriously.
We provide a broad range of affordable professional lawn services to help you meet your lawn care goals, most without contracts! It is the combination of customer-focus and expertise that has made our lawn service and landscaping stand out among the competition.
Our weekly lawn maintenance includes mowing, weed eating, edging, blowing away debris and trimming bushes 4 times a year. Pricing varies mostly on lot size, and the abundance of landscaping designs.
Providing your lawn and plants with the proper type of fertilizer in the correct amounts and at the right time will result in a thick healthy lawn and less weeds. We provide both an annual treatment plan to guarantee the results you are looking for.
Our sod installation works with only the highest quality of sod in the DFW area. We use this high quality, dependable sod provider because they offer the widest variety of types of grass (several different types of Bermuda, St. Augustine and Zoysia).


text:
NJHMFA Provides Funding for Hinchliffe Stadium Renewal Project
Built in the early 1930s, Hinchliffe Stadium, one of the last remaining Negro League ballparks and a later site for high school sports, has been vacant for more than two decades and has suffered extensive neglect and deterioration.
By John Jordan | February 28, 2020 at 06:03 AM
NJHMFA executive director Charles A. Richman
PATERSON, NJ—The New Jersey Housing and Mortgage Finance Agency has agreed to provide nearly $19 million in construction financing and tax credits for a senior housing development that is part of the ambitious redevelopment of the long-vacant and dilapidated Hinchliffe Stadium property here.
John Jordan
John Jordan is a veteran journalist with 36 years of print and digital media experience.
Skilled Nursing to Get Much-Needed Relief From Covid Vaccine
Lisa Brown | December 07, 2020
Skilled nursing facility residents and employees will likely receive the coronavirus vaccine in the initial rollout, which points to credit positivity for the sector, Fitch Rating says.
Lenders Rethink Assumptions as Pandemic Rages On
The cost of financing is roughly double what it was before COVID.
Affordable Housing Collections Rebound in December
Collections for public housing reached 97% of 2019 rates, and affordable housing reached 83%—the highest level for the latter class since June.


It's the 20th Anniversary of HAMS!
On February 10, 1999, a union was made that no one has been able to break up since.
That was the day, that a young radio host named Nick Born, was paired up with a younger producer by the name of Josh Bitney. Little did they know, that first meeting would grow into a relationship, both personally and professionally, that would go strong for another two decades.
That's right, Sunday marks the 20th anniversary of the Half-Assed Morning Show. And through all that time, even though a few things have changed… Like buildings, interns, co-hosts, and station management, a few things remained the same… Their bond to each other, and the lack of respect from the station management. Congratulations guys! Here's to 20 more…. Who are we kidding; we're all getting fired before that happens.


text:
الصفحة الأولى عن استعراضات تربية الأحياء المائية
استعراضات 2010
الاجراءات
Main purpose and content
In a continuing effort to achieve aquaculture sustainability through dissemination of up-to-date information on the status and trends of the sector, FAO publishes Aquaculture Regional Reviews and a Global Synthesis about every 5 years, starting in 1997.
These reviews aim at providing a comprehensive and reliable perspective, over the past 5 years, of the aquaculture status and trends in the main regions of the world, and globally, emphasizing salient issues and success stories, highlighting future trends, and considering likely scenarios.
Up-to-date information on the status and trends of the sector, at regional and global levels, was developed from national, regional and global datasets, and supplemented with expert opinion and literature review.
The Regional Reviews and the Global Synthesis can be of pertinent use to national governments, regional organizations, policy makers, farmers, investors, civil society organizations, research and training institutions and the general public.
Each regional review and the global synthesis contains nine chapters
Social and economic background.
General characteristics of the sector.
Resources, services and technologies.
Aquaculture and environmental integrity.
Markets and trade.
Contribution of aquaculture to food security and social and economic development.
External pressures on the sector.
Governance and management of the sector.
Aquaculture contribution to the FAO strategic objectives.
Process and participation
The preparation of each regional review was led by a top regional expert with the involvement of numerous renowned international experts under the guidance of FAO. The global synthesis was produced by a team of international experts using the information provided by the regional reviews and a global perspective.
Use the tabs on the left to navigate to the Regional Reviews.
Source | Citation
شـروط وأحكـام
الرسائل التحايلية
للمتابعة :
FAO, 2023 ©


This is an easy level, but the difficulty can be making it to Noire on time. She starts off in a walled area surrounded by flying units, which she is strong against but there are quite a few of them. You should prioritize sending a group north to lure the flying units while getting to her before they do.
You can send a power group west as well to deal with the swarm of Bow Knights, more flying units, and the boss of the level at the same time.
Again, prioritize Noire. She will come under your command after the first turn, in which you can choose to make her start to shoot at the flying units that are coming toward her (they have to go around thanks to the wall, but she can still shoot them).
Or, you can make her run east then south to unite with your group coming up, though she may get intercepted by flying units if you choose to do it this way.
You have until about Turn 4 before she can no longer escape from the Griffon Rider while standing where she started. Use flying units to get to that entrance way and cover her.


text:
Tag: Boneshaker
Throwback Thursdays: The Devil Wears Goggles
November 14, 2013 April 18, 2017 torforge
Welcome to Throwback Thursdays on the Tor/Forge blog! Every other week, we're delving into our newsletter archives and sharing some of our favorite posts. Fiddlehead, the fifth book in Cherie Priest's Clockwork Century series, is here! To celebrate the publication of Cherie's latest steampunk adventure, we've reached back in our archives to October 2009, when…
Grab Bag Sweepstakes
April 25, 2013 October 11, 2013 torforge
Our bookshelves are a little overcrowded right now and we need to make room for new books arriving soon. So, we thought we'd make room by offering up books and more to you! Comment below to enter for a chance to win this prize pack: NO PURCHASE NECESSARY. You must be 18 or older and a…
Steampunk Sweepstakes
October 3, 2011 torforge1 Comment
Sign up for the Tor/Forge Newsletter for a chance to win the following prize pack: About our newsletter: every issue of Tor's monthly email newsletter features original writing by, and interviews with, Tor authors and editors about upcoming new titles from all Tor and Forge imprints. In addition, we occasionally send out "special edition" newsletters to highlight…
2010 Goodreads Choice Awards: Winners
January 14, 2011 March 4, 2016 torforge
Voting has ended for the 2010 Goodreads Choice Awards. Congratulations to our Tor authors in the following categories! Favorite Books of 2010 #19 The Way of Kings by Brandon Sanderson Fiction #4 A Dog's Purpose by Bruce Cameron (A Dog's Purpose by Bruce Cameron was also recently listed in Bookpage's Best Books of 2010 at…
Cherie Priest a 2010 Spotlight Award winner in Seattle Magazine
August 16, 2010 March 4, 2016 torforge
Cherie Priest, author of the upcoming DREADNOUGHT has been named a 2010 Spotlight Award Winner in Seattle Magazine! To read the amazing feature on the lovely Cherie Priest, click here. DREADNOUGHT is the sequel to Cherie Priest's steampunk adventure–and runaway hit—Boneshaker. For more information on Cherie Priest's Clockwork Century visit our Facebook page today!
Cherie Priest's Boneshaker wins PNBA Award
January 8, 2010 torforge
Cherie Priest has been selected to win a 2010 PNBA Award for Boneshaker! The Pacific Northwest Booksellers Association (PNBA) is a non-profit association of (primarily) independent bookstores in five Northwest states, Washington, Oregon, Idaho, Montana and Alaska. The Association produces educational and promotional events and materials for its members, and offers literacy, free speech and…
Boneshaker receives a PW starred review
August 31, 2009 torforge
Boneshaker by Cherie Priest receives a starred review in the August 31st issue of Publishers Weekly! "Intelligent, exceptionally well written and showcasing a phenomenal strong female protagonist who embodies the complexities inherent in motherhood, this yarn is a must-read for the discerning steampunk fan."