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The care itinerary for cancer involves difficulties that occur in several different areas, whether in the diagnostic procedures, in surgery, or in adjuvant treatment. The aim of this work was to obtain a valid instrument measuring satisfaction among patients with breast cancer and exploring their care itinerary overall.
Development phase: Patient focus groups were implemented in two French regions in order to identify areas of satisfaction in relation to the different phases of care provision in breast cancer. On the basis of the literature and the themes and wordings derived from the focus groups, the patients identified several areas of satisfaction, which they found to be partially covered in an American satisfaction measure that has been validated in the French general population (the Consumer Satisfaction Survey in its French version, CSS-VF, 39 items). The patient focus groups suggested adaptation of certain dimensions of this instrument to the potential care providers (37 items) and produced 45 new items in six areas.
Validation phase: Using a large sample of patients (cohort of 820 women with invasive non-metastatic breast cancer) approached one month after treatment, this phase selected items that were comprehensible (non-response rate < 10%), non-redundant (r < 0.80) and reproducible (test-retest conducted on a sub-sample of 166 patients). The dimensions were identified by factor analysis on the selected items. Divergent and discriminant validity were assessed (relationships with quality of life questionnaire, comparisons between extreme groups).
Results were in favour of not inserting additional broken-down items into the CSS-VF and retaining 21 new items. The factor analysis found the initial structure of the CSS-VF (39 items in 9 dimensions) and the 21 new items divide up into four dimensions (listening abilities and information provided by doctors, organisation and follow-up of medical care provision, psychological support, material environment). No redundancy was observed between new items and CSS-VF items. Internal consistency was high. Divergent and discriminant validity were satisfactory.
Adding four new dimensions to the CSS-VF yielded a valid 60-item instrument for assessment of care provided in breast cancer. These promising results now require further investigations of its responsiveness and its robustness in other linguistic, cultural and healthcare settings.
Breast cancer is the most frequent cancer among women, with a little over one million new cases per year worldwide . Over recent years, the way the disease has been catered for has changed (screening, diagnosis, prognostic markers, new surgical techniques, oral treatment, etc). As a result, prognosis has improved, and patients have a more regular follow-up by physicians. Alongside this, the assessment of patient satisfaction has gained ground in the literature on cancer. This can be explained by the importance given to patient preferences in medical decisions, and also by the need to measure the results of health strategies [2, 3]. Thus today measuring satisfaction among patients with non-metastatic breast cancer over the complete the care itinerary is an essential step in improving the way the pathology is catered for [3–6].
Satisfaction is a concept that is at once theoretical, multidimensional, and subjective. This concept, which cannot be measured by direct observation of the care provided, involves the identification of expectations, needs, perceptions, past experiences, opinions and attitudes of patients [4, 7, 8]. Several authors have thus considered that the assessment of satisfaction required an operational formalisation of the concept into dimensions with their constituent items making up questionnaires , and hence this rapidly entailed the need to assess the psychometric properties of such instruments .
The majority of these instruments were developed in the USA or the United Kingdom, and socio-cultural differences or differences in the health systems restricted their use in assessment of care itineraries in other countries. In addition, many of these questionnaires measure satisfaction in hospitalised patients, while others focus on a particular moment in the care itinerary, such as the consultation [10–17]. Finally, some questionnaires do not possess the required psychometric properties [18, 19].
The care itinerary for breast cancer involves difficulties that occur in several different areas, whether in the radiological and histological diagnostic procedures, in surgery, or in complementary treatment. Pluri-disciplinarity is essential in the therapeutic decision, and this entails coordination of care interventions throughout treatment, as well as between the different phases of treatment, and subsequent to treatment. The range of expertise required leads to time lapses, and complicates the organisation of care. This applies to all the actors in the care itinerary, and the time required to reach collegiate decisions can have a negative effect on patients. Patients expect care to be instated promptly, and to be accompanied by clear information and psychological support.
To our knowledge, no satisfaction questionnaire explores patient opinion in the different phases of treatment for breast cancer, while several areas of satisfaction have quite specific links with these particular care itineraries.
The aim of the study was therefore to develop a questionnaire measuring satisfaction with the care itinerary as a whole among patients with non-metastatic breast cancer subsequent to initial treatment. In view of the repeated developments of new satisfaction questionnaires, and the time required to construct and validate them [20, 21], we decided to start from an existing validated satisfaction questionnaire, the Consumer Satisfaction Survey in its French version [22, 23].
This study was conducted in two French administrative regions (Aquitaine and Poitou-Charentes) representing 7 to 8% of the national population of France. This study is integrated into a general project of evaluative research on the performance of health networks, entitled REPERES (Recherche Evaluative sur la Performance des Réseaux de Santé).
Simplified development and validation process of the REPERES-60 questionnaire.
2. The second phase (quantitative method) was the first steps of a validation process designed to identify the best set of items using psychometric and statistics methods, and to analyse the association or correlation with other external indicators and assess the known-group validity of the new tool.
Two focus groups were organised successively, involving fifteen patients with cancer for each focus group. The patients were selected to ensure diversity within the focus group, both for clinical and socio-demographic characteristics and for care itinerary [see Additional file 1]. The mean age of patients was 62 years (range 40 to 78), and six were retired. All women were some time from their initial treatment, and were either in remission or in relapse for some cases.
The first group interviews aimed to stimulate participants to put their personal experiences into words, and to explore their perception of quality in the care process . The interviews, recorded with the agreement of the participants, were intended to collect the wordings used by non-medical individuals to talk about certain medical notions. A review of the literature had been conducted to find seven published questionnaires [10, 11, 13, 14, 22, 23, 25, 26], which enabled the drafting of a list of satisfaction dimensions which was presented to the focus group patients. The main domains covered in the questionnaires reviewed were fairly classic: human relationships, technical quality of care, accessibility and convenience, economic aspects, efficiency of care, continuity of care, material environment and availability of doctors [7, 19, 27]. The patients in the focus group successively discussed the different phases in care and treatment of breast cancer.
A list of elements for item development (themes and wordings) derived from the verbatim transcribed from the first focus groups was developed by the REPERES work group (sociologists who analysed content).
On the basis of this material, the patients in the second focus group identified several areas of satisfaction, which they found to be covered in a questionnaire developed by Davies & Ware  and which has been culturally adapted and validated in French (CSS-VF) .
The second focus group made the choice of using the 9 generic dimensions of the CSS-VF as the basis of their work. It is true that certain validated satisfaction questionnaires for use among cancer patients such as the EORTC InPatsat-32 cover some of these dimensions , but they are restricted to the hospitalisation period of the patients' care itineraries. In addition, the CSS-VF had the advantage of exploring satisfaction with General Pratitionner (GP) and specialist care separately: this was indeed used by the focus group to adapt certain dimensions to the different health care actors involved in care of breast cancer, adding 37 items. Thus the items concerning the GP were completed by two items for the gynaecologist and the radiologist, and the items concerning the specialist were subdivided into two items, for the surgeon and the oncologist. This new structure made it possible to distinguish between primary care, provided routinely for diagnosis and follow-p by the GP, the gynaecologist and the radiologist, and secondary care providing treatment of the cancer and hence implicating the surgeon and the oncologist.
- The organisation of follow-up after treatment: patients emphasise " the length and the succession of treatment phases which is more difficult to cope with than the treatment itself", the need to "have a part in the choice of treatment and mode of care", the importance of feeling that "staff work as a team ", and that "communication between the GP and the specialist works well".
The quality of the material environment in which cancer is cared for and treated was also discussed in the focus groups, and although the theme is present in the literature, the aspect of the confidentiality afforded by premises is not in fact explored. The themes of efficiency of care and access to medical information were developed independently by the REPERES working team, in response to the fact that the issues of access to medical files was an ongoing debate at the time (cancer plan) and also to the procedures for evaluation of efficiency of care that were being set up.
Three new items were drafted to complete the existing dimension on insurance cover and 42 new items were drafted to fall into five areas of satisfaction: 1) listening abilities and information provided by the doctors; 2) organisation and follow-up of medical care provision; 3) psycho-social support; 4) outcomes of care; 5) and material environment.
The format of the response choices was ordinal, in line with that used for the CSS-VF, and the best suited to the positive response trends often observed in satisfaction surveys [7, 28].
The test version of the full questionnaire, administered in the form of a self-assessment, comprised a total of 121 items: 45 new items and 76 derived from the original CSS-VF. This version of the questionnaire was then tested with a population of breast cancer patients to assess understanding and exhaustiveness of the items, and this led to some minor alterations to the questionnaire.
A cohort survey was conducted from October 2003 in public and private cancer centres. The patients included in the cohort complied with the following criteria: 1) a first diagnosis of invasive non-metastatic breast cancer in the course of 2003; 2) at least two contacts for cancer with one of the health professionals in one of the two regions between diagnosis and the first year of follow-up; 3) signed informed consent.
The satisfaction questionnaires were sent at three moments in the care itinerary : one month after the end of the initial treatment for the study of the psychometric properties of the instrument (this involved the whole cohort, n = 975); then a year later, and again a week after that to study reproducibility of items (this involved a sub-group representative of the cohort obtained by random selection, n = 172). The reproducibility study entailed questioning patients at a stable period in the course of their disease, and no psychometric study was performed at one year.
The logistics of data collection were ensured by a team specifically dedicated the project, and involved recall procedures at each stage in the study. Telephone support was established to provide patients with explanations or complementary information on the aims, design and expected results of the study. The process of patient inclusion as a whole had been previously approved by the consultative committee on the processing of information in medical research of CNIL (French national commission on individual privacy).
Responses provided to the questionnaires were captured using the Data Base Management System 4D Server, and data were analysed using the SAS programme, version 8.2. (Windows). A verification procedure was implemented via independent duplicate data capture to check the whole data set.
Finally questionnaires that presented more than half the responses missing were removed from the statistical analysis.
The selection of items was based mainly on clinical criteria and priorities expressed by patients in the focus groups. The internal validity of the 121 items was studied by successively examining the distribution of items, any redundancy, and their reproducibility over time.
The distribution of each item was studied to see whether the full range of response choices was used, in order to detect items that were not sufficiently informative because the variability of response was insufficient: floor and ceiling effects. An item was removed if one of the response choices received more than 50% of the responses provided . The proportion of missing data was calculated for each item, and this enabled assessment of how well understood or how relevant the questions were. A percentage of missing data on an item under 10% was considered acceptable.
Items that were strongly correlated, thus likely to be providing the same information, were looked for. Redundancy between two questions was suspected if the Pearson correlation coefficient was over 0.80 in the inter-item correlation matrix [31, 32].
The reproducibility of the measure was studied item by item, examining the agreement between measures at the time of the two re-administrations of the questionnaire. As the response format was ordinal, agreement was explored using a weighted kappa coefficient (Fleiss-Cohen weighting) taking into account the degree of disagreement . A kappa coefficient over 0.70 was considered to indicate good reproducibility, it was considered moderate when values were between 0.50 and 0.70, and insufficient below 0.50.
The selection of items took other factors into account: 1) the proportion of non-response: if higher than 10% a problem of acceptability was likely for the item, without systematic exclusion at this stage; 2) the number of items considered sufficient to account for a given dimension: if at least half the items of a dimension were completed for the calculation of the score, the choice was made to keep the item, so as to retain the information in the particular dimension.
The factorial structure was studied using Principal Component Analysis (PCA). The number of factors retained was determined from eigenvalues greater than or equal to 1 . Factor analysis with rotation enabled identification of the dimensions in the questionnaire, and showed that the items selected measured domains that were identical to those hypothesised at the outset. Rotation was applied to transform the original principal components produced, to ease interpretation. This method searches for a linear combination of the original measurements aiming to maximize the variance of the components loadings. A Varimax rotation (orthogonal) was preferred at a Promax rotation (oblique) if low correlations were observed between factors . An item was attributed to a single factor if it loaded 0.45 or more on a single factor.
The score of each dimension was calculated from the sum of items, standardised so as to obtain a score between 0 (low satisfaction) and 100 (high satisfaction), according to the methodology proposed by Davies and Ware . The score was computed if at least 50% of the items in the dimension were completed. Descriptive statistics were produced for each of the dimensions (mean, standard deviation, percentiles, saturation and asymmetry coefficient).
Reproducibility was studied for the different dimensions using the intra-class correlation coefficient, calculated from a 2-factor variance analysis in a random effect model . An intra-class correlation coefficient over 0.70 was considered to indicate good reproducibility.
The analysis of item-score correlations looked for correlations greater than 0.40 between items and their own dimension. The correlation coefficients should be higher between the item and the dimension to which it belongs (calculating the score without the item under consideration) than between that item and the other dimensions. An analysis of the inter-score correlation matrix was conducted to ascertain independence of dimensions for correlation coefficients below 0.70. The Cronbach alpha coefficient was calculated to assess internal consistency of each dimension. A coefficient over 0.80 was considered satisfactory . Floor and ceiling effects for each dimension were calculated according to the percentage of subjects presenting respectively the maximum and minimum scores in the dimension considered.
In a first approach, divergent validity was checked by assessing the relationship between the REPERES-60 scales and the EORTC QLQ-C30 scales and single items (European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire) . Health Related Quality Of Life (HRQOL) summarizes dimensions of the quality of life which reflect the negative functional repercussions (on the physical activity, the psychological state, the social relations) of its disease and its treatment, such as the patient perceives them . Thus these two measures are intended to explore two distinct concepts and their scales and items should not show marked correlation (Pearson's r < 0.40).
In the second approach, the ability of the questionnaire to discriminate between extreme groups was assessed by comparing patient groups that were expected to differ strongly in terms of satisfaction scores. A lower satisfaction level was expected for younger patients (cut-off at the sample median age of 58), patients with higher education (versus primary and secondary education), those who had experienced problems of communication at the time of the announcement of the diagnosis, and patients who reported a poor health status (score less than five on the QLQ-C30 item: "How would you rate your overall health during the past week ?", scored from very poor to excellent) [38–40]. Discriminant validity was investigated using non-parametric tests (Wilcoxon test) . We could estimated, because of none references are existing on this topic, that a five point difference score between extremes groups are representing a significant discrimination.
Among the 975 patients included, 850 (87%) returned the initial questionnaire within a median time lapse of 18 days. For the study of reproducibility of items, 172 out of 182 (95%) returned the two questionnaires one year after the first completion and again a week after this dispatch.
The proportion of exploitable questionnaires, which presented less than half the responses missing, was over 95% (820/850 and 166/172). Average patient age was 58.0 years (SD 12.4), the majority were living with a partner or spouse (55%) and 44% were working (Table 1).
Just one item from the original CSS-VF (Q7) had a high rate of non-response. The replicated (broken-down) CSS-VF items relating to the gynaecologist and the radiologist did not generate adequate response. There was one phenomenon of saturation of response choices on one item of the global satisfaction domain (Q71).
Two of the three items generated to complete the health insurance cover dimension concerned less than one patient in three. The removal of items Q78-Q79 also led to removal of item Q77.
Among the 42 new items, 10 out of the 13 that registered at least 20% non-response were removed from the analysis at this stage. Two items relating specifically to mastectomy or to a particular treatment (Q86 and Q105) were however maintained on account of the importance given to them in the focus group. It was also thought necessary to maintain the third situation-specific item (Q94) in order to explore the care itinerary as a whole, including all aspects of care provision.
Nine new items of the 15 for which the percentage of missing data ranged from 10 to 20% were maintained as far as the factor analysis. This strategy made it possible to have a sufficient and fairly homogeneous number of items for each dimension.
High correlations were found for replicated items in the primary care dimensions (the breakdown into GP, gynaecologist and radiologist), and also for the replicated items in the secondary care dimensions (for the surgeon and the oncologist). At this stage these results were in favour of not inserting these additional broken-down items into the CSS-VF, but rather of maintaining the original items. In the subsequent analyses, the broken-down item scores were averaged, retaining solely the distinction between primary and secondary care (Q1 to Q63).
Ten of the 42 new items were redundant, but only the item on information given to understand the treatment (Q80) was removed. The other items were retained to enable the measure to give an account of certain specific sequences in the patients' care itineraries: the time lapses before receiving treatment (chemotherapy, radiotherapy, surgery: r = 0.80–0.82), the quality of consultation premises and respect for privacy in consultations (hospitalisation versus consultation: r = 0.87).
No redundancy was evidenced between items in the CSS-VF and the new items (r ≤ 0.68).
At the end of this stage, 64 items remained out of the 121 items (39 items derived from the CSS-VF and 25 new items).
Reproducibility was satisfactory for ten of the 13 (Q64 to Q76) remaining CSS-VF items (weighted kappa ≥ 0.70 for 4 items and between 0.60 and 0.69 for 6 others) and for 22 of the 25 new items (weighted kappa ≥ 0.70 for 11 items and between 0.60 and 0.69 for 11 others). For the six remaining items, the coefficient ranged from 0.55 to 0.59, except for one item in the global satisfaction domain of the original CSS-VF (Q69, kappa = 0.44). No item was excluded on the grounds of its kappa coefficient.
The 64 items retained were entered into principal-components factor analysis with varimax rotation and a twelve-factor PCA solution was retained for 60 items. Four items were not further considered in the subsequent PCA because of absence of loading on any common factor (Q93 to Q96). The factorial structure remained identical with or without them. The first twelve factors explained 45% of the total variance. The dimension "competence" and the dimension "communication skills" for specialists deliberately dissociated in the validation of the French CSS  are found here on a single factor (6 items).
The other dimensions of satisfaction were: "access to primary care" (7 items), "access to secondary care" (3 items), "competence and communication skills of primary care doctors", "choice among different doctors" (4 items), "human qualities shown by doctors" (4 items), "global satisfaction" (4 items), "cover for medical expenses" (5 items), "listening abilities and information provided by the doctor" (7 items), "organisation and follow-up of medical care provision" (5 items), "psychosocial support" (5 items) and "material environment" (4 items).
All items had a good loading on their own factor. Only five items had a loading on a secondary component (I5, I20- I22, I54).
The reproducibility was very satisfactory for eleven out of thirteen dimensions. The dimensions "access to secondary care" and "competence of doctors in secondary care" had intra-class correlation coefficients of 0.62 and 0.66 respectively.
Correlation coefficients between items and their hypothesised scale were all greater than 0.4. One item out of the 60 (the possibility of obtaining medical information or advice by telephone from the GP and/or the gynaecologist) loaded high on its own scale and also on another scale. One high inter-scale correlation was observed between listening abilities and provision of information by doctors and psychosocial support (r = 0.73). Internal consistency was very high (all Cronbach alpha coefficients ≥ 0.82, except for the global satisfaction score at 0.74).
None of the thirteen sub-scales were strongly correlated with the QLQ-C30. The strongest observed correlation was between the QLQ-C30 global quality of life scale and the global satisfaction scale (r = 0.29).
A lower satisfaction level was systematically noted for younger patients, those with higher education, those having experienced problems of communication in the announcement of the diagnosis and those who reported poor health status. All the sub-scales were able to discriminate between patients in terms of age categories, except for the sub-scales competence of secondary care doctors and organisation and follow-up of medical care provision. Differences in satisfaction scores were not significant in relation to educational status in five sub-scales: access to primary care, competence of secondary care doctors, cover for medical expenses, organisation and follow-up of medical care provision and psychological support.
Only the sub-scales for choice among doctors and the cover for medical expenses did not discriminate between patients in terms of health status and problems of communication in announcing the diagnosis.
These first results have shown that the questionnaire REPERES-60 presents very satisfactory psychometric properties. The predominant role given to patients via the focus groups, a procedure often neglected in the early stages of instrument design [6, 42], made it possible to explore and develop to the full the content validity of the 21 new items, using dimensions in line with breast cancer patient expectations [10, 18, 43].
The focus groups demonstrated that the CSS constituted a sound base for the development of complementary dimensions, and also made it possible to reduce the time required to reach a finalised, validated version [5, 40]. The CSS presented the required psychometric properties , had already been validated in the general population in France  and was designed to assess patient opinion with respect to care received, technical competence, human qualities and results. The study of the CSS-VF on a cohort of women with breast cancer made it possible to identify a factorial structure that was strictly similar to that observed in the general population, and thus to validate its metric qualities in a population of cancer patients . The break-down of items relating to each type of medical professional involved in cancer treatment was tested within the CSS-VF. The analysis showed that it was not useful to maintain the distinctions, since the redundancy of the information derived suggested that these items would encumber the instrument for no good reason, and in any case these patients do not all have contact with all the types of professionals that were initially cited. The strong correlations between items can be explained by the way in which cancer is cared for in the French healthcare system. This care is classically provided in one or several health facilities, but with collegiate decisions among the specialists concerned (surgeons and oncologists). A patient when interviewed appears to recall global aspects of care (there is therefore a correlation among specialist scores) rather than aspects concerning each specialist. This tendency is today even more marked in the French "cancer plan" which seeks to develop this collaboration by proposing the establishment of cancer coordination centres.
However, the distinction between primary care professionals (GPs and gynaecologists) and secondary care professionals (surgeons and oncologists) was maintained in the questionnaire , as in the initial CSS-VF structure, and enables assessment of the accessibility of the care institution and the continuity of care in ambulatory treatment , and issues such as the importance of the informal role of GP in breast cancer follow-up .
While the CSS-VF can be used its own, the four new dimensions are complementary to this measure and cannot be evaluated independently. The new measure covers aspects of care that have not been widely dealt with in the literature: continuity of care, solving psychosocial problems , or cooperation between oncologists and GP . The information that patients are provided with, and the doctor-patient relationship are areas to which these patients are particularly sensitive. The 21 items integrates the information given on the disease, as well as information on pain management and breast reconstruction surgery. Some items relate specifically to the types of care received by the patient (reconstruction, time-lapse before receiving chemotherapy, radiotherapy and/or surgery). While care was taken to ensure the internal consistency of the new items, the choice was made to maintain certain items that provide information on specific patient treatment that is not otherwise much explored in measures of satisfaction in cancer. "Not applicable" boxes were added to these items to identify patients who were not concerned by the item content.
As expected, lower correlations were observed between the new scales and QLQ-C30 scales, suggesting that conceptually different issues are assessed . If the correlations observed between the two concepts had proved to be high, the results would have been in favour of proximity, rather than independence, between the two tools. The new scales were able to discriminate clearly between patients who differed in terms of health status and communication experiences, and to a lesser degree between patient groups formed on the basis of age and educational status [38–40].
The comparison between the REPERES-60 questionnaire and the main satisfaction questionnaires in the field of cancer was interesting. The literature mainly reports on instruments developed in hospital environments, the most commonly used today being the EORTC IN-PATSAT32 questionnaire. In a hospital environment, the staffs involved are solely on the one hand cancer specialists and on the other the hospital healthcare staff. In a complete care itinerary, all the doctors encountered over the itinerary are involved. This explains why: 1) the enumeration of staff involved in the two questionnaires differs: doctors and nurses as opposed to all the doctors over the full itinerary (primary and secondary care); 2) if the majority of the dimensions explored by the REPERES-60 questionnaire are also found in the IN-PATSAT32 (interpersonal skills, technical skills, information provision, availability, access, exchange of information, comfort, global satisfaction) psychological support, mentioned by the patients as necessary for the announcement of the diagnosis and on leaving the medical environment, is not explored in the IN-PATSAT32.
Results are convincing but required also further tests such as the responsiveness and the evaluation of its robustness in other settings. It is important in generalizing present results to other linguistic, cultural and healthcare settings . The task now is to analyse the determinants of patient satisfaction in relation to their care itinerary and their clinical characteristics. Identifying the particular needs of breast cancer patients, and pinpointing the aspects of care that are the most important to them, should make it possible to improve the way the disease is catered for, and provide clinicians with indications on the way in which their practice is perceived. In this context, the questionnaire should make it possible, over the complete care itinerary of breast cancer patients, to identify the points where improvements can be implemented and integrated into the organisation of care in cancer. The extension of the questionnaire to other cancers could be envisaged via the implementation of focus groups involving patients with the relevant pathology.
The authors would like to thanks all the patients for their valuable contributions to the study. We also wish to thank E. Dos Santos, C. Pourin (focus group), N. Lapeyrere, N. Mériau, C. Touret (data collections and monitoring), A. Swaine Verdier (translation).
This study was conducted with the financial support of ANAES (Agence Nationale de l'Accréditation et de l'Evaluation en Santé), Ligue régionale contre le cancer, and INSERM MIRe-DREES.
GD performed data analyses and interpretation, and wrote the manuscript. SMP and VM participated in the study design and coordination, and helped to draft the manuscript. II and PI contributed to the data collection, analysis, data interpretation and manuscript preparation. IG, LSR and RS contributed to manuscript preparation. All authors read and approved the final manuscript.


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APRA PRAGATI SERVICES recruiting Rack Guard candidates nearby Kolkata.APRA PRAGATI SERVICES vacancies for Rack Guard is recruited through Written-test, Face to Face Interview etc.
APRA PRAGATI SERVICES Company recruits a lot of candidates every year based on the skills . The candidates with Upto 9th Std are selected to full fill the vacancies in Others job field. The candidates nearby Kolkata can apply for Rack Guard position in APRA PRAGATI SERVICES. All candidates should have a degree or post-graduation in the required field based on the requirement mentioned. The jobs are available in Full Time basis. When it comes to the APRA PRAGATI SERVICES recruitment, candidates are mostly chosen for the department of Others . To learn more about the current jobs and other details, it is better to go through official site of APRA PRAGATI SERVICES and Freshersworld. Find the latest jobs near you and near your home. So, that you don’t need to relocate. The Freshersworld is a leading employment portal that researches the official site of APRA PRAGATI SERVICES and provides all the details about the current vacancies, the application process, selection process, interview test details, important dates and other information. Search and apply for the top job positions in APRA PRAGATI SERVICES and near your city and get a secured career.

industry_corpus2: Others


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Rather than telling people to eat less fat, new guidelines suggest foods to eat.
Nutrition recommendations and guidelines are based on science, but delivering the message to the masses is more of an art.
It’s one thing for experts to put their heads together, analyze scientific data and develop dietary guidelines, but it’s something else entirely to translate the guidelines into behaviors that fit with people's daily lives — their lifestyles, taste preferences and the cultural values that guide those lives.
People want to know what to eat without having to listen to confusing and unfamiliar jargon.
That's why nutrition advice givers need to use language that speaks to the public, rather than asking the public to understand them, according to a new statement by the American Heart Association (AHA). Healthcare providers need to talk to patients about eating specific foods, not specific vitamins and nutrients, taking personal, cultural and ethnic preferences into consideration.
“To consumers, it’s an apple, an orange, a pizza. It’s not saturated fat, refined carbohydrates and potassium. That’s nutrition jargon familiar among professionals; but not normal conversation for the average American,” the chair of the AHA group that wrote the piece, Linda V. Van Horn, said in a statement.
The good news is that today dietary recommendations are based more on eating certain types of foods, rather than nutrients, than they were a few years ago. These food-based guidelines are much easier for people to understand, remember and apply to their lives. You're more likely to help someone cut back on saturated fat when you can point to where the saturated fat is in their diet and offer less fatty foods that fit within their culture, lifestyle and taste preferences as an alternative.
The same goes for shopping. People want to know what to buy in the grocery store, but also how they can change the way they cook the foods they love, so they can continue to enjoy them. They also need a quick and easy way of seeing the correct portions — such as a piece of meat the size of your palm; a fist-sized portion of vegetables.
This is the important change the guidelines offer: healthcare providers should avoid talking about percentages, grams and milligrams; they should avoid using terms like saturated fat, refined carbohydrates or potassium. People want to know what to eat without having to listen to confusing and unfamiliar jargon.
There's another beneficial kind of translation too. Some of the groups in the culturally diverse population in the U.S. have a very high risk of heart disease and stroke, and their dietary patterns are different from the typical U.S. diet. To effectively educate people from other cultures, healthcare providers need to know more about the dishes, herbs and spices common to the cuisines of other countries so they can help patients discover healthy ways of eating that fit into their cultural and personal preferences.
The AHA statement provides a toolkit of food-based suggestions that help people make practical, healthier choices. The paper offers ideas for specific servings of food per food group for various calorie levels, appropriate portion sizes and ways to change eating habits that have been proven by research, as well as methods for tracking food intake and physical activity. The statement is published in Circulation.

industry_corpus2: Health & Medicine


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2.00pm Senior race (other side of road from junior race).
Race entry £1 juniors, £2 seniors all proceeds and donations to Ardgowan Hospice in memory of Lawrence Mulaghton.
3pm onwards – presentations of prizes and thereafter Halloween Party, music, games, prizes – all members welcome. Let’s see a big turnout! En Avant!
This entry was posted in Uncategorized on October 28, 2015 by greenockglenparkharriers.


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A SUBSTANTIAL 4 STOREY Victorian terrace house positioned within reasonable walking distance of a selection of local Secondary and Primary Schools and having the advantage of the enjoyment of VIEWS ACROSS ROPNER PARK directly to the rear. The accommodation, built in 1860, retains many original features, including impressive ceiling roses, cornicing and skirting boards, and provides 2 LARGE RECEPTION ROOMS. To the first floor are 2 DOUBLE BEDROOMS and good size period style family bathroom having both bathing and showering facilities, a further 2 DOUBLE BEDROOMS and an additional bathroom are available on the top floor. The lower ground floor, currently used as offices , has the potential to provide 2 FURTHER DOUBLE BEDROOMS or be converted into a separate apartment. There is off road parking space for up to 2 vehicles to the front and to the rear is where the biggest surprise awaits! Stepping into the rear garden is a pleasure to enjoy with its colourful flowers and planting, private patio area, pond and an archway takes you through to a lawned garden and allotment area and DETACHED GARAGE accessed via a private road.
Accessed via a lobby area with impressive tiled floor and original stained glass door, the entrance hall has an open spindle staircase to the first floor, stairs down to the lower ground floor and French door to balcony with views over the garden and Ropner park to the rear. Radiator.
Bay window to the front with sash openings, feature timber fire surround with cast iron insert and log burner. Radiator. Original coving. Picture rail.
Recently refitted half tiled cloakroom with Victorian style wash hand basin and WC. Victorian style tiled flooring.
Having fitted shelving and free standing pine dresser units, centre island with butchers block wooden worksurface housing Belfast sink, plumbing for dishwasher, Range cooker with gas hob and electric oven. Bay window with sash openings and splendid views to the rear.
Having window to the rear. Newly fitted wall mounted Baxi boiler and plumbing for washer. Original tiled flooring.
Featuring a log burner, stripped wood flooring, radiator, opening sash windows to the front. Coving.
Fitted with a range of wardrobes. Radiator. Window to the rear.
Fitted with a period style suite comprising wash hand basin, shower cubicle, WC and roll top free standing bath with ball and claw feet. Radiator and cover.
Window to the rear. Storage cupboard. Radiator.
Opening sash windows x 2 to the front. Storage cupboard. Radiator.
Originally a 5th bedroom and recently converted to a high standard bathroom having roll top free standing bath, wash hand basin, WC and shower cubicle. Shaving socket. Tiled flooring. Chrome towel radiator. Storage cupboard with stripped wooden door.
With separate front and rear entrance the lower ground floor has the potential to be converted to a separate apartment/annex, or provide business space or two further bedrooms.
Door to the rear of the property. Open spindle staircase to upper ground floor.
Recently refitted half tiled cloakroom with modern wash hand basin and integrated floating WC. Solid oak flooring.
Having access from the front of the property in addition to access internally from the hallway. Bay windows, solid oak wood flooring and radiator.
Double French doors leading to the rear garden, radiator.
Block paved double width driveway to the front for parking of 2 vehicles. Stone staircase to the lower ground floor and stone stairs to main entrance. The large rear garden is a particular feature and backs onto Ropner Park. Featuring a secluded patio area, pond with railway sleeper surrounding, archway leading to lawn area leading to allotment, greenhouse, mature fruit trees and detached garage.

industry_corpus2: Real Estate & Construction


text: Fasâ QIBLA DIRECTION There are many methods to find the Qiblah direction. One of the easiest ways is using compass. Qibla direction changes from city to city or country to country depending on the distance. From this site, you will easily find Qibla direction.


text: Save the date! Annual Central District Dental Association Meeting: May 3-4,2019 Where: The Loews Sapphire Falls Resort at Universal Orlando, Orlando, FL. The C.E. is free to members and their staff.


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TUESDAY, Jan. 17, 2012 (HealthDay News) — One in three American adults and one in six American children are obese, new government reports show.
That’s the bad news. The good news is that over the past 12 years, those rates have remained roughly the same.
“The stabilization of obesity rates has been going on for some time. And, this is not just the U.S. It’s happening all over the world,” said Katherine Flegal, author of the reports and a senior research scientist with the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention.
“Even if we can just keep the prevalence rates the same, we’re doing well,” said registered dietitian Nancy Copperman, director of public health initiatives in the Office of Community Health at the North Shore-LIJ Health System in Great Neck, N.Y.
“It’s as if you’re on an expressway going 65 miles per hour. You can’t suddenly throw the car in reverse. You have to slow down before you can reverse course. Hopefully, what we’re doing now is slowing down so we can reverse course,” Copperman said.
The reports on the obesity trends — one on adults and one on children and teens — are published in the Jan. 17 issue of the Journal of the American Medical Association. Flegal is the lead author of the study on obesity in adults, and the senior author on the study on obesity in children and adolescents.
The consequences of obesity are far-reaching. People who are obese are more likely to develop type 2 diabetes, heart disease, stroke, high blood pressure, certain cancers, high cholesterol, liver and gallbladder disease, sleep apnea, osteoarthritis and gynecological problems, according to the CDC.
The estimated medical costs of caring for the obese average about $147 billion a year, the CDC estimates.
In the current study of obesity trends in adults, Flegal and her colleagues reviewed data from the most recent U.S. National Health and Nutrition Examination Survey (NHANES), from 2009 to 2010. They compared this data to older adult obesity data from 1999 through 2008. The newer set of data included nearly 6,000 adult men and women. The older set of data included almost 23,000 American men and women.
According to the latest data, the average body mass index (BMI) was 28.7 for men and women. BMI is a rough estimate of a person’s body fat. The higher the number, the more overweight or obese a person is. A BMI of 25 to 29.9 is overweight in an adult, and 30 or above is considered obese for an adult, according to the CDC. This means the average American is overweight, but not obese.
However, the rate of obesity was nearly 36 percent for both adult men and adult women in 2009 to 2010. In general, this rate has remained stable since 1999, according to the study.
Several groups did see small, but statistically significant increases in the rate of obesity over the 12-year study period. They included non-Hispanic black women, and Mexican-American women and men, according to the study.
The second study compared the most recent obesity figures (2009-2010) in children and teens from NHANES to obesity trends from six other surveys dating back to 1999 to 2000. The most recent data included 4,111 American children.
In 2009 to 2010, nearly 17 percent of children and adolescents were obese and almost 32 percent were overweight or obese, according to the study. Obesity rates from 2007 to 2008 and 2009 to 2010 stayed the same. The researchers did find an increase in the prevalence of obesity in male children and teens when they compared the most recent figures to 1999 to 2000.
In infants, overweight is measured through weight-for-recumbent length. Almost 10 percent of infants had a high weight-for-recumbent length measurement. But, this rate was the same in 2009 to 2010 as it was in 1999 to 2000, except for one group. Mexican-Americans infants were more likely to have a high weight-for-recumbent length than infants born to other groups.
Copperman also said it’s important to focus on prevention to avoid obesity in the first place. “When you look at this from a public health perspective, it’s easier to prevent something than to let it run its course and then try to treat it. Being overweight and obese isn’t just a cosmetic thing, it’s a disease,” she added.


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Organic Goodness can grace your table in many ways this Holiday.
The quality of the organic food you serve will bring health-giving nutrients to those who share in your meal.
The authentic flavors of real food will bring organic goodness to their taste buds.
The shared good times with good food will bring another kind of organic goodness, cherished memories.
I grew up in a time and place where kids went home for lunch in Elementary School. One of my fondest memories is of the Cream of Celery Soup my Dad would sometimes make for Mom and me to enjoy for my lunch break. No soup can was involved, it was pure, and full of organic goodness in all 3 ways, nutritious, full of flavor, and is still a cherished memory.
My Mom and Dad were both good cooks and did not use recipes, so I don’t have my Dad’s original to pass along. I did find a recipe that looks and sounds as good as his.
Sauce 2 the celery in 1 tablespoon butter until slightly softened. Remove 1/4 cup and reserve. Add the onion, garlic and remaining butter and cook until soft.
Whisk in the flour. Slowly add the broth and blend well, to avoid lumps. Stir in the half and half.
Puree until smooth. Stir in the celery seed and reserved chopped celery. Garnish with celery leaves or chopped organic parsley.
Celery is such an underused veggie and can be used for so much more than as an addition to stuffings and stews and sandwich fillings!
The Celery Toast (cover photo) recipe in the link below is a great idea for a Thanksgiving Hors d’oeuvre that will not stuff your family before the turkey and stuffing arrive on the table!
Steam the potatoes until almost done, and set aside.
In a dutch oven or deep skillet, fry the bacon until crisp on high heat.
Add the potatoes to the pan and a little olive oil if not enough fat from the bacon. Stir in garlic*, herbs, salt and pepper.
Cook covered until potatoes are soft and browned in the fat. Keep warm until serving time.
*If you don’t mind pieces of garlic, use minced garlic. If you prefer the flavor without the garlic bits, use smashed cloves and remove them before serving.
Every year someone asks me how to make cranberry sauce, so I am repeating my recipe here. It’s a good idea to make a batch for the Holidays and keep it ready not only as an accompaniment to meats or fish, but also as a sauce for them or for use with pancakes, French Toast, and on Biscuits.
1 cup water or juice, wine, cider, etc.
Rinse and sort the berries, removing stems. Place them in a pan with the liquid and sweetener of your choice and bring to a boil, cooking until the berries begin to “pop”.
Turn down the heat (they will pop right out of the pan on high heat!) and continue to cook, stirring frequently until thickened.. somewhere between 15-20 minutes. It will thicken a little more upon cooling.
Add some chopped apples, oranges, raspberries or apricots and cook along with the cranberries.
It seems any veggie that is stick shaped or can be cut into a stick is game for being made into a “fry” these days. So, no reason carrots should not be used. We know they are healthy, loved by kids and adults and colorful…more organic goodness.
Maybe you’d like to try these with a day-after Turkey and Cranberry Sauce Sandwich! Carrots are baked in this “fry” recipe, not truly fried.
Peel the carrots and cut them in half lengthwise. Then cut them in half horizontally until you have “French Fry” shaped sticks. If large circumference, you may have to cut them lengthwise into quarters.
Toss with olive oil, salt, and pepper. Spread the carrots in a single line on a baking sheet. Bake for 20-25 minutes, turning halfway through until browned.
For a decadent fry, toss the carrots with extra oil, 1/4 cup grated parmesan, and about 1 tablespoon garlic powder or freshly chopped organic garlic.

industry_corpus2: Agriculture & Fisheries


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Normally, horses have a set amount of gallops that can be used before you need to wait for them to recharge. Dismounting and remounting the horse immediately recharges all available gallops. Infinite Horse Stamina is a technique that dismounts and remounts a horse very quickly.
To perform the technique, you must have a shield and a bow equipped, as well as at least one arrow in your active quiver. When you want to refresh your horse’s gallops, hold target (ZL), the action button (A), and your bow button (ZR). With all three buttons held, tap the jump button (X). If done correctly, your gallops should be fully available again, despite not showing as available on the indicator.
If you fail the technique, it is recommended that you push the jump button (X) while in the air to pull out your Paraglider, which avoids damaging your shield on the landing.
This technique does not work when travelling downhill on your horse. You must be riding over flat ground or travelling uphill at the time that you press the jump button (X).

industry_corpus2: Sports


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The spanish press reported last week that Telefonica and BT may be considering an alliance in the UK. The suggestion appears to be that Telefonica would effectively swap its o2 mobile asset in the UK for a minority stake in the combined entity with BT. BT has been considering expansion into mobile, while Telefonica has reportedly been concerned by its lack of fixed and content assets in the UK market. As such, a deal could be beneficial to both.
The combination would be an incremental negative to Everything Everywhere and to Vodafone, given the emergence of a stronger competitor in the UK. However, if BT really is open to large mobile asset acquisitions in the UK, then presumably the owners of Everything Everywhere – DT and Orange – would also be open to some form of discussions at this point. Rumors have been circulating around the press that EE could very well be a strong contender for acquisition also.
BT said: “We continue to develop our own plans for providing enhanced mobile services to business and consumer customers, in line with our previous announcements. We remain confident of delivering on these plans and have also been exploring ways of accelerating them, including assessing the merits of an acquisition of a mobile network operator in the UK.
“We have received expressions of interest from shareholders in two UK mobile network operators, of which one is O2, about a possible transaction in which BT would acquire their UK mobile business. All discussions are at a highly preliminary stage and there can be no certainty that any transaction will occur.
BT said it remains “confident” of going it alone in mobile but admitted it is “exploring ways of accelerating them, including assessing the merits of an acquisition of a mobile network operator in the UK”.
Vodafone’s recent entry into the market and its growing closeness to TV giant Sky have increased BT’s sense of urgency — and it also threatens EE and O2.

industry_corpus2: Computing & Telecommunications


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Can Employers Access Current or Prospective Employee Social Media Accounts?
In an article on the website of Employee Benefit News titled, “Can employers access an employee's social media account?,” it outlines how the law is changing in some states and when there’s an exception to request social media access. Some states do not allow an employer to ask an employee to either friend them or give them access to their social media accounts. In addition, there are states that prohibit a company from asking an employee to log in to their social media site while a company representative is present and watching. Furthermore, the laws in some states also have language in them forbidding retaliation against an employee who does not provide his or her social media access. Not all states have laws pertaining to employee rights with social media, but with those that do the law often varies. If a company has employees in multiple states, it needs to be especially careful, which is why it’s always best to consult with an attorney. This blog entry, as well as the website article, should not be taken as legal advice.

industry_corpus2: Law & Justice


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Repeat those steps for other servers/networks (there must be only one checked autoconnect line per server/network).
Finally click [Save changes]. and reload.
For allowing widgets to auto-connect, please see the corresponding page in the widget namespace.
This page was last modified on 27 November 2013, at 09:42.


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Do you have a musical artist that you absolutely love that no one would ever guess you’d enjoy?
Another week has passed and it’s time for Tunes Tuesday! It’s a brand new linkup hosted by Kimberly at Kooky Runner, Steffany at Run Steff Run and me! Every Tuesday we’ll be sharing our favorite music with a different theme each week. We hope it’ll be a fun way to find new music to listen to and also get to know each other a little bit better!
Since it’s the second Tuesday of the month, the theme this week is to share some of your favorite random music! Instead of creating a playlist like I did full of motivating songs for 2017, I’m going share and talk about some of my favorite tunes from the singer Santigold, an artist you may or may not know but that I absolutely love!
I’m also joining Marcia, Patty, and Erika for Tuesdays on the Run!
I thought for this round of Tunes Tuesday that I would share my love for Santigold! Santigold is a female singer with an indie, electronic style. She has a very distinct voice that is hard not to notice! I probably started to listening to her music about 5 years ago, but her first self-titled album came out in 2008. She has since produced two more albums with a lot of great songs that I enjoy on a regular basis.
So why should you listen to Santigold? Santigold’s music has some pretty powerful lyrics and the beats are amazing. Each album has a distinct sound but is still very “Santigold”. I thought I’d share some of my favorite songs with you and you can check it out on Spotify or wherever you stream/download music!
L.E.S. Artistes – It’s the first track on the album and will always be one of my favorites!
Say Aha – This is a song I love to sing along with!
Light’s Out – This is an easygoing song that I enjoy.
I’m a Lady – The feminist in me loves this song!
Disparate Youth – This song is pretty popular and has been in various commercials. I stop whatever I’m doing when it’s on, haha!
Freak Like Me – It’s so catchy and has a great hook! It sounds similar to Rich Girl.
The Riot’s Gone – This is another slower song with great lyrics.
The Keepers – I really like this song, it has a great hook.
Can’t Get Enough of Myself – I was shopping in Old Navy the first time I heard this song, and I knew…Santigold’s back!
Banshee – Definitely one of my favorites, I just love how unique the rhythms and melody is!
Chasing Shadows – A pretty chill song.
Who Be Lovin Me – This one’s a duet with a rapper that I would otherwise not be interested in listening to! Santigold makes this song!
Rendezvous Girl – Reminds me on an 80’s song, love it!
Who I Thought You Were – Another strong track!
Third Tuesday – Pump Up Music (Fast-paced jams that get your heart pumping!) Next week’s theme!
[inlinkz_linkup id=689258 mode=0] Have you listened to Santigold’s music? What favorite tunes are you listening to lately?

industry_corpus2: Film & Entertainment


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if, for any reason, you need to cancel your child's trip to Cedar Point, the refund policy is below.
Cancellations after May 10 will not be eligible for a refund. By this date, we have already purchased entry tickets, dinner buffet tickets, and paid for transportation.
Below is information regarding our two overnight trips that take place at the Saline Middle School. Please see the other tabs to the right to view information regarding Clubs, Special Events and Student of the Month.
Trip is for 8th grade students. It will take place April 15th - 18th.
Power Points from DC Parent and Chaperone Meetings.
Please check back for more information about the trip. - The forms below will all be available on line after the parent meeting.

industry_corpus2: Subject Education


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While virtual worlds have been used for social and business collaboration for years, skill-building and training are relatively new. Successful programs must leverage the unique features of virtual worlds in the design of scenarios and activities that would be difficult to do in other learning environments. Virtual worlds lend themselves well to performance-based assessments in which individual competencies can be evaluated through simulated on-the-job scenarios. The ability to role-play, create re-enactments, and connect with others to accomplish tasks are just some of the options available to instructional and experience designers to take advantage of this platform. Virtual worlds hold a great deal of promise for collaboration, training, and visualization within the federal government. There are numerous prototype projects currently underway exploring the many ways to use this technology in the day-to-day business of government.
To learn more about Carney’s virtual environments capabilities, see Virtual Environment Case Study – Center for Development of Security Excellence (CDSE).


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I’m on a quest to find out which London butcher has the best T-Bone steak. This week I check out W H Wellbeloved, a small local butcher in Deptford, South-East London.
Deptford can only really be described as an up-and-coming area in South East London, sandwiched between Lewisham and Greenwich.
I was in Deptford to visit W H Wellbeloved butchers, a local butcher that has been operating in Deptford for almost two centuries. This isn’t a flashy or trendy butcher, it’s a simple, down to earth shop focusing on serving great meat at some really reasonable prices.
The butcher had three sets of T-Bone steak lined up on a shelf against the wall. The T-Bone steak was Scotch steak (Belted Galloway), priced at £22 per kg and aged for 30-40 days.
The Belted Galloway is a distinctive breed of cow named for it’s prominent white belt and its origin in Galloway, Scotland. This breed is known for excellent marbled beef and is thought to have been developed by crossing the continental Lakenvelder belted cattle with black Galloways.
You probably know by now that a T-Bone steak is made up of two steaks; the sirloin on one side which is a large tasty cut and the fillet on the other side which is a smaller and really tender cut.
This T-Bone had an enormous Fillet section which was significantly larger than any of the other steaks on the T-Bone tour. The reason for this is that my T-Bone came from the back of the short loin muscle where the fillet is at its largest. Steaks with large fillet sections are called Porterhouse steaks.
So all this T-Bone means I’m beginning to cook T-Bone steaks like a pro, mastering the art of a nicely seared T-Bone steak. This steak, one of the largest I’ve bought so far at 1.15kg, was a beauty.
I started with the fillet section. I carved into the fillet and it bite into it. It dissolved on my tongue. It had an amazing texture and a hint of beefiness.
The sirloin section was noticeably firmer but not chewy. It was juicy and really beefy. Despite this being an incredibly large steak, it was so good I reckon I could’ve got through another.
I’ve got to take my hat off to W H Wellbeloved Butchers, this was one of the best steaks I have ever had, served by a friendly butcher and at the lowest price point yet (and £10.50 lower than last week’s T-Bone at Hill & Szrok).
W H Wellbeloved butchers move to the top of the leaderboard for their outstanding beef and very reasonable prices (see below).
To keep up with my adventures on the T-Bone Tour of London and more butchers like W H Wellbeloved you can sign up for our newsletter.
W H Well Beloved Butcher also sells outstanding steak pies for £2.50 each. I bought one just because and it was full of enormous chunks of steak.


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Manila, 17 September 2013 – Today, Filipino motoring enthusiasts and Formula One fans had the chance to meet Scuderia Ferrari driver, Felipe Massa.
Stopping by Manila on his way to the Singapore Grand Prix, Felipe surprised motorists when he turned up at the Shell Macapagal station to personally refill a lucky customer’s vehicle with Shell V-Power Nitro+ Gasoline.
“I’m always delighted to meet our fans, but it’s even more exciting today because this is my first visit to the Philippines,” Felipe said.
Following his visit to the Shell station, Felipe then joined Shell VIPs, Shell Scientist, Mae Ascan and over two hundred guests at an exclusive event at the SM Mall of Asia.
“Shell’s close-working relationship with Scuderia Ferrari provides it with an environment to test Shell V-Power Gasoline in extreme conditions,” said Oying.
“The performance fuel also contains increased detergents designed to prevent and clean-up deposits that affect engine performance,” Mae said.
During the presentation, attendees learned that the Shell V-Power Nitro+ Gasoline that Filipinos can buy at their local Shell station contains 99% the same types of compounds found in the Shell V-Power race fuel that will be used in Scuderia Ferrari cars in the upcoming Singapore Grand Prix.
“As we near the celebration of Pilipinas Shell’s 100 years in the country, we look forward to more milestone events such as this that will allow us to show our gratitude and appreciation to the millions of Filipinos who choose Shell every day,” said Ed.

industry_corpus2: Automobiles


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Burnout, stress, endless conflict and pressure – just some of the challenges that leaders face on a daily basis.
In a business landscape that is increasingly characterised by complexity and volatility, organisations are operating in a highly-pressured and competitive environment. The result? Leaders have a limited range of knee-jerk responses: fight, flight or freeze. Using self-compassion to access ‘safe brain’ (Wickremasinghe, 2014) leaders can learn to broaden their range of behavioural choices. This enhanced range of behavioural options brings benefits such as better relationships, productivity, creativity and wellbeing. This harmonious state of affairs helps leaders to become more resilient and to create more resilient organisations.
Human behaviour is driven by three basic motivators: threat, safety and drive (Wickremasinghe, 2014). This neuroscientific approach helps us to understand the way that individuals act and it’s helpful to look at what they each mean.
‘Threat brain’ helps us to recognise threats and to immediately take action; this is the fight, flight or freeze response. As useful as ‘threat brain’ has been to our evolutionary development it cannot distinguish between real or imagined threats and struggles when faced with complexity. When a threat is perceived our body is flooded with noradrenaline and cortisol which boost energy ready for action. The brain and body quickly become fatigued from these chemicals and they can adversely impact health, reduce the ability to think openly and in a non-defensive way, inhibit the processing of new information and decrease memory.
Evolving from the need to nurture and protect the ‘safe brain’ is the opposite to ‘threat brain’, and is the soothing and contentment system. A rested and soothed self is able to make repairs in the body. Endorphins and oxytocin reduce blood pressure, stimulate the immune system, reduce anxiety and stimulate positive social interactions. According to research a mind in ‘safe brain’ can think more clearly and is able to process new information and develop insights with greater ease.
The desire to compete, achieve and accumulate things originates in our ‘drive brain’. The chemicals associated with ‘drive brain’ can be addictive, encouraging the individual to repeat those competitive and achievement-driven behaviours. Oft-regarded as desirable traits in business, competition and ambition are encouraged. However, this frequently is motivated by ‘threat’; while this may deliver results in the short term, without engaging ‘safe brain’ an unhealthy loop can be created in the long term that goes full circle back to stress, burnout and associated illnesses.
Productivity is increased – Chronic exposure to the chemicals released in the ‘threat brain’ state results in burnout. Absenteeism, or even presenteeism, prevails and the business suffers. By accessing ‘safe brain’, individuals can repair their bodies, stimulate their mind and re-engage with work.
Creativity and innovation are enhanced – “Stress causes the part of the brain that is responsible for the human capacity to integrate new information, make complex decisions and creatively adapt, to shut down” (Brown, Kingsley and Paterson, p. 144). When in ‘safe brain’, clear thinking and new insights help to break down threat-drive behaviour patterns.
Relationships become more effective – Oxytocin is released when ‘safe brain’ is accessed and this promotes attachment to and affiliation with others, leading to more positive social interactions. Attachment increases trust and when leaders trust their colleagues, relationships are more harmonious and effective.
All of these factors add up to create leaders that are healthier, feel happier and who are much more resilient. And resilient leaders mean resilient organisations too.
There’s no quick-fix kit that provides access to ‘safe brain’. It’s very much a living, working practice. The demands of corporate life increasingly mean that leaders must face complex problems that require more than linear problem-solving skills. Having access to a part of their mind that is receptive to new ideas, points of view and which is driven by inquiry instead of action provides a significant advantage.
Self-compassion is the foundation. Empathy, non-judgement, care for wellbeing, sensitivity, sympathy, tolerance to distress are all compassionate characteristics (Wickremasinghe, 2014). Access to ‘safe brain’ is much more likely in leaders who have developed in these areas.
Appreciation helps to access ‘safe brain’, as focusing on successes will help to produce oxytocin. This counteracts stress hormones and therefore reduces ‘threat brain’ behaviour.
Self-exploration encourages leaders to become aware of their own behaviour, values, and experiences in order to discover and address issues – this helps to reduce ‘threat brain’ behaviour.
Noticing how they are feeling the moment allows leaders to recognise ‘threat brain’ behaviours and to stop them before they take place. Mindfulness, meditation or deep breathing are examples of how leaders can pause for thought.
There’s no magic password that opens the door to the hallowed halls of ‘safe brain’. If there were, far fewer leader would be burnt out or suffering the ill effects of chronic stress. It takes continual practise and discipline to access ‘safe brain’; to get there, leaders must accept that there may be setbacks. When they can accept this of themselves it sets an example to the rest of the organisation, and curiosity, compassion, and creativity start to pave the way to commercial success. Isn’t that an organisation you’d like to lead?


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The Centurion Guard write protects the hard drive. Users may download, delete files, change system settings, install, even fdisk. With a simple reboot, all changes disappear and the computer is back to its default configuration.
The protection is enabled and disabled with lock and key. When enabled, any changes to the system are wiped clean when the system is rebooted bringing the computer back to its original configuration. Permanent modifications can be made to the system, but only when you want them.
No need to spend long periods of time restoring a system. Files will never be written to the hard drive, so original files will never be modified.
Unless you allow it permanent changes will not be saved to the hard drive.
with this remote administration, you can enable or disable one or all computers on your network.


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"Pay attention to what I am telling you.
The Son of Man is to be handed over to men."
As God Jesus knew that his mission for the Father would end by death on the cross. He became man, born of the Virgin Mary by the power of the Holy Spirit, emptying himself to save humankind. He entered his passion and death willingly. All because he loved us.
His disciples could not understand his statements about his impending death. How could Jesus, their Master and teacher, the one they professed as the Messiah, the one who performed marvelous deeds of healing and mercy, even raised the dead to life, suffer and die? The disciples could not understand the significance and necessity in God's plan of Jesus' passion and death.
The Old Testament Prophet Isaiah had written about the Suffering Servant. Jesus himself spoke several times about his passion, death and rising from the dead. How could the disciples understand "rising from the dead"?
Like the disciples, we too find it difficult to understand how the great teacher and miracle worker Jesus would suffer and die on the cross. We find it difficult to understand how a loving Father God could have planned things this way for his only begotten Son-become-man.
We are reminded that God's ways are not our ways. We are reminded that Jesus' passion, death and resurrection were planned by a loving God to show Jesus' and his own love for us. We are reminded that true love has no boundaries and really follows no logic.
and you who dwell in them."
Today we celebrate the Feast of the Archangels in our Catholic tradition.
Depictions of angels can be found in most specialty shops, catalogs and art stores in the forms of small, medium and large statues, pictures, on prayer cards, garden art and numerous other objects. They can be found in stain glass windows and statuary of the great cathedrals of Europe and around the world. We grow up knowing the guardian angel prayer and hope we haven’t frightened ours off by the time we have “grown up”. In the Catholic faith there are the nine choir of angels beginning with the lowest to highest ranking; Angels, Archangels, Virtues, Powers, Principalities, Dominions, Thrones, Cherubim and Seraphim. In the Church we celebrate the archangels, Michael, Gabriel, and Raphael who are mentioned in both the Old and New Testaments. Michael’s name means, “Who is like God?” We have a prayer calling on St. Michael for protection. This archangel is best known for his battle with evil, as quoted above. Gabriel is known as the messenger angel who announced to Mary that she was going to bear God’s Son. Gabriel’s name means, “God is My Strength” and is known as the Archangel of Wisdom, Revelation, Prophecy, and Visions. Raphael’s name means, “Healing Power of God”. We find this Archangel in the book of Tobit. He was sent in an answer to Tobit’s prayers and the prayers of his daughter. In this book of the Old Testament, Raphael is companion, guide, and heals Tobit of his blindness.
Angels are spiritual beings who assist God with those tasks on earth and in heaven. In the readings today from Mass we read that, “Thousands upon thousands were ministering to him, and myriads upon myriads attended him.”(Dn 7:9 – 10) What a sight that must be! All of those spiritual beings tending to God and doing what God commands. As I picture it in my mind’s eye it seems as if Heaven is a very busy place. During the Triduum I have pondered what the angels were doing as Christ went through his Passion, death and Resurrection. I can hear God telling Michael, No, hold back your angels, do not interfere. Gabriel watching with great sadness and Raphael wanting to heal broken hearts. And then great joy with Christ’s Resurrection and Ascension. And most likely they too understood the plan that God had in mind and tended to Christ on the day of Resurrection and the Ascension.
The gospel is absurd and the life of Jesus is meaningless unless we believe that He lived, died, and rose again with but one purpose in mind: To transform us into a brand new creation - both here on earth as well as in heaven.
still others, "One of the ancient prophets has arisen."
But Herod said, "John I beheaded.
Who then is this about whom I hear such things?"
In the Gospel reading King Herod wonders who this Jesus miracle-worker is: one of the prophets come back to life, Elijah-come-back, or John the Baptist raised to life? Though Herod respected John as "an upright and holy man" and "liked listening to him, although he became very disturbed whenever he heard him (Mk 6: 20), he had John beheaded at the request of the daughter of Herodias his consort.
Like Herod, we are asked the same question? Who is this Jesus of Nazareth? And, more important, what is he to us now? When Jesus asked his disciples at Caesarea Philippi, "Who do you say I am?" Peter replied, "You are the Messiah." What is our answer?
Jesus’ friends are in no way remarkable for their talent or character. He who considers the apostles or disciples great from a human or religious point of view raises the suspicion that he is unacquainted with true greatness. Moreover, he is confusing standards, for the apostle and disciple have nothing to do with such greatness. Their uniqueness consists of their being sent, of their God-given role of pillars for the coming salvation.” ― Servant of God Romano Guardini (1885 – 1968: was an Italian-born German Catholic priest, author, and academic. He was one of the most important figures in Catholic intellectual life in the 20th century.
Jesus gives us his “marching orders” in today’s reading from Luke.
He sends the Twelve out with nothing. All they had was the present moment and the knowledge that the Kingdom of God was at hand. I wonder what I would have done if my marching orders were to leave with nothing, and to proclaim the Kingdom! My guess is that Jesus would have gotten a few questions from me.
This is a good day to reflect on what I need in today’s world to proclaim the Kingdom of God. I seem to need lots of trappings. These trappings can obscure the message I am trying to preach. I need to set aside anything which clouds the truth. The truth is simple, beautiful and life-changing. God loves us. God loves us so much that we are each invited to empty ourselves (die) and be filled with new life (rise).
“Be doers of the word . . . for a doer that acts, he shall be blessed in his doing” (Jas 1:22, 25). On the other hand, “If any one is a hearer of the word and not a doer, he is like a man who observes his natural face in a mirror; for he observes himself and goes away and at once forgets what he was like” (Jas 1:23).


text: The Clemson Tigers 2016 College Football Playoff National Champions mahogany logo football display case features an antique mahogany finished base and a clear acrylic removable lid with championship team logo. It also includes a mirror bottom and back. The case is perfect for displaying your collectible football and is officially licensed by the NCAA. The inner measurements are: 12 1/4" x 8 1/4" x 8". The outer measurements are: 13 1/4" x 9 1/4" x 10". Memorabilia sold separately.


text:
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industry_corpus2: Programming


text: Rigoletto by Giuseppe Verdi. The production was originally produced for the Chicago Lyric Opera in 2000 refurbished in 2012 for the Canadian Opera Company and English National Opera. Performed by The English National Opera 2013.


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It’s been over ten years since the stock market took a major tumble that took stocks down 50%. During the next decade since then North American stocks, specifically the United States, have enjoyed the longest bull run in maybe the history of the US economy.
Despite the cries that the American empire was crumbling, the DOW Jones Industrial average has tripled since then. This means that even if you had bought stocks in 2007 before the crash and didn’t sell anything in 2008, you would still be up double. Unfortunately for the doomers, America didn’t unravel and the empire didn’t fall even with the election of President Trump.
It’s quite unusual for the economy to keep rumbling ahead, especially one that has forged ahead for the greater of a decade. Remember what the great investor Warren Buffet once said, be “Fearful when others are greedy and greedy when others are fearful”.
Last year markets tanked 20% from the peak. To begin 2019 we’ve seen the stock market surge over 10% in both the US and in Canada. As I wrote in one of my previous posts, the gains for the year might already be over. We might be seeing more volatility going forward as the interest rate hikes of last year finally take affect on average households.
One of the major headwinds that face Canadians is the ever rising debt levels of the average Canadian. Despite record low interest rates, Canadians didn’t use the opportunity to pay off debts like student loans or mortgages. In fact, opposite was quite true.
Canadians borrowed themselves silly and now the average Canadian owes over 178% of their annual income in debt. This is the average, so it means for every person with no debt like a child, there’s an adult that owes over 350% of their disposable income. This had led Canadian households to require almost 15% of their monthly disposable income to service debt payments only.
In a service and consumption economy like Canada, this is bad news. For every dollar that is spent paying interest for prior purchases, future growth is taken away. During the 2008 financial crisis, normal Canadians saved the economy by gorging themselves on debt. Now we’re starting to pay the price as normal households are starting to feel the pinch even with a 1% hike in interest rates.
Since we’re starting to see the economy slow it’s important to understand that we do not want to start panicking and making irrational decisions with our long term investments. One of the worst things to do is to sell everything in haste due to an emotional outburst.
When we sense that markets have done really well, like we already have in 2019, it’s time to reflect on our investment portfolio to see if we’re still balanced. One of the worse habits as investors is that we love chasing gains. Greed is our enemy.
Now that markets have climbed up from the 20% correction at the end last year, it’s enticing to continue to chase these gains by buying more stocks, but this is the time to re-balance. If you re-balanced at the bottom, it’s smart to re-balance at the top.
One thing to avoid doing now is buying more weed stocks, chasing Bitcoin and buying more junior oil companies that have come off their lows. The smarter play right now is to get yourself into some bonds. Play it safe, collect some interest and perhaps even see some capital gains as interest rates continue to fall.
Bonds are boring and people look at them and wonder why it’s worth buying even when they only pay a measly 2.5% in annual interest. The reason why we should all own bonds, and a great deal of them, is to protect ourselves from market corrections.
Stocks go up long term and by that I mean over a 10 year period. Why most people fail with investing is that they look short term and when losses pile up they run for the exits. Bonds are there to help during the bad times. It’s the parachute you want when stocks start falling from the skies.
Bonds have historically had a negative correlation with stocks. This means when stocks rise, bonds fall. The opposite is true when stocks fall. Bonds will rise in price as interest rates fall. This pattern has existed for decades.
Just how much bonds one should hold really depends on risk tolerance. Though for many people I feel no less than 40% should be in bonds. In fact, 90% of the people investing shouldn’t go below 40% in bonds. From my own personal experience talking to people, many cannot stomach a turbulent stock market.
A 60-40 split between stocks and bonds or even 50-50 is what most people should aim for when investing long term. This means with 20% correction in stocks, the worst an individual would lose from the market would be closer to 10%. With a 50% correction in stocks, someone holding more bonds would only see a decline around 20-25%. This is probably the most any average Canadian can stomach.
The most important thing to remember about investing is that it’s not a race to get rich. Investing is not a get rich quick scheme. It’s a lifelong commitment. Too many people think that money can be made quickly by gambling on stocks. This is NOT the same as investing passively.
This blog, and many others focusing on financial independence, have always preached a passive balanced portfolio as a way to grow wealth. What really matters to gain wealth isn’t about what we buy, but it’s about how long we stick with it.
Maintaining balance is the key to keeping your portfolio safe from stock market crashes. Just resist the urge to chase stock market gains. Be happy with the slow and steady pace. Remember, if you’re just starting off, it’s not about what you are buying, but what you are saving that matters most.

industry_corpus2: Finance & Economics