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This study documented the treatment cascade for engagement in care and abstinence at treatment exit as well as examined correlates of these outcomes for the first certified Matrix Model® substance abuse treatment site in Sub-Saharan Africa.
This retrospective chart review conducted at a resource-limited community clinic in Cape Town, South Africa, assessed treatment readiness and substance use severity at treatment entry as correlates of the number of sessions attended and biologically confirmed abstinence at treatment exit among 986 clients who initiated treatment from 2009–2014. Sociodemographic and clinical correlates of treatment outcomes were examined using logistic regression, modeling treatment completion and abstinence at treatment exit separately.
Of the 2,233 clients who completed screening, approximately 44% (n = 986) initiated treatment. Among those who initiated treatment, 45% completed at least four group sessions, 30% completed early recovery skills training (i.e., at least eight group sessions), and 13% completed the full 16-week program. Approximately half (54%) of clients who provided a urine sample had negative urine toxicology results for any substance at treatment exit. Higher motivation at treatment entry was independently associated with greater odds of treatment completion and negative urine toxicology results at treatment exit.
Citation: Gouse H, Magidson JF, Burnhams W, Remmert JE, Myers B, Joska JA, et al. (2016) Implementation of Cognitive-Behavioral Substance Abuse Treatment in Sub-Saharan Africa: Treatment Engagement and Abstinence at Treatment Exit. PLoS ONE 11(1): e0147900. https://doi.org/10.1371/journal.pone.0147900
Editor: Philip Anglewicz, Tulane University School of Public Health, UNITED STATES
Received: August 17, 2015; Accepted: January 11, 2016; Published: January 27, 2016
Copyright: © 2016 Gouse et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: These are clinical record data and thus there are restrictions in place preventing us from making the data publically accessible. Any parties interested in this data set can contact Dr. Hetta Gouse to request the data, which will be made available with permission of the City of Cape Town.
Funding: The authors received no specific funding for this work.
Competing interests: Mr. Warren Burnhams is employed by the City of Cape Town as the Key Supervisor for Matrix Clinics in the Western Cape. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
Historically there has been a gap between research and implementation of substance abuse treatment in developed countries [1, 2]. This gap is further heightened in low-and-middle-income countries (LMICs) such as South Africa (SA), where there is limited access to empirically-supported treatments and a shortage of trained health workers to deliver evidence-based interventions [3, 4]. In such settings where resources are scarce and the need for treatment is large, it is critical to understand the implementation of evidence-based treatments to ensure clients are receiving effective and acceptable care [5].
SA's Western Cape province has pushed towards implementing evidence-based approaches to substance abuse treatment because of the well-characterized methamphetamine or "tik" epidemic in this region. Since 2002, Cape Town has experienced a 150-fold increase in methamphetamine users presenting for substance abuse treatment [6]. Because this region is thought to be among those with the highest prevalence of methamphetamine addiction globally [6], research is needed to document the implementation of evidence-based substance abuse treatment.
In 2007, in response to the drastic increase in methamphetamine use in this region, the City of Cape Town developed a multi-sectorial alcohol and drug strategy to manage the rapidly growing drug and alcohol-related challenges. One of the objectives of this strategy was to improve access to evidence-based treatment services through providing the Matrix Model of outpatient treatment for stimulant use disorders [7] within primary health care in local peri-urban communities. Developed and extensively tested in the United States (US), the Matrix model is an evidence-based, 16-week outpatient cognitive-behavioral treatment that includes individual, group, and family sessions [8–10].
Few published reports have documented the implementation of the Matrix Model in LMICs. Thus, it is unclear whether evidence of the effectiveness of this model for US populations can be extended to countries such as SA, where structural factors (e.g., poverty, shortages of trained health care workers, inability to take extended leave from work, and long distances to care) are substantial barriers to engagement in substance abuse treatment [11]. The overarching goal of this study is to describe one of the first examples of Matrix Model implementation in one low-income, resource-limited community clinic in Cape Town. The primary objectives were to: 1) document the services provided and characteristics of the treatment-seeking population; 2) describe the "cascade" of treatment engagement from screening through completion; 3) examine abstinence at treatment exit using urinalysis results; and 4) explore sociodemographic and clinical correlates of treatment engagement and abstinence at treatment exit.
2.1. Setting
This study took place at the first certified Matrix Model site in Africa. The site is based within a community health center in a peri-urban area outside Cape Town. The substance abuse treatment program was launched in 2008, and in 2010 it was certified as a Matrix Model® 'program of excellence' [12]. The clinic serves a low-income, largely "coloured" (an apartheid classification for 'mixed race' that is still in use) community in the surrounding area; however, clients are not limited to this catchment area due to the lack of substance abuse treatment services in the region. Although the program primarily serves methamphetamine users, many clients use multiple substances including alcohol, heroin, methaqualone (mandrax), and cannabis.
2.2. Description of Matrix program
This outpatient treatment program is based on the standardized Matrix Model® [7]. The core 16-week program consists of 8 sessions of early recovery (with two early recovery groups per week for the first four weeks), 32 sessions of relapse prevention (two relapse prevention groups per week for sixteen weeks), and other optional weekly individual or conjoint sessions. Clients typically attend two to four sessions per week. At least one mandatory random urine drug panel test screen is required on a weekly basis from all clients; for clients who are primary alcohol users, an alcohol breathalyzer test is required.
The first point of contact is by a non-appointment screening visit conducted by a lay counselor. Starting in November 2011, the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) [13], the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) [14] and a urine drug test with alcohol breathalyzer were administered at the screening visit. Referrals to other services are made for clients experiencing severe withdrawals from alcohol, heroin users with difficulties remaining abstinent on an outpatient basis (referred for detoxification services and residential treatment), those experiencing psychosis, where there is serious suicide risk (referred to a psychiatric hospital), or those unable to attend an intensive outpatient program (e.g., for work reasons). If the client is suitable for the Matrix Model program, the first session (third contact) is generally attended within two days of enrollment.
2.2.1. Matrix site therapists.
The lay counselor is trained in basic substance abuse and mental health counseling skills. The minimum educational requirement for a therapist is a four-year degree in social work or counseling psychology; and for the Key Supervisor, a Masters level degree in a related field. Therapists receive Matrix Core Training from US-based Matrix program trainers and complete a 5-day Motivational Interviewing Network of Trainers (MINT)-certified Motivational Interviewing course. The program Key Supervisor, experienced in implementation of the Matrix Model, provides individual case supervision and Matrix supervision sessions once per month.
2.3. Procedures
2.3.1. Data extraction.
We retrospectively evaluated services provided at this clinic from one-year post inception (June 2009) until May 2014. The cut off point for inclusion in the evaluation was 4 months prior to the start of data extraction so that all included participants had the opportunity to complete the 16-week program. Informed consent was waived on the basis of it being a retrospective chart review and de-identification of data. Data used in this research project were extracted from chart reviews conducted on all existing intake and discharge assessments collected during routine care. All data identifying clients were removed from clinical records before research activities were implemented. The chart-review was approved by the University of Cape Town Human Research Ethics Committee and City of Cape Town Health Department.
2.3.2. Measures.
Sociodemographics and treatment history: Age, ethnicity, gender, education level, relationship status, and employment, and number of previous treatment episodes were assessed.
ASSIST V.3.0 [13]: The ASSIST assesses level of substance use severity for alcohol, tobacco and illicit drugs. A total score is calculated for each substance that indicates level of substance use involvement, which is then used to categorize the person into low (0–3), medium (4–26) and high risk (>27) of substance-related health problems for illicit drugs, and low (0–10), medium (11–26) and high risk (>27) for alcohol.
SOCRATES [14]: The SOCRATES assesses readiness for change among alcohol and substance users, and has been found to have good internal consistency and reliability across diverse samples. It yields three composite scores ranging from 10 (very low) to 90 (very high): Recognition indexes acknowledgment of substance use related problems (α = .85–95). Ambivalence measures degree of uncertainty about changing substance use (α = .60–.88). Taking Steps provides information regarding the degree to which individuals are taking concrete actions towards changing substance use (α = .83–.96) [14].
Clinical outcome variables: Treatment initiation and engagement. Treatment initiation was defined as attending at least one group or individual session. To define treatment engagement, clinically meaningful cut-offs were based on the existing evidence-based Matrix Model program structure in accordance with the City's Matrix Key Supervisor (WB): 1) attending at least four group sessions (2 weeks), 2) attending at least eight group sessions (i.e., completing early recovery; one month); 3) attending at least sixteen group sessions (2 months); 4) attending at least 24 groups sessions (three months); and 5) completion of the full 16-week program (i.e., completing relapse prevention; 4 months).
Urine tox screen results at treatment exit. Urine drug tests were administered on a weekly basis for all clients using a Drugs of Abuse Panel Test Card for amphetamine, benzodiazipine, cocaine, opiate, marijuana (THC). Tox screen results at treatment exit were assessed using urine drug test results (positive or negative) for all substances in the last two weeks of each client's clinic attendance; any use in the last two weeks was defined as a positive screen, and no use was defined as a negative screen.
2.3.3. Statistical analysis.
To describe the cascade of substance abuse treatment engagement, the number of group sessions attended was calculated to document the markers of treatment engagement described above. Next, frequencies of urine tox screen results were calculated during the two weeks before each client exited treatment. Finally, sociodemographic and clinical correlates of treatment outcomes were examined using logistic regression, modeling treatment completion and abstinence at treatment exit separately.
3.1. Descriptive characteristics of sample
From June 2009 through May 2014 a total of 2,233 clients had a screening visit at the Matrix Model® program. Clients were 66% male (n = 1,471), 97% "coloured" (n = 2,161), 86% unemployed (n = 1,912), 68% single (n = 1,507), and mean age of 28.3 (SD = 7.6) years. Methamphetamine (61%; n = 1,329) and heroin (24%; n = 534) were the two most commonly reported primary substances of abuse. For 76% (n = 1,704) of the sample, this was the first reported substance abuse treatment episode. Of those who received the ASSIST (n = 1,041), 76% were in the moderate- to high-risk categories for amphetamines (n = 790) and 28% in the moderate- to high-risk categories for opioids (n = 288). More than half (58%) of clients were in the moderate to high-risk categories for more than one substance.
3.2. Cascade of treatment engagement
Fig 1 illustrates engagement in outpatient Matrix Model® substance abuse treatment among clients who initiated treatment. Of the 2,233 clients who completed screening, 44% (n = 986) initiated treatment. Among those who initiated treatment, less than half (45%; n = 448) completed two weeks of the program, approximately one-third (n = 293) completed 1 month of treatment, which marks completion of the early recovery module, and one out of eight (13%; n = 129) completed the full program, which marks the completion of relapse prevention.
Attending ≥ 8 groups sessions = completion of early recovery; Complete full 16 week program = completion of relapse prevention.
3.3. Urine toxicology screening results
Of the 986 clients who initiated treatment, 564 (57%) had a urine tox screen result at treatment exit, which could have occurred at any time during the 16-week program. Of those, 304 (54%) had a negative result at treatment exit for all substances. Of those who completed at least eight group sessions (first month of treatment) and had urine tox screen results available in their last two weeks of treatment (n = 260), 69% had a negative result at treatment exit for all substances (n = 180).
3.4. Multivariable models
As shown in Table 1, only treatment motivation as measured by the SOCRATES was significantly associated with treatment completion. Higher scores on the "Taking Steps" and "Recognition" subscales as well as lower scores on the "Ambivalence" subscale were independently associated with greater odds of treatment completion. As shown in Table 2 higher scores on the "Taking Steps" subscale were independently associated with greater odds of abstinence at treatment exit, and greater severity of methamphetamine use was independently associated with lower odds of abstinence at treatment exit.
Findings provide one of the first opportunities to describe implementation of the evidence-based Matrix Model cognitive-behavioral substance abuse treatment program in a resource-limited setting in SA. To our knowledge, there have been limited examples, if any, of studies that have documented the implementation of evidence-based substance abuse treatment in a resource-limited setting in Sub-Saharan Africa, where many structural barriers to treatment exist and there are limited options for evidence-based care [15, 16]. This Matrix site provides treatment in an area of SA with high rates of polysubstance use and one of the highest rates of methamphetamine use in the world [10].
Over a period of 72 months, the clinic had attrition rates comparable to that of published research conducted in industrialized nations. For example, the attrition rate at the Matrix Model clinic site between the initial request for service at screening and treatment initiation was 56%, which is consistent with rates between 29%–63% reported in the literature [2]. Similarly retention after 30 days of treatment was 30%, consistent with rates of 34% reported in the literature for patients with no prior treatment [2, 17]. Overall, findings highlight that enhancing initiation and engagement in treatment is an important area for further study to optimize the benefits of substance abuse treatments in LMICs and industrialized nations.
The opportunity for a drop-in screening visit at this site increases rates of initial contact with the site (versus starting with a visit that requires an appointment), which in turn may also inflate the rate of dropout seen here from screening to the first treatment session. That being said, the population this Matrix site serves (and other populations in resource limited settings) face substantial challenges around treatment initiation and retention including: gaining employment, the impact of gang related activities in the clinic neighborhood, lack of child-care facilities, migration, transport related issues [18], and few other evidence-based substance abuse treatment referral options [19]. The influence that these factors have on treatment retention and possible solutions to overcome these structural barriers should be addressed in future clinical research in LMICs and industrialized nations.
It should also be noted here that early termination of treatment does not equate to treatment failure. Clients may have terminated treatment for reasons other than relapse, including finding employment. Further, the rate of negative drug tox screens for all clients who were tested two weeks prior to treatment termination (54%) and those who completed at least one month of treatment (69%) suggest that even limited interaction with the Matrix Model program may assist clients with achieving some degree of abstinence. The association of degree of engagement with treatment outcomes should be examined in future research.
Motivation emerged as a key psychological factor that predicted greater engagement in treatment and better treatment outcomes. Those who reported awareness of substance-related problems (i.e., Recognition) and taking concrete steps to reduce substance use (i.e., Taking Steps) at treatment entry had greater odds of completing the full 16-week substance abuse treatment program. Greater uncertainty about setting goals for changing one's relationship with substances (i.e., Ambivalence) was independently associated with decreased odds of treatment completion. Findings point to the need for expanded efforts to enhance motivation for treatment, including approaches like contingency management that provide motivational incentives as positive reinforcement for abstinence that could also mitigate the effect of structural barriers to remaining engaged in treatment in this resource-limited setting [20–23].
The study findings must be interpreted in the context of important limitations, including those inherent in this being a retrospective chart review. Urine drug screen data was available only for the last two weeks of program attendance, and as such we were unable to document the number of clients at each step in the cascade with negative urine drug test results. Additionally, we could not assess reasons for 'drop-out' and were limited to only examining the measures included in routine clinical assessments. Tobacco use is not treated explicitly in this clinic setting and was therefore not included in our analysis. Alcohol users had greater odds of abstinence at treatment exit, but this may be due to the fact that breathalyzer data were not extracted. Further research is needed to examine the extent to which those who do not have stimulant use disorders achieve comparable benefits from the Matrix Model in this setting.
Findings provide initial support for the successful implementation the Matrix Model in a resource-limited setting. We found that clients with heterogeneous, severe substance use profiles were making contact with the program for their first treatment episode. Rates of initiation and engagement were comparable to the implementation of substance abuse treatment in industrialized nations. Motivational enhancement interventions could support treatment initiation, promote sustained engagement in treatment, and achieve better treatment outcomes. Future mixed methods research should examine whether the barriers faced to retention in care are distinct in this setting.
We hope this work spurs further efforts to address the many remaining empirical questions about how to optimally deliver evidence-based substance abuse treatment in resource-limited settings where huge clinical needs exist, particularly related to questions regarding how to enhance motivation and address structural barriers to remaining engaged in care.
Author Contributions
Conceived and designed the experiments: HG JM WB JJ AC. Analyzed the data: HG JM JR AC. Contributed reagents/materials/analysis tools: JR. Wrote the paper: HG JM WB JR BM JJ AC.
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Vanilla Ice Is Coming To Frederick
September 23, 2022
The Great Frederick Fair opened on Friday September 16th. This Thursday was the big I Love The 90's Tour! Featured performers were Coolio, Tone Loc, Rob Base, Montell Jordan, Young MC, and the big act was Vanilla Ice. Parents who grew up in the 90s were ecstatic about the concert- When Hope Roberts heard about the tour she said, " Vanilla Ice is coming to town? It's like I'm living out my college dreams!"
Last year Jon Pardi and Drew Parker performed at the Frederick Fair. Though it was a great turn out, and lots of people came to watch them perform , this years performers blew last year out of the woods!
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This concert was the perfect way to bring family and friends together. The fair marks the end of summer and beginning of fall and I'd say Vanilla Ice was the perfect way to close out the summer.


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Barndoor Master Bath Remodel
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Project Cost: $32,000


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We've all chuckled at those memes of naughty-looking potatoes, duck-billed eggplant, and carrots shaped like feet—but have you ever seen such characterful vegetables in the supermarket? Each year in the U.S., some 20 billion pounds of produce go to waste because they don't meet the perfectly straight or round or blemish-free ideal that grocery stores demand.
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Read more from the Watchlist.


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Property sales in the first nine months of 2022 are up by 37.2 per cent, recording the most activity in the real estate market since 2008.
Limassol continues to lead the pack with 3,315 sales so far – compared to 2,221 last year –an increase of 49.3 per cent.
But Paphos roared ahead with a whopping 69 per cent rise in sales as it recorded 2,028 transactions in the first nine months – compared with 1,200 last year.
The latest data from the land registry department, published on Tuesday, showed that Larnaca has the second highest rate of increase at 53 per cent, with 1,734 sales this year.
Nicosia (3.8 per cent increase at 2,043 sales) and Famagusta (1.9 per cent and 490 sales) recorded the lowest rates.
Indeed, there have been 9,610 sales so far this year compared with 7,003 last year, an increase of 37.2 per cent.
The increase compared to the first nine months of 2019 is at 24.2 per cent.
August saw a considerable increase in sales at 34 per cent, while September saw 1,157 sales (compared with 914 last September) – an increase of 27 per cent.
Stockwatch cited experts in the real estate sector who see demand remaining strong despite the fallout following Russia's invasion of Ukraine and concerns over a looming financial slowdown.
After the previous report from the land registry, released in mid-July, sources from the department told media that the rise in sales was mainly due to domestic demand.
They said that people were investing in property due to the inflation crisis, while also hoping to get ahead of the increased lending rates.
The July report, however, showed that sales in Paphos were up 72 per cent which have since decreased slightly to 69 per cent.
A similar trend is evident across the board: Larnaca was at 57.8 per cent (now 53 per cent) and Limassol was at 53.9 per cent (now 49.3 per cent).
The same is true for Famagusta which as of July recorded an increase of three per cent but this has since dipped to 1.9 per cent.
Nicosia was an outlier as it notched a small rise from its 3.1 per cent in July to 3.8 per cent in October.


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Virginia Beach, Va. – The Virginia Beach Fire Department is on scene at a fire at the Courtyards of Chanticleer apartment complex in the 1400 block of Reynard Drive.
The call came in at 1:05 p.m. Crews responded to the multi-family apartment building, and had the fire under control at 1:25 p.m. The fire was deemed out at 1:31 p.m., according to the Virginia Beach Fire Department.
Crews are working to figure out the cause of the fire.
No injuries have been reported.
Additional details will be posted as they become available.


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Will my abs disappear if I bulk?
Bulking will not lead to you losing your abs, they will still be there. But they may not be visible. But you won't lose them if anything they will probably get stronger. Once you begin to lose weight (known in bodybuilding as a cut) your abs may be even more defined then they were before you started bulking.How do I bulk up but keep abs?
Examples of low-intensity cardio are steady-state walking on the treadmill, riding the exercise bike or using the elliptical machine. This will help ensure that you keep your abs while gaining muscle mass.Why do I lose my abs when bulking?
Most people when they bulk, they go on some crazy see food diet and you gain a lot of body fat at the time as muscles. As your body fat increases, you will have less visible abs. Even if you are lean bulking, the extra added body fat will make your abs less visible. It is very normal.Can you bulk and keep a flat stomach?
Increase Your Calorie Intake GraduallyWhen you eat fewer calories than you burn, it's difficult to build muscle unless you're overweight or just getting started with exercise. Bulking will help you gain mass and become stronger, but it leads to fat gain. To maintain a flat stomach, slowly increase your calorie intake.
Why do I get belly fat when bulking?
The reason people get fat while bulking is because they're eating too many extra calories, and those extra calories are being stored as body fat. The best way to improve your results is to maximize your rate of muscle growth by improving your workout routine, diet, and lifestyle.How Bodybuilders Keep Visible Abs Even While Bulking
Should I bulk if I'm already fat?
You Need To Be "Lean Enough" To Bulk. For this reason, you don't want to begin bulking until you are "lean enough" to do so, as attempting to bulk when you're "too fat" means you're just going to end up getting even fatter.What is the dirty bulk?
A dirty bulk refers to a period of aggressive weight gain used to promote muscle and strength gains in strength sports and certain team sports.Why do my abs keep disappearing?
You have too much body fat.The single most important aspect when it comes to getting your abs to show is having a low body fat percentage. All humans have abdominal muscles that can be made more visible with training – but ultimately to see your abs you need to be at 10% body fat or less (18% or less for women.)
Why did my abs just disappear?
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Why do my abs go away so quickly?
When you eat or drink, your body retains water and your muscles lose definition. All these fitness models you see with chunky abs and really hard muscles are dehydrated.What are the first signs of abs?
Your pants and/or shorts are looser in the waistline.It is the easiest and most effortless way to notice your progress on the journey to a washboard stomach. If your pants are fitting more loosely or if you have to tighten your belt, then you are losing fat around your stomach.
How do I guarantee my abs?
- Check your diet. Getting a six-pack requires lowering your body fat percentage. ...
- Do cardio. Cardio can help you achieve a low body fat percentage, which is key for having a visible six-pack, Root says. ...
- Build your core. ...
- Heel tap.
- Leg lower.
- Side plank dips. ...
- Russian twists. ...
- Oblique crunch.
At what body fat percentage can you see abs?
10 to 14 percentThis range of body fat is still lean, which means your abs will be visible. But it's also considered healthier and easier to obtain than the 5 to 9 percent range.
Why do I have abs but no lines?
The most common reason for not having visible abs is simply that your body fat is not low enough, simply there is fat between your skin and muscle which is blurring or obscuring the lines and definition of your six pack.Do carbs hide abs?
Myth #2: Carbohydrates kill absCarbohydrates are an essential nutrient that your body uses for fuel. So, no, carbs don't destroy abs. Fast-digesting carbs like white bread, sports drinks, and sugary cereals, however, can initiate an insulin spike that can hinder fat loss.
How long does it take for abs to show again?
A good rule of thumb (and a safe one) is to aim to lose 1 to 2 percent of body fat per month. So, unveiling your abs can take anywhere from 3 months to 2 years.What percentage of men have abs?
Well, approximately 20% of all people sport the correct number of horizontal bands to achieve an 8-pack. For a 6-pack, the number is around 60%. About 15% of the general population have 4-pack abs, while 2% can only ever achieve a 2-pack.How often should I workout my abs?
So how often should you train your abs? 2-3 exercises 2-3 times per week is plenty to maximize development without overdoing it. If you are already working out 3 times per week you can just tack 1-2 ab exercises on to the end of your workouts.Why do I only have a two pack?
Unfortunately for some, the answer lies in genetics. Everybody has two rectus abdominis muscles, but not everyone has the same number of bands of connective tissue. These bands run horizontally across the abdomen and give the appearance of a 6-pack or 8-pack, and the number you're born with is completely up to chance.What foods make your abs go away?
Foods to avoid when trying to define the abs
- foods with added sugar, including candies, chocolates, and cakes.
- drinks with added sugar, including sports drinks, soda, and alcohol.
- refined grains, including white bread, white pasta, and sugary cereals.
- fried foods, including burgers, fries, and fried chicken.
What foods to avoid to get abs?
Foods to avoid
- Sugar-sweetened drinks. Sugary drinks like soda, sports drinks, and juice can increase body fat and stall progress on getting abs. ...
- Fried foods. In addition to being high in calories, fried foods like French fries, chicken strips, and mozzarella sticks are also high in trans fats. ...
- Alcohol. ...
- Sugary snacks.
Does lack of sleep affect abs?
Not getting a healthy dose of sleep regularly show on your abs. The hormone cortisol, that causes extra fat storage around the belly is raised when you don't have enough quality sleep.Does everyone have an ab crack?
Can Everyone Get an Ab Crack? No, not everyone can get an ab crack. This is just one of those areas in which our genetics decide our fate. Some people can do ab workouts religiously and never develop an ab crack, while others can have an ab crack without working out.Does everyone have abs inside?
Everyone has abdominal muscles, known as abs. These muscles may not be visible because of the fat around them. Some fat, called subcutaneous fat, is close to the skin's surface, but fat also exists deep within the abdominal cavity.Does everyone have visible abs?
The short answer: unfortunately, no. "Visible abs are very difficult to achieve for those of us who aren't genetically blessed," says Scharff. "Everyone's muscles are built differently. Some people have deep muscle bellies, which create higher peaks in between those tendons, and thus abs are more visible.
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Robin On Rusty A Fence Metal Print
by Demetrai Johnson
Product Details
Robin On Rusty A Fence metal print by Demetrai Johnson. Bring your artwork to life with the stylish lines and added depth of a metal print. Your image gets printed directly onto a sheet of 1/16" thick aluminum. The aluminum sheet is offset from the wall by a 3/4" thick wooden frame which is attached to the back. The high gloss of the aluminum sheet complements the rich colors of any image to produce stunning results.
Design Details
This beautiful picture is photo of a Robin on a rusty fence.
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Artist's Description
This beautiful picture is photo of a Robin on a rusty fence.
About Demetrai Johnson
Demetrai L. Johnson is the photographer of Deme J Photos. She loves taking photographs of nature, people, animals, events, and anything else that catches her eye.


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Social media is king of the ring when it comes to advertising. I don't know about you, but I can't get through 30 seconds of Facebook, LinkedIn or Twitter without being bombarded with sponsored ads. If you feel like your senses have been dulled by the constant barrage of adverts, we all share your … [Read more...]
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Mistakes to avoid while planning a social media campaign
With it's impressive scale of reach, many businesses flock to causal media and use it as one of their marketing channels. Before diving into your social media marketing campaign, there are numerous pitfalls, which I really don't want to see you tumbling into. In this post, I'll uncover the common … [Read more...]
Ensure your social media efforts don't go in vain
Prior starting the actual topic, we want to ask you some questions! – What is the first thing you do when you wake up? If you want to have a conversation with a friend who is internationally situated – what would you do then? If you want to check a company's environment – what will you do? You can … [Read more...]
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Many people are aware of the damage sugary drinks can do to your teeth. Did you know that acidic drinks also pose a risk? We're here to help you get informed on why acidic beverages are harmful to your teeth, what the biggest offenders are, and how to avoid potential damage.
How Acidic Drinks Affect Your Teeth
Why Are Acidic Drinks Bad for My Teeth?
Acidic drinks are loved by many but can be tough on your teeth if consumed regularly. A drink's acidity level is determined by how much acid it contains from citrus or other additives. The pH scale measures this trait, but what pH is bad for your teeth? Any pH level below 7.0 is considered acidic, and the lower the number, the more harmful to your teeth.
Enamel is the strong outer layer that protects your teeth. Acidic drinks can wear enamel down, weakening it and causing long-term tooth erosion. It's essential to care for your teeth because tooth erosion is permanent. Enamel isn't a living cell and doesn't naturally repair itself as your skin does.
You can experience several side-effects from improper enamel care.
Consuming acidic drinks could lead to:
- Tooth pain
- Tooth sensitivity (to hot, cold and air)
- Discolouration of your teeth
- Increased risk of cavities
- Abscesses or loss of teeth (in extreme cases)
If you don't take care of your enamel, you may require more advanced dental care like a filling, crown, root canal or tooth extraction.
Fun fact: Your enamel is the strongest material in the human body. It is even stronger than your bones.
Common Acidic Drinks to Avoid
It might surprise you how many drinks are acidic and pose a risk to your enamel's health. Even beverages that offer health benefits, like fruit juice, can be tough on your teeth. Any flavour or type of drink can be acidic, depending on the ingredients, additives and formulation.
It's essential to remember that even sugar-free drinks can be acidic. Carbonation raises every drink's acidity, so any bubbly beverage is likely to be harmful to your dental health over time.
Is acidic coffee bad for your teeth? Is sugar-free soda okay? Let's take a look.
Here are some acidic drinks to avoid:
- Coffee
- Tea, both hot and cold
- Carbonated drinks
- Alcohol, especially wine
- Juice, especially those high in citrus ingredients
- Sports drinks
- Soda and soft drinks (even sugar-free types)
How Do I Protect My Teeth From Acidic Drinks?
We recommend practising moderation when consuming acidic drinks as the first step to protect your smile.
Even though your enamel will not regenerate, saliva does a great job maintaining your teeth's hard outer layer. Letting saliva do its job and consuming items that stimulate saliva production can give you the best chance to fight against acid and erosion.
Any type of acidic drink will cause tooth erosion over time. The more acidic the substance, the more damage it will cause. With this in mind, completely cutting acidic beverages from your diet is the only way to avoid adverse effects altogether. Do not worry, as there are still ways to lower the amount of damage done when you consume acidic beverages.
Tips to protect your teeth from acidic drinks:
- Use moderation: Many people will consume acidic drinks on occasion, so it's vital to limit the amount you drink.
- Rinse with water: Tap or bottled water can wash away acids left in your mouth from other drinks. Consider rinsing with water after enjoying an acidic drink to limit the amount of damage it can do.
- Reach for a straw: Straws can help acidic drinks go past your teeth and straight down your throat. Straws can be helpful to a certain extent but won't prevent all the dental erosion from acidic beverages.
- Don't brush right after drinking: Reaching for your toothbrush too quickly after a drink can make things worse. Wait for at least 30 minutes to an hour after consuming an acidic drink before brushing your teeth as the acid content of the drink will be smeared all over your teeth and can cause quicker deterioration to them.
- Build healthy habits: While it can be challenging to make changes to your routine, doing so will have lasting effects on your dental health. Buying a reusable water bottle can be a convenient way of establishing a new habit to avoid acidic drinks and save money.
- Consume dairy: Dairy products provide a protective film on enamel to prevent cavities.
- Chew sugar-free gum: This easy option can promote saliva production. Saliva is healthy for your teeth because it removes some of the acids and even repairs enamel.
- Practice good dental hygiene: We recommend brushing your teeth for two minutes twice daily to limit decay and cavities. Also, use floss, an interdental brush, or a water flosser to clean between teeth once a day.
- Talk to your dentist: When in doubt, consulting with an expert is the safest option. Your dentist can advise dietary choices for your long-term dental health.
While we've provided some easy tips to limit the damage caused by acidic drinks, there's no way to prevent it entirely. Restricting your consumption of these drinks is the best bet for your dental health. Luckily, you've done a great job learning about tooth erosion caused by acidic drinks and are now prepared to make changes to your diet and build new habits.


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Thermostats are vital to your home comfort.
Think of it like this. You and your air conditioner speak two completely different languages and your thermostat serves as a translator. With this system, your AC understands what it needs to do and when.
So what happens when your thermostat runs into trouble? Well in some cases, your thermostat may just need a break. In other cases though, your thermostat isn't going to be able to do its job.
Needing a new thermostat is something that you need to take care of quickly. We're here to help get you started by teaching you the signs that warn you it's time to upgrade.
These 5 Signs Mean It's Time To Upgrade Your Thermostat
Look into getting an upgrade for your thermostat in Egg Harbor Township if you notice these warning signs.
- It's old. Just as an AC system or heater has a limited number of years that it can operate at its best, so to a thermostat has a limit. If your thermostat is between 10 to 15 years old then it is time to consider getting a new one.
- It can't detect the temperature. Your thermostat needs to be able to figure out what the temperature is in your home. If your thermostat can't accomplish this first step then it won't be able to provide the right instructions to your AC unit either.
- It wasn't replaced with your last system upgrade. Have you replaced your AC or heater in the past several years? Whenever you upgrade one of your HVAC systems, you also need to make sure that you change out your thermostat too. Pairing a new HVAC system with an older thermostat is going to undermine your system efficiency.
- It isn't responding. When you go to change the temperature on the thermostat, is there a delay in the response? Or maybe, even worse, the thermostat doesn't respond at all. If this sounds familiar, then you absolutely need to upgrade your thermostat
- You want to upgrade. At the end of the day, if you want to upgrade your thermostat, then you should be able to. You should be able to come to our team when you want to upgrade, especially if you are looking for a thermostat that will help improve your comfort and efficiency.
Consider Your Options With Our Help
Our team is here to help with every aspect of your home comfort. This means that we don't just look at ensuring you have a good air conditioner in place. We also look to ensure that you have the best thermostat on hand in order to give you the best level of control too.
We work with wireless and smart thermostats. When we install one of these systems into your home in a timely manner so that you can get your home comfort under control again. What's more one of these systems can even help to improve the efficiency of your comfort systems.
Contact Elliott-McElwee, Inc. to schedule your thermostat upgrade today. Your comfort is our business!


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Everyone knows someone who needs to go for a walk to take the edge off the day! OR is it you?
Our mugs have a gloss finish on the outside and a gloss-coloured finish on the inside and hold approximately 330ml (i.e. a standard 11oz mug).
The design is repeated on both sides.
The mug is shipped in a black branded gift box.


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Inclement Weather Eighty Mile Beach
Inclement Weather is played at 92 Beats Per Minute (Andante),
or 23 Measures/Bars Per Minute.
Time Signature: 4/4.
Use our Online Metronome to practice at a tempo of 92BPM.
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Get Inclement Weather Song Key
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Sarti: Te Deum Settings for Prince Potemkin's Victories, Part 2
Series: Classical Era Publisher: A-R Editions
This volume is part of the set Sarti: Te Deum Settings for Prince Potemkin's Victories
Te Deum Settings for Prince Potemkin's Victories, Part 2
Te Deum laudamus (1790)
Edited by Bella Brover-Lubovsky
C118 Sarti: Te Deum Settings for Prince Potemkin's Victories, Part 2
Full Score (2023)
9x12, xii + 141
Performance Parts (Available Separately)
Rental Parts (2023)
Set of 36 parts: 2200 4200 timp 66443 chorus, errata
The upcoming three hundredth anniversary of the birth of Giuseppe Sarti (1729–1802) prompts an artistic and academic reappraisal of the legacy of this once powerful and successful but nowadays virtually neglected composer. Sarti's four-movement Te Deum laudamus—a choral-orchestral reworking of his earlier Te Deum for double choir and two organs, written in 1781 in Milan—was created during his sojourn in southeastern Europe in the retinue of the Russian Prince Grigorii Potemkin during the 1787–91 Russo-Turkish War. Following Potemkin between his administrative headquarters and military camps, Sarti composed and directed performances of works celebrating victories of the Russian army under his patron's leadership. Te Deum laudamus was first performed in October 1790 in Bendery (Bender, Moldova) in celebration of the victorious capture of the fortress of Kiliia. Previously preserved exclusively in difficult-to-access manuscripts, this splendid composition is at last available to scholars, performers, and audiences through this volume.
Te Deum laudamus (1790)
I. "Te Deum laudamus," Allegro con spirito
II. "Te ergo quaesumus," Largo
III. "Aeterna fac," Allegro
IV. "In te Domine speravi," Allegro
Bella Brover-Lubovsky is the author of Tonal Space in the Music of Antonio Vivaldi (Bloomington: Indiana University Press, 2008) and numerous articles concerning music and writings on music in eighteenth-century Italy. Her edition of the musical spectacle Nachal'noe upravlenie Olega (The Early Reign of Oleg) was published by A-R Editions in 2018 as volume 109 in Recent Researches in the Music of the Classical Era. Her work on Te Deum Settings for Prince Potemkin's Victories is sponsored by a research grant from the Einstein Foundation (Berlin).