text:
Police are searching for a woman and her two children, who have been missing from their home in north London for two weeks.
Sian Blake, 43, was last seen with her children Zachary, eight, and four-year-old Amon, on 13 December in Waltham Forest.
The Metropolitan Police say that they are "increasingly concerned for her and the children's wellbeing", but that they believe she is still in the London area.
Blake is described as being black, 5ft 2ins tall, with short black hair and a slim build. Police say that she normally wears glasses, but sometimes uses contact lenses.
Anyone who may have any information on the whereabouts of Blake or her children should call officers on 101, or call Missing People on 116000 quoting the reference 15MS050346.


text:
"You are the only reason you need to get dressed up."
And with that flash of genius, this month's #fashiontruth spotlight Abby had us hooked. Because who doesn't look in the mirror sometimes and think, "Would [insert external influence here] like this?" instead of thinking, "Do I like it?" Abby is full of insights like these. Check out our Q & A below for more awesome Abby-isms, and if you're as inspired by her on-point pattern mixing as we are, shop her special collection here, including the All About Abby Dress!
Hi Abby! Tell us a little bit about yourself.
I'm the youngest of four very headstrong girls. I grew up in Portland, Oregon until I was eleven, at which time I moved to Moscow for my dad's work. I moved again a little more than four years later to Munich for almost three years to finish out high school and the IB program. I loved living abroad, but am now back in Portland again.
I've never been a particularly healthy kid, but going on two years ago — at the start of my senior year of high school — I started to become really ill and doctors diagnosed me with a severe neurological-autoimmune condition. All the details still aren't known. I managed to graduate from high school with the work I had done before things became particularly bad, but have had to defer my acceptance to university until a time that I may be able to function as a college student. I'm essentially home and wheelchair bound — I rely on my mom for just about everything. My symptoms include extreme fatigue and cognitive dysfunction. I'm not exactly eloquent as of late, and am prone to word vomit. My command of words is galaxies worse in person though, without the time to work out the sentences from the mess.
I collect children's books. People say I should have been born British. I have a penchant for bright colors, poppies, Harry Potter, naming everything, and the poetry of Emily Dickinson. My cognitive issues have been especially difficult for me, as I've always been known as the most academic and perfectionistic of my sisters, as well as being a biology geek (I love the intricate puzzle of it all) and book worm (my favorites include A Tree Grows in Brooklyn, The Complete Winnie the Pooh Collection, and Frankenstein). I do listen to audio books now that I can't physically read novels, but with my issues, I've also been embracing some of my more artsy interests. I'm passionate about music — for instance, I have a private collaborative playlist on Spotify with each of my sisters and my best friend Jess in London (who will be visiting this summer). I also do puzzles, knit, and am hoping to be able to start oil painting soon.
Your #fashiontruth — "You are the only reason you need to get dressed up" — is especially poignant given your struggles with your health. How do those things intersect?
I'm still trying to learn this one — sometimes it feels so futile. I have about no external justification to get dressed at all, as someone mostly homebound who rarely sees a soul other than my parents and nurses. But I love and find comfort in clothes. They make me feel more confident and more like myself. I think a lot of people who are seriously ill have a hard time holding onto that sense of self, and if getting into a skirt makes me feel the tiniest bit more like maybe I am still Abby… well, it's worth it.
My style has always been a big deal for me. When I was younger I had a growth disorder, I was deficient of a particular hormone and had to do twice-daily injections of the stuff. Which basically mean that when I was 14/15 my bones said I was 11. I definitely didn't look like the rest of my peers, which was an utter disaster to an extremely socially anxious introvert in a foreign country who already felt isolated. The last thing I wanted was to stand out. In exposure therapy, you repeatedly do things that you fear, until you reach the point at which they cause less anxiety. My clothes became a kind of exposure for me. I remember wearing these cropped pinstripe pants and patterned knee-highs. It was incredibly stressful, but liberating choosing not to fit in for once. And so I learned to not let fear trap me in a style comfort zone. I learned that taking risks, whether they failed miserably or succeeded fabulously, ultimately helped me feel better in my clothes and in my own skin. My clothes became a part of my identity, they expressed a little of who I was without talking.
Describe your style now! What's your ideal outfit, and do you have any style icons that inspire you?
My style is bright and quirkily feminine. I love the contrast of taking a more girly, formal outfit and adding a sporty element, like Converse, a sweatshirt, or a baseball/graphic tee. The more colors the better. And I love myself some texture/pattern mixing and 40s/50s influences. For my ideal outfit, I think a brightly colored, delightfully swishy, pleated midi skirt, a slightly off-beat graphic tee, pointed shoes, and the necklace I made from a button from a British WWI soldier's uniform that I got in Ypres, Belgium.
My fashion icon is probably Petra Flannery. She's the styling goddess behind Emma Stone and Zoe Saldana, and she collaborates with Gwen Stefani on her look as well. I especially adore her work with Emma Stone. But I also love Anna, Roberta K, Marlen, and Jesi from the Style Gallery. I feel like the street style of ordinary women is where it's at.
You mentioned you collect children's books. What about them appeals to you? If you could live in any children's book, which would you choose?
There's this gorgeous spirit and inexplicable clarity in children's books. They can be unabashedly tender and whimsical, free from the filters that often plague us as adults. So much of what happens when we get older is we become burdened by pragmatism — we set limits on our belief. Children's books are an expansive world of possibility — you can be carried off on a kite to strange planets and swallow constellations. And you have a singular relationship with books you read as a child. Revisiting them, you feel something extraordinary — bewilderingly fresh yet familiar.
If there was a world from children's literature I would like to live in, it would probably be that of the A Wrinkle in Time series. In it, there is a terrible evil, yes, but also ecstatic beauty and transcendent, intrinsic goodness. It's an inextricably interconnected universe that believes in the power of the little things and of the individual. It is endlessly gigantic, and yet every human is a galaxy you can never fully comprehend. It's all about sacrifice, loving imperfect people, overcoming the fear of others' otherness, and fighting against the temptations of nothingness. It's just so ridiculously creative and poetically powerful.
Ridiculously creative? Poetically powerful? That sounds just like Abby to us.
+Tell the world your #fashiontruth on Instagram, Twitter, or Tumblr for a chance to win $100 GC and much more!

subset: commoncrawl


text:
Freezing Rain…
Tags : www.nestuccariverfishing.com
Comments : Off
With all of the crazy weather, we are making the best of it. Big rain, wind, snow, and now several rounds of freezing rain. This is what we have been seeing for a while now. Sagging trees, slick streets, and various skating options here and there.


text:
Our site offers a list of Farmhouses in rapolano terme and rapolano terme Farms.
The farmhouses are divided by commons and location so you can easily find the Farmhouse in rapolano terme that suit your needs.
Monday 13 July 2020
Sorry, there aren't any Farmhouse in rapolano terme.
Back to the list Farmhouse in provice of Siena


text:
- Original Articles
- Open Access
- Published:
Correlation of laparoscopic and hysteroscopic 30° scope camera navigation skills on box trainers
Gynecological Surgery volume 11, pages75–81(2014)
852 Accesses
3 Citations
This study investigated a possible correlation between training of camera navigation skills with a 30° optic in hysteroscopy and laparoscopy by exploring whether 30° camera navigation training in hysteroscopy provides a certain level of expertise in laparoscopic camera navigation. If a correlation exists, training models and programs in gynecology could be simplified. In this prospective, randomized, nonblinded study 34 medical students were divided into two groups. Group A (n = 17) performed five exercises on a box trainer for hysteroscopy (HYSTT) and five exercises on a box trainer for laparoscopy (LASTT). Group B (n = 17) performed 2×5 exercises on the LASTT model. Both groups performed a LASTT post-test directly afterwards. The outcome parameter recorded was time to correctly perform the exercise. Comparing the results of the LASTT post-test between group A and B, a similar performance of both groups was shown (p = .131). A slightly faster performance in group A is displayed, when comparing the first LASTT exercise between group A (with previous HYSTT training) and group B (without previous HYSTT training); however, this was a nonsignificant finding (p = .114). Both groups display quite similar learning curves, and after five LASTT repetitions, both groups have reached comparable levels for procedure time, despite the earlier HYSTT training of group A. Previous training on the HYSTT model offers some advantage for training on the LASTT model. However, training of 30° camera navigation skills in a hysteroscopic environment does not seem supportive for obtaining the same level of camera expertise in laparoscopy. Therefore, 30° camera navigation in hysteroscopy and laparoscopy should be trained separately to reach adequate levels of expertise for each procedure.
Laparoscopy and hysteroscopy have become standard procedures in gynecology. During endoscopic procedures, good visualization of the surgical field is essential and this is achieved by adequate camera navigation [1–3]. Camera navigation is often perceived to be an easy task, but it is far from an innate ability. Psychomotor skills need to be learned to overcome the barriers that are known for endoscopic skills in general, namely the fulcrum effect, loss of binocular vision, a fixed access point, and decreased range of motion [3, 4]. In addition, skills unique to camera navigation include maintaining a correct horizontal axis while centering the operative field, focusing and sizing, maintaining a steady image, and tracking instruments in motion [2, 3]. Especially, angled scopes, by the addition of off-axis viewing, require complex visuospatial skills [5].
In laparoscopy, handling of the camera is often performed by the least experienced person present. Incorrect camera handling results in poor visualization and may cause frustration of the operator, increased operating time and errors [1, 3, 5]. In hysteroscopy, camera navigation is essential due to the decreased range of motion when navigating through the narrow cervical canal and uterine cavity. A 30° angled scope affords an increased view with fewer movements and is increasingly used for vaginoscopic hysteroscopy in the office setting. But when knowledge and skills are lacking, the 30° angled scope can lead to unnecessary damage of the cervical canal and endometrium. In a national UK survey among gynecologists, a disappointing percentage of 25.8 of all responders who perform 30º hysteroscopy showed understanding of the principles of 30º angled view [6].
Despite the importance of camera navigation skills, they are not often explicitly addressed in training programs [7, 8]. However, camera navigation skills can be trained easily and effectively outside the operating room [5, 9–11]. During the past years, several models have been developed and validated for camera navigation training in laparoscopy [3, 12, 13] and to a lesser extent in hysteroscopy [14]. The same principles can be observed in urology as well, for laparoscopy and cystoscopy [15]. Even though endoscopy comprises different types of procedures (e.g., laparoscopy and hysteroscopy), they all require mastering of adequate camera navigation skills with a 30° optic. One could question whether a possible correlation exists between the training of camera navigation skills with a 30° optic in hysteroscopy and laparoscopy even though the environments of the abdominal and uterine cavity are fairly different. If this correlation exists, it implies that obtaining 30° camera navigation skills in hysteroscopy also indicates the built up of a certain level of expertise in laparoscopy camera handling. This would mean that training models and programs in gynecology could be simplified. Furthermore, it might also apply for other specialties, for example cystoscopy and laparoscopy in urology. That could lead to a situation in which several endoscopic specialties could train 30° camera navigation on a uniform training model, without a direct relation between the model, a specific organ, cavity or specialty, and the type of endoscopy.
The aim of the present study is to investigate whether 30° camera navigation practice in hysteroscopy also creates a built up of expertise in laparoscopic 30° camera navigation.
Two box trainers have been used in this study: the laparoscopic skills testing and training (LASTT) model and the hysteroscopic skills testing and training (HYSTT) model. Both were designed under auspices of the European Academy for Gynaecological Surgery (Leuven, Belgium). These models train various psychomotor skills including specific exercises for 30° camera navigation training [12, 14].
Participants and setting
From April to June 2013, 34 novices voluntarily participated in this study. Medical students served as novices and they were invited during or after their gynecology internship via oral and written means, and all agreed to participate. The study was carried out at the University Medical Center Utrecht and at the teaching hospital St. Antonius Ziekenhuis, Nieuwegein, the Netherlands. All participating students filled out a questionnaire which recorded their baseline characteristics. The study was exempt from the institutional review board approval, since no potential harm could be done to humans or nonhumans. All participants gave written consent prior to the start of the study.
This study is a prospective, randomized, nonblinded trial. The participants were divided into two groups by randomization by sealed envelopes. Short series of exercises were designed for the present study, because Molinas et al. observed a plateau phase for the LASTT 30° camera navigation exercise after 5–15 repetitions [12]. Figure 1 displays the scheme of exercises per group. In addition, the scheme shows the two comparative analyses. Analysis 1 addresses the question whether mixed training will lead to the same laparoscopy level as only-laparoscopy training, by comparing the LASTT post-test between both groups. Analysis 2 addresses the question whether prior hysteroscopy training will lead to a higher achievement in laparoscopy in comparison to a short laparoscopy training only. This analysis will compare the first LASTT exercise of group A (with previous HYSTT training) with the first LASTT exercise of group B (without previous HYSTT training).
Both groups received a short standardized introduction on 30° optics and the study protocol. Group A (n = 17) was given a specific introduction on hysteroscopy and the HYSTT model, while group B (n = 17) received a similar standardized introduction on laparoscopy and the LASTT model. One-minute practice time was given to each participant to obtain familiarization with the model; during this practice time, feedback and instructions were provided. Then, group A performed the HYSTT exercise five times, followed by a 5-min break. During the break, group A received the standardized introduction on laparoscopy and the LASTT model, and 1-minute practice time was provided. After the break, group A performed the LASTT exercise five times, followed by a final LASTT repetition which was recorded as a post-test. Group B performed the LASTT exercise five times, also followed by a 5-min break. After the break, this group repeated the LASTT exercise another five times and performed the post-test on the LASTT model. The post-test, as performed by both groups, consists of a single repetition of the camera navigation exercise on the LASTT model and is performed directly after the training sessions in the same environment. One investigator (E.H.) supervised all exercises and tests to limit intersupervisor bias. During all exercises and tests, no feedback or instructions were provided nor could any questions be asked. After each repetition, the participant could ask questions and feedback was offered.
The LASTT model consists of a wooden platform (16.5×30 cm) with two modules in the back, two modules in the middle, and two modules in the front. These modules contain in total of 14 targets. Each target consists of a large symbol, only identifiable from a panoramic view, and a small symbol, only identifiable from a close-up view [12]. The LASTT model was inserted into a Szabo trainer box (Karl Storz, Tutlingen, Germany) (Fig. 2a).
The HYSTT model consists of a white plastic uterus model in which twelve symbols are placed at twelve locations, known as front/mid/back (referring to the depth of the space) combined with anterior/posterior/left/right (referring to the walls of the space). Six models are available in which each location contains a different symbol (models A–F). This plastic uterus is placed in a silicone model of a vulva, which in turn is situated in a plastic pelvis model (Fig. 2b). Originally, the HYSTT model contained 14 target locations with anatomical names as "fundal anterior", "cornual left", "tubal ostium right", and "isthmic posterior". Due to the observation in a pilot study that these anatomical names seem confusing when applied in this simple uterus, the model was adjusted by covering the "cornual" symbols and by renaming the other twelve locations by general terms as front/mid/back.
Both models were designed under auspices of the European Academy for Gynaecological Surgery (Leuven, Belgium). The exercises on the LASTT model were performed with a 10 mm 30° scope and the exercises on the HYSTT model with a 5 mm 30° scope (Karl Storz), both connected to the same straight video camera, light source, and monitor (Telepack, Karl Storz). With regards to the exercises, a black circle (2.5 cm in diameter) was applied in the center of the monitor. The box trainers and the monitor were set up on a large table in line with each other.
The participants stood behind the box trainer in the midline, holding the camera with their dominant hand and the fiber optic cable with their nondominant hand for lateral, rotatory, and zoom-in/out navigation. For the LASTT exercise, the scope was inserted through the middle port of the trainer box. At the start of the exercise, the participant had to visualize the first large symbol (i.e., 1) and then identify the small one situated next to it. The small symbol had to be sharply visualized inside the black circle on the screen. This small symbol indicated the next large symbol that had to be visualized. The exercise was finished when the small symbol on the last target (end) was identified correctly. After every run, the targets were ordered differently according to a standardized schedule to prevent memorization.
For the HYSTT exercise, the scope was inserted into the uterus model (model B) through the silicone vulva. The participant had to navigate to a specific location (e.g., mid posterior) as commanded by the investigator and visualize the corresponding symbol inside the black circle on the monitor, after which a new command was given until all 12 symbols were correctly visualized. After every completed session, the sequence of the commands was changed according to a standardized schedule, and after three sessions, another uterus model (model C) was inserted for the last two sessions to prevent memorization.
Outcome measure
The outcome measure for both the HYSTT and LASTT exercises was the total time (recorded in seconds) needed to correctly visualize all the signs.
Statistical analysis
The statistical analysis was performed with SPSS 20.0 for Windows. A power analysis was performed prior to the study to determine the minimal sample size. It showed that a power level of 0.8 with a desired significance level of 0.05 and a difference of 1 SD between groups should be reached at a minimal total sample size of 34 participants. To compare the participants' characteristics, the chi-square test was used. Differences in the time measurements between the two groups were analyzed using the nonparametrical Mann–Whitney U test for independent samples. The results are presented as medians with interquartile ranges (IQR) and were considered significant in case of a p value < .05.
The baseline characteristics of the participants are reported in Table 1. The participants were randomized into two groups (n = 17 per group), and there were no significant differences regarding personal characteristics between these groups. Both groups existed of five men (29.4 %) and 12 women (70.6 %). The median age in group A was 23 years (IQR 22–23) and in group B, 23 years (IQR 23–24). All participants had attended at least one hysteroscopy and/or laparoscopy.
When comparing the results of the LASTT post-test between groups A and B (analysis 1), a similar performance of both groups is shown. The median time needed to complete the post-test was 100.3 (IQR 88.1–121.8) s for group A and 91.1 (IQR 77.2–104.4) s for group B (p = .131) (Fig. 3).
Figure 4 displays the median time of both groups per LASTT exercise graphically. It shows that both groups have reached approximately the same level of procedure time during their post-test, and this endorses the results of a similar performance described above. However, despite of their earlier training on the HYSTT model, group A follows more or less the same (steep) learning curve as group B in the first LASTT series instead of following the (flatter) curve in the second LASTT series of group B.
Analysis 2 compares the first LASTT exercise between group A (with previous HYSTT training) and group B (without previous HYSTT training). Group A performed the exercise slightly faster than group B, but this was a nonsignificant finding (p = .114). The median performance time of group A was 214.3 (IQR 152.2–261.6) s, while group B recorded a median time of 249.6 (IQR 178.9–307.0) s (Fig. 3).
Both groups display quite similar learning curves, and after five LASTT repetitions, both groups have reached comparable levels for procedure time, despite the earlier HYSTT training of group A.
Training programs for endoscopic skills vary throughout institutions worldwide. Furthermore, every specialty has its own training models for specific procedures. As described in the introduction, the basic skills required for different endoscopic procedures are fairly similar and endoscopy training outside the operating room could be standardized [7, 12]. This led to the idea that certain general endoscopic skills, such as 30° camera navigation, might be trained on a uniform training model. This study investigated whether a correlation exists between training of camera navigation skills with a 30° optic in hysteroscopy and laparoscopy by exploring whether 30° camera navigation training in hysteroscopy provides a certain expertise in laparoscopic camera navigation.
Firstly, the results show that regardless of training on the HYSTT or the LASTT model, 30° optic skills are easily learned when a standardized explanation and specific exercises for camera navigation are provided. Medical students were able to strongly improve their performance within five repetitions on the LASTT model, reaching a time score of 110 s. This was faster than expected by the results of Molinas et al., where novices (students and inexperienced gynecologists) needed approximately 10 repetitions to reach a procedure time of 110 s [12]. However, in both studies, certain variability between subjects is observed. In the current study, it is not investigated whether this fast performance is lasting.
Secondly, concerning a possible correlation for camera navigation, a similar performance of both groups during the LASTT post-test was found (analysis 1). This might indicate that previous hysteroscopy training does provide built up of expertise in laparoscopic camera navigation. However, after apprehending the fast learning curve in this study, a similar performance after five repetitions can be expected regardless of previous training. And even though group A (with previous HYSTT training) did perform slightly better than group B (without previous HYSTT training) during their first LASTT exercise, this finding was not significant (analysis 2). In addition, the learning curves of both groups were fairly similar when they started performing exercises on the LASTT. Therefore, according to these results, the existence of a pronounced correlation between training of 30° camera navigation skills in hysteroscopy and laparoscopy seems implausible.
A possible explanation for not finding a correlation could be that even though the principles of angled optics are easy to learn when time, attention, and exercises are provided, the abdominal and uterine cavity are too different regarding space and shape. In the uterus and in the corresponding HYSTT model, camera navigation takes place within a small and narrow cavity (a specific organ), which requires subtle movements of the scope combined with extensive angled optic use. In the abdomen and in the corresponding LASTT model, a distinctly higher degree of freedom of scope movement is observed. This is due to the wide space after CO2 inflation during laparoscopy and the environment within the spacious box trainer, respectively. One has to train how to navigate and to apply the principles of angled optics in each different cavity. Camera navigation in hysteroscopy and laparoscopy should be trained separately to reach adequate levels of expertise for each procedure.
Strong points of the present study are the power analysis performed prior to the study and the randomization process, which was executed effectively. The study was nonblinded, because blinding was not possible due to the distinctly different appearances of the two box trainers. Medical students were included in this study as novices, because of their blank training background which gave all participants the same starting point.
The current study design was not established as a proficiency-based training curriculum, since the aim was to investigate a correlation between skills acquisition in two training environments and not to evaluate the efficacy of a curriculum. The number of repetitions was kept small to ensure that participants were not yet fully proficient at the HYSTT model before training at the LASTT box. We wanted to see if the change of environment would alter the ongoing learning curve in comparison to the group that continuously trained at the LASTT model. One could argue that a proficiency-based study design with a 'retention test' performed several weeks to months after the training might provide a better way to investigate our hypothesis, and this presents an area for future research. For clinical use, it should be emphasized that the design of an efficient training curriculum needs to be proficiency-focused to accommodate the ability and development of each individual [16].
One of the factors that might have influenced the current results is the fact that the exercises per model differ in the way they have to be executed. During the HYSTT exercise, the participants had to follow the investigator's commands, whereas in the LASTT exercise, the visualized sign itself included the next command. Furthermore, time to correctly perform the exercise is the only outcome parameter recorded, and it is recorded by a person. One can imagine that a computerized system as in a virtual reality simulator can offer a more objective scoring and that other factors might affect performance; after all, a faster performance does not automatically mean a better performance. Outcome parameters as the number of errors, path length, camera stability, and number of collisions were not recorded, which is inherent to the design of box trainers. In addition, box trainers in general often lack a realistic display of human anatomy. Even though, box trainers have proven to be simple and relatively cheap models that can effectively train specific psychomotor skills needed for endoscopy [4, 12, 17]. On the other hand, the possibly influencing factors of a box trainer might be overcome by using virtual reality simulators, which objectively record various parameters. The software could provide similar commands for both exercises and record parameters that could display the varying nuances in camera navigation that one has to train when performing both hysteroscopy and laparoscopy. This might provide an area for future research. In addition, it could be an interesting idea for future research to include a test on visuospatial abilities for all participants, in order to retrieve extra information on the training capacity for endoscopic skills.
Correct camera navigation skills with a 30° optic are essential in endoscopy and need to be trained outside of the operating room. This study shows that, regardless of training on the HYSTT or the LASTT model, 30° optic skills are easily learned when specific exercises for camera navigation are provided. Previous training on the HYSTT model offers some advantage for training on the LASTT model, compared to no previous training. However, training of camera navigation skills in a hysteroscopic environment does not seem supportive for obtaining the same level of camera expertise in laparoscopy. The two environments appear too distinct to train both procedures on one unified model. Therefore, 30° camera navigation in hysteroscopy and laparoscopy should be trained separately to reach adequate levels of expertise for each procedure.
- 1.
Conrad J, Shah AH, Divino CM, Schluender S, Gurland B, Shlasko E, Szold A (2006) The role of mental rotation and memory scanning on the performance of laparoscopic skills. Surg Endosc 20:504–510
- 2.
Shetty S, Panait L, Baranoski J, Dudrick SJ, Bell RL, Roberts KE, Duffy AJ (2012) Construct and face validity of a virtual reality-based camera navigation curriculum. J Surg Res 177:191–195
- 3.
Korndorffer JR, Hayes DJ, Dunne JB, Sierra R, Touchard CL, Markert RJ, Scott DJ (2005) Development and transferability of a cost-effective laparoscopic camera navigation simulator. Surg Endosc 19:161–167
- 4.
Schreuder HWR, van den Berg CB, Hazebroek EJ, Verheijen RHM, Schijven MP (2011) Laparoscopic skills training using inexpensive box trainers: which exercises to choose when constructing a validated training course. BJOG 118(13):1576–1584
- 5.
Ganai S, Donroe JA, St. Louis MR, Lewis GM, Seymour NE (2007) Virtual-reality training improves angled telescope skills in novice laparoscopists. Am J Surg 193:260–265
- 6.
Tawfeek S, Scott P (2010) National inpatient diagnostic hysteroscopy survey. Gynecol Surg 7:53–59
- 7.
VanBlaricom AL, Goff BA, Chinn M, Icasiano MM, Nielsen P, Mandel L (2005) A new curriculum for hysteroscopy training as demonstrated by an objective structured assessment of technical skills (OSATS). AJOG 193:1856–1865
- 8.
Kingston A, Abbott J, Lenart M, Vancaillie T (2004) Hysteroscopic training: the butternut pumpkin model. J Am Assoc Gynecol Laparosc 11(2):256–261
- 9.
Paschold M, Niebisch S, Kronfeld K, Herzer M, Lang H, Kneist W (2013) Cold-start capability in virtual-reality laparoscopic camera navigation: a base for tailored training in undergraduates. Surg Endosc 27:2169–2177
- 10.
Franzeck FM, Rosenthal R, Muller MK, Nocito A, Wittich F, Maurus C, Dindo D, Clavien PA, Hahnloser D (2012) Prospective randomized controlled trial of simulator-based versus traditional in-surgery laparoscopic camera navigation training. Surg Endosc 26:235–241
- 11.
Andreatta PB, Woodrum DT, Birkmeyer JD, Yellamanchilli RK, Doherty GM, Gauger PG, Minter RM (2006) Laparoscopic skills are improved with LapMentorTM training. Results of a randomized double-blinded study. Ann Surg 243:854–863
- 12.
Molinas CR, De Win G, Ritter O, Keckstein J, Miserez M, Campo R (2008) Feasibility and construct validity of a novel laparoscopic skills testing and training model. Gynecol Surg 4(5):281–290
- 13.
Yee KA, Karmali S, Sherman V (2009) Validation of a simple camera navigation trainer. J Am Coll Surg 209:753–757
- 14.
Janse JA, Tolman CJ, Veersema S, Broekmans FJM, Schreuder HWR (2013) Hysteroscopy training and learning curve of 30º camera navigation on a new box trainer: the HYSTT. Gynecol Surg. doi:10.1007/s10397-014-0833-9
- 15.
Schout BMA, Ananias HJK, Bemelmans BLH, d'Ancona FCH, Muijtjens AMM, Dolmans VEMG, Scherpbier AJJA, Hendrikx AJM (2009) Transfer of cysto-urethroscopy skills from a virtual-reality simulator to the operating room: a randomized controlled trial. BJUI 106:226–231
- 16.
De Win G, Van Bruwaene S, Allen C, De Ridder D (2013) Design and implementation of a proficiency-based, structured endoscopy course for medical students applying for a surgical specialty. Adv Med Educ Pract 4:103–115
- 17.
Chou B, Handa VL (2006) Simulators and virtual reality in surgical education. Obstet Gynecol Clin N Am 33:283–296
We would like to thank all the participants who voluntarily participated in this study. We would like to thank M.J.C. Eijkemans, Associate Professor in BioStatistics from the Julius Center for Health Sciences and Primary care, University of Utrecht, the Netherlands, for his help with the statistical analysis.
Conflict of interest
For all authors, there is no financial interest. All the authors have nothing to disclose, and no funding was received for this study.
Ethics approval
The study was exempt from the institutional review board approval, since no potential harm could be done to humans or nonhumans. All participants gave written consent prior to the start of the study.
Rights and permissions
About this article
Cite this article
Janse, J.A., Hitzerd, E., Veersema, S. et al. Correlation of laparoscopic and hysteroscopic 30° scope camera navigation skills on box trainers. Gynecol Surg 11, 75–81 (2014). https://doi.org/10.1007/s10397-014-0835-7
Issue Date:
- Box trainer
- Hysteroscopy
- Laparoscopy
- Training
- Camera navigation
- Angled optic


text:
The Rt Hon Penny Mordaunt MP and Stuart Rivers, Sailors' Society CEO, at Sailors' Society's 200th anniversary reception at Westminster
A host of industry representatives, MPs and members of the House of Lords joined international maritime charity Sailors' Society to mark its 200 years of supporting seafarers and their families around the world, at a reception held in Parliament last week (6 June).
Event host and MP for Portsmouth South Stephen Morgan gave a warm welcome to guests, including Secretary of State for International Development and Minister for Women and Equalities Penny Mordaunt MP, Minister of State for Care Caroline Dinenage MP, and the Shadow Shipping Minister Karl Turner MP.
Penny Mordaunt MP said, "It was great to hear about the care and support Sailors' Society has provided to seafarers in need over the past 200 years, such as working to help seafarers look after their mental health during the long contracts at sea and supporting their families back at home in times of crisis."
Representatives from many of the charity's partners joined the event, including from Britannia P&I, Coltraco Ultrasonics Ltd, Inmarsat, UK P&I, Waves Group, Queen Victoria Seamen's Rest and Seafarers' International Research Centre. The event was also attended by Jackie Doyle-Price, Minister for Mental Health, who recently went ship visiting with the charity to hear about its Wellness at Sea programme and talk first hand with seafarers about conditions on board.
Kim Spooner, whose aunt and uncle lost their lives in the Herald of Free Enterprise disaster, spoke movingly about her family's experience and the support they have received from Sailors' Society over the years. A video case study from Sailors' Society's Albanian port chaplain, Ilir Cami, highlighted why seafarers are often reluctant to be open about health problems for fear of losing their job, and the sometimes tragic consequences of this.
Sailors' Society's CEO Stuart Rivers said, "We're so grateful for the support we receive from our corporate partners, which makes so much of what we do possible. MPs also have a long history of supporting the charity's work – very appropriately, our first Chairman was Bernard Shaw MP.
"However, being 200 years old doesn't mean we can sit back on our laurels, and we continue to change and adapt in order to better support the men and women who play such an important role in transporting our goods at sea."
Sailors' Society was founded on 18 March 1818 to minister to the needs of destitute seafarers returning home from the Napoleonic Wars.
The charity now works in 30 countries around the world, supporting seafarers and their families at home, in port and at sea, through the delivery of chaplaincy, education and the relief of poverty and distress.
Notes to Editors:
For more information, please contact James Leslie on 023 8051 5950 or via firstname.lastname@example.com.
About Sailors' Society
Sailors' Society has been bringing people together for 200 years, transforming the lives of seafarers and their families at home, in port and at sea through the delivery of chaplaincy, education and the relief of poverty and distress.
The charity works internationally to provide practical, emotional and spiritual welfare support to the world's 1.6m seafarers, regardless of background or faith. Sailors' Society chaplains and ship visitors have a presence in 91 global ports, with wider projects and services covering 30 countries.
You can explore the charity's 200 year journey at https://www.sailors-society.org/200-years/
For more information on the charity's work and the 200th anniversary celebrations, please visit www.sailors-society.org or contact Charis Gibson or James Leslie on 023 8051 5950 or firstname.lastname@example.com.


text:
Lenii andd Benta just linked up for a beautiful collab that will be one of the best songs you'll hear all week. Lenii's gorgeous voice shines over top of the emotional beat that Benta lays down. This track comes from the heart and is sure to hit you right in the feels while listening. Here's what Lenii had to say about Bones: Proud to be releasing this meaningful song. It's … [Read more...]
Home » Benta


text:
Create Your Responsive Grid System with Gridpak
Posted · Category: License Free, Tools
Gridpak is the starting point for your responsive projects, improving your workflow and saving time. Create your responsive grid system once using the simple interface and let Gridpak do the heavy lifting by generating PNGs, CSS and JavaScript.
The CSS that Gridpak generates is compatible with IE 8+, however it makes use of some more experimental CSS properties such as the media query, box-sizing and background-clip properties so we suggest using it in conjunction with a library such as Modernizr to ensure backwards compatibility.
Requirements: –
Demo: http://gridpak.com/
License: License Free
0 Comments


text:
Looking Back At The Gulf Of Mexico Oil Spill In Retrospect
What happened?
Let us take a quick look at what had exactly happened. On April 20th, 2010, a geyser of seawater erupted from the marine riser onto the Deepwater Horizon rig, owned and operated by offshore-oil-drilling company Transocean and leased by oil company British Petroleum (BP), situated in the Macondo oil prospect in the Mississippi Canyon. This was soon followed by the eruption of drilling mud, methane gas and water, leading to the worst known oil spill to have ever occurred in the history. The well from which this rig was extracting oil was situated on the seabed 4,993 feet below the surface and extended approximately 18,000 feet into the rock. The blast was caused by natural gas which rose up the drill riser reaching the rig where it ignited and caused an explosion, resulting in deaths of 11 workers, injuring 17 others. The rig later capsized on 22nd April 36 hours after the initial explosion, causing the oil to flow freely upwards as the rig no longer existed.
BP tried shutting down the channel through which oil was extracted using Blowout Preventers (BOP) but the device malfunctioned. This throws some light on the kind security and quality measures and standards this company had been maintaining. After the initial explosion, the damaged Macondo wellhead leaked an estimated 3.19 million barrels (over 130 million gallons) of oil into the Gulf of Mexico over the course of 87 days, making the spill the largest accidental ocean spill in history. The oil spill contaminated more than 1,100 miles of coastline, at least 1,200 square miles of the deep ocean floor, and 68,000 square miles of surface water.
Impact on Marine Lives
The leaked oil spread abominably. Some floated to the ocean's surface to form oil slicks, which can spread more quickly by being pushed by winds. Some hovered suspended in the midwater after rising from the wellhead like a chimney and forming several layers of oil. What ensued were the widespread destruction of aquatic flora and fauna and poisoning of the sea water. According to researchers from the Oregon State University (OSU), the affected water contained 40 times more polycyclic aromatic hydrocarbons (PAHs) than the pre-spill period. PAHs are often linked to oil spills and include carcinogens and chemicals that pose various health risks to humans and marine life. From an average death rate of 63 dolphins a year, the number shot up to 311 dolphins a year for the year 2011. Seabirds were initially harmed by crude surface oil as even a small bit of oil on their feathers impeded their ability to fly, swim and find food by diving. Subsequently, they were dying in hoards due to oil ingestion as they tried to clean themselves or because the substance interfered with their ability to regulate their body temperatures. The brown pelican, recently delisted as an endangered species, was among the species most affected. Researchers are currently studying how oil may have affected land birds that live in the marshes along the Gulf coast. Almost 320,000 turtles got affected due to the oil spill, a number that is much higher than the earlier predicted one. Coral reefs got turned into graveyards as oil completely engulfed them.
Economic impact
Economic prospects in the Gulf Coast states became dire as the spill affected many of the industries upon which residents depended. More than a third of federal waters in the gulf were closed to fishing at the peak of the spill, due to fears of contamination. The Gulf of Mexico commercial fishing industry was estimated to have lost $247 million as a result of postspill fisheries closures. One study projects that the overall impact of lost or degraded commercial, recreational, and mariculture fisheries in the Gulf could be $8.7 billion by 2020, with a potential loss of 22,000 jobs over the same time frame. The tourism industry in the Gulf coastal economy reportedly lost up to $22.7 billion through 2013. It In July, last year, BP went on record to say that it expects its Deepwater Horizon explosion and oil spill cost exceeded $60 billion to cover multiple comprehensive settlements. In just about 50 days, its stock price fell by 52% in 50 days, its lowest level since August 1996. By the end of July, 2010, the company's loss in market value totalled $60 billion, a 35% decline since the explosion. In the second quarter of 2010, BP reported a loss of $17 billion, its first loss in 18 years. The hydrocarbon giant also lost its position as the second largest oil company to become the fourth largest oil company by 2013.
HSE Negligence Can Make or Break Fortunes
BP's reputation, assets and legacy built over a century were shaken due negligence towards HSE practices on a single rig. The purpose of going through the environmental and economic impact, even after 7 years of the incident, was to establish that the HSE risks cannot be ignored at any cost. After the spill there has been an emergence of new regulations, working methodology, safety measures and development of new industry wide practices along with new government imposed safety norms and checks.
To begin with, BP's new CEO Bob Dudley completely revamped the company's approach to safety, setting up a new safety and risk division with sweeping powers to oversee and audit its operations.
Interestingly, even before the Macondo well was finally sealed, four of the world's biggest oil companies, ExxonMobil, Royal Dutch Shell, Chevron and ConocoPhillips agreed to pool $1 billion to form a joint venture to develop a Gulf of Mexico oil spill response and containment system. Under the plans, the venture committed to developing equipment to prevent another spill on the scale suffered by BP's Macondo well.
Note that even after the Gulf of Mexico mega oil spill, 32 major oil spills took place between 2011 and 2017, resulting in the direct loss of 28,349 tonnes crude oil in terms of spillage. Let us not even get into the economic loss of cleaning up, other industries and environmental cost, which would run into unimaginable losses. Oil spill prevention and response has still not received the kind of urgent attention it needs. As I mentioned in one of my previous articles, investment in health, safety and environment is like paying premium for risk coverage. One may not see annual returns but if ever misfortune strikes, a robust HSE safety net mitigates the damage significantly.


text:
Places to visit in Cape Town are awe-inspiring and some of the celebrated tourist attractions of the world. To travel and explore the surreal setting of this multifaceted city is a once in a lifetime experience. Cape Town is a historical city with contemporary attractions as well as stunning natural marvels that attract people from far and wide. From the magnificent Table Mountain that guards the city to the urban setting variegated with wildlife and nature reserves; the city can be called a cosmopolitan hub.
Although there are plenty of places to visit in Cape Town, the befitting itinerary isn't one in which everything can be covered in a short vacation. To add value to your trip and make sure the top tourist attractions of Cape Town are not missed by you, below is the list of best places to visit and things to do in Cape Town.
Best time to visit in Cape Town
Cape Town is listed among the top 10 best cities in the world, because of variegated culture and historical importance and pleasant climatic conditions for touristy. Although the climate and weather conditions are favourable throughout the year for tourists; be it summer or winter, yet the best time to visit Cape Town is January to April for beach vacations. Whereas, for whale watching and wildlife tours, July to November are ideal months.
Best places to visit in Cape Town
1. Table Mountain
Nestled in the Table Mountain National Park, the splendid beauty of flat-topped Table Mountain crowns the city of Cape Town. It completes the extravagant tapestry of South Africa's natural beauty and is among the top tourist attractions of Cape Town. Flanked by Lion's head and Devil's peak from west and east, it offers plenty of mountain sports, of which trekking, cableway and
hiking to the summit are common.
Adorned by indigenous trees, fynbos, blossoming 1470 flowering plant species, verdant slopes; the National Park is home to varied animal species like baboons and caracals to name a few. The spectacular trails, azure beaches and surreal landscapes, cafes and restaurants with a terrace as viewpoints and 350 different routes to reach the summit makes your visit worthwhile.
2. Cape Point Nature Reserve
Located 65 km from Cape Town, Cape Point is a stunning viewpoint and forms a part of Table Mountain National Park. The photogenic esplanade of this place is undoubtedly meant to make you visit the place over and over. Around 250 species of birds, baboons and ostriches hitching the coastline, antelopes and elands at the grassy pastures, rodents, mongoose, zebras and other reptiles make this nature reserve one of the best places to visit in Cape Town. Shipwrecks are also a common sight to indulge the visitors into a fantasy setting while at the Cape Point.
3. Bo Kaap
Polychromatic neighbourhood situated at the foothills of Signal Hill, Bo Kaap is a former township known as Malay Quarter. Its multicoloured houses and Bo Kaap Museum make it one of the best places to visit in Cape Town. It is located away from the bustling neighbourhoods and areas of the city.
The few interesting things to do here visit the museums, enjoy the local cuisine at restaurants, swim and walk at the beachside. Walk through the cobblestoned Wale Street to the Bo Kaap Museum to experience the routine life of indigenous people. The houses are coloured in different shades to signify the independence of culture and celebrate it alike.
3. Victoria and Alfred Waterfront
Commonly known as the entertainment hub of the city, Victoria and Alfred Waterfront is an ancient harbour. Many buildings and sites from the earlier times have been preserved. The area is surrounded by some of the best tourist attractions in South Africa like Green Point to the west, Nelson Mandela Gateway, Springbok Experience Rugby Museum.
Two Oceans Aquarium is a significant visiting place to mark on the itinerary for the top tourist attractions in Cape Town. As the name suggests, it houses 300 fish species from the Atlantic and the Indian Ocean and penguin encounter, diving, marine creatures, touch tank and predators exhibit. Cape Town Stadium, the location for the 2010 FIFA World Cup matches held in the city is also a momentary place to stop by while taking a stroll around the area.
The V&A food market is infused with visitors and hosts restaurants and cafes offering local and continental cuisines. The speciality shops, craft market, fashion and decor exhibit, theatres, jazz concert venues, cinemas are flocked by tourists year round.
4. Kirstenbosch botanical gardens
Established in 1913 with a mission to protect the indigenous flora and vegetation of the country, Kirstenbosch botanical gardens are the first mission oriented botanical gardens. It is also one of the most famous picnic spots and places to visit in Cape Town. Indigenous flora with 20,000 African species are protected, collected, studied and grown covering an area of 528 hectares.
The Kirstenbosch Estate is a part of a UNESCO World Heritage site, Cape Floristic Region; this estate includes a cycad amphitheatre – great picnic spot for kids, a medicinal garden, fragrance garden and Tree Canopy Walkway known as the Boomslang which is a 130 metre bridge and was listed as the Best Objects of South Africa in 2015.
Kirstenbosch Tea Room and other restaurants offer picnic hampers for visitors. Company's Garden, Iziko South African Museum and Planetarium are places of interest around Kirstenbosch gardens.
5. Cape Winelands
It is no myth that South Africa's best wine estates are located in Cape Winelands, which is the best place to visit in Cape Town. It lies in a valley circumscribed by a continuous range of Cape mountains, offering scenic views of little hamlets, historic Dutch farmlands and towns. Stellenbosch, Paarl and Cape Winelands share a similar topography and soil consistency. This explains the favourable conditions for wine farmlands common at these locations.
On your full-day trip to finest wineries of the valley, you'll find the best restaurants for food and wine combinations at the gourmet capital, Franschhoek. Explore the vineyards of Groot Constantina, Tulbagh, Franschhoek, Stellenbosch, Pniel and many more to learn about the cultivation and processing of world-class wines; don't forget to taste the artisanal wines of these regions for a better experience.
6. Clifton Beach and Camp's Bay
Clifton beach is one of the best beach settings of Cape Peninsula, flanked by granite boulders, and pristine blue seas with tidal waves drenching the gleaming white sands of the beach. The First and the Fourth beach are a getaway location for family picnics and beachside volleyball lovers.
Camp's Bay lies south of Clifton beach is an escapade for both tourists and locals with a number of options to spend the day and relax during weekends. Boutiques, cafes and restaurants found here to keep the crowd busy while tourists enjoy the spectacular views of Lion's head and Twelve Apostles.
7. Boulders Penguin Beach
Home to endangered penguin species which settled in 1982, Boulder's Beach is one of the best beaches in South Africa. Watching the penguin waddling and breeding in their natural habitat is an awe-inspiring sight for first-time visitors. A colony of around 2000 species of endangered African penguins can be watched from a safe distance along the walkway at the Foxy Beach.
Glowing sand beaches, calm waters, granite boulders of the Boulders penguin colony are all a part of Table Mountain National Park. The nature lovers who enjoy beach time with wildlife and native creatures must save time from their day trips and escape to this beach.
8. Old Biscuit Mill
Most recommended food and shopping market of the town is Old Biscuit Mill, situated in Cape Town Central; without paying a visit to this area, the trip would be incomplete. To satiate your hunger and love for the indigenous craft and tourist shopping, this is one of the best places to visit in Cape Town. You name it and you'll find it here from the gourmet food, local dishes to shopping malls and entertainment centres.
For foodies and chocolate and wine lovers, this small town is heaven with plenty of options like CocoaFair, Redemption Burgers, The Test Kitchen (Africa's best restaurant), Espresso LabMicroroasters and Wine at the Mill.
9. Robben Island
Robben Island is a place of historical importance and enriched with the struggle stories of freedom fighters from the Apartheid era. What was known as the prison capital of the country where Nelson Mandela was imprisoned as well, is now a UNESCO World Heritage site, symbolic of independence and triumph.
It is situated 12 km from the Cape Town and can be accessed through boat rides, sailing from the Nelson Mandela Gateway at the Victoria and Alfred Waterfront. The lime quarry where prisoners were forced to work as labourers and Mandela's former cell are places of interest at the island. The guides are mostly former prisoners of the island with information and experiences to share, which makes the tour more appealing to the visitors.
The places and tourist destinations of Cape Town, nestled in Western Cape of South Africa cannot be summarised in mere words. There are many activities and adventure tours for visitors to revel, no matter where you are in the city.
Things to do in Cape Town
- Hike to Lion's head and enjoy one-hour cableway ride to the Table Mountain summit with panoramic views of Cape Town.
- Enjoy a picnic with horse-riding, meal and wine, and mountain biking at the Manor House and Kirstenbosch botanical gardens to learn about the native African floral diversity.
- Steal some time for taking a stroll across the Babylonstoren gardens infused with floral biodiversity and watch bees, ducks, chickens and tortoises.
- Savour the taste of finest wines at the Night Market in Cape Vineyards, where festivities and events take place on Thursday evenings.
- Kalk Bay is a harbour offering beautiful sunset views with possibilities to trail the isolated lighthouse.
Join the early morning yoga session at the Clifton beach held every Sunday.
- Enjoy the tea with evening views of gardens and fountains from the terrace if Mount Nelson Hotel.
- For pizza, cake, ice-cream and beer lovers, Spice Route in Paarl is a perfect stop.
- Learn about different types of gin in a three-hour workshop and make your artisanal gin on Saturdays at the New Harbour Distillery, Woodstock.
- Spend some time kloofing and hiking at the Suicide gorge trails.
- Explore Africa's largest bird park, World of Birds with more than 3000 species of birds.
- Befriend and watch the wild species at Table Mountain National Park, Karoo National Park, Robben Island penguin colony and other wildlife reserves.


text:
Before Stephon Marbury was shipped to Phoenix last summer by the Nets, he knew he was being shopped. According to a source, Marbury told one member of the Nets' family two days before the historic Jason Kidd trade, "I hope they ship me out West. That way I'll have a better chance of being traded to the Knicks."
The Coney Island point guard keeps his Knick desires to himself. When asked last night about the Knicks' decline, he said, "I really don't care how they're doing. Why should I? It really doesn't matter to me."
League executives believe it's possible the Suns would deal Marbury since Penny Hardaway can handle the point. GM Scott Layden had no chance of getting Marbury when he was with the Nets, who would never deal him to their cross-river rivals. Former Knick GM Ernie Grunfeld tried to obtain him from Minnesota four years ago but his agent David Falk steered him to New Jersey.
Kidd is on Sports Illustrated's cover this week leading the Nets' resurgence. Asked if he's surprised, Marbury said, "Not at all. They've got a big man who can score. Jason Kidd is a great point guard. Kerry [Kittles] is back healthy. Keith is back healthy. Kenyon is back healthy. I'm not surprised at all. I know those guys are capable of playing this way. Kidd is a point guard who doesn't need to score for them to win."
Marbury was averaging 20.2 points and 8.2 assists before scoring 21 points and handing out nine assists in last night's 96-92 Knick victory at the Garden. "It takes time whenever there's a new point guard," Marbury said. "It takes time to jell. We're playing together now."
The Knicks have now won two straight under Don Chaney for the first time.
The coach praised Mark Jackson's defense on Alvin Williams in Toronto.
"He really got into it. He's giving up a lot of age and physical ability but he has a lot of heart."


text:
NJ Trooper Strip Searches Man for Drugs on Hi-Way at Traffic Stop
Video of a New Jersey State Trooper searching a man's underwear for drugs on the highway while he is pulled over for tailgating has surfaced more than a year after the incident, raising claims of a possible violation of body cavity search requirements and procedures.
The trooper said he smelled marijuana on the 23-year old driver after pulling him over and searched his car and his pockets without finding anything before saying, "If you think this is the worst I'm going to do, you have another thing coming, my friend."
According to Philly.com, when the trooper said he planned to take the driver to the station for a body search, the man asked if he was being charged and whether such a search was legal. He said that if he had no choice about the search, he wanted it to be conducted in front of the dashboard camera.
The trooper is shown on dash-cam and police cam video putting on latex gloves and reaching inside the handcuffed man's underwear as the two stood on the shoulder of a Burlington County highway.
No drugs were found during the search and the motorist is now planning to sue the state for civil rights infractions.
The videos were obtained by John Paff, who runs the New Jersey Libertarian Party's Open Government Advocacy Project. He frequently requests court documents and police videos and posts them on his website, NJ Open Government Notes.
A state police spokesman said the agency has launched an internal affairs investigation into the traffic stop, which occurred on March 8, 2017. The troopers are still on active patrol pending the results of the probe.
Here is a short edit of the video on the trooper's roadside body search from Philly.com. What do you think? Is this really the normal state police procedure in such cases or did this trooper go far beyond his authority?
Sources: Philly.com/ NJ Open Government Notes


text:
Looking for a local plumber in Canberra? Throne Plumbing are 'The Canberra Plumbing Maintenance Specialists'.
We offer extensive plumbing maintenance, drainage and gas fitting services. We also specialise in roof plumbing, including gutter, gutter guard, metal fascia and down-pipe installation services.
We also provide a convenient 24/7 emergency service. Throne plumbing is licensed in the ACT and NSW and services all Canberra suburbs and surrounding regions.
Our staff promise to deliver a professional service and honest advice. Our qualified Canberra plumbers have extensive knowledge, skills and expertise in their field and are fully equipped with the industries finest tools and machinery.
For a prompt quality service, to resolve your plumbing issues with ease call 0424 162 427.
Looking for a local Canberra plumber?
Contact 'The Canberra Plumbing Maintenance Specialists' today!


text:
M-F: 8:30 a.m. - 5:30 p.m. (EST)
A postcard can also be a coupon, a gift certificate, or a ticket to an event. Ask people to present the coupon to take advantage of an offer or promotion. Counting coupons helps you measure the effectiveness of your promotions. That way you can better understand what worked and what didn't.
Want to learn more about marketing with postcards? Then read Direct Mail Marketing. This will give you insight on the stopping power.


text:
Using games in the contact center can change associates' behavior, by boosting motivation, engagement and performance. More importantly, it creates fun! Games can even be used as a wanted distraction during more stressful and demanding times.
Professor B.J. Fogg, an experimental psychologist at Stanford University, outlines three elements that must simultaneously converge for a change in behavior to occur:
- Motivation – the chance to win, receive rewards or gain recognition
- Ability to carry out a task – by facilitating it, or breaking each task into bite-size chunks, increasing the perceived capability for the user trigger
- A trigger or cue – to complete the action
Games help create these elements while promoting a positive work environment that rewards and recognizes associates. Aligning competitive games with strategic goals focuses the team on those goals and helps boost the brand's performance as well.
Below are 5 tips for setting up motivational games and engaging your team.
1. Determine the behavior or metric you want to affect.
- All games should have a purpose. Whether improving morale, emphasizing perfect attendance or decreasing Auxiliary time (AUX, when an agent is unavailable for calls) , the game should be focused around improving or sustaining a particular behavior.
- Games can serve multiple purposes, but there should be a primary. This will help you in later steps to establish an engaging and clear contest.
- Assess the talent of your team to make sure everyone has realistic opportunities and is involved in the fun and the challenge.
2. Set your individual and team goals.
- Identifying the goals to be achieved will signal to the team how they participate. Individual goals will motivate people to do their best, but can sometimes have an opposite impact if the agent is new or a lower performer. This is where team goals can keep someone in the game. Team goals will encourage communication, training and camaraderie across the group. Often times, achieving team goals are the most fulfilling of the challenge.
- When setting goals, use the SMART program. Goals should be Specific, Measurable, Achievable, Relevant and Time Bound.
- If the end result is an improved metric, work with your forecasting team to set low, medium and high goals. You can align tiered rewards accordingly. This will help the participants see progress and remain motivated through the length of the challenge.
- If the focus is on morale and fun, be sure to choose topics that are relevant and inclusive of as many people as possible. Not everyone is familiar with filling out a March Madness bracket, but if you include team mascots and uniform colors it can become more inclusive. It is particularly fun when the person who choses by colors beats the local college basketball guru.
3. Define the rules and rewards.
- Rules must be clear, concise and well thought out. You want your friendly competition to be free of arguments or accusations of cheating.
- Create a conflict resolution process. There should be a "commissioner" internally and a potential third-party tie breaker if necessary.
- Plan for as many exceptions as possible. For example, what happens if the system goes down or call volume is too low?
- Rewards should also be clear and if there is a calculation involved to determine the reward, provide a simple formula to help associates understand. The best motivation in achieving the goal is knowing where you stand.
- Remember that rewards can be something other than monetary. Lunch, coffee, time-off or one-on-one time with a senior leader can be even more valuable.
- Make all rules and rewards public. It will be your responsibility that everyone knows how to play and how to win.
4. Choose your game.
- Be creative. Remember that fun and engagement are at the heart of the competition.
- Decide whether to focus on single behaviors or be more complex and assess associates on several factors.
- Identify the people and process for updating game results. This will create accountability and keep the challenge top of mind.
- Determine the timeframe. Will this run for a season, sale period or some other time? The goal is to keep interest and excitement up.
5. Have fun and celebrate!
- Be the biggest cheerleader! Show that you are part of the team and find a way to participate by dressing up, passing out snacks, giving an impromptu reward or just being present.
- Regardless of the outcome, make sure to celebrate the end of the competition. Even if you are short of meeting goals, be sure to have planned for the celebration of the effort or any progress.
- Use the rewards to create excitement and anticipation for the next time.
- Rewards and ceremony should be significant enough to make the recipient feel special and motivate associates.
Using games and competition to engage your team will require some time investment, but it will be well worth the effort. Games are a win-win for associates and customers: The boost in workplace motivation will translate into increased associate engagement and better customer experience.
We'd love to continue the conversation!
Interested in how we can improve your customer service? Reach out to us any time using the form below.


text:
LMS Competition Chess Team
- The interest meeting / try outs for the 2019-2020 school year will be held in Blue Pod #237 on August 19th at 3:15 pm.
- Chess Club meets on Mondays after school in Ms. Collins' room, #237 (Blue Pod)
- Chess Club dismisses through front carline at 4:45 p.m.
- Members must participate in at least two tournaments a semester.
Head Coach: Dr. Gerald Larson
Assistant Coach: Om Badhe
Sponsor: Whitney Collins
We are excited to have a new head coach this year. Read about him here!


text:
About the product
Pucker up! Our Sour Gummy Bears are the perfect balance of sour and sweet. These adorable little bears come in 6 wonderful colors and flavors that candy lovers of all ages are sure to love. What will your favorite sour gummy flavor be?
Assorted flavors of Pineapple, Grape, Cherry, Orange, Lemon, and Watermelon.
At Richardson Brands, we believe in the power of creativity. We're constantly challenging ourselves to come up with delicious new confections to delight and inspire. Now, we're proud to announce our new gummy candy collection, a selection of treats designed for gummy candy lovers. 6 irresistible fruit flavors wrapped up in a charmingly chewy texture – what's not to love? Our gummies are available in classic bear form, as rings, or as sour gummy bears for a variety of candy-eating experiences. Don't be afraid to try them all in search of your favorite flavor!


text:
ROOFS over saleyards have been a big game changer in terms of effluent management but still there are significant efficiencies to be gained.
Biogas is one area where experts in this field see untapped potential.
Senior engineer with facility designers Wiley, Heath Barker, says any saleyard manager not processing wastewater and getting all the available benefits from it, is losing out.
Mr Barker spoke at the recent National Saleyards Expo in Casino on the latest trends in effluent management and why it counts when it comes to running a profitable and sustainable livestock marketing facility.
Big investments have been made around the country in recent years constructing saleyard roofs and that has delivered large areas unaffected by rainwater which means facilities can then look at management and animal welfare improvements like soft flooring.
But it has also meant far less runoff to deal with and far more rainwater captured and available for re-use - for the likes of holding for fire fighting, dust mitigation and even watering cattle, Mr Barker said.
"One thing to note is that the effluent you do have to deal with becomes quite concentrated because there is little dilution happening," he said.
Typically, there were three streams of effluent produced at a saleyard, he explained.
They are the runoff from hosing down floors, from rain and storm water and from truck washing.
"Waste streams need to be treated and that depends on what rules are in play for your facility but the typical processes are screening out the big solids, breaking down the organics with bacteria, removing nitrogen and phosphorus, then disinfecting and recycling."
Many industrial sites are now installing covered anaerobic lagoon (CAL) systems, which both reduce emissions and capture biogas as an on-site renewable energy source, Mr Barker reported.
Existing anaerobic lagoons can be easily covered with high-density polyethylene to capture the biogas being released, which can then be utilised as a fuel to generate energy in the form of heat, electricity or both.
"It allows you to generate an energy source you didn't have before, which offsets an energy source you were paying for, and at the same time it reduces carbon emissions," Mr Barker said.
"For a saleyard, that equates to some very interesting opportunities ahead for turning waste streams into sustainable resources"
Recent projects Wiley has been involved in have seen CAL systems generate up to half a megawatt of power a day.
The bottom line?
"Don't waste your wastewater. It's a valuable resource that, like saleyard roofs, could be the next industry game changer," said Mr Barker.
The story Roofs and biogas prove game changers at saleyards first appeared on Farm Online.


text:
This one may be at a low price, but I think they undid themselves in terms of the value they provide so many needles buttons and so much thread at such a low cost is ridiculous let alone getting the imprint for free.
Actually there is a large amount of thread in these packs amazing at the price-point really. Delivery was swift and no damages during process.
I wanted a sewing kit as I feel every home should have one and that I stand a greater chance of my promotional product not just becoming garbage by using it. This one definitely takes on a better logo imprint in my book. made a good decision.
A very versatile product named Threaded Sewing Kit with a list of wonderful features like 10 pre threaded needles, 10 different color threads, 2 safety pins, 2 buttons, transparent sliding plastic lid that will give your company some good marketing exposure with handful amount of facilities for your customers those who can effectively use it for sewing, stitching.


text:
We are a leading Manufacturer & Trader of Fan Filters such as Metallic Filters, Pre Filter, Fine Filter, Fine filters and Pre Filters from India.
Product Price :Get Latest PriceProduct Details:
Product Price :Get Latest PriceProduct Details:
|1.5 kg
Explore More Products
© Flowline India Private Limited. All Rights Reserved (Terms of Use)
Developed and Managed by IndiaMART InterMESH Limited


text:
We offer a wide and varied programme which consists of:
Supervisor Forum Sessions: these are tailored to meet the needs of new and experienced supervisors.
Strategic Development Seminars: an opportunity for staff to meet over lunch and explore a topical theme, idea or initiative related to research in HE.
Lunchtime workshops: these informal and interactive lunchtime sessions are for staff and doctoral researchers. Invited speakers lead discussions and participants share best practice and questions on research related activities.
Annual Reception: this is the highlight of our annual events programme. It brings together doctoral researchers, staff and external guests to celebrate the achievements of our doctoral researchers, showcasing a selection of the innovative research projects being undertaken at the University. You can view images and booklets from previous years via the left-hand menu options.
Annual Lecture: all are welcome to attend and hear an engaging, topical lecture by an invited, external speaker. In 2015 we explored the importance of public engagement for researchers.
This year's lecture takes place on 6 December 2016 and will be given by Carenza Lewis, Professor for the Public Understanding of Research, University of Lincoln. More information and booking details.