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- Competing interests at medical journals: industry sponsored trials boost impact factors
- What's in placebos? No one's telling…
- Schemes that promote cycling seem to have limited benefit
- Sleep starved dieters might be thwarting their fat loss plans
- "Do it yourself" tests for chlamydia could be missing around 80% of cases
- Unexpected findings on medical imaging are usually harmless
- Medical students keep quiet about depression because of fear of stigma
- Hosting big sports events might not benefit the local population
- Mary Poppins was right: a spoonful of sugar DOES help the medicine go down
- Hookah smokers more likely to use marijuana or other illicit drugs
These days medical journals are rigorous when it comes to getting researchers to declare any associations with industry that might influence how a trial is reported. Before agreeing to publish a paper, many of the top medical journals require authors to sign a comprehensive conflicts of interest form that outlines any financial or personal relationships that could be perceived as inappropriately influencing the authors' actions with regard to the research. But what about the journals themselves, how do they fare when subjected to the same rigorous transparency they impose on their authors? Not too well according to a study published recently in _PLoS Medicine_. Industry supported trials published in six major medical journals were cited more often than trials not sponsored by industry, and had a considerable bolstering effect on the journals' impact factors - a measure of the "importance" of a journal. The authors of this study looked at 1,353 randomised controlled trials published in six general medical journals in 1996-7 and 2005-6: _Annals of Internal Medicine_, _Archives of Internal Medicine_, _BMJ_, _Journal of the American Medical Association_, _Lancet_, and _New England Journal of Medicine_. When they categorised these trials they found that a third (32%) of trials published in _NEJM_ in 1996-7 were industry sponsored, compared with roughly one in 10 (13%) published in _BMJ_. These proportions dropped for all journals by 2005-6 except for _NEJM_, so the same proportions nine years later were 32% and 7%. They then looked at citations for these trials, in 1998 for the 651 published 1996-7 and in 2007 for the 702 from 2005-6. For all journals, there was a significant association between the degree of industry support among the studies published in 2005-6 and the number of citations. This was most pronounced for _Annals_, _Archives_, and _Lancet_, where industry sponsored trials were cited more than twice as often as trials not supported by industry. Citations are important because they indicate how much a paper has affected a field - the more it has been cited by other authors, the more it has influenced research in the field. Having a high number of citations thus reflects well on the journal that published the study, suggesting that it is featuring the most important research. The authors then calculated approximate impact factors for the journals by dividing the number of citations by the number of trials published in order to figure out how often the "average" article would be cited. When they removed industry sponsored trials from these equations, the impact factors dropped notably, in particular for _NEJM_ (13-15%) and _Lancet _(6-11%). Lastly, editors in chief were contacted and asked to provide information on what proportion of the journal's total income was from sales of advertisements, reprints, and industry supported supplements. Only _BMJ_ and _Lancet_ provided this data. Almost half (41%) of _Lancet_'s income was from article reprints, which are often bought up by drug companies that sponsored a particular trial to promote the efficacy of their product. A further 1% of the journal's total income was from display adverts. On the other hand, only 3% of the _BMJ_'s income was from reprints and 16% was from display adverts. Neither made much money from industry supported supplements. Then the authors got cunning. To get financial data for the three American journals - _Annals_, _Archives_, and _NEJM_ - they dug up publicly available tax information for the journals' parent companies. The Massachusetts Medical Society, owner of _NEJM_, earned 23% of its income from adverts, whereas no data was available on reprints and supplements. For the American Medical Association, publisher of _JAMA_, 53% of its income was from adverts and 12% from reprints (no data on supplements). Richard Smith, former editor of the BMJ, reported that reprint sales from a single trial may lead to an income of US$1 million for a journal, so the 12% figure for JAMA is quite noteworthy. The Internal Revenue Service data did not specify the income for the American College of Physicians, publisher of _Annals_. So what do all these findings mean? It seems that publishing industry sponsored trials boosts the reputation of journals, some more than others. Of course, it is important that industry data does get published rather than sit in a drawer somewhere, and it seems a bit misplaced to criticise journals for benefiting from this process. Instead perhaps journals should make clear to what degree they benefit from publishing industry supported trials - financially and status wise. --------------------------------------------------------------- Lundh A _et al._ (2010) Conflicts of Interest at Medical Journals: The Influence of Industry-Supported Randomised Trials on Journal Impact Factors and Revenue – Cohort Study. PLoS Medicine 7 (10). DOI: 10.1371/journal.pmed.1000354.
Placebos - the inert substances taken by control groups in clinical trials - are often assumed to be harmless sugar pills or something along those lines. New research has found that actually it's impossible to know what's in placebos because there's precious little documentation of what exactly is used in clinical trials. Out of 176 research studies published in four of the biggest international medical journals, only one in five fully disclosed the composition of the placebo treatment. This lack of transparency suggests that all sorts of things could be being used, some of which might be having some sort of physiological effect and compromising the validity of findings on the study drug. Placebo controlled clinical trials investigate the effects of a particular drug on a disease by comparing people who receive the treatment against patients receiving a placebo, which looks, smells, and tastes the same as the study drug but has no active ingredients. This design accounts for the placebo effect - the possibility that people in a trial may experience a health benefit because they're taking a drug, not because the study drug they're taking is effective. In this study, the authors searched for randomised, placebo controlled trials published from January 2008 to December 2009 in four top medical journals - _New England Journal of Medicine_, _JAMA_, _The Lancet_, and _Annals of Internal Medicine_. A total of 176 trials were eligible for inclusion in the study - six studies of placebo pills, 65 studies of placebo injections, and 25 studies of other treatment methods (for example, nasal spray). Only 40 (23%) of the 176 trials studied fully disclosed the composition of the placebo treatment, and 120 (68%) did not disclose any information on the placebo at all. The remainder partially disclosed what was in the placebo treatment. Less than one in 10 (9.3%) studies that used pills disclosed the placebo, compared with 33.8% of studies that used injections and 40.0% that assessed other treatments. When papers that referred to previous publications for their primary findings or study design were excluded, these figures fell to 8.24%, 26.3%, and 27.8%, respectively. By not paying attention to what's in the placebo, researchers could be burying cases where the placebo has some sort of effect that's similar to the effect of the study drug. The authors cite the example of trials of cholesterol lowering drugs that use olive oil and corn oil as the placebo. The monounsaturated and polyunsaturated fatty acids of these "placebos," and their antioxidant and anti-inflammatory effects, could potentially reduce lipid levels and heart disease, just like the study drug, causing researchers to underestimate the effect of the cholesterol lowering drug. "A positive or negative effect of the placebo can lead to the misleading appearance of a negative or positive effect of the drug," author Beatrice Golomb, associate professor of medicine at the University of California, San Diego School of Medicine, told Science Daily. "And an effect in the same direction as the drug can lead a true effect of the drug to be lost. These concerns aren't just theoretical. Where the composition has been disclosed, the ingredients of the placebo have in some instances had a likely impact on the result of the study - in either direction (obscuring a real effect, or creating a spurious one). In the cases we know about, this is not because of any willful manipulation, but because it can in fact be difficult to come up with a placebo that does not have some kind of problem." The authors highlight what a huge effect this lack of transparency regarding placebos could have on medical research. "Because inferences from clinical trials propagate to clinical practice, failure to report placebo composition compromises the foundation on which medical decisions are based, and on which the fate of lives may rest," they write. ----------------------------------------------------------------- Golomb BA et al. (2010) What's in placebos: who knows? Analysis of randomized, controlled trials. Annals of Internal Medicine 153 (8): 532-5 PMID: 20956710
City wide programmes that promote cycling - such as London's new bike hire scheme - seem a great way to get the public active and tackle the obesity epidemic. But new research published in the _BMJ_ suggests that interventions to promote cycling don't have much discernible effect after all. Public health programmes that specifically aimed to increase cycling in a population found increases the the proportion of trips made by bike or the number of bike trips per person of 3.4 percentage points at the most, whereas there was little evidence that cycling increased physical activity or reduces obesity population wide. Adults in the UK are supposed to at least 150 minutes of moderate intensity physical activity or 75 minutes of vigorous physical activity a week, but few manage. Cycling can fit relatively easily people's daily routines as a means of travel from place to place, so people might be more inclined to adopt and maintain this type of physical activity than something like running or swimming. Also, if people cycle rather than take the bus or get in their cars, they're helping to reduce harmful traffic pollution - so cycling could help the environment as well as provide a double whammy of health benefits. The authors of this paper looked at 25 controlled or "before and after" studies on the effect of various different cycle schemes, such as free bike programmes, building new cycle routes, and promoting cycling to families. The studies were from seven countries, including the UK and the US. Six studies assessed programmes that specifically aimed to promote cycling, of which four - an intensive one-to-one scheme for obese women, improvements to a cycle route network, and two multifaceted cycle promotion initiatives at town or city level - were found to be associated with increases in cycling. For example, one study found that improving the connectivity of the cycle route network in the Dutch city of Delft increased the proportion of household trips made by bicycle from 40% to 43% over a three year period compared with a change from 38% to 39% over the same period in an area where no improvements had been made. A further 16 studies evaluated individualised marketing of "environmentally friendly" modes of transport (walking, cycling, and public transport) via marketing and incentives such as free bus tickets. On average this approach increased the number of cycling trips each individual made by eight a year. Three other studies examined the effects of efforts to change travel behaviour in general, such as car sharing schemes. Two of these trials found small increases in the proportion of trips made by bicycle or the frequency of cycle trips per person (+1.1 and +0.17 a week, respectively), whereas the third actually found a decrease in the proportion of bike trips of almost 12%. Only two of the 25 studies assessed looked at the health benefits of schemes to promote cycling, one of which reported a small but positive shift in the amount of overall physical activity in the population studied. Discussing their less that glowing findings, the authors write that "There is nevertheless a strong case for promoting cycling on health grounds," pointing to evidence that at an individual level cycling to work or school has been shown to improve cardiorespiratory fitness and reduce mortality. "Promoting cycling is, therefore, a viable approach to improving health," they conclude. ---------------------------------------------------------------- Yang L et al. (2010) Interventions to promote cycling: systematic review. BMJ 341:c5293. DOI: 10.1136/bmj.c5293
A small study from the United States has suggested that getting too little sleep might prevent dieters from losing as much body fat as they would have had they slept properly. When individuals slept for five and a half hours a night, they lost half as much body fat as when they were allowed to sleep for eight and a half hours a night and 50% more lean body mass. These results highlight the importance of human sleep for the loss of body fat when dieting. Many people today are overweight or obese - the prevalence of obesity in England is thought to be 33% and 28% for men and women, respectively. Furthermore, 42% of men and 30% of women are expected to be overweight in 2010. Losing weight by dieting is one sensible way of addressing this epidemic and thus reducing the poor health associated with being overweight or obese. However, emerging data suggest that insufficient sleep might affect the response of our hormones to reduced food intake and negatively influence the metabolic effects of eating less. A total of 12 overweight, non-smoking, middle aged (range 35 to 49 years) individuals were enrolled in this study, of whom 10 (three women and seven men) took part. Alarmingly, one woman was withdrawn from the study because the combination of calorie and sleep restriction caused heart palpitations, whereas another woman dropped out for reasons unrelated to the study. Participants spent two 14 day stints in the University of Chicago sleep laboratory, with three months inbetween to recover. To start with six were allowed 8.5 hours of sleep a night, while the other four were only allowed 5.5 hours. Then the groups switched over so that those who had been enjoying 8.5 hours a sleep a night were only allowed 5.5, and vice versa. Before and after each study period, fasting body weight, adiposity, fat-free body mass, and the levels of various hormones related to metabolism were measured. Participants ate their normal diet during each 14-day intervention period, but its calorie content was 10% than what they would usually eat. Interestingly, both the sleep situations – 5.5 hours a night and 8.5 hours a night – were associated with about 3kg of weight loss. However, when people were sleeping 8.5 hours a night, roughly half of the weight loss (1.4kg) was down to reduction in fat, compared with only about a quarter (0.6kg) when people had 5.5 hours of sleep (55% less fat loss in the sleep reduction group). When sleep was restricted to 5.5 hours a night, people lost more fat-free body mass instead, which is largely made up of muscle and water (60% increase in fat-free weight loss). People were also hungrier and had higher concentrations of the hormone ghrelin when they only got 5.5 hours of sleep a night. Ghrelin has been shown to reduce energy expenditure, stimulate hunger and food intake, and promote retention of fat. People also had a lower resting metabolic rate during the 5.5 hours a night study period - all the better to ensure the finite amount of energy available would stretch to cover the longer waking hours. The authors suggest that in the sleep deprived state, the body concentrates increasing amounts glucose in fat tissue to support the more prolonged energy needs of the glucose hungry brain. When energy intake is reduced in this situation, the body "holds on" to fat stores to make sure enough energy is available for the drawn out waking hours and instead uses energy stored in muscle - the fat-free body mass. The authors also suggest that people trying to lose weight who don't get enough sleep could find it harder to stick to their diet and might be more susceptible to piling on the pounds if they do slack off. "The enhanced metabolic, neuroendocrine, and behavioral compensation in the form of increased hunger and reduced energy expenditure that develop in response to combined caloric and sleep restriction can disrupt adherence to a lower-energy diet and promote efficient weight regain once it is discontinued," they write. Writing in an editorial on the topic, Shahrad Taheri of the University of Birmingham, UK, and Emmanuel Mignot from Stanford Sleep Medicine Center in California suggest that sleep should be included as part of the lifestyle package for weight loss, which traditionally has focused on diet and exercise instead. -------------------------------------------------------------- Nedeltcheva AV et al. (2010) Insufficient sleep undermines dietary efforts to reduce adiposity. Annals of Internal Medicine 153 (7): 435-41. PMID: 20921542
Commercially available home tests for chlamydia could be failing to identify between 75% and 83% of people infected when compared with the "gold standard" biochemical lab test, according to new research from the Netherlands. The study of 772 women found that three "point of care" tests available on the internet and in pharmacies only correctly identified 17-25% of women who had chlamydia according to nucleic acid amplification testing commonly used by GPs and sexual health clinics. Chlamydia is the most common sexually transmitted infection in the United Kingdom. More than 200,000 people were diagnosed in 2009, the majority of whom were aged 15-24. Around 50% of men and 70-80% of women who get chlamydia will have no symptoms, yet left undiagnosed chlamydia cause infertility. Point of care tests for chlamydia usually involve the woman taking a vaginal swab herself and sending the sample to a laboratory to be tested, then going for an appointment with her doctor to get the result. Currently testing involves one doctor's appointment to have a sample taken and a second 1-2 weeks to get the result, which is a much more time consuming approach. The authors of this study assessed all women over the age of 16 who applied for a consultation at a sexual health clinic in Maastricht between September 2007 and April 2008. A total of 772 women with a median age of 23 were included in the final study. When nucleic acid amplification testing was used, 11% of these women were found to be infected with _Chlamydia trachomatis_. The authors then assessed whether three tests commercially available and certified in Europe - Handilab-C, Biorapid CHLAMYDIA Ag test, and QuickVue Chlamydia test - could identify which women had chlamydia. The three tests only picked up 17.1-25.0% of women who had chlamydia (sensitivity) and correctly excluded 93.7-99.7% of those who didn't (specificity). World Health Organization criteria indicate that point of care tests should have a sensitivity of between 43% and 65% and a specificity of 98%. The sensitivity of two of the tests improved slightly if they were performed within 72 hours of the women taking a vaginal swab. As little as 19.8% of women who tested positive actually had chlamydia, although about 90% of those who tested negative were free from disease. The results of this study indicate that many infections would have been missed had these point of care tests been used on their own, allowing women to go untreated and potentially spread the infection, and people with false positive results could have been treated unnecessarily. On this basis the authors state: "In our opinion, the chlamydia point of care tests we have evaluated are not ready for widespread use." In an editorial on the topic, Dr Sue Skidmore from the Department of Microbiology at Princess Royal Hospital, Telford, agrees. "It is widely agreed that rapid tests for sexually transmitted infections with high sensitivity and specificity would provide advantages," she writes, "although the introduction of their use, particularly for home use, needs to be rigorously evaluated and controlled with an assurance that robust quality assurance is in place when appropriate." ----------------------------------------------------------------- van Dommelen L et al. (2010) Alarmingly poor performance in _Chlamydia trachomatis_ point-of-care testing. Sexually Transmitted Infections 86:355-359. DOI: 10.1136/sti.2010.042598
Imagine you go for an MRI or an x ray and the radiologist spots something they didn't anticipate on your scan - you would be worried, right? Well, maybe you don't need to be. A study of more than 1,400 scan found that almost 40% showed at least one such "incidental finding" but only 2.5% were thought to show a genuine medical problem and required further clinical action. Although spotting something by accident on a medical scan can mean that a disease or disorder is detected and treated early, the extra scans and tests that follow might be painful or dangerous if the incidental finding turns out to be clinically harmless. As such, it's important that radiologists have some kind of idea which findings are worth acting on and which represent innocuous anatomical quirks. The authors of this study raked through the medical records of patients at Mayo Clinic in Minnesota who had taken part in imaging research between January and March 2004. Of the 1,426 scans for which three years of follow-up was reported, 567 (38.9%) had at least one incidental finding. Out of these people whose scan had an incidental finding, 35 (6.2%) underwent further clinical action such as follow-up imaging or invasive diagnostic tests like broncoscopy. Four people turned out to have diseases or disorders that were medically serious or even life threatening, which would have gone undetected had they not been in an imaging study. Only one person was found to have minimal or trivial disease, which presumably would not have merited the further investigations conducted. Six (1.1%) people with an incidental finding had treatment that resolved or improved the newly detected disorder or disease, whereas only three underwent medical or surgical treatment that resulted in lack of improvement. In the rest of the participants with an incidental finding the medical benefit or burden of the subsequent treatment was unclear. The likelihood of an incidental finding varied considerably depending on the type of scan used - nearly two thirds (61%) of people who had computed tomography of the abdomen and pelvis had an incidental finding on their scan, compared with only 4% of people who underwent some sort of nuclear medicine procedure. However, only computed tomography and MRI of the head yielded incidental findings that received further investigation. It seems that people whose incidental finding does represent serious disease are being checked out and few people whose odd findings on imaging are harmless are being pursued. However, the authors say: "the clinical investigation of a suspicious incidental finding that results in a benign diagnosis is not necessarily without clinical value or avoidable when presented with potentially life-threatening consequences (e.g. a solid renal mass)." ------------------------------------------------------------ Orme N et al. (2010) Incidental Findings in Imaging Research: Evaluating Incidence, Benefit, and Burden. Archives of Internal Medicine 170:1525-1532. DOI: 10.1001/archinternmed.2010.317
Not only are a considerable proportion of medical students depressed, those who are believe they'll lose the respect of their peers and their tutors if they speak out, according to new research in published in _Journal of the American Medical Association_. The study of 505 medical students in Michigan found that more than one in 10 (14.3%) of them were depressed, almost three times as many as in the general population of the United States (prevalence 5.4%). More than half of those who were depressed felt that telling a counselor would be risky and that fellow medical students would respect their opinions less if they knew (53.3% and 56.0%, respectively), whereas far fewer of their non-depressed peers held these views (16.7% and 23.7%). The authors of this research invited all 769 medical students enrolled at the University of Michigan Medical School in September-November 2009 to do an anonymous internet survey on depression and their attitudes to the disease. Women were more likely than men to have moderate to severe depression (18.0% vs 9.0%), and students who were depressed were nearly eight times more likely to have considered leaving medical school than had those with minimal depression (43.1% vs 5.6%). As many as 68% of those with depression had seriously considered committing suicide, although the overall number of students with "suicidal ideation" was small (22/505 (4.4%)). Medical school is mentally and academically demanding, so it's not surprising that rates of depression, burnout, and suicide are higher in medical students than in the general population. Yet despite no doubt being familiar with mental health issues given their training, medical students with depression are notoriously bad at seeking treatment. In this study, for example, approximately 70-80% of students with moderate to severe depression had not received a diagnosis or treatment for depression. As well as worrying about what their tutors and peers thought of them, medical students with moderate to severe depression were more likely than those not depressed to think that asking for help would mean their coping skills were inadequate (61.7% vs 33.5%). They also felt that others would consider them unable to handle their medical school responsibilities (83.1% vs 55.1%). It wasn't just the students who were depressed who believed stigmas associated with the disease: those without depression were more likely to think that depressed medical students would be a danger to patients (25.7% vs 13.6%). The fact that so many medical students seem to hold negative views of depression is rather worrying, not least because one study found that 30% of first year and second year medical students with depression cited stigma as a barrier to seeking treatment. It does seem counter-intuitive that this group exposed to health messages pretty much non-stop thanks to their course of study seems to sign up to negative stigmas surrounding depression. The authors suggest that rather than the emphasis on academic excellence and professionalism scaring medical students out of reporting depression, medical education programmes could be tweaked so that students perceive looking after the mental health of themselves and their peers as a key aspect of being an outstanding doctor. ----------------------------------------------------------------- Schwenk T, Davis L, & Wimsatt L (2010) Depression, Stigma, and Suicidal Ideation in Medical Students. JAMA: The Journal of the American Medical Association 304 (11): 1181-1190. DOI: 10.1001/jama.2010.1300
Hosting an international sporting event like the Olympic Games or the Commonwealth Games is an expensive business. The London 2012 Olympic and Paralympic Games, for example, will cost a total of £9.35bn, equivalent to £150 for every man, woman, and child in the United Kingdom. Such costs are generally justified in terms of collateral benefits for the population of the host city, both during the event and for years after - the so called "legacy" of the event. However, Researchers in Glasgow - host of the 2014 Commonwealth Games - have searched through the sparse published and unpublished research on the topic and found little overall evidence that major multi-sport events provide health or socioeconomic benefits for the population of the host city. They looked for studies on the long term effects of major sports events held between between 1978 and 2008 and came across very few papers - only 54 poor quality studies. Five studies looked at the benefits on the host population in terms of health; more specifically, rates of suicide, paediatric health service demand, presentations for asthma in children (two studies), and problems related to illicit drug use. Overall, the data did not show a clear cut negative or positive health impact of major multi-sport events. Of the studies that looked at whether sports participation in the population was affected, one found a decrease in the Manchester after the 2002 Commonwealth Games, whereas another reported upward trend in sports participation from the early 1980s to 1994 in association with the 1992 Olympic Games in Barcelona, Spain. More studies - 18 in total - looked at whether big sports events improved economic factors, which in turn might have a positive effect on the health of the population; for example, by giving people the cash flow to pay their dentist's fees or make healthy eating choices. But again the overall effect was unclear. Most studies did associate big sports events with an increase in economic growth and employment, but the studies often used lots of estimated data and didn't collect the data very long after the event, so are hardly water tight. The more robust studies weren't any more conclusive when looked at collectively - inflation increased in Barcelona and Atlanta in the run up to hosting the Olympic Games, but not in Sydney. "The available evidence does not refute expectations of a legacy, positive or negative, but it does establish that very little is known about the impacts of previous large multi-sport events and, therefore, the possible impacts of future events," conclude the authors. "This contrasts with official documentation used recently to promote such events," they add curtly. However, we Brits may not be throwing money down the drain by financing the next Olympic Games. As the authors of this study acknowledge, the research on the legacy benefits of major multi-sports events is patchy to say the least, hence why they were unable to draw any clear positive or negative conclusion. The London 2012 Olympics will be the first for which long term health and socioeconomic impacts will be explicitly measured, so should hopefully clear up whether or not hosting these big events really does benefit the local population. Editorialist Mike Weed isn't so sure that this effort will give us the evidence we need though, as he feels the measures being used for the 2012 event are not detailed enough. "The risk for the UK population is not that we will not get the benefits we want for our £150 a head investment in London 2012, but that there will be no robust evidence of what we have paid for," he says. -------------------------------------------------------------- McCartney G et al. (2010). The health and socioeconomic impacts of major multi-sport events: systematic review (1978-2008). BMJ 340. DOI: 10.1136/bmj.c2369
A new study has found that giving children up to one year old a sweet solution before jabs reduces the pain of the immunisation, providing a scientific basis for Mary Poppins' maxim that "a spoonful of sugar helps the medicine go down." The meta-analysis looked at fourteen randomised controlled trials that assessed the effects of oral sucrose, glucose, or another sweet solution compared with placebo (water) or no treatment during 1674 injections in infants aged 1-12 months. Thirteen (92.9%) of the trials found that the sweet solutions reduced various behavioural indicators of pain, such as crying, during and after immunisation compared with placebo. In the fourteenth study, the effects of a sucrose solution were only evident during a single immunisation and not for the second and third injections. The pain reduction was largely seen after the procedure had been completed rather than during the procedure. Although the sweet solutions reduced behavioural signs of pain, they had less of an effect on physiological signs: none of the studies found that glucose or sucrose solutions reduced heart rate in infants during immunisation. On the other hand, one study found that infants who received a glucose solution (and were allowed to suck on a dummy) had lower levels of cortisol, the stress hormone,in their saliva after immunisation than infants who received water (with or without a dummy). When data from the studies were pooled, sweet solutions were found to reduce the incidence of crying by 20%, the proportion of crying time by 10%, and the duration of crying time by 12 seconds compared with placebo. The 14 studies all used different volumes and concentrations of sucrose and glucose, so the authors were not able to determine an optimal dose of sweet solution to be used in infants during immunisation. However, the findings did imply that more concentrated sugar solutions - for example, 50% sucrose in water - are more effective. The authors recommend that "sucrose or glucose along with other recommended physical or psychological pain reduction strategies, such as non-nutritive sucking [e.g. using a dummy], breast feeding or effective means of distraction, should be consistently utilised for immunisation." ----------------------------------------------------------------- Harrison D et al. (2010) Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Archives of Disease in Childhood DOI: 10.1136/adc.2009.174227
Young people who smoke tobacco through a water pipe - also known as a hookah, shisha, or goza - are more likely to use illicit drugs than their non-smoking contemporaries, according to a study of young Canadians. Most notably, hookah smokers were much more likely to smoke marijuana: 74% of water-pipe users reported marijuana use, compared with 35% of non-users. A hookah or shisha comprises an upright device with a small platform where tobacco, often flavoured, is burned, a metal body, a base half-filled with water, and a tube with a mouthpiece for inhaling. Smoking tobacco using water pipes is an old Arabic tradition that is becoming more popular in the Western world, with an estimated 40% of US college students and 38% of British university students having ever used a hookah. The rise in popularity is thought to be linked to the perception that smoking tobacco through a water pipe is harmless. However, water pipe smoke may contain greater amounts of tar and heavy metals, such as lead, than cigarette smoke and has been linked to lung cancer, heart disease, and infectious diseases. In this study, the authors posted questionnaires to 1,208 18-24 year olds who lived in the Montreal area of Canada, 878 (73%) of whom responded and 871 (72%) of whom were included in the analyses. A total of 204 participants (23%) reported having smoked tobacco using a water pipe in the past year. Among these water-pipe users, 78% smoked water-pipes less than once per month, 19% smoked 1-3 times per month, and 3% smoked 1-6 times per week. None used a water pipe every day. Individuals who had used a hookah were younger, more likely to be male and not living with their parents, and had a higher household income than those who hadn't, leading the authors to suggest that "Water-pipe users may represent an advantaged group of young people with the leisure time, resources, and opportunity to use water-pipes." So hookah smokers are nice middle class kids with too much time on their hands then? Compared with people who hadn't used a water pipe in the previous year, those who had were more likely to have also used cigarettes and other tobacco products like chewing tobacco or snus and to have used alcohol, including having up to five or more drinks on one occasion (i.e. to a binge drinking level). Interestingly, a third of water-pipe users had not smoked cigarettes in the past year, perhaps using a hookah as a perceived "healthier" alternative. Water-pipe users were more likely to have used marijuana (74% vs 35%) or other illicit drugs like speed or cocaine (33% vs 11%) in the past year, suggesting perhaps that smoking tobacco through a water pipe may act as a "gateway" to using more harmful substances. Nevertheless, the authors point out that the design of their study means no cause and effect inferences can be drawn between using a hookah and illicit drug use. ----------------------------------------------------------------- Dugas E et al. (2010) Water-Pipe Smoking Among North American Youths. Pediatrics DOI: 10.1542/peds.2009-2335


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Over the past couple of years, the bathroom has become more than just somewhere to relax and have a soak. No longer content with bog-standard blue walls, homeowners now want to renovate their bathroom and create a beautiful statement.
Certain bathroom trends are already coming to the fore as ones to watch over the coming months. Here are the top bathroom trends to look out for in 2017.
Whether vintage inspired or modern and contemporary, freestanding baths are soaring in popularity. Claw foot tubs with copper taps are great for adding an elegant, vintage feel to your bathroom, while tall, bucket-style baths look endlessly stylish.
But it isn't just the style of freestanding bath you need to think about, it's where to put it. There's nothing wrong with placing it against a wall, but you could really make a statement by placing your bath in the middle of the room. If space allows, of course!
From bedrooms to kitchens, Scandi style is everywhere. And the same rules apply in the bathroom as elsewhere in your home: effortlessly minimalist styling. Think pastel colour palettes and copper accessories, alongside bathroom furniture made from pale wood.
The aim of the Scandinavian look is to make your bathroom feel as airy and relaxing as possible. Why not try copper toothbrush holders or plant pots, and instead of traditional shelving, a leaning ladder? These are perfect for displaying towels.
Bathroom tiles are incredibly versatile, as illustrated by one of our favourite new bathroom trends. Pale subway tiles will make any bathroom look like it belongs on the pages of an interior design magazine, while bathrooms decked out in large, neutral, floor-to-ceiling tiles create a real feeling of five-star luxury.
One of our favourite ways to utilise the trend for tiles, however, is in patterned floor tiles. Portuguese patterns add a lovely splash of colour, while pale geometric shapes inject a little Scandi style.
Showers are becoming more than just an added extra in modern bathrooms. Homeowners are turning them into a feature, choosing contemporary showers that leave a lasting impression over generic cubicles.
Waterfall showerheads, uninterrupted expanses of glass, tiled interiors: there are countless ways to turn your shower into a real focal point. Let your creativity run wild!
Who said bathrooms always have to be light and airy? More and more homeowners are turning their bathrooms into dramatic retreats that ooze sophistication. Alongside rich woods and dark gloss cabinets, budding interior designers are choosing deep wall colours like navy, plum and even black.
If you aren't feeling quite so brave, the easiest way to incorporate this trend is through bathroom furniture and accessories. Dark cabinets never go out of style, while things like dark towels add drama without being too overpowering. How far do you dare to go?
What are you favourite 2017 bathroom trends? Will you be trying any of these over the coming months? Let us know on Twitter or Facebook!
Don't Forget
Open Monday - Friday, 8am - 5pm, Saturday, 8am - 3pm
Montague St, Blackburn BB2 1EH (Next to Aldi)


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This Senior Turned a Class Project into a Nonprofit Organization
Irvington school children read books donated by NJIT senior Tamer Marshood, who founed a nonprofit to encourage the children to read.
Tamer Marshood turned what began as a class project into a nonprofit organization – one that is now encouraging children to read and helping to feed hungry people.
Last week Tamer launched the nonprofit, called "Feeding by Reading," by delivering 1,500 books to elementary schools in nearby Irvington. The district endorsed Tamer's program, in which fourth and fifth graders in eight schools will read books and raise money for The Church Women United Food Pantry of Irvington.
"Feeding by Reading" has a simple yet heart-felt premise. It's similar to a walk-a-thon, but instead of walking for a cause the children read books for a cause -- and the cause is the food pantry.
Tamer designed a website where the children have their own pages. People can visit the "Feeding by Reading" site and sponsor a child for every book he or she reads. The money raised from the sponsors is then donated to the pantry. His nonprofit is thus doubly helpful: It encourages children to read while helping to feed the hungry.
The Feeding by Reading site also uses various means to induce the children to read. The site has online comics featuring a group of characters known as the "Feeding by Reading Team," and there are prizes for top readers - including a special MAD Science Assembly program for the elementary school that collectively reads the most. Tamer used $5,000 of his own money to build "Feeding by Reading." And now that the books are in the hands of the children and the pilot program is in place, he is happy.
"When I dropped off the books I was ecstatic," says Tamer, a senior majoring in mechanical engineering who has a keen sense of social justice. "I started this project because it combines so many wonderful elements. It's more than just about reading and feeding hungry people. It's about setting an example for what's possible. It's about showing children that they have the power, right now, to make their world a better place."
He said the idea for his nonprofit grew out of an assignment for Entrepreneurship 410, a management class he took last year at NJIT. For that class, students had to come up with a plan for a new business. Tamer didn't enter the class intending to start a company. He enrolled to learn a bit about business. But as the semester went on, he found himself infatuated with his own idea, which slowly blossomed into "Feeding by Reading."
He spent a year developing his nonprofit, sometimes putting in 60 hour a weeks: He created the website; trademarked the name; incorporated the company; enlisted the support of the Irvington schools and even met with Rochelle Hendricks, New Jersey's Secretary of Higher Education. Hendricks supported Tamer's project and introduced him to people who could help. So what began as a simple class project morphed into a labor of love and a mission to help two of society's most vulnerable groups: children and the poor.
In this interview, Tamer talks about how a class project grew into a nonprofit that is spreading literacy and sustenance to residents of a town – Irvington -- that is near to the NJIT campus.
Why did you start this project?
It's about standing up for basic human justice. There's absolutely no reason why children shouldn't own books and that people should be hungry. There are more than enough resources for everyone to be well fed. Yet, as far as we've come as a society, we have not been able to create functioning social systems that properly handle life's most basic necessity. I'm not saying that "Feeding by Reading" is the final answer. I'm suggesting that programs like this are a good way to encourage momentum in such a socially beneficial direction.
You did all the work yourself but now you are hoping that people will sponsor the children, which will be more of a communal effort.
Yes: "Feeding by Reading" encourages reading AND creates an opportunity to make it useful to one's own community. Humanity's ultimate success is dependent upon a mix of individual achievement and collaborative efforts, and Feeding by Reading is a wonderful example of the promise that can be found if we, as a society, continue to move creatively in this direction.
Why do you empathize with needy people?
It makes me angry to see people hungry. Human suffering pisses me off.
Talk about how this started off as a class assignment?
I took the management class not in order to build "Feeding by Reading" specifically, but because I wanted to improve my business acumen. On the first day of the class, Entrepreneurship 410, as Professor Bandera was explaining his expectations for the class, all I could think about was my project. My main question was, 'Can I really build an organization out of this?' I had the intent, though I hadn't the slightest idea of how it would work. I stayed after class and spoke to Professor B about it. He was very encouraging! That evening I decided to make it my project for the semester.
Then you later won a contest for your idea.
Right, I was one of the winners of the Newark Innovation Acceleration Challenge, a yearly competition for people with their own startup company ideas. I won a $3,000 prize and used that money to help me build the company. But part of the prize was also taking a summer class in business management and development with Professor Michael Ehrlich.
Did that class help you?
Yes, I had a proof of concept but I really refined my ideas in that class. And the class helped legitimize the project for me. I started to talk to people in Irvington and the nonprofit started to feel like a reality. I worked on it all that summer. I later met with the superintendent of schools for Irvington and she eventually liked the idea and gave her approval to the program that I launched there last week.
How much time have you spent on this and who is supporting you?
Dude, a lot of time. My support is growing, though I'm still a one-man show. I'm almost to the point where the systems are in place so that I can put a team in place to handle certain aspects of the program. I put a lot of money (altogether $7,000) and a lot of time into it – I'd say a solid year of my life, just building and pushing and meeting with people. It's been a huge orchestral organizational effort.
You also met with the highest education official in the state. How did that happen?
I met N.J. Secretary of Higher Education Rochelle Hendricks at a business event at Princeton University. It was a N.J. entrepreneur network poster session. After hearing Secretary Hendricks speak, I knew I had to meet her. I got her email, emailed her the next day and jumped for joy about four months later when her secretary reached out to schedule a meeting. I went to Trenton and met with her twice. I had been keeping her up to date via email as things progressed and by the time we met we had much to discuss. She's introduced me to quite a few people and I'm starting to build a great network. She's been very supportive and I might ask her to be on my board.
Did a local TV station shoot a commercial about the launch of "Feeding by Reading" in the Irvington schools?
Yes, the day I delivered the books the local cable station from Irvington met me at the Florence Avenue Elementary School. We selected five children to be in the commercial, which will air soon on the local cable station. Officials from the mayor's office were also there. It was amazing.
And are students at Montclair State University are using "Feeding by Reading" as case study of a successful nonprofit startup?
Yes, this idea began as an idea for a management class at NJIT. And recently a professor from Montclair State University contacted me and said a group of students in his marketing class would like to do a case study on "Feeding by Reading," to study how a successful nonprofit got off the ground. I, of course, agreed and will have a lot to tell the students – all good.
(By Robert Florida, 10/14)


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Tsai Ming-liangFilm Director
- Video
Tsai Ming-liang, a Malaysian Chinese, was well-known as one of the most famous Second New Wave film directors of of Taiwanese Cinema. During his career, he have received numerous awards, including a Golden Lion (best picture) for Vive L'Amour at the Venice Film Festival in 1994, the 1998 Cannes Film Festival's FIPRESCI award for The Hole and the Alfred Bauer Prize and Silver Bear for Outstanding Artistic Achievement for The Wayward Cloud at the 2005 Berlin International Film Festival.
Before fame
After graduating from the Chinese Culture University of Taiwan, majoring in Drama and Cinema, in 1982, he was involved in several jobs in Hong Kong, including theatrical producer, screenwriter, and television director.
Related to
Lee Kang-Shenghas appeared in all of Tsai Ming-liang's feature films.


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Some of you might find this interesting.
If not, just skip it.
New York in the 1920's and the NYFD.
How they received alarms in those days and the fun of watching the chief drive like a maniac to get to the fire.
The 1920's may not sound so long ago until you realize it's over 90 years.
Yes, they had cars back then.
But they didn't have fireproof clothes and air tanks and masks and you have to give these guys credit fighting a fire and breathing that stuff.


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Product Description
One 1600 White Boot – Asym Flex 8
A perfect blend of support and mobility for a ride at the park or a day behind the boat. Danny Harf's time tested, iconic boot is now built on our innovative new Brainframe. Unbelievable heat molded fit, lined with asymmetrical medium density support.
- Brainframe Technologies – a footwear breakthrough in fit, function, and interchangeability
- Intuition + liners – the standard for custom moldable footwear
- Asymmetrical medium density liner blends mobility and precision board control in a high top cut
- Front end perforation increases comfort and contact
- Made around our Perfect Lasts – the foundation to our acclaimed fit
- Footbed Feel #3
- Feetbelts – retain ankle and heel with a conforming independent wrap
- Double Stuff Footbeds – self-aligns to your natural foot canting
- Rad Foam – built into the heel area for those big landings
- Articulating cuff – the boot flexes with the rider without boot distortion
- Stitched reinforcing in the heel area eliminates delamination
- Danny Harf signature boot
- And why 1600
Brainframe Technologies – not brain freeze like after a big sip of a slushy but BRAINFRAME. To many features to mention but here are a few – Secures the foot from the bottom up, Instant energy transfer reducing rider fatigue and energy loss, limits distortion in the boot and eliminates much of the stitching and lamination problems of older boots.


text: Property Development Services for the Domestic, Commercial and Industrial Sectors Domestic SCPS offers an extensive choice in quality home improvement products and services. Our team will advise the best options to suit your needs and with package discounts available on two or more products you have come to the right place. Read MoreSpecial Offers Commercial / Industrial Supplying commercial and light industrial products, enhancing functionality and security to your business. SCPS has a solution to suit your business - from space saving shutters to insulated and security products. Read MoreSpecial Offers Latest News CheckaTrade Feedback Score Reaches 212! 15 July 2018 We are proud to announce that we have just reached 213 feedback! With a 9.87% Rating!! Please feel free to Check out our customer reviews! Read More Online Shop Our online shop will be launching soon where you'll be able to purchase spare parts and accessories. Check back soon!


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Our Event Producers:
Kassie Seaton
Kris Brown
April 2015
Edition 6 / Issue 3
Quick Links
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Recipe of the Month
Grape Salsa on a Crostini
Back by Popular Demand-
This is an Oldie but a Goodie!
Click Here for the Recipe!
Our Pastry Chef - Steffie Dikeakos
Steffie was born and raised in upstate New York where she grew up working
in her family's restaurant business. She attended the Culinary Institute
of America and worked as a Pastry Chef at several New York City establishments.
Steffie loves to travel and enjoys cooking for friends and family. She
brings quite a repertoire of tasty new pasty's and desserts to Green
Apple Events & Catering in addition to being an extremely kind person.
We love having Steffie on our team!
Catersource 2015
Green Apple AdminTeam
Cheryl, Kris, Kassie and Kate
Our Chefs have been busy in the test kitchen creating new menu's for
all the upcoming corporate events, social parties and weddings! Take a
look at some of our new Spring / Summer options below!
To our existing customers, we are honored to be called "your"
caterer and to our new customers, we look forward to catering for you!
It is our pleasure to serve you!
~Cheryl Seaton and Kris Brown, Owners
(206) 713-1353 /
(206) 755-9575
Our new address: 14828 Northeast 95th Street, Redmond WA 98052
Seared Prawns with Pickled Radish & Cucumber, Salted Caramel Macaroons
with Smoked Gouda and Bourbon Bacon, Spring Green Salad, Trio of Desserts
- Greek Doughnut / Nanimo Bar / Saffran Pannacotta with Pistachio Brittle,
Watermelon Salad, Kalbi Beef Pops, Chicken Marbella
FEATURED VENUE: Argosy Cruise Ship
We are a preferred caterer on the Argosy Cruise Ships.
With the most amazing views of Seattle, an Argosy Cruise Ship makes a spectacular
setting to celebrate your wedding or entertain your corporate clients
and colleagues.
We look forward to catering your next business or social event on an Argosy
Cruise Ship!


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STEM Saturdays
STEM Saturday classes help students explore interesting topics through hands-on activities and exciting demonstrations. Parents are encouraged to attend students' classes and get in on the fun. This season's offerings include woodworking, speaker construction, and STEM activities for young divas.
STEM Saturday Courses Spring 2018
Please take a close look at the descriptions for recommended ages for each class. Some classes are two sessions.
February 17 – STEM Divas: Woodworking
Meeting Times: 9:00am – 1:00pm
Meeting Room: NIU STEM Classroom (Swen Parson 146)
Our STEM Divas program helps to inspire young girls by providing strong female role models and developing confidence in STEM skills. In this class, we'll be using simple woodworking tools to build our own fun wooden games to take home. Class fee includes all materials needed for the project.
Suggested ages: 7 and up
Price: $49
Register here!
March 3 & 10 – Pump up the Jams: Speaker Construction
Meeting Time: 9:00am – 12:00pm
Meeting Room: NIU STEM Classroom (Swen Parson 146)
Earbuds and Beats by Dre are great, but how many of your friends can say that they've built their own set of speakers from scratch? During this STEM Saturday class, students will learn about electricity, magnetism and sound, as they solder electrical components and experiment with different cone materials to create their very own set of amplified speakers. This class will meet over two weeks.
Suggested ages: 12 and up
Price: $69
Register here!
March 17 – STEM Juniors: Luck of the Irish
Meeting Times: 9:00am – 12:00pm
Meeting Room: NIU STEM Classroom (Swen Parson 146)
Have you ever wondered what's at the end of the rainbow? If so, you're in luck, because this class will be all about the science of St. Patrick's Day. We'll learn about rainbows, probability (luck) and even design our own leprechaun traps!
Suggested Ages: 7 and up
Price: $29
Register here!
April 21 – STEM Divas: Gardening
Meeting Times: 9:00am – 1:00pm
Meeting Room: NIU STEM Classroom (Swen Parson 146)
Just in time for Earth Day, this STEM Divas class is sure to plant a seed and help grow your child's interest in learning. We'll make our own planter boxes and learn all about how plants help keep the earth healthy. Students will also get to plant their own flower seeds to take home and grow.
Suggested Ages: 7 and up
Price: $39
Register here!
Scholarships are available for students who qualify for discounted school lunch programs. Contact email@example.com for more information.
Still have questions?
Contact us at 815.753.0533 or email@example.com


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It's been a lazy Sunday for us here at the Nation today. We got horribly drunk after last night's shoot-out win against the 'Hawks and played poker until we'd bet the farm. Now, we have to relocate to an abandoned hovel. Thank gods for the ubiquity of internet access.
But there's a lot of good being said about the team's performance last night, and more than a few comments about members of the Canadian Forces and their attendance to Rexall.
Here are a few links you should be reading, if you haven't already:
- Joanne Ireland at the Edmonton Journal notes what a hero Horcoff is becoming, among other observations.
- TSN.ca efficiently summarizes the game, as only a sports channel can.
- James Mirtle has an interesting (and lengthy) post on the purposes of goons on a hockey team, and how exactly they contribute.
- And I can't find the link, but Craig MacTavish was recently spotted walking slowly, and with a strange limp, down the middle of Jasper Avenue in search of, you guessed, it: braaaaaaaaaains.
I expect a great many of you, though, aren't thinking too much about hockey this afternoon and are instead turning your sights to the Grey Cup match. Hey, it's not hockey, but at least… Well, I think we'll just leave it at "it's not hockey."
Go Oil!


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|Top: the poster. Bottom: the web ad.
The work request for publicity asked for: "White paper with some color in the background or letters. What I'm trying to convey here is that the program showcases teen musicians and vocalists and is primarily for other teens. I would like any characters in the sign to reflect the demographics of our community and high school, which is roughly 50/50 African American and white."
I followed the brief, but had difficulty finding public domain photography that supported a teen 50/50 racial audience mix. I did find a few other images that I thought could work, however, and submitted four design choices. I lobbied for the concept shown here for a variety of reasons. Thankfully, the librarian organizing the event concurred, approving this one over the others as well.
Because most of the work was already done during the concept stage, there were only minor things to tweak to complete the design. This design is a compilation of two separate photo images: the jumping singer and a generic swirling background that I changed the hue on to be slightly bluer than the grey it began as. I made the headlines slightly translucent and added an outer white glow. To help the headlines stand out a little more, I added a soft drop shadow as well.
I kept the colours subdued and cool to reflect the season, and added some snowflakes to reinforce that sensibility. After a test printing, I discovered my light grey and blue colours printed darker than expected, so I went back to lighten them even more and add more contrast on the singer to brighten his skin tone. A last minute change was made from using the numeral "2" to become a roman numeral "II". This helped reduce any confusion over when the event took place, as it was easy to initially interpret the event date as "January 2" instead of reading it as being the second annual event. Overall, I was very pleased with the result of this series of promotional materials.
Items requested to promote this event included:
1 Large format 20x30in. poster (an enlarged version of the 11x17in. sign)
2 Tabloid-sized 11x17in signs
30 pages of quarter-page handbills
1 ACLD website homepage web ad


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In Lower Merion High School's Minority Achievement Program (M.A.P.), the highest achieving African American and Hispanic students are supported to take primarily honors and AP courses and be successful. The tactics have resulted in the doubling, in just one year, of the number of honors /AP classes being taken by minority students. Additionally, 84 percent of the 9th graders earned a GPA of 3.0 or above in those classes.
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Learn about Firebase
Enjoy technical sessions, learn hands-on via instructor-led codelabs, and be the first to hear our latest news. We're excited to share what we've been working on and want to hear your feedback.
Meet the team
Spend a full day with the engineers, designers, and PMs who work on Firebase. Get answers to your burning questions and give us your feedback to help shape the future of Firebase.
Build a community
Meet up with other developers from a variety of backgrounds. We are dedicated to providing a harassment-free and inclusive event experience for everyone. Let's be excellent to each other.


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What is the reason for the prohibition on pork?Tuesday, July 17th, 2012
I am an Arab living in Malta and I want to know the reason why pork is forbidden, because my friends at work are asking me about that.
Praise be to Allaah.
The basic principle for the Muslim is that he obeys whatever Allaah enjoins upon him, and refrains from whatever He forbids him, whether the reason behind that is clear or not.


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Know more about this business than we do? Cool! Please submit any corrections or missing details you may have.Help us make it right
- over 30 yrs. Experience
Be the first NOLA.com user to add photos or videos of H & P Sheet Metal Works
Since 1988 the company has been providing Sheet Metal Work, Nec.
H & P Sheet Metal Works can be found at Barrow St 1138. The following is offered: Metal Industries. The entry is present with us since Sep 7, 2010 and was last updated on Nov 12, 2013. In Houma there are 42 other Metal Industries. An overview can be found here.


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For CHW certification questions:
(512) 776-2570; or
(512) 776-2624
For Instructor or Training Program certification questions:
(512) 776-3860; or
(512) 776-2208
Email questions:
Email the CHW program
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Leadership in Organizations and Systems is an online course which explores leadership theory, organization theory, philosophy, culture, structure, processes, information management, and other areas relevant to healthcare organizations. This course also examines the role of the nurse within the larger context of the health care system.
Leadership in Organizations and Systems is an instructionally designed and completely online course aligned to the AACN DNP Essentials, QSEN Competencies and National Academy of Medicine Competencies (formerly the IOM). The course features best-selling Jones & Bartlett Learning text, Quantum Leadership: Creating Sustainable Value in Health Care.
Course Features:
To learn more or request a product demonstration visit www.jblnursing.com.
Jones & Bartlett Learning
Founded in 1983, Jones & Bartlett Learning is a world-leading provider of instructional, assessment, and learning-performance management solutions for the secondary education, post-secondary education, and professional markets. We develop educational programs and services that improve learning outcomes and enhance student achievement by combining authoritative content written by respected authors with innovative, proven, and engaging technology applications that meet the diverse needs of today's instructors, students, and professionals.


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Crowdfunding Marketing
You can't be said as the aware citizen of this global village until you don't at least consider crowdfunding for raising the funds for your projects. So, before you launch your projects or ventures or cause, it is very important on the part of initiator to come up with effective marketing strategy. Since crowdfunding is the online way of getting the funds, online marketing can give great deal of success for the initiator than any other form of marketing. Below in this article is some online crowdfunding marketing strategy that if followed lifts your chances if not guarantee of...read more


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National economic indicators paint a picture of a steadily improving economy, yet Americans continue to disagree over whether the economy is improving or worsening. Here, we explain why opinions may differ so strongly, even after accounting for partisan biases.Read More »
Spatial Analysis for the Social Sciences
Do concepts of space and geography play a big role in the questions you're interested in? These concepts are prominent across the social sciences, in disciplines as diverse as anthropology, criminology, demography, political science, public health, and sociology, and on subjects as different as tribal customs, residential segregation, disease clusters, ...Read More »


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As the thread indicates. What is fungus on the lens and sensor and how does a newbie identify?
Become a part of the community. Register and take part in all the features the site has to offer.
Results 1 to 11 of 11
Thread: What is fungus in a lens....


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How to Make Skin Whitening Cream at Home
This tutorial shows you how to add natural skin whitening ingredients to your base lotion at home.
- 35
Can Lemon Juice Really Lighten Skin?
Lemon juice is commonly used in skin whitening recipes, to reduce the appearance of dark spots or to lighten the overall complexion, but does it really work?
- 222
8 Natural Ingredients to Lighten Skin and Remove Dark Spots
Here is a list of 8 ingredients from nature that are proven to really whiten the skin and offer an alternative to using synthetic products like hydroquinine creams.
- 199
Brighten Your Skin with a Natural Gram Flour Facial Mask
Gram flour, or chickpea flour, has been used in India as a natural skin brightener for many years. Learn how to make your own skin-lightening masks at home using simple ingredients.
- 8
Why Pugs Dogs Are The Perfect Family Pet
Pug dogs are happy and lovable dogs with one of the sweetest nature of any breed. They are intelligent, fun and affectionate and rarely aggressive, which makes them a perfect pet for families.


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The Holy Spirit empowers and animates the Church
Jesus had come down from heaven to pay the price for man's sin. After he had completed his task, it was time for Jesus to return to the Father. But he had reassured his disciples that he was not abandoning them; instead, he was going back to the Father so that he can send the Holy Spirit to take God's mission of salvation into its next phase.
Pentecost celebrates the event in the history of the Church when the Holy Spirit came down on the Apostles and indeed on the whole Church. At that time, the Apostles were holed up in the Upper Room for fear of the Jews (John 20:19). But when the Holy Spirit swooped down on them in tongues of fire, the Apostles felt a mighty surge of power as they had never experienced before. They started speaking about the marvels of God. The people of different nationalities -- Parthians, Medes, Elamites, Phrygians, Pamphylians, Egyptians, Syrians and even Romans and those from other lands -- were amazed that they could hear them in their own native language. And since it was the first time that the Church became fully charged and fully animated, Pentecost is considered as the birthday of the Church.
The Role of the Spirit
During his earthly ministry, Jesus had tried to tell his disciples about the things of heaven and many other things, but his disciples lacked either the intellect or the faith to grasp what he was trying to say. Now the Holy Spirit transformed their hearts and minds to understand the more sublime things pertaining to God and the heavenly kingdom.
The Holy Spirit also injected a boldness and sense of purpose in the disciples so that they were prepared to make sacrifices to bring the good news of salvation to the ends of the world. Indeed, some of them took after Jesus and give their lives in extending the gospel message. From hiding in the Upper Room, they started fanning out to the far reaches of the ancient world.
The Gifts of the Spirit
The Holy Spirit is the dispenser of spiritual gifts. The Catechism of the Catholic Church names seven gifts: Wisdom, Understanding, Knowledge, Counsel, Fortitude, Piety and Fear of the Lord. However, the variety of gifts that God gives us through the Holy Spirit cannot be limited. Indeed, there are also the Charismatic gifts of Healing, Miracles, Prophecy, the Discernment of Spirits, Tongues, the Interpretation of Tongues and many others besides.
Some of the gifts such as piety and tongues are meant to enrich the individual; others such as prophecy, the Interpretation of Tongues and healing are meant to edify and benefit the larger Christian community.
The Fruits of the Spirit
If we live our lives fully in the Spirit, we will experience some, if not all, of the Fruits of the Spirit. The Book of Galatians mentions Love, Joy, Peace, Patience, Kindness, Goodness, Gentleness, Faithfulness, Long Suffering, Modesty, Chastity and Self-Control (Gal 5:22-23). As with the gifts of the Spirit, there are countless other fruits which are not named.
The Holy Spirit of God is as present and active today as it was in the days of the Apostles. It is available to all baptised Christians for all time. But how effective the Spirit is in us depends on how fully we avail ourselves of its fellowship and its power.
We pray to the Holy Spirit to melt us, mould us, fill us and use us for the benefit of the Church and the glory of God. "Come Holy Spirit, fill the hearts of your faithful and kindle in them the fire of your love. Send forth Your Spirit and they shall be created. And You shall renew the face of the earth."
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Speakers were nearly evenly divided Friday on the question of whether the closed St. John the Divine Church in Kansas City, Kan., should be razed or preserved.
The public meeting was called to discuss alternatives to demolition, but several people said that's what they wanted to see.
"We don't need that building to have our heritage," said Monica DeLeon. "We know where we come from, and that's Argentine."
The church at 2511 Metropolitan Ave. was closed in 1992, and the roof has partially collapsed. The neighborhood association wants it demolished, but it has been nominated for the National Register of Historic Places.
A nonprofit group that owns the structure wants to save it as part of the history of the Mexican-American experience. The group proposes to turn it into an art center.
"The St. John the Divine Community Art and Education Center will only enhance the quality of life for future generations," Carolyn Ruiz said.
Of 17 people who spoke at the meeting at the Argentine Community Center, nine favored demolition and eight opposed it. The Unified Government has filed a demolition order for the building, but that is on hold pending a historical review.


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Eros picks up international rights for Rakesh Roshan's 'Krazzy 4'
19 Oct, 2007 - 08:20 PM IST | | 230 Reads
MUMBAI: Eros International has announced the acquisition of the international rights of Rakesh Roshan?s Krazzy 4.
Produced by Film Kraft Productions and directed by Jaideep Sen. Krazzy 4 stars Juhi Chawla, Dia Mirza, Arshad Warsi, Irrfan Khan, Rajpal Yadav and Suresh Menon.
Krazzy 4 is a comedy with a social message. Based around the four characters played by Arshad Warsi, Irrfan Khan, Suresh Menon and Rajpal Yadav who form the crazy foursome with key supporting roles by Juhi Chawla and Dia Mirza.
Following tradition of all Rakesh Roshan films, Krazzy 4, currently under production, also begins with the letter K and will have music by Rajesh Roshan.


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Round Sixteen AFL Plays
ADELAIDE v WESTERN BULLDOGS
Adelaide and Western Bulldogs is this weeks Friday night game. Both sides are struggling at the present the Dogs more so.
The Crows last game at home saw them start minus 52.5 against the Hawks. The failed to cover the line and failed to win the game in a massive upset. Last week they did enough against a determined Carlton outfit winning by 3 goals. You wouldn't say the Crows are at the top of their game at present.
Last years premiers are going very ordinary. They got rolled last week by an Eagles side that has been atrocious in Melbourne this year and was also without a number of key players. The Dogs are just a shadow of the side that took all before them last year. Players like Jake Stringer and Tom Liberatore haven't got even close to the form of previous seasons. Tom Boyd is now out for the short term. To make matters worse skipper Bob Murphy has agains succumbed to a hamstring injury. As I have said previously the Dogs seem to be making three or four changes every week and have not been able to have a consistent 22/24 all year.
Adelaide is forecast to have a wet day tomorrow and should start to clear around match time. If the rain is still about during the game this will help the Dogs make it a scrap and slow down the fast running - quick ball moving Crows outfit.
The Crows will be out to make amends in front of their passionate crowd after the Hawks loss at home and I expect they will have to much firepower for a low scoring Bulldogs side. I'm not keen on taking the Crows at the line of 23/24 with the weather a possible issue and I expect the Dogs to fight tooth and nail.
Going to take Adelaide at the Margin 1-39.
OTP Recommendation
Adelaide 1-392 at 2.17-2
COLLINGWOOD v ESSENDON
Collingwood and Essendon do battle for the second time this season on Saturday. The Bombers won the Anzac Day clash earlier in the season by 18 points and have been the better of the two sides this year. That said they will be seething after giving up a 27 point lead last week in the last qtr against the bottom side Brisbane. Expect a response.
What do we make of Collingwood? They have won just five games for the year but have been competitive in the majority of matches. They seem a typical "looks good on paper side". They have average skills and a very poor game plan/structure. They just don't have a functioning forward line and now find themselves without Darcy Moore for this weeks game. Ben Reid returns after being dropped in a puzzling decision by Nathan Buckley.
When assessing these two sides the difference seems to lie in the fact the Bombers have Joe Daniher and Cale Hooker up forward and Michael Hurley down back. The Pies are going to be relying heavily on Mason Cox - Ben Reid up forward and Lynden Dunn down back.
I fancy the Bombers to win here and keep alive a spot for the final 8.
SYDNEY v GOLD COAST
Quick preview here. Sydney starting minus 44.5 here against a Suns side that is missing Gary Ablett and a host of other players. The value is gone at the line (started 36.5) and therefore perhaps the better bet for now is taking the games total over 176.5
The Swans are notoriously low scoring side but with an opportunity here to cement a spot in the top 8 and build some percentage I expect the Swans to a bit more offensive.
The Suns really do struggle on the road and will have a lot of defending to do against a Sydney side that seems to be getting back to its best and also has just about a full list to pick from.
The weather forecast is fine.
ST KILDA v RICHMOND
Etihad is the venue Saturday night when St Kilda takes on the flying Richmond. The Tigers have been the story of season 2017.
Many an expert would have had them in the bottom five at the start of the season after there terrible finish to season 2016. It's a credit to Damien Hardwick that he has managed to turn their fortunes around with only a few additions to the squad. That said Prestia and Caddy have only been fair but Nankervis has been excellent. The real change for the Tigers is there change in game style - they have gone from a slow moving chipping the ball around side to a fast moving side who like to play on and run hard from half back. They have two superstars in Dusty Martin and Alex Rance. Cotchin and Riewoldt have been much better the year after poor seasons in 2016. The Tigers right now as we speak are genuine top 4 contenders.
St Kilda have been up and down this year which is not unexpected for a side that is still relatively young but relies on the experience of Nick Riewoldt and Leigh Montagna. The Saints had a hard fought win last week in Perth against the Dockers. They have had some good wins at Etihad this year including beating the Premiership faves GWS.
I fancy this to be a tight contest. The Tigers are not a high scoring side and wear teams down through their solid defence and catching teams on the rebound. The Saints will fancy themselves to cause an upset at Etihad however the Tigers have played well at the ground this year.
Going to select Richmond at 1-39.
OTP Recommendation
Richmond 1-392 at 2.30-2
CARLTON v MELBOURNE
Melbourne coming off a bad loss and with injuries and suspensions find themselves with a tough match up this week against Carlton on Sunday at the G.
The prices for this game were as short as 1.35-1.38 Melbourne two weeks ago. Two weeks is a long time in AFL these days. The current prices are now around the 1.60 -2.30 price. It's little wonder the money has come for the Blues. They have been more than competitive this year and with a bit of luck could have won more than the five games in 2017. The Demons have a wonderful young side but rarely have there best 22 to pick from. They have been decimated this year by injuries to key players and stupid suspensions. Jack Viney is the latest to succumb to injury and with Nathan Jones still missing the midfield is starting to look thin. Thomas Bugg got himself suspended for the rest of the home and away season and probably won't play again this season after such poor discipline.
The Dees will be sweating on Jesse Hogan being fit and playing as they need a key forward desperately with Jack Watts and Jeff Garlett battling injuries.
The Blues will do what they do best here. Stack players behind the ball and make it hard for Melbourne to break them down. They will rely heavily on the in form Bryce Gibbs - Marc Murphy and Patrick Cripps to get on top in the midfield.
I fancy the Blues to win here. They had their chances to beat Adelaide last week and they will sense a huge opportunity here. I suggest taking the Blues at the handicap - head to head and 1-39.
OTP Recommendation
Carlton +8.53 at 1.80+2.4
OTP Recommendation
Carlton to Win2 at 2.35-2
WEEK RESULTS STAKES ROI Grand Final +9 11 82% Finals Week Three -4.2 12 -35% Finals Week Two +0.42 11 4% Finals Week One +7.18 11 65% Round Twenty-Three -9.09 21 -43% Round Twenty-Two +9.47 16 59% Round Twenty-One +8.55 13 66% Round Twenty -8 17 -47% Round Nineteen -9.2 13 -71% Round Eighteen +3.01 15 20% Round Seventeen +9.88 16 62% Round Sixteen -4.05 15 -27% Round Fifteen +0.12 13 1% Round Fourteen -2.48 15 -17% Round Thirteen +1.93 5 39% Round Twelve -6.3 14 -45% Round Eleven -2.1 9 -23% Round Ten -5.26 10 -53% Round Nine +4 11 36% Round Eight +10.01 9 111% Round Seven -10.26 17 -60% Round Six -2.4 14 -17% Round Five -12.3 18 -68% Round Four -5.21 11 -47% Round Three -1.16 10 -12% Round Two -11 11 -100% Round One -0.27 6 -5% Total -29.71 345 -9%


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Juan Manuel La Vista is every single woman's idea of a perfect guy handsome,perfect hunk, and a billionaire.
Helena Contreras an orphan and trying to live with no idea of her past she was raised in an orphanage.
When she first saw Juan Manuel,she knew he was the one.But she just kept it within her they are worlds apart and she knew it would take more than a miracle for him to notice her she was a nobody
What will happen.Will there be a happy ending...O mauuwi din lang sa heartbreak lets see...
- ceo
- heiress
- love
- loveatfirstsight
- romance
LovelyYson Jan 30, 2017
Wow di halatang fist_time,.,😁😁😁😁umpisa plang KC duon malalaman Kong maganda Ang story o Hindi,.,at Ito for sure may pag pupuyatan nanaman akong basahin,.,😃😃😃😃😃😃


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Despite announcing his retirement from the series a couple of months ago, some new Instagram posts from Sylvester Stallone suggest that the actor is back onboard "The Expendables" franchise.
The fourth film, which was expected to team the OG's of the first three films (Stallone, Jason Statham, Arnold Schwarzenegger etc) with new recruits like Jackie Chan and Hulk Hogan, was put on pause while Millennium/Nu-Image could figure out how to push forward without Sly.
But a new post from the "Creed" star would indicate that he's back in business with the prod co, and involved in the new film after all – which he suggests will be a "dark" entry in the franchise.
Stallone had previously said that the fourth "Expendables" would be the final entry in the series.
The actor is currently involved in a "Creed" sequel, with Dolph Lundgren reprising Ivan Drago


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craig armstrong the space between us
This is Craig Armstrong's first solo release. Armstrong has said himself that this album was a retrospective of where he had come from, in terms of his work for Massive Attack and for film scores.
Featuring new arrangements and some of his film writing efforts, the album also featured new solo pieces 'Rise', 'After The Storm' and 'Childhood'.
This is a stunning body of work, one which should feature in every Craig Armstrong fan's music collection.
Track Listings
- Weather Storm
- This Love (Cruel Intentions)
- Sly II
- After The Storm
- Laura's Theme
- My Father
- Balcony Scene (Romeo + Juliet)
- Rise
- Glasgow
- Let's Go Out Tonight
- Childhood
- Hymn
Back to Music & Video
- Performed & Composed By:
- Craig Armstrong
- Download
- Album Art Collection
- Song Lyrics
- This Love
- Let's Go Out Tonight
- External Links
- Massive Attack
- Elizabeth Fraser
- Paul Buchanan


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Classic smaller vintage huipil from the town of Todos Santos Cuchumatán. This lovely huipil measures 28″ across the shoulders and 24″ from the neckline to the bottom edges (folded). The neck opening is square and measures 3″ by 3″ with an additional tie-closed 2″ slit on one side of the opening (very tight to pull over adult head). The sides have been sewn to create armholes.
This daily use vintage huipil is striking with delicate woven designs that feature mayan stars and zigzag rivers and mountains throughout the bodice on both sides. This style of weaving leaves the loose ends on the inside, creating a shaggy lining that aids in warmth in the high mountain area. The huipil is accented around the collar with radiating lines of applique that is classic to the area. The neckline and shoulders are trimmed with a black accent. The background fabric is a rich cranberry/red colored cotton in the center and striped blue fabric on the outer panels.
Additional photos can be found here.
This vintage huipil is in good used condition. There are a few loose threads. There is a small hole in the lower section of the bodice on one side. The neck opening shows typical wear of a vintage textile and one of the tie ends is worn. A wonderfully detailed huipil!