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Updated NASS Guidelines on Multidisciplinary Low Back Pain Treatment

D. Scott Kreiner, MD, co-chair of the NASS Evidence-Based Guideline Development Committee, shares details on the updated multidisciplinary recommendations for nonspecific low back pain. Plus: Chiropractors offer their take.

Editor's Note: New clinician comments posted at end of article.

The North American Spine Society (NASS) published Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care in early 2020.1 Developed by a group of multidisciplinary spine specialists, the guidelines are the first by NASS to address low back pain as a symptom potentially due to a variety of diagnoses rather than as a specific disease.

The guidelines focus on a specific subset of patients – those with nonspecific low back pain – which excludes patients with leg pain below the knee or neurologic deficits that may indicate a specific cause of the back pain, such as disc herniation.

Recommendations were developed for diagnosis and treatment of nonspecific low back pain in patients 18 years and older. These recommendations were based on 82 clinical questions identified by guideline participants as pertinent to addressing the clinical issues of diagnosing and treating low back pain. Evidence for the recommendations came from a systematic review of the evidence up to February 2016. A total of 45,000 articles were reviewed.

A range of evidence exists for the treatment of nonspecific low back pain – but a combination of therapies may be best. (Image iStock)

This article focuses on treatment recommendations, which the guideline breaks down into four categories:

  • Medical and Psychological Treatment
  • Physical Medicine & Rehabilitation (PM&R)
  • Interventional Treatment
  • Surgical Treatment

PPM spoke to D. Scott Kreiner, MD, co-chair of the NASS Evidence-Based Guideline Development Committee, to gain some insight into how the guidelines were developed, what they mean for clinical practice, and ongoing issues that still need addressing to better treat a condition that diminishes the quality of life for many people.

PPM: What was most difficult in shaping the treatment recommendations overall?

Dr. Kreiner: The biggest challenge when developing all sections of this guideline was keeping the recommendations as specific to the patient population with our pre-defined inclusion and exclusion criteria. Before starting the literature search, we spent a lot of time defining ‘low back pain.’

Ultimately, we decided to focus on non-radicular low back pain that excluded conditions such as the presence of neurological deficit or leg pain experienced below the knee, among others. We came across many studies that we could not include in our analysis because the patients had radicular pain or there was no subgroup analysis. This caused us to exclude well-known and well-designed studies that just didn’t meet our inclusion criteria. Overall, it was a strength to have recommendations that focus on this specific patient population.

PPM: When looking at each of the four treatment approaches, what can clinicians put into practice today based on these recommendations? In turn, what should they avoid that perhaps has been commonly used until now?

Dr. Kreiner: One of the biggest benefits of a clinical guideline is that it provides actionable information that providers can use in their daily practice.

For the medical and psychological treatment of nonspecific low back pain, there were a few high-level recommendations that can help steer a clinician’s practice. In particular, cognitive-behavioral therapy (CBT) and treatments targeting fear avoidance – when used in combination with physical therapy – are effective at reducing pain in this group of patients. There was also high-level evidence against the use of antidepressants as a treatment for low back pain.

Studies on PM&R for patients with nonspecific low back pain provide high-level evidence that aerobic exercise improves pain, disability, and mental health. As a practitioner, you can feel comfortable providing information such as this to your patients. Unfortunately, within the narrow scope of nonspecific, non-radicular low back pain, many of the questions did not have adequate evidence to provide an answer.

Interestingly, spinal manipulative therapy in this narrow scope of patients was shown to be no better than no treatment, medications, or modalities. Therefore, for this particular group of patients, this treatment is probably not indicated.

For interventional treatment, the evidence in support of most of these treatments were excluded because interventional treatments are not typically recommended for nonspecific low back pain. Grade B recommendations (ie, based on fair evidence) were given in support of medial branch radiofrequency ablation (RFA) in patients with low back pain from the zygapophyseal joints, as well as the use of intradiscal steroid injections in patients with low back pain and Modic changes on MRI scan.

Surgical treatments tend to be directed at a specific cause of pain and therefore, by definition, not treatments for nonspecific low back pain. While the workgroup attempted to identify how patients with back pain respond to various fusion techniques, nearly all studies evaluated included patients with leg pain or spondylolisthesis, excluding them from evaluation.

PPM: How do these recommendations change approaches to back pain?

Dr. Kreiner: The recommendations in all sections of this guideline are specific to the defined patient population (that is, patients without leg pain, neurological deficits, and other exclusion criteria defined in the guideline). The recommendations may not be the same as other guidelines for low back pain in general, demonstrating that these patients should not necessarily be treated the same way as patients who do experience those conditions.

These multidisciplinary recommendations may change approaches to low back pain care for this specific subset of patients instead of being grouped together with all patients with low back pain.

PPM: Some have noted that there are some limitations with the final recommendations given that the data period used to shape the guidelines culminated in February 2016. What’s your take?

Dr. Kreiner: Yes, the evidence surrounding spine care is constantly evolving. It is definitely possible that, if this guideline were updated with a revised literature search date, evidence that is more recent could alter the existing recommendations. The only way that would be possible is if a systematic review was completed again and the new evidence met the pre-defined inclusion criteria. For example, even if the recently published studies provide good evidence, if they involve a patient population excluded in our guideline (such as patients with radiculopathy) without a subgroup analysis, they would not be included in our analysis and would not have any impact on the existing recommendations.

Further, we could not rely on a single article that may potentially change a recommendation, because there may be conflicting evidence that we are not aware of until a complete search is done…. Updating guideline recommendations is a complex process. This specific guideline took significantly more time than a typical guideline due to the volume of literature and multiple participants, among other factors.

PPM: What is still needed in the different treatment approaches to improve back pain care?

Dr. Kreiner: The workgroup provided future recommendations for research for each question.

For medical and psychological treatment, for example, recommendations include the need for high-quality prospective studies that clearly identify what types of psychosocial intervention in what frequency, timing, duration, and combination that is most effective for the treatment of low back pain and the development of registries that collect information regarding psychological factors that can influence low back pain and quantitative analysis of this information.

For PM&R, recommendations include the need for higher quality studies to show the benefits of the addition of cognitive-behavioral therapy in this patient population and the effectiveness of rehab programs before and after surgery for low back pain as we defined it.

For interventional treatment, we included the need for RCTs of radiofrequency denervation of the lateral branch nerves following lateral branch blocks, and randomized controlled trials comparing the various nerve ablation techniques of the lateral branch nerves for sacroiliac joint (SIJ) pain.

For surgical treatment, we recommended undertaking additional randomized controlled trials comparing surgical treatment to medical/interventional treatment in patients with low back pain only without a history of prior lumbar surgery.

PPM: Given the current evidence supported in this guideline, do you think there is now a consensus on how to treat low back pain?

Dr. Kreiner: First, it is important to emphasize again that this guideline focuses on a very specific patient population. Even within this subset of patients, low back pain is a symptom rather than a diagnosis, and treatment should be individualized. The main consensus on the treatment of low back pain throughout all treatment sections in the guideline is that it needs to continue to be individualized.

The NASS Low Back Pain Guideline is not intended to be a fixed treatment protocol and the ultimate judgment regarding any specific procedure or treatment is to be made by the provider and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution.

Editor's Note

The following Letters to the Editor were submitted to PPM after publication of the above Q&A.

Submitted by David M. Glick, DC, DAAPM, CP, FASPE:
This was one subject I could not ignore.  Maybe I am missing something, but the NASS guidelines on multidisciplinary low back pain treatment are highly flawed and are more likely to result in a disservice, or at best, to maintain the status quo when it comes to treating low back pain. At least that was my take when reading this interview with Dr. Kreiner about the guideline.

It would be my argument that there is perceived clinical incompetence with the concept involving an actual diagnosis of “nonspecific back pain” or idiopathic back pain as one can question whether the mindset is valid to begin with. Virtually all back pain has an underlying cause. It is the skilled physician or clinician that is responsible for identifying the underlying cause(s) of a patient’s low back pain (technically any musculoskeletal pain pathology) and to deliver an effective treatment targeted to mitigate or resolve such, in a highly patient-centered manner. That is the art of delivering the science of healthcare in general and how back pain, or any pain, should be best managed.

Glancing through the guideline, there appears to be a clear deficiency in the authors’ ability to understand basic pathophysiology when it comes to underlying causes, nor the skill set required to help identify how such pathologies impact the patient manifestation of pain. In the absence of such knowledge, it would seem clinicians are “spinning the wheel of misfortune” to help deliver patient treatment. In this regard, NASS is contributing to the problem rather than to the solution, which is what I find most frustrating about clinical practice.

In 30 years of practice, I cannot recall ever having a patient where a more specific patient-centered diagnosis could not be rendered. I may not have been able to effectively treat all patients but having an understanding as to why they have pain is half the battle, and accounts for a track record of better outcomes with long-term management for those patients in which a resolution is not possible, and a treatment resolution for many, even those with long-standing histories of back pain.

Do I appreciate a multidisciplinary approach, of course? Combining disciplines or individual treatments in a highly patient-centered manner has been the hallmark of what I and many others do best in a true multidisciplinary mindset. Technically, there is a patient for every treatment.  The key to clinical success is to determine what treatment(s) would best for each patient at a particular time. In a sense, this is the concept of triaging patient care for pain.

In an earlier article for PPM, we identified a major concern for treating back pain that centered around contradictions relative to guidelines for back pain treatment. NASS has exemplified this problem once again. In contrast, I thought the Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline, offered a much more positive approach to LBP and well as MSK pain.

Of note, I personally identify as a musculoskeletal pain physician, whose practice is more akin to PM&R/neurology pain management even though I have training in chiropractic medicine.  In practice, I find it quite valuable to leverage rational pharmacology, interventions, CBT, and conservative treatments, including manipulation. My bias is more toward favoring the individual needs of the patient, regardless of the discipline.  Remember, back pain is nothing more than a symptom, not a diagnosis. Do we treat chest pain, or do we seek to determine the underlying cause and treat the underlying pathology?

Submitted by Ryan Kain, DC:
After reading this guideline update Q&A, I felt transported back to the ‘80s, when we didn’t have decades of research showing chiropractic – spinal manipulation (SMT) in particular – to be the most cost-effective and clinically effective treatment with one of the highest patient satisfaction rates for treating not only low back pain but also neck pain and headaches, with millions of patient visits attesting to these facts. Transported back to the ‘80s before the AMA lost a federal racketeering lawsuit for smearing chiropractic practice and pressuring state medical boards against cooperation with chiropractic physicians.

For decades, we as a profession were told we needed more research. Now, after 40 years of federally and privately funded research overwhelmingly proving our points, we are still making the same arguments about the effectiveness of chiropractic care, still dealing with professional bias, misinformation, counter-studies using cherry-picked references and criteria, and just plain ignorance. We have done the research and we have the patient satisfaction to back it up. It boggles my mind that I can attend integrative pain management meetings and there will only be one or two, if any, mention of chiropractic – it’s all about the outdated care approaches and “if it works” instead of talking about how it works and, more importantly, how to incorporate chiropractic with your patient’s care. (If you need a short education on the science behind chiropractic and what it actually does, might I suggest the book “Reality Check” by neuroscientist Dr. Heidi Haavik.)

When is it going to penetrate that “nonspecific low back pain” is only nonspecific to some medical researchers and others who have not bothered to learn anything new? I realize that, according to research, it takes the medical community an average of 15 years to accept clinical research and change their practices to fit now-old research. However, I just shake my head when I read about “new” guidelines like this one. Let’s move forward!

Last updated on: October 26, 2020
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SAMHSA Zero Suicide Grant: The “New Yorkers Advancing Suicide Safer Care” initiative adapts the Zero Suicide AIM model to train clinicians in NYS to provide best practice suicide prevention approaches. AIM stands for Assess, Intervene, and Monitor, a three-part framework where “Assess” refers to the use of systematic screening and comprehensive risk assessment to identify at-risk patients. “Intervene” consists of conducting suicide-specific brief and psychosocial interventions. “Monitor” provides strategies for ongoing monitoring and increased contact during known high risk periods. This model developed in outpatient behavioral health expands to implement Suicide Care Management Plans (SCMP) across CPEP, inpatient, outpatient, and substance use disorder treatment settings.

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Treatment development: Development and pilot testing of novel interventions, including a brief suicide prevention group treatment for inpatients and a peer support program for survivors of suicide attempt

Evaluation: Evaluation of attitude and knowledge gain, clinical uptake of suicide prevention skills, and continuous quality improvement for our live and archived trainings in: screening; risk assessment; safety planning; and follow-up monitoring.

Implementation Assistance – Learning Collaboratives: OMH and OASAS collaboration to introduce the “Zero Suicide” Model to OMH and OASAS clinics

SAMHSA Grant: Train and evaluate clinical uptake for emergency departments (ED) and crisis hotline staff in safety planning and follow-up monitoring for suicide prevention

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August 2011 Physician Licensure Examination results released in three (3) working days

The Professional Regulation Commission (PRC) announces that 1,605 out of 2,131 passed the Physician (Complete, Finals and Finals with Prelims) Licensure Examination given by the Board of Medicine in the cities of Manila, Cebu and Davao this August 2011.

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The oathtaking ceremony of the successful examinees in the said examination as well as the previous ones who have not taken their Oath of Professional will be held before the Board on Sunday, September 11, 2011 at 1:00 o’clock in the afternoon at the Plenary Hall of the Philippine International Convention Center (PICC), Roxas Blvd., Manila.

Registration for membership with the Philippine Medical Association, Inc. (PMA) will start on Monday, August 22, 2011 at PMA Building, North Avenue, Diliman, Quezon City.

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Remarks to Westinghouse Employees in Linthicum, Maryland

March 11, 1993

Thank you very much. I want to say a special word of thanks to the people from Westinghouse who greeted me when I arrived: Gary Clark, who introduced me, Dick Linder, Gladys Green, Rich O'Leary, and Gary Eder. And thank you to all of you who made this tour possible.

I want to thank the Members of the United States Congress who are here, who have worked very hard for a long time and before I became President to help to design a plan to strengthen our economy even as we reduce military spending. Your Senators, Barbara Mikulski and Paul Sarbanes, are here. Your Congressman, Ben Cardin, is here. Senator Jeff Bingaman of New Mexico; Senators Barbara Boxer and Dianne Feinstein of California; Senator Bill Cohen of Maine; Senator Claiborne Pell of Rhode Island; Congressman Martin Frost of Texas; Congresswoman Jane Harman of California; and Congressman Tom Foglietta of Pennsylvania. I think that is the entire delegation here, along with Mayor Kurt Schmoke of Baltimore and Governor Schaefer. I'm glad to see all of them. I have to note here, you can tell who the best politician is. Of all these people I've introduced, only Senator Mikulski found a seat. [Laughter]

I'd also like to thank the members of my Cabinet who have helped to work on the statement that I will announce today who are here: the Defense Secretary Les Aspin, Labor Secretary Bob Reich, Veterans Affairs Director Jesse Brown, Energy Secretary Hazel O'Leary, Commerce Secretary Ron Brown. I want to thank all of them for their work.

All of you know from personal experience how much American industry has been changed by the cutbacks in defense. Defense spending peaked in 1985. And by 1997, it will have been reduced approximately 40 percent, perhaps more, from its 1985 peak. These changes have led not only to reductions in military personnel abroad and closings of bases at home but dramatic changes in military contracting that have affected companies like this one and which have affected the economies of the States of California, Connecticut, Texas, and many others.

It has been said that while change is certain, progress is not. And that certainly is true when it comes to the challenge of meeting the national economic goals that we have in the face of cutbacks in military spending. As I said, these cutbacks have been made since 1985; more are to come. They are essential in a world in which we need funds to be reinvested in the domestic economy and in which the security threats we meet today, while very serious, are different and clearly less expensive than those we faced when the Soviet Union and the United States faced each other across the Berlin Wall with the barriers of the cold war and the imminent prospect of nuclear war. So these changes had to come. But if we do nothing in the face of change, we have learned the hard way that we are its victims. If we take bold action, we can be the beneficiaries of change.

All of you here at Westinghouse Electronic Systems Group are proof that you can make change your friend. In 1986, just 16 percent of the work done here was nondefense. Today, it's 27 percent. By 1995, half or more of your work will be nondefense. What you have done here is what I wish to do nationally: take some of the most talented people in the world who produce some of the most sophisticated military technology and put that to work in the civilian economy.

The military surveillance technology I have seen here can now be used to help commercial airlines avoid wind shears. Military security technology can now be used to help police officers on the streets and in their patrol cars to be safer and to solve crimes and to find missing children more rapidly. State-of-the-art batteries is helping here to develop an electric car which may well provide an enormous opportunity for America to become more energy-independent and to dramatically reduce the pollution of our atmosphere, at a time when we have been reminded anew that there really is a hole in the ozone layer and there really are problems with unlimited emissions of CO2.

Clearly, defense conversion can be done and can be done well, making change our friend and not our enemy. But in order to do it we must act, act decisively, act intelligently, and not simply react years after the cuts occur.

Last year, when a candidate for President, I outlined a plan to create new jobs in the civilian economy. Anticipating this challenge, farsighted Members of Congress appropriated approximately $1.5 billion for defense conversion last year, including ideas that literally came from the minds and the efforts of some of the Members of Congress who are here with us today. They've demonstrated aggressiveness in adapting to change. But until today, in spite of that act, none of the money appropriated by Congress was released, and there was no comprehensive plan for what to do with it.

Today I want to explain how we're going to put your money to work to put Americans to work and how we're planning for the future by investing in our people, encouraging our companies, and assisting our communities. Our first priority has to be investing in our people. Keep in mind, as you all know here, when the defense budget is reduced, that affects, obviously, contracts and therefore the jobs of people who work in the private sector. It also affects the size of the military force itself, the configuration of our defense forces abroad and here at home, and the people who will be affected by the reductions.

Our defense reinvestment and conversion initiative will rededicate $375 million right away to help working people affected by defense reductions with employment services, job training, and transition assistance; $150 million of that will go to Government and employer-sponsored job training programs; $112 million will help members of the Guard and the Reserves make the transition to civilian life and to provide severance pay and health benefits to civilians who are leaving Government employment.

There's also initiative to provide early retirement benefits for military personnel with 15 years of service or more, to start a new program to encourage them to put their skills to work in vital areas like teaching, law enforcement, environmental restoration, and health care. Under a provision offered by Senator Sam Nunn of Georgia, any member of the military who is being mustered out with 15 years or more of service can go to work in law enforcement, for example, and earn a year of military retirement for every year they were in law enforcement, so that these people who have committed their lives to the service of our country and could not reasonably have known that this reduction would occur and would affect them can still earn their military retirement by serving their country here at home.

We must also recognize the ripple effect of defense adjustment and target assistance to our communities. In 1993 alone, we will triple the budget of the Defense Department's Office of Economic Adjustment. The $30 million we've committed to this task will be invested in helping our communities find the tools and the expertise to adjust to the changed nature of their local economy. It will be an investment that pays off in the long-term.

In addition, through the Commerce Department, we'll invest another $80 million in a revolving loan and grant program to directly and immediately aid communities hit hardest by defense cuts.

Finally, the Secretary of Defense has assured me that he will do everything he can to speed the environmental cleanup on bases that are closed so that they can be turned over either to commercial purposes or to local government at the earliest possible time so that there will be a minimum loss of economic activity in areas where bases are closed.

But all the worker training in the world and all the community assistance in the word will do no good if there are no jobs for those workers and no businesses for those communities. The private sector is the engine of lasting economic growth in our system, and therefore, our plan must help our companies to make these transitions to compete and to win.

We seek to go beyond the debate of the past in which some thought Government alone could do everything and others claimed Government could do nothing. In this area there are two things Government can do to aid companies like this one: promote dual use research and promote civilian use of technology that was formerly developed for military purposes. That is what you have done here. We want to speed and expand that process all across the United States.

One of the success stories of the cold war was the Defense Advanced Research Agency, or DARPA. DARPA helped keep America on the cutting edge of defense research. To meet the new challenges of the new world, we're giving DARPA a new mission and restoring its old name, because before 1972 that Agency was known simply as the Advanced Research Products Agency. By going back to that name and refocusing the Agency's efforts on dual use technologies, such as that which you have demonstrated to me here today, rather than strictly military applications, we'll be better able to integrate research to strengthen defense and to promote our economic security here at home.

Starting now, this Agency, ARPA, will allocate more than $500 million to technology and industrial programs like the ones we've seen here today. We'll support industry-led consortia and dual use technologies and promote efforts to break through with commercial uses of formerly defense technologies. Programs will be selected on the basis of merit and will require matching funds from the corporations affected. We're even going to set up a toll-free number to attract good ideas from good companies. And you will like this. The number is 1-800-DUALUSE. The hot line will be hooked up tomorrow, so don't call today. [Laughter]

To help walk companies through their new opportunities, ARPA will provide them with this book, which puts together programs from the Defense Department, the Department of Commerce, the Department of Energy, NASA, and the National Science Foundation. It is a remarkable coalition of Agencies finally putting all the information together for defense technology conversion, reinvestment, and transition assistance.

To further coordinate assistance, ARPA will work with four other Agencies, the ones I just mentioned. And we're going to have a series of regional outreach meetings all across this country, again, to try to mobilize other companies to get involved in this initiative so that they can save or create jobs instead of lose jobs in the face of defense reductions.

We want Government-industry partnerships to help develop advanced materials. We want companies to form regional technology alliances so they can share information and develop new products and new markets. Our manufacturing extension programs will help bring state-of-the-art technology to companies in much the same way as the Agricultural Extension Service helped our farmers more than two generations ago begin to become the most productive in the world. And through the Small Business Innovation Research Program, we'll help small businesses in their efforts to develop dual use technology.

But dual use technology is just the beginning. We have to explore also new opportunities in purely civilian technologies. This year alone, we'll invest $300 million in emerging nondefense technology. The Department of Energy will speed the transfer of technology to private industry from our national labs. And when Congress passes the stimulus package I have proposed, we'll have millions more to invest in research and development partnerships, in advanced technology programs, and in computer networks for schools and libraries around the country.

As with every aspect of the program for change I have asked the American people and the Congress to embrace, defense conversion will require us to literally reimagine and reinvent the way Government works. I've asked the National Economic Council to take the lead in our efforts to streamline and coordinate our conversion efforts so that you don't have to deal with a big bureaucracy where all the information is in many different places and sometimes seems to be operating at cross purposes.

Shifting to a civilian economy is of obvious concern to the Defense Department, but it's also the business of the Commerce Department, the Labor Department, the Energy Department, NASA, and many other agencies, including the Department of Veterans Affairs, which will have even more veterans now as people are coming out of the service and going into the civilian work force. Our National Economic Council will cut through red tape, break through turf battles, and help to deliver services to our customers quickly and efficiently.

I don't pretend that this will be easy, and all of it will take some time. But the choice we face is between bold action to build a stronger and safer and smarter America, or continuing to cut defense with no appropriate response or with one that is too localized and too limited.

The soldier-statesman Dwight Eisenhower once observed that the resourceful American makers of plowshares could, with time and as required, make swords as well. Our challenge is now to reverse the process. You have given us a stunning example of just how brilliantly that can be done here in this fine facility. I know today that the world's finest makers of swords can and will be the finest makers of plowshares, and they will lead America into a new century of strength, growth, and opportunity.

Thank you very much.

NOTE: The President spoke at 12:29 p.m. at Westinghouse Electric Corp. In his remarks, he referred to Dick Linder, president, Westinghouse Electronic Systems Group; Gary Clark, acting CEO, Westinghouse Electric Corp.; and union local presidents Gladys Green, IBEW, Rick O'Leary, IUE, and Gary Eder, Salaried Employees Association.

William J. Clinton, Remarks to Westinghouse Employees in Linthicum, Maryland Online by Gerhard Peters and John T. Woolley, The American Presidency Project

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Painters Working Near You – Here is What to Look for in House Painters

in Home Improvement

You might notice that your home needs a painting job. It might have been 10 years already since the last coat of paint was applied and you might have an upcoming party in your home. This might be a good opportunity for a new coat of paint for your home.

Painting your home can make a big difference. Dark rooms can become lighter especially if you choose the right color of paint. Your room will have a newer and fresher look. Paint can cover cracks, nail holes, adhesive from previous posters, and a lot of other imperfections that one doesn’t want to see in a room. You can make your room feel brand new and you will better enjoy spending your time in it. Read more about paint in this link here.

DIY vs. Hiring a Painter

Many people think that it’s better to hire a painter especially if they don’t have experience with previous painting jobs. A professional painter knows how many coats of paint are needed, knows how to cover the cracks and holes effectively, knows how to make the paint look more consistent and they also know the best colors that will suit the room in your house. If you live in a very big ranch, hiring a painter can save you a lot of effort, time, energy, and money. Professional painters can also reach small gaps and other critical areas that many homeowners miss when they are painting their own homes. You can get more information on websites such as Mays Landing Painters to know more about the services of a professional painter.

Here’s What to Look for When Choosing a Painter

  1. Timely and High-Quality Painting Jobs

Modern home

You need to set a standard when hiring a painter. They should arrive at your home in a timely manner and they should not take extended breaks. They should give you an estimate of the number of coats of paint they will require, take measurements, and tell you if there are additional charges for moving your furniture. They should consult with you about the colors of paint that will be used for the job. After all, it is your house that they will be painting and you will be living in it. You should have something to say about the color of the paint that you want to see every day.

  1. Licenses and Insurances

Proper painters should have licenses and insurance. These things can add a layer of security to you in case they accidentally damage your furniture. Their licenses should be up-to-date. They should be able to show you relevant papers about their training and previously completed jobs. This way, you will have security and peace of mind that you are dealing with true professionals. Read more about house painters and decorators in this link here:

  1. They Should Have a Lot of Experience

Nobody wants to hire someone who doesn’t have enough experience especially when it comes to painting homes. Your home can be your largest asset and you need someone who has experience painting commercial and residential buildings to make sure that they will do a great job. They should be an expert when it comes to cracks, caulking, multiple paint coats, brushes, rollers, and other painting tools. They should know how to mix paint, make sure that the walls are painted uniformly and not patchily covered, and do the job in the fastest time possible. You can get reliable painters through word of mouth from friends and families, from reputable websites, or through the yellow pages. Ask the painters if there are previous painting jobs that you could see in order to make sure that they will fit your needs.

  1. They Make Necessary Preparations Before Painting

Paintjobs can easily chip, crack or peel if done incorrectly. If there are major repairs necessary then a professional painter should be able to point it out to you before they begin painting. Ask them if they are able to fill the cracks and gaps on your walls. If not, hire someone who can do it. They should clean dirty walls, chip old paint to make room for the new coat, and remove soap scum and grease deposits. These things can interfere with paint adhesiveness. An expert painter should know all of this. If they remove the things that can interfere with the paint’s adhesion, the paint should last for a long time.

  1. They Should Recommend a Great Finish

Modern living room

When it comes to painting sheens, it is best to remember that the higher the sheen, the higher the shine. And the shinier the finish, the more durable it will be in the long-term. An expert painter should be able to choose from a wide variety of paint finishes such as eggshell, semi-gloss, satin and more. They should know the right finish to use on each of your rooms so that the walls will be easier to clean later on.

If you are looking for a painter who has the right qualities, the great news is that you only have to go to the right website to find him. There are a lot of other things that a professional painter can do. Go to the right website and find out more.

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COVID-19 Special
African Americans in Nashville and the COVID-19 Pandemic

Tamera Thomas hands out paperwork to people waiting for a COVID-19 test at a drive-thru site offered by Meharry Medical College at St. Luke Christian Methodist Episcopal Church in Nashville, Tenn. Thomas, part of an all-volunteer team, is a dental student at the United Methodist-related medical school. (Photo by Mike DuBose, UM News.)

The world has been impacted by the emergence of a tiny bug with a huge bite. In just this calendar year, the SARS-COV2 virus, which is commonly known as COVID-19, has disrupted life globally in a way this generation has only experienced in genre fiction in books, film, and television. But this is not science fiction, it is real life horror. As of this publication, worldwide over 7 million Americans are known to have contracted the virus, and over 200,000 deaths have been attributed to it. The question is, what does this mean for and how has this affected Nashville’s African American community and citizens? We’ll try to explore a few answers in this special publication.

Historically, the world has seen similar biological events over the course of the past several centuries, but few have been as widespread as SARS-COV2. Two major international pandemics that were similar include the Black Death, or plague, in the 1600s in Europe, and the 1918 influenza outbreak known as the Spanish Flu Epidemic. Each of those resulted in millions of deaths worldwide, and this one is feared to perhaps join those two in killing millions worldwide.

In the world, in the US, in Tennessee, and in Nashville, there are public health agencies that have formed policies and attempted to give guidance and leadership in combatting this continuing crisis. Global leadership has come from the World Health Organization, which the United States Executive branch has frequently disregarded, in pushing what may call an agenda of misinformation and minimization. Agencies within the United States have seemingly worked at cross-purposes occasionally for what are seen as political purposes, with disagreements coming between the Centers for Disease Control and Prevention (CDC) and that self-same Executive branch. In Tennessee, the Executive branch has basically followed the national Executive branch and frequently taken steps in contradiction of public health agency recommendations.

In the city of Nashville and its county of Davidson, leadership has largely followed the science and been much more in step with the scientific health community in protecting its citizens. We are fortunate to have had internationally respected physician scientists with expertise in infectious diseases such as Dr. James Hildreth at Meharry Medical College and Dr. Carl Schoffner at Vanderbilt serve as expert advisors to Mayor John Cooper and the city health apparatus during this crisis. Thanks to them as well as the other medical professionals in the city, especially the Metro Health Department, we in Nashville have not suffered quite as much as other communities. While there are no cures for this disease, we have developed and implemented surveillance and mitigation strategies that have helped.

Among these are COVID-19 testing centers, jointly operated by Metro Health Department and Meharry, which provide free diagnostic services at three locations, currently operating from 8 a.m. until the last person in line at 2 p.m. is served. These are located on the Meharry Campus, at Nissan Stadium, and the parking lot of the former K-Mart at 2491 Murfreesboro Pike in Antioch.

Nashville PRIDE special COVID-19 section

This special section is made possible through Google’s Journalism Emergency Relief Fund. The fund is made possible through the Google News Initiative to support small and medium-sized news organizations producing original news for local communities. The Fund’s aim is to support the production of original journalism for local communities in the face of the COVID-19 pandemic.


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• 24 hour emergencies01332 678333
  • 24 hour referrals01332 548911

Rita Mocci

Anaesthesia & Analgesia

Rita Mocci
Rita Mocci DVM MRCVS

Rita graduated from the University of Sassari in 2005 and subsequently working in private practice in Sardinia before moving to France. She completed a Residency programme in Anaesthesia and Analgesia (ECVAA) in Lyon. Rita joined the Anaesthesia and Analgesia team at Pride Veterinary Centre in 2021.

Her areas of clinical interest multimodal analgesia, perioperative and chronic pain management, geriatric and paediatric anaesthesia, and anaesthesia of exotics.

Outside of work, Rita loves sports, travel and tries to visit her native island of Sardinia as often as possible. As a perfect Italian cliché, she loves to cook, enjoys playing ukulele with her partner and above all loves her crazy cat, Cesare.


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Sale and Leaseback Transactions Explained

Sale and leaseback transactions are much discussed and often promoted by surveyors and solicitors, unsurprisingly given that the yield often makes this a lucrative area of work for professional advisors.  However, it is in nobody’s interest to promote a strategy where it is not suitable, so it is important to establish that sale and leaseback is the best strategic route for the future stability and resilience of a practice, and where this is the case, I have advised as such.

What is a sale and leaseback transaction?

Sale and leasebacks apply to practices where the surgery is a partnership owned asset (i.e. in owner occupation) and where in effect we are separating ownership from occupation.  The freehold of the property can be sold to a property company or private investor who will become the landlord (this is the sale part of the transaction), with the occupying Practice remaining in occupation by way of a lease.

This means the occupational and operational arrangements of the practice need not change, to the extent that patients will be none the wiser and commonly the staff of the practice will also not be affected.  These transactions can be handled very discretely.

Why is now a good time for sale and leasebacks?

I have seen an increase in the relevance of sale and leaseback opportunities often following on from undertaking a valuation for partnership purposes.  With interest rates still at an historical low, investment yields are also low.  This is largely driven by demand with many property investors seeing commercial property, and in particular healthcare property, as a secure investment.

The low yields being paid by investors for property transactions is having a knock-on effect on the values surveyors are reporting when undertaking valuations for partnership purposes.  Whilst this is often good news for the retiring partners, it is not such good news for prospective partners, who might find themselves faced with a buy-in price higher than was perhaps expected.  The issues surrounding recruitment and retention of GPs is well known; such further barriers to recruitment are unwelcome.

A sale and leaseback transaction will often release capital to pay off retiring partners (as well as hopefully leaving a surplus).  To have the practice continue in occupation as before but now by way of a lease and without a buy-in price, can make the partnership more attractive for recruitment (although even then some partners are reluctant to sign a lease).

In partnerships where there are property owning partners, non-property owning partners and salaried doctors all thrown into the mix, there is sometimes a “them and us” atmosphere which has not been conducive to a dynamic and resilient practice.  Effecting a sale and leaseback whereby the distinction between property owning partners and non-property owning partners is removed, has often encouraged salaried doctors to become partners, which has had the effect of improving the cohesion and sustainability of the practice.

What are the pros and cons of a sale and leaseback?

  1. Removes property from being a partnership asset.
  2. Releases capital to the partners.
  3. Sale prices are particularly high at the moment due to low interest rates.
  4. Can ease the recruitment of prospective partners.
  5. Removes debt from partnership and individual partners.
  6. Provides capital to pay off retiring partners.
  7. Can make the partnership more flexible and sustainable.

  1. The lease is a liability.
  2. Obligation to repair can be similar to owning the property.
  3. Obligation to pay rent.
  4. Need to ensure that the lease rent and rent reimbursement are in parity, save for issue of third party occupiers, such as pharmacy.
  5. May have obligation to sub-lease parts of the premises (e.g. to community staff).
  6. Liability to pay dilapidations (reinstatement of property at the end of the lease).

These are the main issues that need to be discussed with the practice, with the ultimate sale price being largely influenced by the terms of the lease.  It is essential to engage in discussion with the practice to understand the aspirations and objectives of the sale and leaseback between maximising price and some flexibility within the lease.  There can be a sliding scale of options, with the eventual sale price target often being driven by the extent of mortgages to be redeemed, together with any penalties to be paid.

Often the discussions concern the age profile of the current partners and the general attitude towards risk and liabilities.

For a sale and leaseback to proceed, it is essential to have the approval of NHS England/Clinical Commissioning Group.  This isn’t in connection with the sale, but rather in terms of the proposed lease.  This makes sense in that the lease length needs to be commensurate with the age and quality of the premises, which in turn needs to be reflective of possible NHS Estates strategy.  It follows that it is not appropriate to seek a 25-year lease on a house conversion type surgery that might have an extant patient list of circa 3,000.  In such instances, a lease of, say, 10 years may be the maximum likely to be approved, possibly with a break option in the fifth year.  For modern, purpose-built medical centres, leases of 15-20 years are sometimes approved and often a lease of this length is required in order to generate sufficient capital value to cover the redemption of mortgages and associated penalty costs.

What is the impact on rent?

There is an important subtlety in the NHS Premises Directions which is sometimes overlooked.  Many people in primary care (or indeed professional advisors) talk about notional rent, Current Market Rent and rent reimbursement interchangeably.  Certainly notional rent and Current Market Rent have the same meaning, however rent reimbursement is different.  Notional rent/Current Market Rent applies to surgeries that are owner occupied with rent reimbursement being applicable to leased premises.  It follows that the practice will switch from the former to the latter when a sale and leaseback transaction has been effected.  The amount of rent reimbursed to a practice can only change if the lease rent has changed first.  This means that at rent review, if the rent changes and the practice then applies for rent reimbursement of a higher level of rent, the NHS and District Valuer cannot review the amount of rent reimbursed on their own accord.  The amount of rent reimbursement as assessed by the District Valuer is to have regard to the terms of the lease.  This rent again can be negotiated with the District Valuer at the appropriate time, ultimately with recourse to dispute proceedings if necessary.

What are the VAT implications?

Property is unusual in that there is a general exemption from VAT unless the owner of the building elects the property to be subject to VAT.  If VAT is elected, then the rent charged under the lease will be subject to VAT.  If this occurs, then even if the sale and leaseback transaction has been undertaken at the same amount of rent as the previous notional rent, the revenue cost to the CCG will now be 20% higher due to VAT.  Part of the NHS approval process considers this point with the NHS sometimes not approving leases where VAT is to be levied.  There are, however, circumstances where it is appropriate for VAT to be levied.

As you will see from the foregoing, there are many issues to be considered in effecting a sale and leaseback transactions.  These points need to be considered further with often there being advice taken from surveyors, solicitors and accountants as to the impact of undertaking such a transaction.


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Port Safety Induction

If you require entry to PrimePort operational areas, you will be required to complete a PrimePort Induction.

Please click here to carry out the PrimePort's Health, Safety and Security Induction (for port employees, contractors, agents, Government agencies and other regular visitors).

One you have passed the induction, you will be eligible for issue of a security access tag and/or photo identification card.  A security access tag or photo identification can only be issued to the inductee in person at PrimePort's office (1 Marine Parade, Timaru).

Drug & Alcohol Policy

Due to the complex nature of Port operations there are many potential hazards and associated risks, which means the Port operational areas are considered a safety sensitive work environment.

It is crucial that all persons working within the common user areas of the Port are 'fit for work' and pose no safety risk to themselves or others by being impaired through the misuse of illicit drugs and/or alcohol.

It is the responsibility of all Port Users to ensure that all practicable steps are taken to lower this risk as is reasonably practicable.  PrimePort's Drug & Alcohol Policy/Procedures allow PrimePort to undertake random drugs or alcohol testing of any person working within a common user area on Port property.

Please take the time to familiarise yourself with the content of PrimePort's Drug & Alcohol Policy.

Common User Safety Rules

The Common User Safety Rules have been developed to encourage all port users to work in a safe and efficient manner, especially within the ports common user areas where multiple port users may be operating simultaneously and in close proximity to each other's work zones.  Please take the time to familiarise yourself with the content of the Common User Safety Rules as there are consequences for breaches of security and safety.

Incident Reporting

Port users are required to supply PrimePort with incident and accident reports and statistics, which enables PrimePort to fulfil its duty to promote and facilitate good health and safety practices by monitoring that corrective actions are in put in place, or appropriate safety alerts have been issued.  Incident reports must be forward to PrimePort's Health & Safety Manager, either by a hand delivered written report (PrimePort, 1 Marine Parade, Timaru) or via email.

Emergency Procedures

The first priority in the event of an emergency is for the safety of all people present, raise the alarm and then dial 111, ask for Fire/Police/Ambulance.

All fires, emergencies, accidents, oil spills, chemical leaks, vandalism or damage should be reported to PrimePort Management as soon as practicable.  You can make your report to PrimePort's Office during normal working hours on 03 687 2700, or afterhours to the 24/7 security watchman on 027 433 4124.

Important Note!

All contractors who visit PrimePort must carry a copy of PrimePort's Contractor Emergency Response - Quick Reference Guide.  the guide contains a short form emergency procedure, emergency contacts for PrimePort and the Timaru Container Terminal gates and on the flipside a site map showing escape routes and emergency assembly points.


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Search Results

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Outsourcing specialist Indigo Premedia launches UK arm

  • Thursday, September 23, 2021
A specialist outsourcer for creative agencies headquartered in Singapore and using teams in India and other low-cost economies has opened a new UK operation and appointed a new chairman to enhance its offering to UK clients.

Belmont moves to four-day week

  • Tuesday, September 21, 2021
Belmont Packaging has launched a four-day working week, with all employees enjoying a three-day weekend from this week.

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© MA Business Limited 2021. Published by MA Business Limited, St Jude's Church, Dulwich Road, London, SE24 0PB, a company registered in England and Wales no. 06779864. MA Business is part of the Mark Allen Group .


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    Kansas City Star: New Garmin tracking device raises privacy concern

    The Kansas City Star reports on privacy questions surrounding a new location-tracking device from Garmin:

    Garmin’s newest device, the GTU 10 personal tracking unit, offers buyers a broad slate of uses — as well as the potential for abuses. […] Instead of telling you where you’re going, Garmin’s GTU 10 tells you where it has been. You attach it to something, or someone, you’d like to keep track of and check for updates using your cell phone, computer or compatible Garmin device.

    Clipped to a backpack, it lets parents know their youngster made it to school today. Stashed inside a boat, it alerts the boat’s owner if the craft unexpectedly leaves the slip at the lake. Tucked in the trunk of a car, the device reveals where a teenager actually goes when borrowing the keys.

    Like other technology that locates individuals, the GTU 10 device raises questions about privacy and security when it comes to someone’s whereabouts. Namely, is this crossing the line? […]

    Location data could reveal, for example, that an employee with a doctor’s appointment had visited an oncologist or a Planned Parenthood facility — information the employee might have preferred to keep private.

    Cell phones already allow phone companies to know the device’s whereabouts, and this information is available to law enforcement. Device location information is even mandated for 911 emergency services.

    Improper access to that data could create privacy and security problems.

    Garmin spokesman Ted Gartner said the location information that the GTU 10 generates comes to Garmin’s computers, where the information is secure and access is password-protected by the consumer. […]

    The GTU 10’s small size means it also can generate data showing location without the individual knowing. The device is 3 inches long and weighs 1.7 ounces

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    Vox: 23andMe reverses its decision to move to more lax privacy settings

    Vox reports on a decision concerning the privacy of medical data by by genetics testing company 23andMe:

    The personal genetics testing company 23andMe is reversing plans to make a major change to its privacy settings, after a Vox story raised concerns about the move.

    On September 9, we published a feature about some of the pitfalls of personal DNA testing, with a focus on 23andMe, a leading company in the field. We talked to some people who used 23andMe and ended up unexpectedly finding close family members they didn’t know they had. In one case, a professor’s parents divorced after the site revealed that his father had a child before he was married. We reported that 23andMe was planning to alter its user settings in a way that could make these unexpected reunions happen more frequently. […]

    But, because of concerns raised by the Vox story, the company reversed its decision to make those changes. It is also going to hire a Chief Privacy Officer.

    Read the Vox story for the full statement from the 23andMe chief executive.

    Leave a Reply


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Precision Restorations Owner Dale Oestreich Sells Company

St. Louis classic car and truck restoration business sold to local investors
By: BSI Services, Inc.
ST. LOUIS - July 20, 2021 - PRLog -- Dale Oestreich, a lifelong entrepreneur, recently sold his 13-year-old Precision Restorations business to local investors.  Founded in 2008, the company is one of the largest classic car restorers in the country.

Oestreich plans to utilize his extensive experience by focusing on his new brokerage and consulting firm Business Services, Inc., which assists small business owners with preparing, marketing, negotiating, and selling their businesses for the highest market value.  Oestreich will also help small businesses handle the daily challenges of marketing and HR accountability, as well as improve their operations and identify expense reductions.

Oestreich has more than 41 years of entrepreneurial experience with developing his own businesses including American Delivery Service, Office Supplies, Etc., ADS Logistics, and Franchise Business Services.  He is a sought-after public speaker on a variety of topics relating to small business transactions and development.

Precision Restorations will retain all 14 employees at its 4151 Forest Park Ave. location.  St. Louis investor and entrepreneur Steven Shelley, a former customer of Precision Restorations, is the new owner of the company.  His father John Shelley along with Aaron Smoller are minority partners.

Precision Restorations provides restoration and customization for antique, vintage and classic cars and trucks.  The company typically handles 30 simultaneous projects at different restoration stages in its 24,000-square-foot location.  Projects average $100,000 per car with many exceeding $150,000.

"I'm excited to concentrate my efforts on helping small businesses become more successful," said Oestreich.  "As a perpetual entrepreneur, I look forward to sharing my experience with those who want to improve their existing businesses or seek new opportunities."

Business Services, Inc. is located at 877 Topsfield Dr. in Lake St. Louis.  For more information, call (636) 549-6220 or visit http://www.BSIconsultant.com.

Dale Oestreich
Tags:Small Business Consulting
Location:St. Louis - Missouri - United States
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Driving in Wet Weather

My customers have had lots of valuable experience drivng in wet weather conditions recently. News from the Met Office shows that December and January combined were the wettest in the previous one hundred years and that January had twenty three days of rain.

One of the key points at Prodrive Driving School we’ve been talking about is the increase in braking distances. Water on the ground reduces the contact that a tyre would normally have and increases braking distance by at least double.  As a result we’ve been keeping well back from the vehicle in front.  This brings us other benefits as well.  We can see further ahead and anticipate earlier any developing hazards.

As important as the ability to see is being visible yourself to others.  Opinions appear to differ amongst drivers as to what lights to use when driving in rain. Sidelights, headlights or fog lights?  Save sidelights for parking.  You may as well stick Christmas lights on your bonnet for how bright they are on some cars.  The Highway Code is very clear on the use of fog lights.  Only use them when visibility is seriously reduced, that is to no more than one hundred metres.

Finally, take extra care around pedestrians.  A twenty two year old man from Colchester has been summonsed to appear in court for careless driving after he allegedly drenched children walking to their primary school by driving through a puddle.  He is being prosecuted under Section 3 of the Road Traffic Act, which relates to careless and inconsiderate driving, an offence that carries a maximum fine of £5,000 as well as between three and nine penalty points.

Safe Driving.

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Over the last few years, more than 30 states around the US have legalized smoking marijuana for either medicinal or recreational use. This has helped reduce the social stigma around pot use and bring it into the mainstream. So, how do you address this on your dating profile?

Until recently, most online dating sites banned even the mention of drug use in online dating profiles. Sure, you could slip in a comment about being ‘420 friendly’ or that you’re down with ‘420 singles’ without them dropping the ban hammer on you, but that would still usually get you labeled as a stoner by most prospective matches.

While some of that social stigma exists, more and more people are accepting of the fact that some people smoke weed for anything from help with anxiety to just relaxing at the end of the day. Acknowledges Cannabis Use as a Compatibility Factor

Now, has just taken the major step of adding a profile question to their app about marijuana.

Match isn’t the first major online dating site to include drugs in their profiles or search options. POF has had a question about them for years, but it is vague and not useful at all. It just asks members if they “do drugs” socially, often, or never.

It doesn’t discriminate between marijuana and cocaine, or any of the other drugs that could be included.

On their search tool, it gives you the option to select people by their level of general drug-use or to just select that you are fine with any level:

marijuana-use-on-POFIn just the last few days, has embraced the reality that nearly one-quarter of Americans smoke pot and even more have an interest in knowing if the person they could end up dating enjoys the occasional toke. They’ve made it ok to admit you smoke weed so it allows you to meet locals who are also cannabis users.

After years of threatening members with being banned from the site for bringing it up in their profiles, Match has added options to include your own smoking habits in your profile and to search for users by their marijuana usage habits.

On your Match dating profile you can now share your views on marijuana use by either selecting “420 friendly”, “not for me”, or “no answer”.

marijuana-use-on-matchThe new question is an important one, but the meanings of these answers are still up for some debate.

  • “420 friendly”  You could choose this if you either smoke pot or are OK with the idea of dating weed smokers.
  • “Not for me” could either mean that you are against the idea of being someone who smokes pot, or you are cannabis friendly, but just don’t smoke it yourself.
  • “No answer” just means that the question is not important to you.

Just adding in the profile question is a big step for Match owed in big part to the shifting landscape of the United States and their ideals regarding becoming a cannabis consumer. But we’re hoping Match will eventually give options with a little more clarity.

When you are searching for potential dates on Match, the marijuana question is located in the Healthy Habits tab of the Lifestyle section of the dating website:

where-to-find-marijuana-use-on-matchThe options you choose here are a little more straight-forward. If you want to date a pot-smoker, choose “420 friendly”. If you don’t, choose “Not for me”. And, if you don’t care, just leave it blank or select  “Any”.

Profile Tips

It’s one thing to check a box saying that you are 4/20 friendly, but deciding whether or not to bring up marijuana, or any other drug, when you are writing your online dating profile is a little more complicated.

Occasional Marijuana Smokers

If you enjoy the occasional joint or edible, there’s no real reason to bring it up in your profile. The new search and profile options help you let people know your feelings on the matter without making a big deal about it.

Regular Marijuana Users

If “wake and bake” is your motto and you partake in marijuana several times a week for recreational purposes, it is definitely a good idea to mention it in your profile.

You want to do this because it not only helps attract the right people, but it helps scare off the people who disagree with your lifestyle. It doesn’t require more than a small mention in one sentence.

Anything more than that and you’ll give the impression that your marijuana use might be a distractingly large part of your life.

Medicinal Marijuana Smokers

There’s no reason that you have to include this in your profile. Checking the box that says you are 4/20 friendly should be more than enough.

If you aren’t sure how to bring up your personal smoking habits, or any other tricky topics in your profile, we can help you with our online dating profile writing services. You can also call us toll-free at 888-447-7634.

Photo Tips

There’s really only one tip when it comes to marijuana use and the photos for your dating profile. Your photos should neither show you actively smoking, feature you with any drugs or smoking paraphernalia, or show you in a state where you appear to be stoned.

Despite the fact that marijuana usage has become more acceptable in society, posting photos like this can give the impression that you have poor judgment and impulse control. Also, once you post a photo online, you never know where it could end up.

The last thing you want is a prospective employer judging you because a photo of you taking a bong hit or looking higher than Jim Brewer in Haf-Baked pops up when they Google you before an interview.

Update Your Profile

Dating sites are constantly adding and removing questions from their profiles to improve the experience for their users.

Along with the recent addition of marijuana to the profile, the site has also changed their options for body type no less than six times in the last three months in an effort to find a set of adjectives that feels more inclusive and does not offend anyone.

If you don’t update online dating profile every so often, you will miss out on the singles who are searching by the newer criteria. Also, your profile will look dated when potential mates see that your profile still has options that haven’t been offered on the site for more than a year.

Also, when you’re checking for new questions, be sure to look over your online dating profile text to make sure it is up to date and fresh. Talking about your recent trip to the beach might have been great in July, but when people see it on your profile in December, it makes you seem stale.

If you need help freshening it up, we’ve been helping singles write great dating profiles for the last fifteen years.


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Offer Your Customers Affordable, Premier Roof De-icing Solutions

Winter months are approaching quickly, and that means snow will be on walkways, driveways, and rooftops. Rooftops can be one of the dangerous places for snow and ice buildup during the winter. Filling icicles and sheets of ice can pose a danger to pedestrians below, not to mention the damage that ice dams can cause to structures. Runoff that pools behind ice dams and refreezes can eventually damage roofs, and lead to interior problems as well, such as water damage and mold and mildew. Roof de-icing is a great way to offer safety and assurance to customers during the often extreme conditions of the winter season. Roof de-icing systems from ProLine are commonly installed on hotel roofs and other commercial structures to enhance safety and protect roofs. The systems are versatile, fully automated, and energy efficient.

Roof de-icing systems typically consist of a contactor panel, an activation device, and a heating element. Each system from ProLine features state of the art, unique heating elements that allow for complete customization when installing a roof de-icing system. Most systems are self-regulating and fully automated, so when the sensor detects the appropriate temperature and precipitation, it will activate and keep the area clear of snow and ice. This convenience makes it a great option for any business or home looking to ensure pedestrian safety and prolong the life of the roof. Roof de-icing systems will prevent ice dams that form when snow and ice melts, runs down the roof, and refreezes along the colder roof eaves. These dams can cause roof leaking that can lead to expensive water damage. Ice and snow buildup can also happen in gutters, downspouts, and roof valleys, destroying your gutters as well as the roof. Installing a roof de-icing system in these areas or along the edge of a roof is not only extremely popular, but an effective choice for eliminating potential problems. Installing a roof de-icing system along the edge of a roof – or any area – will assure proper drainage and help to prevent damage.

Heated roof edges with self-regulating heat cable.

ProLine’s self regulating heat cable is an excellent choice for a variety of roof de-icing applications. This industry leading cable is not only effective, but energy efficient. It is UL recognized, and features an irradiated conductive core that will increase the output of heat as the temperature outside falls. This core is protected by a UV-stabilized thermoplastic elastomer outerjacket that is rugged enough for any environment, and the sturdy cable is available in a variety of lengths for quick and easy installation. Self-regulating heat cable is extremely versatile and can be easily installed in any area of the roof, gutters, downspouts, and oddly shaped areas. ProLine’s self regulating cable is one the most recommended roof heating solutions available today, and is a great investment to offer any home or business owner.

ProLine also offers a pre-terminated self-regulated heat cable. This single-point connection, 120V 6-watt cable comes pre-assembled, and can be installed and plugged directly into a standard outlet or GFCI power plug. The cable is available in 50, 75, or 100 foot lengths. The main benefit of pre-assembled self terminated cable is its quick and easy installation, which requires no special skills or tools. The heat trace cable can also be used for industrial applications, including hazardous or corrosive environments.

Another convenient option for heat trace solutions on rooflines, gutters, downspouts, or even pipes is ProLine’s constant wattage heat cable. This cable is also pre-assembled and can be plugged into a regular outlet, but has a parallel heating core. This core produces a uniform thermal output over the entire length, and power output remains the same in any temperature, unlike self-regulating heat cable. With just a single power point, heat tracing systems can be installed along lengths up to several hundred feet. Constant wattage cable can be easily installed, making it a good choice for small trouble spots or industrial and even most chemically hostile environments. This cable is also used for process heating to control the flow of viscous materials.

If heat cable isn’t your first choice for the application at hand, ProLine also offers an industry leading low-voltage roof de-icing system. This system is different from self regulated heat cable, as the heating element is a semi-conductive thin polymer panel that can be cut, stapled, and nailed on site. Low-voltage systems are most often used for melting snow and ice under shingle and metal roofs. With the low-voltage de-icing system, transformers step down from high-voltage to low- voltage while controlling a different section of the roof de-icing system. The low-voltage system is also self-regulating, so when the temperature rises, consumption of energy decreases, assuring energy efficient performance. ProLine’s low-voltage roof-de-icing system is available in multiple widths, (3, 6, 9, or 12 inches) making it versatile enough for any roof de-icing project.

ProLine’s array of products makes offering roof de-icing systems for your customers easy. Industry leading, versatile self-regulated heating cable is the most popular and efficient choice for most customers, but heat trace cable can also be paired with other roof de-icing systems (such as the low-voltage system) to assure that each customer receives the systems that best fit their needs. Working with ProLine also means industry leading customer service; which includes system design, free installation training, and technical support. If you’re looking for a way to increase your business this winter and provide safe, efficient roof de-icing for your customers, ProLine offers a selection and prices that can’t be beat. If you are ready to get started with roof de-icing for your business, contact a ProLine customer service specialist today at 866.676.9276.


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Local Logic is a real estate artificial intelligence company that matches people to places. We use geo-spatial and user generated data to quantify lifestyle and location qualities for any address in the US and Canada.  We provide precise data for making real estate decisions at an individual and professional level. You can find our data and tools among great brands such as REMAX, Zillow, Inside Real Estate, CoreLogic, and more. OUR STORY Urban planners & data scientists In the spring of 2014, a committed group of urban planners and data scientists met to discuss the future of real estate.  From their years of experience in city planning and real estate development, it was clear: technology is transforming the way in which real estate is built, bought and sold. Local Logic was born to provide an innovative approach, applying location based data and algorithms, to change the way cities are built and real estate decisions are made.

Number of Employees: 24

CEO: Vincent-Charles Hodder
COO : Amanda Levin
Director Of Finance And Accounting : Laura MacDonald
Cofounder & CPO : Gabriel Damant Sirois
Company Page

Stage: Non-equity Assistance
Funding: CA$1.3M
Source: Crunchbase

Local Logic Partners With CoreLogic to Provide Location ...

Business Wire - 2 weeks ago

Local Logic is a location intelligence platform that digitizes the built world for consumers, investors, developers and governments – delivering...

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This study explores links between adults' attachment representations and the task of caring for elderly parents with dementia. Participants were 87 adults serving as primary caregivers of a parent or parent-in-law with dementia. Waters and Waters' ( 2006 ) Attachment Script Assessment was adapted to assess script-like attachment representation in the context of caring for their elderly parent. The quality of adult-elderly parent interactions was assessed using the Level of Expressed Emotions Scale (Cole & Kazarian, 1988 ) and self-report measures of caregivers' perception of caregiving as difficult. Caregivers' secure base script knowledge predicted lower levels of negative expressed emotion. This effect was moderated by the extent to which participants experienced caring for elderly parents as difficult. Attachment representations played a greater role in caregiving when caregiving tasks were perceived as more difficult. These results support the hypothesis that attachment representations influence the quality of care that adults provide their elderly parents. Clinical implications are discussed.

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332 - 348

Adult, Adult Children, Aged, Caregivers, Dementia, Expressed Emotion, Female, Humans, Male, North Carolina, Object Attachment, Parent-Child Relations, Psychology, Child, Self Report, Stress, Psychological, Surveys and Questionnaires, Time


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At the end of 2020, the Hachette Book Group was the fourth-largest trade publisher in the country, with estimated annual sales of roughly $700 million. When the acquisition of Simon & Schuster—the third-largest trade publisher—by #1 trade publisher Penguin Random House is finally completed, HBG will move into the third spot.

Last week, HBG took a major step to ensure that it will assume S&S’s position as the largest trade publisher behind PRH and HarperCollins, with its agreement to acquire Workman Publishing for $240 million. One of few remaining independent publishers of its size, Workman had sales of $134 million last year, and its addition will get HBG revenue over the $800 million level.

HBG CEO Michael Pietsch noted that the Workman deal was HBG’s sixth, and largest, acquisition in eight years. Similar to the previous five, the Workman purchase adds more nonfiction and backlist titles to what had once been a heavily frontlist-fiction-oriented publisher. The five earlier purchases added about 9,000 titles to HBG, and the Workman deal will bring 3,500 more, which are part of a highly profitable Workman backlist. Pietsch praised the depth and quality of the Workman catalog.

Workman CEO Dan Reynolds, who will continue to oversee the company under HBG, said that at some Workman imprints, 70%–80% of revenue is generated by its backlist. He added that Workman’s strategy has always been to develop a list in which one-third of the titles per season translate into ongoing backlist sales, and in some cases become franchises.

Indeed, Workman has created some of publishing’s best-known and bestselling brands, including the What to Expect and Brain Quest series, as well as Page-a-Day calendars. One of its rapidly growing new brands is its Atlas Obscura line of books and products, with a new entry, Gastro Obscura, due out October 12.

Pietsch called Workman “a brilliant publisher, the most creative in the industry,” noting that it pioneered the method of combining images and information to create popular books.

Workman Publishing currently has about 300 employees in offices in New York City; Chapel Hill, N.C.; North Adams, Mass.; and Portland, Ore. Its imprints are Workman, Algonquin, Algonquin Young Readers, Artisan, Storey Publishing, and Timber Press. The purchase is expected to be completed before the end of September, and at that point Workman will become HBG’s eighth publishing group. Carolan Workman—who has been heading the publisher since the death of her husband, company founder Peter Workman, in 2013—will retire following the completion of the deal.

Reynolds said finding a new owner for Workman, which launched in 1968, had been in the works for a few years and involved discussions with more than a dozen parties. Reynolds added that Carolan Workman’s “#1 priority in finding a new home for the company, even over price, was the security of our employees, and we have found that with Hachette. They understand what makes us tick.”

Pietsch said given that most of Workman’s most popular books and products have been developed in-house, HBG would be “crazy” to interfere with the company. “They have a unique culture,” he explained.

Workman will bring more to HBG than just its backlist. With its unique approach to publishing, Workman has maintained it own sales force and has sold its line far beyond bookstores. Both Reynolds and Pietsch said that they see a big opportunity in reaching gift stores and other specialty markets with a broader list from the combined companies. Another practical reason for the deal, Reynolds noted, is to relieve some of the financial pressure of investing in new products and maintaining an infrastructure. Freed from those concerns, Workman can devote its full attention to developing new products.


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Bone Tag

Top Rated Local®
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Free shipping with
promo code FREESHIP

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Call us 1-888-471-2787

Product Description

  • Vibrant and adorable, this pink bone tag is perfect for divas. Designed with a bone shape, the tag will add a cute accent to any collar, whether it’s used with a matching pink color or to add contrast to a black collar. It;Pink tag for dogs
  • Gorgeous purple color
  • Easy to customize

Perfect for stylish pooches, this purple bone tag will add an adorable accent to your pet’s collar! The beautiful color and the bone shape combine in a cute design. Practical and convenient, this tag can be customized to display the dog’s name. That way, any collar can become truly unique! Available in two sizes, this custom dog tag will suit small pups and medium sized dogs in equal measure. Need a tag in another color or designed with another shape? We carry a great range of designs, to suit any preference!


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Shop for More: Fifties Costume Ideas | Grease Costumes | I Love Lucy Costumes

This Halloween, time travel back to the days of poodle skirts, pompadours and the rise of rock and roll with our 1950's costumes for plus size adults! We've got a great collection of costumes and accessories to get you ready to shake, rattle and roll under the blue moon. These 50's outfits are perfect for your next Halloween event or Grease-inspired sock hop, so get moving on finding your costume today!