what makes a community healthy

. The identification and use of community assets and resources which both take advantage of what already exists, and teach the community what it can do with its own considerable resources. The fostering of community commitment to the process of building a healthy community. The creation of a healthy community self-image.

Section 3. Healthy Cities/Healthy Communities

"Learn how to use this framework for an inclusive, participatory process for improving quality of life and creating a healthy community. What is Healthy Cities/Healthy Communities? Why use Healthy Cities/Healthy Communities? Who should participate in Healthy Cities/Healthy Communities? How do you use Healthy Cities/Healthy Communities?25 Years of Healthy Communities Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 4:20In this video, Tyler Norris, Vice President of Kaiser Permanente Center for Total Health, discusses the meaning and impacts of community health. ""What is a healthy community? What is healthy, and what is a community?"" He asks. In this section, we will explore the concepts of defining, creating, and promoting healthy communities. What is Healthy Cities/Healthy Communities? Healthy Cities/Healthy Communities is a theoretical framework for a participatory process by which citizens can create healthy communities. In 1985, at a conference in Toronto organized by Trevor Hancock, Len Duhl spoke about his long-held conviction that health issues could only be effectively addressed through an inclusive, community-wide approach. Ilona Kickbusch, a World Health Organization (WHO) official who was attending the conference, brought the idea back to her superiors at the WHO European office in Copenhagen. Within a matter of weeks, Duhl and Hancock had been hired as consultants to help WHO and Kickbusch start a Healthy Cities movement in Europe. A year later, the attendees of a WHO conference in Ottawa drafted the Ottawa Charter, the “Constitution” of Healthy Cities/Healthy Communities. In the years since that first conference, the concept has spread to hundreds of large and medium-sized cities on all continents, and has also been used in smaller municipalities and rural communities in both the developing and the developed world. It is now the standard way in which the WHO addresses community health, and it encompasses other community issues as well. A healthy community, as we discussed above, is one in which all systems work well (and work together), and in which all citizens enjoy a good quality of life. This means that the health of the community is affected by the social determinants of health and development – the factors that influence individual and community health and development. So, what does the Healthy Cities/Healthy Communities model look like? Unlike PRECEDE/PROCEED, it has no flow chart or diagram, largely because its process may be totally different in different communities. It’s a loosely-defined strategy that asks citizens and officials to make becoming a healthy community a priority, and to pursue that end by involving all community members in identifying and addressing the issues most important to them. We have created an informal logic model in order to connect you to your Community Tool Box resources that can support your effort to implement Healthy Cities/Healthy Communities. Healthy Cities/Healthy Communities rests on two basic premises: A comprehensive view of health. As we’ve been discussing, a comprehensive view of health takes in all the elements of a community’s life, since they affect both individual health and the health of the community itself. The Ottawa Charter lays out the prerequisites for health in communities: Peace. This can be interpreted to cover both freedom from warfare, and freedom from fear of physical harm. During the Vietnam War, young black men on the streets of their home neighborhoods in the U. S. were statistically more likely to be killed by gunfire than were young black soldiers in combat. Those home neighborhoods weren’t at peace, by anyone’s definition. Shelter. Shelter adequate to the climate, to the needs of the occupants, and to withstand extremes of weather. Education. Education for children (and often adults as well, as in the case of adult literacy) that is free, adequate to equip them for a productive and comfortable life in their society, and available and accessible to all. Food. Not just food, but enough of it, and of adequate nutritional value, to assure continued health and vigor for adults, and proper development for children. Income. Employment that provides an income adequate for a reasonable quality of life, and public support for those who are unable to work or find jobs. A stable ecosystem. Clean air, clean water, and protection of the natural environment. Sustainable resources. These might include water, farmland, minerals, industrial resources, power sources (sun, wind, water, biomass), plants, animals, etc. Social justice. Where there is social justice, no one is mistreated or exploited by those more powerful. No one is discriminated against. No one suffers needlessly because she’s poor or ill or disabled. All are treated equally and fairly under the law, and everyone has a voice in how the community and the society are run. Equity. Equity is not exactly the same thing as equality. It doesn’t mean that everyone gets the same things, but that everyone gets, or has access to, what he needs. If all of these factors are considered, then health must extend far beyond medical treatment to all aspects of community life. A commitment to health promotion. Health promotion differs from the more familiar medical models of treatment and prevention. Both of these look at health from a negative point of view: there’s something wrong or potentially wrong, and the medical expert will step in to fix it or head it off. Health promotion looks at it from a positive point of view: you can take positive steps to improve and sustain your well-being. Health promotion – and we’ll use the term here to mean the promotion of healthy communities as well as healthy individuals – is a key both to the thinking behind the Healthy Cities/Healthy Communities concept, and to actually developing healthy communities. It calls for a commitment on the part of all sectors of the community, particularly government, to promote community health by: Building healthy public policy. Communities can establish policies that foster the health of the community. According to the Ottawa Charter, such policies are “coordinated action that leads to health, income, and social policies that foster greater equity.” Thus, smoking bans in restaurants, local tax policies that encourage businesses to create jobs, training for police and youth workers to help them communicate with youth and curb youth violence, and strong environmental ordinances might all be seen as healthy public policy. Community support of such policy produces an atmosphere that makes it easier for policy makers to make the right choices, because they know the public is behind them. Like all elements of a Healthy Cities/Healthy Communities strategy, healthy public policy is about a great deal more than simply fostering individual health – it’s about public policy that fosters a healthy society. That means equity, health for all, and attention to such things as supportive environments (see below). Len Duhl talks about the fact that most public policy doesn’t deal with real needs, but rather with concerns of economics and power. For public policy to be healthy, it has to reflect reality, rather than what policy makers want to see, or what will get them elected. Objectivity leads to public policy that benefits everyone, not just the influential few. Creating supportive environments. Community environments run the gamut from the physical to the social to the economic to the political. Some supportive environments can be created by laws or regulations, some by community effort, and some only by changes in attitude (which may or may not be influenced by social and other pressures). Some examples: The natural environment. Laws and regulations that restore and/or preserve clean air and water; preservation and creation of open space, natural beauty, and wilderness; restrictions on the use and disposal of toxic substances; conservation of natural resources, including plants and animals. All of these can enhance health and reduce stress, provide an aesthetic experience, and affect community life for the better. The Peak to Peak Healthy Communities Project, based in Nederland, CO, is working on renovating parks and creating a transportation link from downtown to trails and natural areas outside the city. The built environment. People-friendly design of buildings and spaces (human scale, with pedestrian passageways, gathering places, views, attractiveness, etc. ); handicap access; preservation of historic and cultural heritage; cleanliness; safety (lighting, building and bridge design, long views, traffic patterns, bans on the use of toxic materials); good public transportation; traffic-free paths to encourage walking, jogging, and bicycling. For example, a city that builds or designates traffic-free walking and bike paths will probably see more of its citizens walk and bicycle to work and on errands than one where walking and biking are difficult and dangerous. Davis, California, for instance, has encouraged bicycling since 1960, when it became the first city in the US to paint bike lanes on its streets. It has been able to discontinue its school bus service, because it’s so easy for children to bike, walk, or skate to school on its miles of car-free bike paths. The economic environment. A healthy economic environment is one where there is work for everyone capable of working, where workers are treated as assets (see directly below) and are paid a living wage, where there is equal economic opportunity for all, where those who can’t work are supported, and where money doesn’t buy political power or immunity from the law. Bethel New Life, a faith-based, grass roots initiative in the Garfield Park neighborhood of Chicago, started out to rehabilitate derelict housing in the area, using “sweat equity” – i.e., the labor of local residents, who could then exchange their work for part of the cost of the home they had rebuilt. Now, Bethel employs more than 300, mostly local residents, in housing, employment training and job placement, economic development, cultural, family support, and community development programs. Its board is drawn almost wholly from the community, and its programs are responses to voiced community need. Bethel continues to try to build assets and bring greater economic stability to the West Side of Chicago. The work environment. The work environment should be a source of stimulation, rather than stress. Respect for employees, good safety precautions and procedures, firm rules forbidding harassment or abuse, adequate pay and/or other compensation, humane and fair production expectations and treatment – all contribute to work environments that nurture creativity and enthusiasm, and improve, rather than detract from, both production and workers’ quality of life. The leisure environment. The work and home environments can provide time for leisure. The community can provide recreational and cultural opportunities to use in that leisure time: museums, parks and beaches, cultural and sports events, libraries, etc. The social environment. A healthy community encourages social networks, provides gathering places where people from all parts of the community may mingle, nurtures families and children, offers universal education and other services, strives to forster non-violent an healthy behavior, invites familiartity and interaction among the various groups that make up the community, and treats all groups and individuals with respect. The North Quabbin Community Coalition, in north central Massachusetts, was concerned, among other things, with the high incidence of child physical and sexual abuse in the area. A task force on the issue eventually developed into Valuing Our Children, a parent education and family life program, that has trained large numbers of area parents as “parent educators,” and that provides services to area families. The political environment. In a healthy community, all citizens have a say in how and by whom their community is governed, and have easy access to the information necessary to understand political situations and to make informed political decisions. Political decisions, opinions, and speech are protected. Citizens feel they have the power in the community – that they own it, and can and should control its direction. Strengthening community action. Communities can encourage and strengthen community action in at least three ways: The first involves encouraging and fostering grass roots planning and action. When issues are identified and addressed by the people affected by them, as well as by others concerned, two things happen: the issues are more likely to be resolved successfully, and the people involved learn how to use their own resources to take charge of their lives and their communities. A second way of strengthening community action is through a commitment from government, community leaders, and other decision makers to encourage action by passing legislation conducive to it, lending public support to it through the media and other communication channels, and including members of all segments of the community in the conception, planning, and implementation of any community initiative. The third is by decision makers and the media ensuring a free and accurate flow of necessary information about the community and community initiatives to all citizens, and providing everyone in the community with learning opportunities about issues and about the quality of life in general. The latter two of these methods are really top-down conceptions where government and others in power “let” citizens share in the decision-making process. While community members – particularly those with less experience in planning and running projects, or with less education – often need support to learn some necessary skills, the drive for change can and should come from them to begin with. There is a big difference between officials organizing an initiative and inviting citizens to join, and officials approaching citizens with a request to participate in envisioning and organizing an initiative. Developing personal skills. Healthy communities aid their citizens in gaining the skills necessary to address health and community issues, by providing education and information in school, home (through the media and other sources), work, and community settings. Courses, workshops, billboards and posters, TV and radio ads, newspaper articles, mailings, fliers, community meetings, presentations in social clubs and churches, the use of electronic technology – all might serve to help citizens understand an issue, and make decisions about it. The education referred to here doesn’t relate only to health and wellness issues and life skills (e.g., parenting). In fact, it could, and does, apply to all learning that touches on topics related to the life of the community – political, social, environmental, and economic issues, for instance. Furthermore, the encouragement and accessibility of lifelong learning is a mark of a healthy community. Reorienting services. To be useful to a Healthy Cities/Healthy Communities strategy, health and other human and municipal services have to change from an individual- and treatment-centered point of view to one that is community-centered and focuses on the promotion of a healthy community. It’s not only a matter of reorienting health services, but one of reorienting all services to work together toward the goal of a healthy community. Any community issue has to be viewed through the lenses of both the individual and the community. It takes a village not only to raise a child, but to pull families out of poverty, to create employment, to improve mental health, to stop violence, to safeguard the natural environment, and to create a just and equitable society. Why use Healthy Cities/Healthy Communities? There are a number of reasons to consider using the Healthy Cities/Healthy Communities framework in planning and implementing community action: Community perspective. Virtually all health and community issues are affected by (or are the direct result of) economic, social, political, and/or environmental factors that operate at the community level. If you don’t deal with those factors, the chances are slim that you’ll be able to resolve the issue you’re concerned with. Participatory planning and community ownership. Planning that includes those who will be directly affected by or benefit from any community initiative is more likely to reflect the real needs of the community than planning done only by one group. Furthermore, the participatory nature of the Healthy Cities/Healthy Communities framework means that citizens themselves create initiatives and goals for the community. Those initiatives and goals are theirs – not imposed by those in power or by outside “experts”. As a result, their commitment to the process and to the goals makes them far more likely to support and work for the outcomes they’ve chosen. Range of ideas. Citizen participation leads to the presentation and consideration of a greater range of ideas and possibilities, and is therefore more likely to hit upon effective goals and actions. Knowledge of the community. Citizen participation taps the community’s wisdom about its own history, relationships, and conflicts, and can thus steer initiatives around potentially fatal pitfalls. Community-wide ties. Involving all segments of the community encourages interaction across social, economic, and political lines. Those ties strengthen the community as a whole, change people’s perspectives for the better, increase community-wide cooperation, and can positively transform how the community works. Achievable and measurable goals. Although Healthy Cities/Healthy Communities’ ultimate goals are wide and long-term, each goal is achievable in a manageable amount of time, and its successful achievement can be demonstrated. Each success sets the stage for enthusiasm for the next initiative. Identification and use of community assets and resources. A Healthy Cities/Healthy Communities initiative depends to a large extent on human, institutional, organizational, environmental, and other assets and resources already available within the community. Through identifying and using these, communities learn that they can create their own positive change, and reshape themselves in the ways they want to. Community commitment to the long-term process. Because of the participatory nature of the process, and because it requires recruiting more people at each new phase, it builds an ever-expanding core of people with varied skills, talents, and experience committed to the ideal of building a healthy community and improving the quality of life for everyone. That’s important for sustaining the work indefinitely. Community self-image. Through the use of the Healthy Cities/Healthy Communities process, the community comes to think of itself as a healthy community, and is concerned with maintaining that image through addressing issues as they come up. Perhaps more important, it is brought to look at the larger picture as well. Holding out an ultimate goal of a totally healthy community, whether attainable or not, keeps everyone working toward it, and means that planning goes on as a matter of course. The healthy community ideal becomes embedded in the self-image of the community, and people understand that they can take their fate in their own hands and work to improve it. The process itself thus becomes an important element in the definition of a healthy community – one in which citizens work together to identify and solve problems, create and consolidate assets, generate improvements, and raise the quality of life for all. Who should participate in Healthy Cities/Healthy Communities? The easy answer to this question is everyone in the community, and that’s in fact the ideal. In a perfect world, everyone everywhere would participate in some way in creating a healthy community. In the real world, while it’s important to try to involve all sectors of the community, you have to work to involve some particular people and groups if your effort is to be successful. Crucial participants include: Elected and appointed officials. Although a Healthy Cities/Healthy Communities initiative should not be top-down, it needs the commitment and backing of those with the power to make things happen. Officials can use the media to publicize the effort, pass laws and regulations (and enforce those already existing) that reinforce it, and throw the weight and resources of government behind it. Without official support, a community-wide effort is more likely to fail. Those most affected by the issue. A sure recipe for failure is to try to impose an intervention or initiative on a population “for their own good.” All too often, “experts” – often people who have no real knowledge of the group or its issues – formulate plans that might make perfect sense on paper, but make no sense at all in the actual situation for which they’re proposed. The participation of those affected in identifying the issues to address, developing action plans for addressing them, and implementing and overseeing those plans is absolutely crucial to the success of a Healthy Communities initiative. (This is equally true when the group concerned is the whole community. )There are, unfortunately, many instances of a group resisting and short-circuiting well-meaning changes because they weren’t part of the planning. The author experienced one as a teacher in Philadelphia, which had, at the time, an innovative and progressive school superintendent. He tried to institute reforms that probably would have improved the lives of teachers students in the system, but he did it without conferring with them. As a result, the teachers simply ignored directives from the central office, the reforms failed, and the superintendent was gone within three years. The people who will actually administer and carry out the initiative, or whose jobs or lives will be affected by it. It is both unfair and unwise to expect organization staff, community employees (police, firefighters, Department of Public Works personnel, etc. ), business people, and others to throw themselves into carrying out an initiative they had no part in devising. It may have elements that ignore the realities of their jobs or their lives, or that make things harder than necessary for them, and they may be the only people who have the information to understand that. In addition, they may regard it as just another foolish imposition to be gotten around, and do as little as possible to make it effective. All the agencies and groups that will need to cooperate and to coordinate their activities in order to implement a community-wide effort. Both the ways in which these groups will work together, and which of them will have responsibility for what have to be part of the planning for any community-wide initiative. Without their full participation, there’s no guarantee that they’ll work together at all, let alone that the methods for their doing so will be simple and efficient. Community opinion leaders. These are the people whose opinions others trust, and who lead the community by adopting new ideas and pulling others with them. They are seen as level-headed, smart, and serving the best interests of the community. Some may be current or former members of the groups already listed, and others may be clergy, credible institutional or business people (college presidents or faculty, CEO’s), or just average citizens who are known for their integrity and common sense. If you can gain the participation of members of all these groups, it is more likely that everyone else will follow. If you can’t get people from all these groups to buy in at the outset, an alternative is educating them about the process and persuading them to join it, while you continue to recruit other participants. Ultimately, the combination of education and your momentum will bring in those who were initially reluctant. That may take time and patience, but it’s worth the effort – it can easily mean the difference between a successful long-term Healthy Community movement and a dead-on-arrival, failed attempt at one. How do you use Healthy Cities/Healthy Communities? Because the Healthy Cities/Healthy Communities framework is just that – an intellectual framework, rather than a prescription – there is no step-by-step instruction for employing it. It is meant to be adapted to the different needs of different communities. There are, however, necessary components of any Healthy Cities/Healthy Communities initiative: Create a compelling vision based on shared values. As with virtually any process that involves planning – and particularly participatory planning – the first step is to create a vision that defines the effort to be made. That vision may be broad (“A community that is truly just and equitable”) or more specific (“A community where every potential worker in the community can find employment that offers a living wage and acceptable working conditions”). Whatever the case, the vision must be compelling – one that motivates people to work for its realization. It must be founded in those values that they hold in common, and must be widely shared and recognized as legitimate and desirable. ( Proclaiming Your Dream: Developing Vision and Mission Statements. )In Orlando, Florida, the Healthy Community Initiative began with meetings of a few influential people. As they learned about healthy communities, the convened a group of about 160, representing all sectors of the city’s population – citizens of all races and economic levels, organizations and institutions, city government, other groups – to hash out a vision. That group, in turn, conducted citizen focus groups and public meetings to hear and understand citizens’ concerns. Ultimately, they drafted a vision, based on their own discussions and the input of hundreds of others from all walks of life, that contained 14 statements about what Orlando should be. That vision became the foundation of the initiative. Embrace a broad definition of health and well-being. Health must be seen as not merely the physical health of individuals, but the creation and nurturing of those factors leading to health named in the Ottawa Charter (peace, shelter, education, income, food, a stable ecosystem, sustainable resources, social justice, and equity). A truly healthy community encompasses – or works toward – all those elements and more. Address quality of life for everyone. The key word here is “everyone.” A Healthy Cities/Healthy Communities initiative should be aimed at improving the quality of life for all groups and individuals in the community, not just those in a particular target group or those who began the initiative. Engage diverse citizen participation and be citizen-driven. Initiatives should be originated, planned, and implemented with the full participation of citizens from all racial, ethnic, and socio-economic groups and all walks of life. Citizens themselves, rather than a government agency or experts of some sort, should be the force behind both the direction and the implementation of any community initiative. Seek multi-sectoral membership and widespread community ownership. All sectors of the community – government, the business and non-profit communities, health care, education, faith communities, cultural institutions and the arts, target populations, and ordinary citizens – should be represented in an initiative, and the community should feel that it created the initiative and owns it. In many places in this and other sections of the Community Tool Box, we refer to “ownership” of an initiative or intervention or organization. In most cases, what we mean is that those who take part in creating and/or running such an endeavor feel that it belongs to them. It was their idea, and they therefore see themselves as not only supportive of it, but responsible for it. True ownership can rarely, if ever, be attached to actions or ideas that are imposed, by others who “know better” or have more power. It comes from within, from the feeling that you’ve made a choice based on your best judgment. That’s why the inclusion of people from all sectors of the community is so important to a successful Healthy Cities/ Healthy Communities process. At the end, perhaps after a lot of argument and soul-searching, participants feel that they’ve had a hand in creating something important that will result in better lives for everyone in the community. There’s no substitute for that feeling to ensure their doing all they can to make their creation work. Acknowledge the social determinants of health and the interrelationship of health with other issues (housing, education, peace, equity, social justice ). The research on the social determinants of health points to three overarching factors: Socioeconomic equity. For developed countries, the economic and social equality within the society or a given community is a greater determinant of death rates and average lifespan than the country’s position with regard to others. The size of the income gap between the most and least affluent segments of the society or community is tremendously important, and determines to a large extent whether people get what they need. Social connectedness. Many studies indicate that “belonging” – whether to a large extended family, a network of friends, a social or volunteer organization, or a faith community – is related to longer life and better health, as well as to community participation. Sense of personal efficacy. This refers to people’s sense of control over their lives. People with a higher sense of efficacy tend to live longer, maintain better health, and participate more vigorously in community affairs and politics. Like the Ottawa Charter, the World Health Organization, in its publication The Solid Facts, recognizes the need to break these factors down into more manageable pieces. It lists ten factors that affect health and life expectancy, and advocates addressing each within a coherent program that looks at all of them within a society. These ten factors are: The social gradient (equity)Stress Early life Social exclusion (the opposite of social connectedness)Work Unemployment Social support Addiction Food Transport Address issues through collaborative problem-solving. Given a diverse group, there are bound to be disagreements and conflicts. These should be viewed as opportunities, rather than roadblocks, and people should be encouraged and helped to work together to reach creative solutions. Focus on systems change. To be successful, a Healthy Cities/Healthy Communities initiative has to be active, rather than reactive. It’s not enough to “fix” a problem: your goal is to eliminate the causes of that and other problems and improve the long-term quality of life in the community in the process. In order to address causes, you have to concentrate not on individual problems, but on improving and changing systems – the ways in which the community operates, and the attitudes, assumptions, and policies behind them. That includes identifying, using, and strengthening the assets the community already possesses, as well as changing the systems that pose problem Build capacity using local assets and resources. All communities, no matter how troubled, have great real and potential strengths. These vary from community to community, but could include: Individuals with the talents, skills, leadership, and passion to work to change the community for the better. Individuals, businesses, and foundations that can provide material resources – money, space, etc. – to a community effort. Institutions – libraries, schools, hospitals, houses of worship – that have the capacity to act as both resources for and agents of change. Community-based and other organizations whose mission is to work for the betterment of the whole community. Governments and individual government officials that can add both official support and legal and regulatory power to an initiative. Human resources – the skills and work ethic of the community’s work force, for example. Natural and other environmental resources – open space, clean air and water, wilderness, fisheries, historic sites or buildings, housing stock. Perhaps most important, the potential for all these individuals, groups, and resources to be joined in a coordinated pursuit of a common vision. At least some of these and other assets already exist in virtually every community – usually to a far greater extent than most citizens realize until they start looking for them. They must be identified and included in a Healthy Cities/Healthy Communities effort. Measure and benchmark progress and outcomes. Whatever you’re doing, whether it’s a PR campaign or a complex behavioral intervention, you have to monitor and evaluate it in order to be sure that it’s effective. That means setting objectives – benchmarks – to indicate your progress along the road to your goal, and defining clearly the outcome you’re aiming for. Regularly monitoring what you’re doing is crucial, because it allows you to spot problems or inadequacies in goals, methods, procedures, communication, etc. and correct them before they derail your initiative entirely. Even more important, regular monitoring allows you to change what you’re doing to respond to changes in circumstances and community needs, so that you’re always addressing current reality. Communities are dynamic: they develop and change, sometimes in short periods. Your initiative has to be dynamic, too, especially if you expect it to continue for the long term. Implementing a Healthy Communities strategy How do you actually put these components together to create a healthy community? There’s no one way to do that – it depends on your community, the issues you want to address, and the ideas and capacities of the groups and individuals that participate in the Healthy Cities/Healthy Communities process. There are, however, some basic procedures that, at least in outline, should be common to any Healthy Cities/Healthy Communities initiative. Assemble a diverse and inclusive group. To begin a Healthy Cities/Healthy Communities initiative, people from all parts of the community have to come together to hammer out a vision. That group, as we’ve been saying throughout this section, should be representative of everyone in the community, so that whatever it decides will be seen as legitimate by just about everyone, and will be owned by the community. Someone has to start the process. That may be a charismatic or persistent individual, an organization, a coalition, or a government office or agency. Whoever it is should be simply a convener, and not necessarily expect to lead over the long term. Leaders should be chosen by the group itself as it forms, and they should be collaborative ( Collaborative Leadership . )This is not to say that a Healthy Communities effort doesn’t need leadership. Quite the contrary – leadership and structure are necessary for any successful effort. But leadership should be collaborative and arise from the community. The leader may be an individual, or two, or a larger group. Whatever the situation, the leadership should be one of an equal among equals, and decision-making should be the province of the whole group. That’s how a participatory process works. It is assumed that all the other steps listed here will also be carried out by an inclusive group, and that all sectors of the community – including those affected and individual citizens – will be represented and have decision-making power. The group may change from step to step or over time, but should remain inclusive and participatory. Generate a vision. A vision of how the community should be, based not on a single issue, but on values shared among all participants and on a high quality of life for everyone in the community, is needed to motivate and inspire participants and to guide the initiative over the long term. Generating such a vision may take time and a great deal of discussion, but it’s absolutely necessary for a successful effort. Assess the assets and resources in the community that can help you realize your vision, and the issues that act as barriers to it. Placing assets first is not just an accident here. A Healthy Cities/Healthy Communities initiative is best served by looking at the community through a positive lens, and asking first what’s right with it, rather than what’s wrong with it. The initiative then becomes an exercise in community health promotion, instead of the treatment of a diseased community. Taking a positive perspective affects for the better the attitudes of everyone involved, the community’s self-image, and the perception of whether or not realizing your vision is possible. By the same token, it’s important to be honest and clear-eyed about issues and problems in the community. Once they’ve been identified, they have to be acknowledged and understood, so they can be addressed at some point in the process. Choose a first issue to focus on. The best way to sink a long-term initiative is to try to accomplish all your goals at once. It’s vital to choose one issue – or in some cases, perhaps, two or three – to attack, and to make it one that can be resolved, so that your first effort leads to success. What the issue is doesn’t matter, except in that it must be one chosen by citizens as important to them, and must be one that is specific enough to be resolvable. Len Duhl talks about the process in a 1993 interview by Joe Flower in Healthcare Forum Journal. The first thing that happens when the Healthy Cities program develops in a new place is that some persons assume the responsibility of bringing together all segments of the community to deal with the issues: the business community, the government, the voluntary sector and the citizens themselves. ... Then there are ""vision workshops"" in which people are asked, ""What kind of city do you really want?"" My personal surprise is that the clearer I am about what a Healthy City program is, the less likely a community is to develop it. The fuzzier I am in what a Healthy City is, ""A Healthy City is what you want to make it,"" the greater the odds are that they will start. The various participants define the program. All I say is that you have to start someplace. You have to begin to look at it in an ecological and systemic way. You have to involve people. You have to start thinking of values of equity and participation. Beyond that, you can start wherever you want. Some cities start on the environment, on pollution, on smoking, seat belts and the quality of life index. Some have government operations, some have newspapers, big organizations, housing. Barcelona linked it to the Olympics. Glasgow linked it to developing itself as the cultural capital of Europe. It is being done every way. Develop a community-wide strategy, incorporating as many organizations, levels, and sectors as possible. Here’s where Healthy Cities/Healthy Communities differs most from many logic models and other methods that are clear on exactly how to go about planning and carrying out an initiative. Rather than offering a step-by-step process, HC might use any participatory planning process that incorporates a community-wide approach and that looks at all the possible areas that might affect the issue chosen. Thus, you might use VMOSA, PRECEDE/PROCEED, or some variant, or a less structured process – whatever seems appropriate and works for your community. It is important, however, that your plan result in a community-wide, multi-pronged approach. If your focus is on youth violence, for instance, it should involve some sort of action or supportive function by local government, parents and parent advocates, schools, law enforcement, the court system, welfare, agencies that deal with youth and families, physical and mental health services, Family Planning, the media, adult literacy (dropouts), and potentially or formerly violent youth and their victims. All of these groups and individuals should be working together as a team, each referring youth to other appropriate services or agencies among them, and all coordinated and collaborating in their operation. The focus should be on changing the systems that make a problem possible, or that present barriers to the ideal the community is working toward. Implement the plan. Once again, this should involve a community-wide effort. Any oversight of the implementation should include a broad range of individuals and groups, representing a cross-section of the community. Monitor and adjust your initiative or intervention. Once you’ve implemented your plan, it’s crucial to evaluate the effectiveness of both your process (Are you doing what you set out to do?) and your results (Are you reaching your benchmarks? Are you having the planned effect on the issue?) If an evaluation gives unsatisfactory answers to any of these questions, you can revisit the issue, determine the reasons your plan isn’t working well, and change it accordingly. Establish new systems that will maintain and build on the gains you’ve made. Once you’ve reduced youth violence, for example, you still have to do whatever is necessary to make sure it doesn’t rise again, and that it continues to decline. (What’s the ultimate goal here? Is there an acceptable level of youth violence?) That may mean setting up new organizations or programs, working to change or cement changes in community attitudes and procedures, redesigning school curricula, working regularly with the media – whatever it takes to sustain progress. Celebrate benchmarks and successes. Public celebration of achievements not only energizes those who have been working toward them, but informs the community that the drive toward a healthy community is moving forward successfully. It helps to establish the idea of a healthy community in the public mind, and to build a foundation for the continuation of the initiative. Tackle the next issue (s). The ultimate goal here is the development of a truly healthy community, which translates to improving the quality of life for everyone in the community. After your first success, it’s time to use your momentum to address another (or more than one other) issue. That may be the removal of a barrier to a healthy community, or it may be the creation of a necessary element of a healthy community. In either case, it means sustaining citizens’ commitment to an ongoing and long-term process, the end result of which is a community controlled by its residents, where all systems work toward the public good. In Summary The health of a community, like that of an individual, depends on far more than freedom from pain or disease. Health, or its lack, for a community is the result of a large number of factors, often intertwined, that span the social, economic, political, physical, and environmental spheres. Virtually any community issue has an effect on, and is affected by, the overall health of the community as a whole, and therefore should be approached in a community context. Healthy Cities/Healthy Communities provides a philosophical framework for an inclusive, participatory process aimed at raising the quality of life for everyone, and creating a truly healthy community. Two basic premises underlying the Healthy Cities/Healthy Communities concept are a comprehensive view of health and community issues, covering a broad range of factors that contribute to a healthy community; and a commitment to the active promotion of a healthy community, rather than the “treatment” of problems. By addressing the social and other determinants of health and community issues (including the Ottawa Charter’s list of peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity), and by creating appropriate policy and environments, encouraging social action, providing personal skills, and reorienting services to a more wide-ranging approach, communities can foster citizen empowerment and equity. Reasons for adopting the Healthy Cities/Healthy Communities approach include: Its community perspective, leading to a more effective approach to issues. Community ownership of any effort, resulting from community participation in its development and implementation. The broad range of ideas gained from a participatory process. Its access to citizens’ knowledge of the community, helping to avoid pitfalls caused by ignorance of community history and relationships. The forging of community-wide and ties that cross economic, social, racial, and other lines. Participatory planning leading to solutions that reflect the community’s real needs. The adoption of achievable goals, leading to success

While a Healthy Cities/Healthy Communities process should involve everyone, some particularly important participants include local government and officials; those affected by the issue (s); those who will actually administer and implement the initiative, or whose lives or jobs will be affected by it; any organizations that will be expected to work together; and opinion leaders. There are 10 important components of a Healthy Cities/Healthy Communities process: Create a compelling vision based on shared values. Embrace a broad definition of health and well-being. Address quality of life for everyone. Engage diverse citizen participation and be citizen-driven. Multi-sectoral membership and widespread community ownership. Acknowledge the social determinants of health and the interrelationship of health with other issues (housing, education, peace, equity, social justice). Address issues through collaborative problem-solving. Focus on systems change. Build capacity using local assets and resources. Measure and benchmark progress and outcomes. Although there is no one step-by-step procedure for a Healthy Cities/Healthy Communities initiative – both the content and the structure of the process depend upon your community’s needs, and, particularly on community decisions – there is, given the ten components above, a reasonable way to approach it in most cases. Assemble a diverse and inclusive group. Generate a vision. Assess the assets and resources in the community that can help you realize your vision, and the issues that act as barriers to it. Choose a first issue to focus on. Develop a community-wide strategy, incorporating as many organizations, levels, and sectors as possible. Implement the plan. Monitor and adjust your initiative or intervention. Establish new systems that will maintain and build on the gains you’ve made. Celebrate benchmarks and successes. Tackle the next issue. "


phone number for groupone healthsource

ers What is the phone number for Groupone Health Source? The phone number for Groupone Health Source is (573) 893-8567What is the internet address for Groupone Health Source? The website (URL) for Groupone Health Source is www.grouponehealthsource.com.

Groupone Health Source, Inc.

"Groupone Health Source, Inc. Action Contact Information Groupone Health Source, Inc.1002 Diamond Rdg Jefferson City, MO 65109Contact: Arun Murali Title: Chief Executive Officer Phone: (573) 893-8567Website: www.grouponehealthsource.com There are 14Companies located at 1002 Diamond Rdg, Jefferson City, MO 65109Map Map data ©2018 Google Terms of Use Sign in38°34'11.7""N 92°14'17.6""WView larger map View larger map Directions Business Description Groupone Health Source is located in Jefferson City, Missouri. This organization primarily operates in the Data Processing and Preparation business / industry within the Business Services sector. This organization has been operating for approximately 14 years. Groupone Health Source is estimated to generate $2.7 million in annual revenues, and employs approximately 60 people at this single location. Sector: Business Services Category: Data Processing and Preparation Industry: Data Processing and Preparation SIC Code: 7374Name: Groupone Health Source, Inc. Year Founded: 2004Engaged In: Manufacturing Importing Exporting State of Inc: Indiana Location Type: Single Revenue: $ 2,684,567Employees Here: 60Facility Size: N/A* Revenue & Employees are estimates Server Error in '/' Application. Object reference not set to an instance of an object. Description: An unhandled exception occurred during the execution of the current web request. Please review the stack trace for more information about the error and where it originated in the code. Exception Details: System. Null Reference Exception: Object reference not set to an instance of an object. Source Error: Line 5:
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Is Arun Murali the only contact you have for Groupone Health Source, Inc.? On Buzzfile's Professional (subscription) Service we have 4 contacts for Groupone Health Source, Inc. How big is Groupone Health Source? Groupone Health Source is estimated to generate $2.7 million in annual revenues, employs approximately 60 people at this location Where is Groupone Health Source located? Groupone Health Source is located at 1002 Diamond Rdg, Jefferson City, MO 65109. This location is in Cole County and the Jefferson City, MO Metropolitan Area. Are there other companies located at 1002 Diamond Rdg, Jefferson City, MO? There are 14 commercial tenants at 1002 Diamond Rdg, Jefferson City, MO. How many people work at Groupone Health Source? Groupone Health Source has approximately 60 employees at this location. Is there a key contact at Groupone Health Source? Arun Murali is the Chief Executive Officer at Groupone Health Source. You can contact Arun at (573) 893-8567. Where is Groupone Health Source incorporated? Groupone Health Source is incorporated in the state of Indiana. What are the annual sales for Groupone Health Source? Groupone Health Source generates approximately $2.7 million in annual sales. How long has Groupone Health Source been in business? Groupone Health Source has been in business for approximately 14 years. Who is the CEO of Groupone Health Source? The CEO of Groupone Health Source is Arun Murali. "


what are legacy matters

Your Legacy Matters is an important book that teaches us how to harvest and pass on our love and wisdom to those who matter to us. Comment 3 people found this helpful. Was this review helpful to you?

Your Legacy Matters: a Multi-generational Guide for Writing Your Ethical Will

"4.0 out of 5 stars A thoughtful, reflective resource for expressing your legacy By Richard O Weijo on September 22, 2014Format: Paperback Verified Purchase This book is for those individuals who are considering writing a legacy letter but ask themselves ""What should I write?"" Your Legacy Matters is reflective and spiritual. This book is not to be rushed through. I found it best to read each chapter and reflected upon it before moving forward. Each chapter speaks to different aspects of legacy - a few examples include blessings, linking past and future generations, personal relationships, regrets, and aging. Instead of writing just one (or a few) legacy letters, the author encourages writing a variety of letters to different people on different topics. The author encourages writing draft letters, lettings them sit for a few days or a week, and then revising and editing them. Some legacy letters can be given to recipients immediately, some are given at upcoming special events, some are left in a legacy file or safe deposit box with directions to be given at death, and finally, some are used to understand oneself and are eventually destroyed. A thoughtful, reflective resource for expressing your legacy. Comment 2 people found this helpful. Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars Amust for every family. By Roni on December 19, 2015Format: Paperback Verified Purchase Interesting way to leaving a written legeacy for your children. Sometimes we need to give our children our blessing for different parts of their life. this book helps you write what you really have kept inside . very easy book to understand and has examples to give you ideas of what and how one could/should start and say. I will be writing mine in 2016. Comment Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars Time to Get Started!By morninglyn on April 14, 2014Format: Paperback Verified Purchase This is a great book to show you how to write your ethical wills. Starting with the ""why"" you should do this, it provides a step-by-step guide for getting it done. Since there is no guarantee as to how long we will live, legacy writing is a way to link the past with the future. Rachal Freed has provided us with the means and motivation for doing this. Comment 2 people found this helpful. Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars Five Stars By Sister Barbara Klodt on March 14, 2017Format: Paperback Verified Purchase Book has valuable information. Comment Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars Five Stars By Shopper on April 11, 2015Format: Paperback Verified Purchase Outstanding!Comment Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars DISCOVERING YOUR OWN TREASURE ISLANDBy BRIAN on September 8, 2013Format: Paperback... it is urgent for legacy writers of every age to write legacy letters now--to one another, other loved ones, and to future generations--given the uncertainties of life and the momentum of change in our times."" p. 2 ""It takes a village to raise a child""; but at what stage of life do we not need a village? My observation is that our emphasis on independence has left the ""civil contract"" a bit tattered. One might say that many have forgotten how to be a village. We are a village in the midst of wilderness wanderings. A nomadic people need the experience of those in the second half of life to survive. Those in the second half of life have experienced the intricacies of relationships, and have adapted to the wide ranging changes that have always been and always will be part of surviving. Rachael Freed, through her years of legacy work, teaching, speaking, and writing has become an experienced guide. Through Your Legacy Matters she helps us to do so much more than survive; she guides us in uncovering the treasure that we have accumulated over the journey. This treasure becomes the legacy of values we offer through the writing of legacy letters in which we offer stories and blessings to those we know and love, as well as those who come after. Your Legacy Matters offers what is necessary for people to recognize they have a legacy worth leaving to the next generation. The world needs people who are growing not only older, but wiser. Rachael offers us a process that lets us reflect upon the big picture of our lives. Wisdom is not about learning anything new but rather gaining a different perspective. The process of reflection and writing offers us new vantage points from which to look upon our lives. Through questions and examples she sharpens our awareness of where we have come from, who have been our companions on the way, what experiences and ideas have shaped us. A photo in an album with a name and a date does not remain a bare fact, but becomes a full story. A chance encounter, a piece on the news, a song on the radio, a sunrise shared are identified as transformative moments. Even more comes to life as we look to the future, revealing our hopes and dreams for the ones we love as well as the ones yet to come. We say what we have found important. We bear witness to lives lived fully. The letters that we write and the blessings that we offer become the treasures of another generation. Through working the process in Your Legacy Matters we recognize that we have not been alone in our wilderness wanderings. We may find that some of the stones we've stumbled over and cursed have turned out to be exceedingly valuable; our experience, strength, and hope allows us to take our place among the villagers, to draw together in a celebration of life as we offer encouragement and support to each other and those yet to come. Comment 5 people found this helpful. Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars Freed shares that beautiful ancient tradition with a broader audience in ""Your Legacy ... By Sue Schuerman on March 29, 2015Format: Paperback I was first introduced to legacy writing through Rachael Freed's book ""Women's Lives, Women's Legacies."" Reading that book and completing the exercises was a pivotal experience for me. Now, Freed shares that beautiful ancient tradition with a broader audience in ""Your Legacy Matters."" Through gently guided exercises, men and women learn to focus on what really matters in their lives. Legacy letters are different from memoir or autobiography because the intention is to pass along the meaning or lesson of the story to those who come after us. Legacy writers are the link between the past and future generations. In ""Your Legacy Matters,"" Freed gives us the tools we need to pen our wisdom, insight, life stories and special messages. As a Life Legacies Facilitator, I find this book invaluable. Comment One person found this helpful. Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars Your Legacy Matters--A Treasure Trove of Wisdom!By john b nienstadt on March 1, 2014Format: Paperback Your Legacy Matters is a treasure trove of Legacy wisdom and ideas for community. As a professional storyteller and legacy letter community facilitator I have found this book an amazing tool to use with community. Recently, I utilized the beautiful exercises on writing about an ancestor who inspired you. I work with Veteran Care Partners--all women. These women immediately, took paper and pen and wrote and wrote. Each shared a legacy story with passion, touching the other women in the circle. Each of the group members felt nourished. Rachael Freed's legacy work is extremely important in our ""aging"" world. This is book is stellar!!! Carla Vogel Comment 2 people found this helpful. Was this review helpful to you? Yes No Report abuse5.0 out of 5 stars This Book Matters By Joanne Turnbull on September 23, 2013Format: Paperback Here in the Information Age,human connection is more important than ever. Rachael Freed knows this, and in this new book, she provides clear strategies to help people connect, not only with family and friends in the here and now, but with ancestors and future generations.

Yes No Report abuse5.0 out of 5 stars Wise and practical By portlandcarol on October 24, 2013Format: Paperback I am just knocked out by the flow and readability and practicality of this book. Somehow, Rachael got her own voice, legacy writer's voices, and wisdom voices all going in the same direction, to our benefit. Comment 3 people found this helpful. Was this review helpful to you? Yes No Report abuse "


what are mofongo

Classic mofongo is redolent of garlic; a generous dollop is key. Mofongo may be served as a starchy side or the base of a protein-laden main course. Chicken, shrimp, and pernil, a.k.a. slow-cooked pork shoulder, are traditional toppers. Hearty and homey, mofongo combines the best flavors Puerto Rico has to offer.

"Mofongo: Puerto Rican Plantain Mash Recipe and Video In this video from our series, Around the World in 80 Dishes, chef Sergio Remolina of The Culinary Institute of America shows you how to make mofongo, the Puerto Rican staple that is a beloved national dishshare Facebook Tweet pinit googleplus emailprintdish video Recipe Mofongo (Puerto Rican Plantain Balls)Mofongo is pure Puerto Rican soul food, and no culinary tour of the country is complete without a heaping helping. This hearty dish of mashed plantain mixed with chicharrónes, or pork cracklings, and chicken stock resembles thick, golden mashed potatoes.

No wonder it's a national favorite. Puerto Rico isn't the only country with a dish like this. Mofongo is thought to have evolved from fufu, an African staple made by mashing starchy roots, like cassava or true yams, to yield a nutritious mass. Plantain mashes are hugely popular in the Spanish-speaking Caribbean islands and parts of South America. Cuba calls theirs fufú Cubano, the Dominican Republic has mangú, and Ecuador has bolones, or balls of plantain purée. Although indigenous to Southeast Asia, plantains traveled early to India and Africa and proliferated there, before a Spanish Dominican friar brought them to Hispaniola (the island now shared by Haiti and the Dominican Republic) in the early 1500s. Plantains quickly adapted to the tropical areas of the Americas. According to Maricel Presilla, author of Gran Cocina Latina, plantains ""are an import from the Old World that flourished here [the New World] wherever Africans settled."" Mofongo, along with the other plantain mashes, ""are the legacy of slavery and the Columbian Exchange,"" says Presilla. Amazingly, the plantain isn't a root but rather a fruit that in its firm, green, unripe state, cooks up into something resembling a mildly flavored starchy tuber or vegetable, making it ideal for mashing. The plantain resembles its close cousin, the banana, but the fruit is larger, the skin is thicker, and the flesh is only edible when cooked. What makes plantains so versatile—and one of the reasons why they were adopted so quickly in the Caribbean—is that they can be eaten at every stage, from unripe green fruit to ripe yellow and even black-ripe. As the fruit ripens, the flesh becomes quite sweet. Because green plantains are so firm, they aren't easy to peel, like bananas. In this video, Culinary Institute of America chef Sergio Remolina shows you how to slice off the ends, then cut the peel lengthwise along the visible sectional lines of the plantain, which allows you to remove the skin in big sections—but expect to expend some energy doing it. He then cuts the plantain into 1-inch sections and fries it slowly in oil so that it cooks through without taking on too much golden color. Nowadays mofongo can be made with a food processor, but Puerto Rican chefs agree that nothing compares to one made in a traditional pilón, a high-sided wooden mortar with a large blunt pestle. Chef Remolina demonstrates a single portion of mofongo in a small pilón by first pounding the garlic with salt and olive oil until it looks like a creamy aioli, before adding the fried slices of plantain. Then comes the fun: mashing! As you push down on the plantains on one side of the pilón, the mash gets pushed up along the other side of the mortar, ready to be mashed in again. Chicken or other stock is added to lubricate the process and bring moisture to the mixture. Add chicharrónes and bacon to the pilón and keep mashing. A large pilón would allow you to make multiple servings at once. Mofongo is an absolute indulgence—fun to say, fun to make, fun to eat. Top with chopped fresh herbs, like cilantro, or more crushed chicharrónes. It's often served bathed in rich chicken broth, accompanied by rice and beans. Experiment with different ingredients and make mofongo your own. Text by Megan Labrise and Kemp Minifie, illustrations by Matthew Brennan Nigerian Akara (Black-Eyed Pea Fritters)South African Bobotie Lamb Khorma from Northern India Southern Indian Masala Dosas Malaysian Chicken Curry Coq au Vin from Burgundy, Francesee more dishes ›Get more information about The Culinary Institute of Americanext: video ›share Facebook Tweet pinit googleplus emailprint "


what is deck over on gooseneck trailers

Us From farm machinery to vehicles, supplies and equipment, deck over trailers are designed for maximum capacity hauling with widths up to 101 and 1/2"". Whether you're hauling cars, construction equipment or supplies, we offer a variety of deck over trailers with innovative features for every need.

Deck Over Trailers

"SEARCH DECKOVER TRAILERSDeck Over Trailers We know what it takes to build a trailer that’s tough and innovative. Our standards are high and we put a lot of time into selecting the deck over trailers we feature on our lot. Looking for additional trailer features? We can customize trailers and truck beds specifically for you. Contact

Check out our deck over trailers from top manufacturers including Aluma, Belmont and BWise. Need help finding the right deck over trailer? Our inventory of deck over trailers is constantly changing. Tell us what you're looking for, and we'll help you get the best solution on your hitch. View Deck Over Trailers for Sale Aluma Deck Over Trailers Aluma’s aluminum deck over trailers are recognized for being more durable than steel, perfect for securely transporting 4-wheelers, dirt bikes and more. Regardless of which you choose, they’re built to last. New Aluma trailers even come with an all-inclusive five-year warranty. Belmont Deck Over Trailers With Belmont, you get high-quality deck over trailers from a leader in trailer manufacturing. Belmont offers standard deck over trailers, gooseneck styles and an impressive deck over tilt model for easy loading and unloading. It’s not just a trailer, it’s a Belmont. BWise Deck Over Trailers BWise offers high-quality deck over trailers with innovative features you won't find anywhere else. Bwise's line of deck over trailers include flatbed and gooseneck styles with impressive hauling capacities up to 24,000 pounds. Why settle for less? Make the Wise choice. Looking for additional trailer features? We can customize trailers and truck beds specifically for you. Here are just a few of the features we can add for you. Ladder Racks Spare Tire Mount Standard and Custom Tool boxes Industry Tools Winches Sliding Winch Tracks E-Track and Tie Downs Don’t see what you’re looking for on this list? CONTACT USDeck Over Trailers Previous Aluma Trailers We carry Aluma- aluminum trailers, including landscape trailers, open utility trailers, enclosed trailers and a variety of specialty trailers for hauling cars, ATVs, motorcycles and snowmobiles. All Aluma trailers come with a full five-year warranty. Bri-Mar Trailers We carry a variety of trailers by Bri-Mar, which is one of the largest hydraulic dump trailer manufacturers in the country. They also manufacture a full line of equipment trailers, utility trailers, tilt trailers, car trailers and pick-up truck dump inserts. BWise Trailers Our BWise trailers are high-quality trailers with innovative features you won't find anywhere else – besides Pine Hill. Choose from a wide variety of deck over trailers and dump trailers in a variety of sizes. These trailers come with or without a gooseneck design. Bauxlite Trailers The aluminum deck over and gooseneck trailers manufactured by Pine Hill are known as Bauxlite trailers. You can be confident in knowing these trailers are built to the Pine Hill standard when it comes to durability and innovation. Belmont Trailers We carry a Belmont trailer for almost every need. Choose from medium and heavy-duty models of a variety of trailers, including deck over trailers, dump trailers and utility trailers to help you haul everything from mulch to cars. Next "


is keppra medication a barbiturate?

Reports of KEPPRA causing BARBITURATES POSITIVE: 2 Reports of any side effect of KEPPRA : 19758 Percentage of KEPPRA patients where BARBITURATES POSITIVE is a reported side effect: 0.0101% FDA reports of any drug causing BARBITURATES POSITIVE : 52 Average percentage for all medicated patients where BARBITURATES POSITIVE is reported as a complication: 0.0003%P

Study of possible correlation between BARBITURATES POSITIVE and KEPPRA

Introduction This page is designed to help you determine the relationship, if any, between KEPPRA and BARBITURATES POSITIVE. In doing so, we compare KEPPRA with other drugs that cause BARBITURATES POSITIVE, to help you evaluate whether or not KEPPRA causes BARBITURATES POSITIVE. Likewise, this page shows the most highly-reported side effects of KEPPRA, so you can see if BARBITURATES POSITIVE ranks among KEPPRA's most well-known side effects. Summary Statistics

hysician opinion on KEPPRA as adverse event culprit: Overall opinion for all reports of this drug: Highly Suspected - 7090Unlikely - 8065Possible Culprit - 4520


what is a vector source in microbiology

Best Answer: Biological Vector: An arthropod vector in whose body the infecting organism develops or multiplies before becoming infective to the recipient individual. Mechanical Vector: An arthropod vector which transmits an infective organism from one host to another but which is not essential to the life cycle of the parasite. Biological e.g Tick - Lyme Disease

Science & Mathematics Biology What is the difference between biological and mechanical vectors? I remember my teacher saying one hurts and one doesn't, but can't remember which is which. I'd just like to know the differences and maybe some examples of each. Thanks :)1 following 3 answers Answers Relevance Rating Newest Oldest

Mosquitoes - Malaria Sand fly - Leishmania Mechanical e.g, Housefly picking up salmonella with its feet and depositing it on human food Source (s):http://medical-dictionary.thefreedictionary.com/biological+vector http://wiki.answers.com/Q/Give_examples_of_biological_versus_mechanical_vectors Oliver 사랑 Gothic · 6 years ago4 0 Comment Asker's rating Biological Vector Source (s):https://shrinks.im/a8s Zeholcey · 1 year ago0 0 Comment For the best answers, search on this site https://shorturl.im/avhc S Good question. This concept thoroughly confused me for a whole week in college before I asked for explanations. In physics, vectors have to do with direction and magnitude. In biology, a vector is an agent, probably a plasmid, used to transfer a DNA sequence of interest to an organism (usually a bacterium). They are completely unrelated. Christina · 2 years ago0 0 Commentwhat the difference between biological and mechanical vectors? Lina · 2 years ago1 0 Commentmechanical vector are vectors that are mainly transmit parasite either by picking of droping eg cockoach while biological are vectors in which parasite undergo developing within it eg mosquito.? · 2 years ago2 0 Comment Maybe you would like to learn more about one of these? Need a DUI Attorney? Graphic Design Degrees Considering an online college? Looking for a new chandelier?


lemon juice = how much lemon

Sent by Cara Editor: Cara, here are standard measurements for lemon and lime juice:• 1 lemon yields: 3 tablespoons juice • 1 lime yields: 2 tablespoons juice Now, of course there are variations between fruits of different sizes, and there will also be variations depending on what kind of extraction you use.

How Much Juice Is In a Lemon?

"Good Questions How Much Juice Is In a Lemon? Faith Durand Jul 11, 2012Share Email Q: In recipes that call for the juice of one lemon or lime or other citrus fruit, how much are they asking? 1/4 cup? 1/8 cup? Some fruits are very juicy, and fruit size can vary too. I also have a tendency to wring out every last drop of juice! It'd be nice to have a standard measurement to go off of.

But a good recipe should also specify the actual quantity needed, unless it's a looser recipe for a salad dressing or something like that. Next question? Related: Citrus Tips: Get the Most Juice from Limes & Lemons (Image: Faith Durand)You Might Also Like This Is Absolutely the Best Way to Cook Chicken Breasts The Basics Behind Making Fluffy, Tasty Quinoa The 4 Best Methods to Keep Mashed Potatoes Warm Jamie Oliver's Chicken in Milk Is the Best Chicken Recipe The Best Thing You Can Do For Your Bathroom for $25 [AT]What NOT To Do When Decluttering Your Home [AT]Save This Story Share Email7 Comment s Subroutine 3 years ago I'm a man of average strength. I have measured this several times in the past using store bought whole lemons. I consistently get about 2 & 1/2 tbls of juice by hand squeezing and a full 1/4 cup when using a lemon juicer. Flag Reply Annie Calif 4 years ago Thank you!! had a hard time locating this website, but now that I've found you I'll definitely keep in touch. Bless you, - - annie Flag Replycarinb 6 years ago We have a lemon tree in our garden, so I love making lemon meringue pie, but I've had wildly varying juice yield from the lemons. One week they all looked perfectly ripe, but three ""normal sized"" lemons didn't yield nearly enough juice, so I had to go lemon hunting in the dark, with my torch to find a few more. Two weeks later, I had a handful of smallish lemons, that yielded double the amount of juice I needed, so I made pie and a warm lemon drink. ps The recipe calls for a volume of juice, can't remember how much now, but it's a lot. Flag Reply Show 4 more comments Join the Conversation!Enter your email to sign in or to create an account Next Need help? Click here. "


fish city grill phone number

it3Fish City Grill - Sugar Land15980 City Walk, Sugar Land TX 77479Phone Number: (281) 494-3474

Fish City Grill Locations & Hours near Toronto

1Fish City Grill - Pearland11200 Broadway St, Ste 380, Pearland TX 77584Phone Number: (713) 340-1493Store Hours Hours may fluctuate Distance: 2,097.29 km Edit2Fish City Grill - Katy23501 Cinco Ranch Blvd, Ste S-140, Katy TX 77494Phone Number: (281) 693-3474Store Hours Hours may fluctuate Distance: 2,103.42 km Ed

Store Hours Hours may fluctuate Distance: 2,107.08 km Edit4Fish City Grill - Harker Heights201 E Central Texas Expy, Ste 1480, Harker Heights TX 76548Phone Number: (254) 953-2474Store Hours Hours may fluctuate Distance: 2,111.13 km Edit5Fish City Grill - Aurora6105 S Main St, Ste F103, Aurora CO 80016Phone Number: (720) 214-3474Store Hours Hours may fluctuate Distance: 2,124.82 km Edit6Fish City Grill - Highlands Ranch8433 S Park Meadows Center Dr, Ste 144, Highlands Ranch CO 80010Phone Number: (303) 643-0224Store Hours Hours may fluctuate Distance: 2,146.32 km Edit7Fish City Grill - Georgetown1019 W University Ave, Georgetown TX 78628Phone Number: (512) 864-7400Store Hours Hours may fluctuate Distance: 2,148.42 km Edit8Fish City Grill - Austin4616 Triangle Ave #200, Austin TX 78705Phone Number: (512) 494-6323Store Hours Hours may fluctuate Distance: 2,177.24 km Edit9Fish City Grill - Austin4200 S Lamar Blvd, Ste 300, Austin TX 78704Phone Number: (512) 442-3474Store Hours Hours may fluctuate Distance: 2,187.53 km Edit10Fish City Grill - San Antonio15900 La Cantera Pky, Ste 19160, San Antonio TX 78256Phone Number: (210) 530-4584Store Hours Hours may fluctuate Distance: 2,294.38 km Edit1 2View all Fish City Grill locations »Show Map Fish City Grill Avg. Customer Rating No reviews yet Useful Links Add a Fish City Grill Store


how much money can i make before i file taxes

me. If you work for a church or nonprofit group, you must file a tax return for earnings in excess of $108.28. Bottom Line You could potentially earn thousands of dollars in a small business and pay no taxes. Your expenses to earn the income may be greater than the income earned. Your Schedule C profit or loss calculations may reflect a loss.

How Much Income Can a Small Business Make Without Paying Taxes?

A small business requires recordkeeping and payment of taxes. You may be the only employee of a small business, operating as a self-employed independent contractor, but federal income taxes apply to your income. A sole proprietorship is the simplest form of business to set up. You are the owner, and the liabilities of the business are your liabilities. Calculating profit and loss determines income, and you can subtract expenses from income to determine tax liability. Keep careful records for a small business to determine tax liability. Taxation You must pay taxes on the income for a small business. You must also pay self-employment taxes for income in excess of $400 for your small business. If you have an employee, you must withhold federal and maybe state income taxes along with Social Security and Medicare taxes. You pay federal and state unemployment taxes for your employee as well. Self-employment taxes cover your Social Security and Medicare taxes to provide for your future. If you have a sole proprietorship, you file IRS Form 1040, Schedule C and Schedule SE if your net income is greater than $400. Net income is your gross income less expenses incurred in earning the income. Net income determines your tax liability for a small busines

s. General Rule You can earn $400 in excess of expenses without paying taxes for a small business, but many types of businesses have different limitations. The U. S. tax system requires that you pay as you earn. Most small businesses must file quarterly tax estimates, paying an estimated amount for income and self-employment taxes.

If you anticipate you will owe more than $1,000 in taxes, the IRS expects you to make quarterly tax payments. Once you start a small business, you must file a tax return for your business every year, regardless of the profit or loss. Special Rules Farming, fishing, government employees, aliens and nonprofit workers have different regulations for self-employment taxes and reporting small business income. Ministers and clergy have special rules for self-employment and small business inco

If the IRS considers your small business as a hobby, you cannot subtract losses from your other income. You must run a business for profit to deduct losses. The IRS considers a profit for three years out of the last five years as a business, but less than that may turn your small business into a hobby for IRS purposes.


strenuously definition

When you do something strenuously, you work really hard at it. After working strenuously on your neighbor's farm all day, you'll be exhausted and ready for a break. The adverb strenuously is good for describing activities or actions that require hard work. You can play strenuously during your high school football team's final game, working up a sweat, or you can argue strenuously during a debate. In either case, what you're doing is seriously demanding.

strenuously

"strenuously

The Latin root is strenuus, which means ""active, vigorous, or keen. ""Thesaurus Definitions of strenuously1adv in a strenuous manner; strongly or vigorously“he objected strenuously to the stand his party was taking”Word Family Usage Examples "


how car gears work

For example, an engine might produce its maximum horsepower at 5,500 rpm. The transmission allows the gear ratio between the engine and the drive wheels to change as the car speeds up and slows down. You shift gears so the engine can stay below the redline and near the rpm band of its best performance.

How Manual Transmissions Work

"NEXTToday's car transmissions come in standard, manual, CVT and even automated manual. 00ONE/ISTOCKIf you drive a stick-shift car, then you may have several questions floating in your head. How does the funny ""H"" pattern that I am moving this shift knob through have any relation to the gears inside the transmission? What is moving inside the transmission when I move the shifter? When I mess up and hear that horrible grinding sound, what is actually grinding? What would happen if I were to accidentally shift into reverse while I am speeding down the freeway? Would the entire transmission explode? In this article, we'll answer all of these questions and more as we explore the interior of a manual transmission. Cars need transmissions because of the physics of the gasoline engine. First, any engine has a redline — a maximum rpm value above which the engine cannot go without exploding. Second, if you have read How Horsepower Works, then you know that engines have narrow rpm ranges where horsepower and torque are at their maximum.

Ideally, the transmission would be so flexible in its ratios that the engine could always run at its single, best-performance rpm value. That is the idea behind the continuously variable transmission (CVT). We'll talk about that next. Tech Stuff CLASSIC: What Do Transmissions Do? In a classic Tech Stuff episode, Jonathan and Lauren explain the purpose of a transmission and how it actually works.00:32:23Share Subscribe1 … 7 8 NEXTPrint | Citation & Date | Reprint Flash plugin failed to load More to Explore Related Content Can you return a used car? 1968 Dodge Charger R/T Hemi The Five Most Collectible Ferraris "


what are the steelers worth

Pittsburgh Steelers Net Worth is 1,100 $Million. Pittsburgh Steelers Net Worth is 1,100 $Million. The Pittsburgh Steelers are a professional football team based in Pittsburgh, Pennsylvania. The team currently belongs to the North Division of the Ame The Pittsburgh Steelers are a professional football team based in Pittsburgh, Pennsylvania.

"How Much Is Pittsburgh Steelers Net Worth· In Businessmen, Sport Team Read more...

The team currently belongs to the North Division of the American Football Conference in the National Football League . Founded in 1933, the Steelers are the oldest franchise in the AFC. Pittsburgh has won more Super Bowl titles , won more AFC Championship Games and played in and hosted more conference championship games than any other AFC or NFC team. The Steelers share the record for most Super Bowl appearances with the Dallas Cowboys . The Steelers won their most recent championship, Super Bowl XLIII, on February 1, 2009. The Steelers were founded as the Pittsburgh Pirates on July 8, 1933, by Art Rooney, taking its original name from the baseball team of the same name, as was common practice for NFL teams to do at the time. The ownership of the Steelers has remained within the Rooney family since its founding. The current owner is Art's son,... Read more about How Much is Pittsburgh Steelers Net Worth Pittsburgh Steelers Latest News Steelers’ Villanueva Makes Special Delivery To Veterans The Pittsburgh Steelers have teamed up with the Veterans Place of Washington Boulevard to help a few vets who have fallen on hard times; KDKA's David Highfield reports. CBS Pittsburgh 4:34Posted: April 6, 2018, 4:09 pm Steelers Rumors: Stevan Ridley Re-Signs with Pittsburgh on 1-Year Contract The Pittsburgh Steelers will retain running back Stevan Ridley after re-signing the veteran to a one-year deal, according to Adam Schefter of ESPN. Ridley only appeared in two games for Pittsburgh last season, but he finished the year with 108 rushing ... Posted: April 3, 2018, 7:07 pm Friday Night Steelers Six Pack of questions and open thread: Offseason Edition, Vol. 12Randy Fichtner heads back to his old stomping grounds for Memphis Pro Day The Pittsburgh Steelers new offensive coordinator was back at Memphis to watch the team’s Pro Day. Steelers host four defenders in the latest round of official Pre-Draft visits ... Posted: April 6, 2018, 4:02 pm Steelers’ David De Castro on NFL’s heads-up rule: ‘Might as well take the ball away while your at it’Steelers guard David De Castro ... It’s like the nature of the game,"" De Castro told the Pittsburgh Post-Gazette. “I just can’t wait until the referees come into training camp like they do every year, and they show us the videos of what to do and ... Posted: April 6, 2018, 7:33 am Stadium - Pittsburgh Steelers | Are Steelers Mishandling Le'Veon Bell's Contract Situation? The Steelers are reportedly not prioritizing RB Le'Veon Bell's contract situation and could use the franchise tag on Bell for the second consecutive season. Bell had 1,291 rushing yards and 655 receiving yards with Pittsï¿½Posted: April 6, 2018, 6:25 am Related Topics: How Much Is Pittsburgh Steelers Earnings, How Much Is Pittsburgh Steelers Income, How Much Is Pittsburgh Steelers Net Worth, How Much Is Pittsburgh Steelers Salary, How Much Is Pittsburgh Steelers Worth, Pittsburgh Steelers, Pittsburgh Steelers 2013 Schedule, Pittsburgh Steelers Age, Pittsburgh Steelers Bio, Pittsburgh Steelers Coaches,Pittsburgh Steelers Country,Pittsburgh Steelers Date Of Birth,Pittsburgh Steelers Depth Chart,Pittsburgh Steelers Draft Picks 2013,Pittsburgh Steelers Earnings,Pittsburgh Steelers Ethnicity,Pittsburgh Steelers Gossips,Pittsburgh Steelers Height,Pittsburgh Steelers History,Pittsburgh Steelers Home Town,Pittsburgh Steelers Images,Pittsburgh Steelers Income,Pittsburgh Steelers Injury Report,Pittsburgh Steelers Job,Pittsburgh Steelers Merchandise,Pittsburgh Steelers Message Board,Pittsburgh Steelers Nationality,Pittsburgh Steelers Net Worth,Pittsburgh Steelers Networth,Pittsburgh Steelers News,Pittsburgh Steelers Partner,Pittsburgh Steelers Place Of Birth,Pittsburgh Steelers Post Gazette,Pittsburgh Steelers Quarterbacks,Pittsburgh Steelers Radio,Pittsburgh Steelers Record,Pittsburgh Steelers Rookie Mini Camp,Pittsburgh Steelers Roster,Pittsburgh Steelers Rumors,Pittsburgh Steelers Salary,Pittsburgh Steelers Schedule,Pittsburgh Steelers Schedule 2013,Pittsburgh Steelers Secrets,Pittsburgh Steelers Super Bowls,Pittsburgh Steelers Tickets,Pittsburgh Steelers Training Camp,Pittsburgh Steelers Videos,Pittsburgh Steelers Weight,Pittsburghsteelers.com,Who Is Pittsburgh Steelers, "


when was larry nassar convicted

“We, like so many others, are outraged and disgusted by the conduct of which Larry Nassar is accused. We are sorry that any athlete has been harmed during her or his gymnastics career. Dr. Larry Nassar pleaded guilty to child porn possession in July 2017.

Olympic gymnast McKayla Maroney says team doctor repeatedly molested her

Olympic gymnast Mc Kayla Maroney says team doctor repeatedly molested her BY Jessica Chia Nicole Hensley Graham Rayman NEW YORK DAILY NEWS Updated: Wednesday, October 18, 2017, 8:31 PMfacebook Tweet email Two time Olympic medalist Mc Kayla Maroney revealed on Wednesday that her former USA Gymnastics doctor sexually abused her for seven years — starting when she was just 13. Maroney identified convicted sex offender Larry Nassar as her repeat abuser in a statement inspired by the #Me Too movement, which encourages those who’ve been victims of sexual harassment or sexual assault to speak out. Nassar has been accused of molesting dozens of young athletes associated with USA Gymnastics and his Michigan State University clinic. He is being sued by more than 125 women claiming he sexually assaulted them under the pretense of medical treatment. Molly Ringwald reflects on years of sexual harassment on set Maroney became a viral sensation during the 2012 Olympics in London when she famously scowled on the podium after winning just the silver medal in the vault event. President Obama doubled down on the “Mc Kayla Is Not Impressed” meme in a photo with her in the Oval Office in November 2012. Mc Kayla Maroney stands with her silver medal at the London 2012 Olympic Games. Maroney came forward as a longtime victim of sexual assault in a statement inspired by the “Me too” movement. (THOMAS COEX/AFP/Getty Images)But Maroney on Wednesday said her famous scowl came on the heels of one of Nassar’s abusive episodes.“It seemed whenever and wherever this man could find the chance, I was ‘treated,’” Maroney wrote. “It happened in London before my team and I won the gold medal, and it happened before I won my silver.”'Good Morning Britain' pressed guest over Harvey Weinstein Maroney, now 21, said her 2012 Olympic victories were marred by his abuse. In a statement to ABC News Wednesday, USA Gymnastics said it “admires the courage of those, like Mc Kayla Maroney, who have come forward to share their personal experiences with sexual abuse.

(Robert Killips/AP)We are strengthening and enhancing our policies and procedures regarding abuse, as well as expanding our educational efforts to increase awareness of signs to watch for and reporting suspicions of abuse, including the obligation to immediately report,” the organization added. Bob Weinstein accused of making unwanted advances on TV producer Maroney said Nassar’s abuse began at a Karolyi training camp in Texas and continued until she retired from gymnastics last year. She said the worst of the abuse took place during the 2011 world championships in Japan, when she became a breakout star. She said Nassar gave her a sleeping pill on the flight to Tokyo and she woke up in his hotel room, once again “getting a ‘treatment.’”“I thought I was going to die that night,” she wrote. She remembered watching the 2004 Olympic games in Athens as an 8-year-old and said she had hopes of one day competing. And while she fulfilled her dreams, she lamented the abuse she suffered along the way.‘Scream’ star Skeet Ulrich says he knew about Harvey Weinstein Mc Kayla Maroney says she was repeatedly molested by Dr. Larry Nassar. (Jae C. Hong/AP)“Sure, from the outside looking in, it’s an amazing story. I did it. I got there, but not without a price,” she added. It’s unclear if Maroney is a plaintiff in the federal lawsuit against Nassar. FBI Agent Rod Charles testified in his 2016 child porn case that Nassar targeted victims as young as six. He would tell his victims that the abuse, which often involved digital penetration, would help treat hip or back pain, according to court papers. Nassar tried to dispose of several hard drives, which were filled with tens of thousands of child porn images, according to a transcript of his arraignment. He pleaded guilty to child porn possession in July and is awaiting trial in three criminal cases alleging that he sexually molested nine girls, including nine gymnasts seeking treatment for injuries.#Me Too pic.twitter.com/l YXa DTu Os S— mckayla (@Mc Kayla Maroney) October 18, 2017He has pleaded not guilty to those accusations, and his attorney said Nassar intends to go to trial in December. Jamie Dantzscher, 35, was an early accuser of Nassar. She, too, claimed he abused her while claiming to be providing her with medical treatment. She won a team bronze in the 2000 Olympics in Sydney. Rachael Denhollander has alleged that Nassar abused her five times when she was 15 in Nassar’s office at Michigan State. Denhollander told the Indianapolis Star that Nassar abused her treating her for back pain in 2000. Three-time national champion rhythmic gymnast Jessica Howard was another victim. In an op-ed in the New York Times this year, she called for “additional systemic change ... to safeguard athletes from psychological and physical abuse.”With News Wire Services. Sign up for BREAKING NEWS Emailsprivacy policy Tags: mckayla maroney larry nassar fbi sex crimescrimes against children olympics gymnastics Send a Letter to the Editor Join the Conversation: facebook Tweet


who was a doctor tha

Dr. Tha Cha is a physiatrist in Fresno, CA. He helps patients to recuperate from injury or disease to enjoy a higher quality of life.

Tha Cha, MD

Make an Appointment+ Locations, Office Hours & Directions H-care Inc.125 E Barstow Avenue , Suite 118, Fresno , CA93710 map Call for an Appointment


what is twilled dutch weave

Twilled Dutch Weave is produced by a combination of the features of the Dutch Weave and the Twilled Weave. Fill wires are passed alternately over and under two warp wires forming a fine mesh in one direction and a coarse mesh (mesh wire, woven wire mesh, wire mesh basket) in the other.

TYPE OF WEAVE FOR WIRE MESH

TYPE OF WEAVE FOR WIRE MESHHow to measure wire mesh? Plain Weave is the most commonly used and simplest wire cloth weave. Each warp wire (wire running-parallel to length of cloth) passes alternately over and under the wires running traversely through the cloth (fill or shoot wires) at 90 degree angles. It has an extremely wide range of applications. Dutch Weave is produced by the use of coarse mesh (mesh wire, woven wire mesh, wire mesh basket) in the warp and a fine mesh with relatively smaller wire in the fill. This weave results in greater strength with very fine openings and is primarily used as a filter cloth. The shape and position of the openings aid particle retention and increase filter cake formation. Twilled Weave is produced by passing each fill wire alternately over and under two warp wires. The pattern is staggered on successive warp wires, giving the appearance of parallel diagonal lines. This weave allows the use of proportionately heavier wires in a particular mesh count (number of openings per lineal inch) than is possible in plain weave. This cloth has a wide application capable of supporting greater loads and finer filtrations.

This type of weave is capable of supporting greater loads than the Dutch Weave, with finer openings than the Twilled Weave. It is used in applications where the filtering of heavy material is necessary. Reverse Dutch Weave is produced by the use of coarse mesh (mesh wire, woven wire mesh) in the warp and a fine mesh with relatively smaller wire in the fill. This weave results in greater strength with very fine openings and is primarily used as a filter cloth. The shape and position of the openings aid particle retention and increase filter cake formation. Five Heddle Weave is produced by passing each fill wire alternately over and under five warp wires. The pattern is staggered on successive warp wires, giving the appearance of parallel diagonal lines. This weave allows the use of proportionately heavier wires in a particular mesh count (number of openings per lineal inch) than is possible in other weave. This cloth has a wide application capable of supporting greater loads.