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All updates for this rule:
This rulemaking is to address the requirements that employers must follow with regard to compressed air work and underground construction. In addition, internal references will be updated.
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New Medicines Emerge, but Few Blockbusters
Drug Makers Find It Hard to Elbow Aside Established, Often Cheaper, Products
After years of anemic productivity, pharmaceutical companies are launching new drugs at the fastest pace since the 1990s, including 39 last year alone.
But there is a problem: selling the new drugs.
New medicines, including blood thinners from Johnson & Johnson, Pfizer Inc. and Bristol-Myers Squibb Co. and autoimmune-disorder drugs from...

subset: commoncrawl


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Sunday, October 11, 2009
Ashley's Burlap Placemats
56 comments:
- Kim @ NewlyWoodwards said...
This is so cute. I love the idea of trimming it with grosgrain ribbon. I actually have a few yards of burlap. I may have to try something similar as a tablerunner.
- October 11, 2009 at 6:10 PM
- KellyH said...
Too Cute. You Girls are great! Do you ever sleep? Just curious :)
- October 11, 2009 at 6:18 PM
- Paula said...
Those look great! I love how you added the jute detail on the corners.
- October 11, 2009 at 6:21 PM
- Miss Mustard Seed said...
Very simple project, but great impact. So cute as always!
- October 11, 2009 at 6:36 PM
- Diann said...
So, very cute! Simple and easy, something fun to do in an evening! Thanks for sharing the great idea!
- October 11, 2009 at 8:29 PM
I love them!! So cute. I am gonna have to try this myself. :)
- October 11, 2009 at 8:30 PM
- Linda@Coastal Charm said...
BURLAP is my new best friend...these are just too cute! Thanks for sharing the idea.
- October 11, 2009 at 8:43 PM
- { L } said...
These rock! Beautiful stencils!
- October 11, 2009 at 11:55 PM
- Kimm at Reinvented said...
Fabulous. I am really loving the texture of burlap, and have some ideas brewing to update my family room. Since that room is attached to my kitchen, I will try some burlap in there too!
- October 12, 2009 at 4:58 AM
- Sheri said...
Love it! I think you already linked to me but just in case:
I have a linky party going on, come by and link up! http://theshadesofpink.blogspot.com/2009/10/room-month-monster-dominoes.html
- October 12, 2009 at 5:02 AM
- Diane Duda said...
Love this blog! Thanks for all of the inspiration!!!
- October 12, 2009 at 5:41 AM
- Sherri S said...
These look REALLY nice! Inexpensive and easy. Great combos! Always love all of ya'lls ideas. You just keep inspiring!
- October 12, 2009 at 6:31 AM
- REbekah said...
Seriously....SERIOUSLY!!! How cool are YOU BOTH!!?!?!? EVERY DAY you inspire me!!! EVERY DAY, I tell ya!!! Thanks for all the ideas!! Keep it up!!!! HUGS!! - REbekah
- October 12, 2009 at 6:37 AM
- ...::Mrs. Southern Bride::... said...
I LOVE this idea! Too fun!
- October 12, 2009 at 6:57 AM
- Kari @ Ucreate said...
- October 12, 2009 at 7:14 AM
- Sue said...
Ashley, These turned out very cute! I like the jute embellishment in the corners... As for practicality, does burlap clean up well? I would probably be the one spilling red wine or spaghetti sauce on them! LOL I like the idea of a table runner, like your first commenter. Thanks for the idea.
:-) Sue
- October 12, 2009 at 8:20 AM
- The DIY Show Off said...
So cute! I'm going to add it to the DIY Burlap/Jute Shout Out.
Glad you're feeling better Whitney!
- October 12, 2009 at 8:55 AM
- Sarah said...
how creative! these turned out fantastic.
- October 12, 2009 at 9:29 AM
Burlap + stenciled numbers = heavenly! :)
- October 12, 2009 at 10:35 AM
- Memphis Mama said...
Would you maybe post a picture of your dining room? I swear it is painted the same color as mine and the furniture looks similar and I am in a decorating funk as to what to do with it...just thought I'd ask! I always love your projects and would love to see what you did with the entire room;)
- October 12, 2009 at 12:45 PM
- Brittany said...
OMG, I just discovered your blog and am in LOVE with all of your cute stuff!
- October 12, 2009 at 5:31 PM
- Pat B. said...
I am so glad that I found your blog. I go to it everyday. You have really creative ideas. I'm thinking you girls are working all of the time----there's no way that you could be sleeping at all.
Keep up the great work.
- October 12, 2009 at 6:37 PM
- Amanda @ Serenity Now said...
Love the jute details. :) I made a burlap table runner over the summer, so I think I'm up to trying these...very fun! Visiting from Kimba's party. :)
- October 12, 2009 at 7:20 PM
- Traci @ Beneath My Heart said...
Very cute! I can never get enough of burlap! Thanks for sharing!
- October 12, 2009 at 7:23 PM
- Karen- The Graphics Fairy said...
Soo cute! Love the burlap, love the numbers!!
- October 12, 2009 at 7:27 PM
- Cindy said...
Yep yep. Totally amazing again. :)
- October 12, 2009 at 7:50 PM
- Dresser Girl said...
WOW!! How cute!
- October 12, 2009 at 8:17 PM
- Michelle@Sweet Something said...
Love this! I like the ribbon trim! Great job!
- October 12, 2009 at 9:36 PM
- Randi said...
Those are so cute ... perfect for a Thanksgiving table.
- October 13, 2009 at 5:43 AM
- Jill said...
Those look so elegant! I especially love the dark ribbon trim. It's just yummy.
- October 13, 2009 at 7:13 AM
- Gina @ The Shabby Chic Cottage said...
Another great project! You girls are just full of it -- creativity it is!
- October 13, 2009 at 8:08 AM
- Kendra @ Domestic Princess in Training said...
Super, Super, Super cute!!!! The stencils just add that right touch. I need to get myself some stencils. I have a few things around the house that can use a little stencil love :o)
- October 13, 2009 at 8:31 AM
I loved this project so much, I went to Hob Lob yesterday and bought the supplies. I hope mine are as cute as yours!
- October 13, 2009 at 9:06 AM
- elizabeth said...
love this idea - thanks for sharing
- October 13, 2009 at 9:28 AM
- Kristens Creations said...
Thanks for checking out my craft desk redo! I appreciate you visit...These placemats are adorable!! What a great idea! Kristen
- October 13, 2009 at 10:26 AM
- Jamie said...
I just found your blog today & love it! I love that you're sisters doing it together, too, cuz I have a blog with my sisters. I just finished looking at ALL of your posts & have decided that you 2 are crazy creative!!! I am definitely going to be a follower of your blog!
- October 13, 2009 at 11:13 AM
- Beth@The Stories of A to Z said...
These are so cute! Love them.
- October 13, 2009 at 11:54 AM
- Carrie said...
That is really cute...I have quite a bit of burlap left from a curtain project...
hhhmm....thanks for the idea!
- October 13, 2009 at 1:32 PM
- The Style Sister said...
I love this idea! You girls are amazing always coming up with unique fun ideas. Thanks for sharing.
- October 13, 2009 at 2:51 PM
- Carolyn @ My Backyard Eden said...
I love these! I was just at the fabric store looking at the burlap and wondering what I could do with it.
I've seen so many Cricuts these days. I need to find out about them!
Great idea!
- October 13, 2009 at 5:52 PM
- Jenn said...
I absolutely adore these!
- October 13, 2009 at 7:52 PM
- Oliver's said...
What an excellent idea..I may have to copy this one! You guys rock! Paula
- October 14, 2009 at 5:49 AM
- rebecca said...
Love the new placemats! I have a blog award waiting for you over on Blue Cricket!
- October 14, 2009 at 7:04 AM
- Kim -today's creative blog said...
great idea!
- October 15, 2009 at 1:37 PM
- { L } said...
These are perfect for fall! You always do such a good job with paint and a stencil! Wow.
- October 15, 2009 at 8:01 PM
- Brenda@ **Dragonflys and Stars** said...
It is always fun to see what you are doing. I like the little extra touches that take them over the top!
- October 16, 2009 at 8:38 AM
- Tracy is ... Loving Pretty Things said...
what an awesome and easy craft! I love it. You girls are SO talented!
- October 16, 2009 at 8:57 AM
- Sharon said...
Cute, easy and inexpensive ... doesn't get any better.
- October 16, 2009 at 11:29 AM
- Kathy @ Creative Home Expressions said...
I love this! This looks so easy and what a great outcome you get. I am definitely going to do this!
- October 29, 2009 at 7:03 AM
- ~ ~ Ahrisha ~ ~ said...
You gals are so clever. I love this idea. Numbers are hot, aren't they?
- October 29, 2009 at 1:09 PM
- Kim @ Starshine Chic said...
Not sure if I commented before (too lazy to look through the comments), but I love these place mats. I need to make me some.
- October 29, 2009 at 4:58 PM
- Jeanette said...
These are so neat. I bet I could even do that. So cute!
- October 29, 2009 at 5:03 PM
- Lori (All That Splatters) said...
You are entirely too talented!! So creative - I love this idea!
- October 29, 2009 at 8:47 PM
- Dining Delight said...
Very creative and that look is so "in" right now!
- October 29, 2009 at 10:41 PM
- Mid-Atlantic Martha said...
So clever -- and cute for everything fall!
- October 31, 2009 at 5:17 PM
- Denise @ http://www.somanytables.com/ said...
I'll be making these for my Thanksgiving Table. Thank you for sharing.
- November 14, 2010 at 6:24 PM


text:
Ways To Play It Safe
Today's post requires a special intro, so here's Dara G. to explain:
"My local [CENSORED*] bakery has this new policy - not strictly enforced, but kinda enforced - NO PHOTOS in the bakery department. None, nada. Per an ex-employee there, upper management is afraid that one of that store's specific cakes will be posted on 'that bad cake site.' Per what they tell you in the store, their cakes are 'all copyright protected.'"
(*Store name omitted. Because I care.)
She goes on to say:
"Apparently this new 'no photos' thing came about after y'all had posted their 'Popcorn' cakes on the site."
Oh, you mean these ones?
Now, I honestly didn't know all these popcorn cakes were even from this particular store-which-shall-remain-nameless, but it's nice to know folks over there are reading the site and recognizing their handiwork!
Anyway, Dara goes on to say that she was actually accosted by an employee citing "copyright protection" after Dara snapped a picture of this:
The employee of this bakery-which-shall-not-be named even made Dara delete the photo off her phone, not knowing that Dara had actually taken TWO photos. (Sneaky girl...)
Now, I have always been of the opinion that if you don't want your bakery's wrecks on Cake Wrecks, STOP MAKING WRECKS. But, hey, banning pictures is one way to go about it, too.
After all, if you ban photos in your bakery, then no one will ever know that your bakers made something like this:
Yes, that IS a plastic bunny tail where the mouth should be. A copyrighted bunny tail.
As a joke, Katelyn's friends asked for her cake to read, "Katelyn's Failure Cake." Little did they know they'd get EXACTLY what they asked for.
Or even this:
If ONLY we had SOME way of knowing who is responsible for this glorious copyrighted cake design!
Of course, even if you do successfully bar people from photographing your wrecks in-store, there are still all those who'll just snap pics at home and then gleefully send them to me, with captions like, "Yummy piles of candy vomit!!"
In fact, here are two more sitting in the inbox right now, both from the same bakery I'm still not going to name, no matter HOW much you beg:
Jennifer J. writes, "Found this today, post-Halloween, at a [CENSORED] in Seattle, WA."
I've pointed out the unfortunate "I" placement on this design before, but this one is doubly unfortunate:
The fact that there's no period after the "P" might, shall we say, arouse suspicion as to the baker's true motives, don't you think?
And here's one that came in yesterday, where an election consolation cake got "owned:"
We have a winner!
Of course this bakery isn't the only chain to ban photos; fact is, most stores now have similar rules. I hear from readers every week who are harassed, shooed away, and even outright kicked out of stores for whipping out their cellphones in the bakery.
Now, far be it from me to criticize rules (even ones I find really, REALLY stupid) but I don't see how harassing your own customers - and ones who often buy your wrecks because Cake Wrecks has made them a world-wide inside joke - is good for business.
Then again, I also thought it would make more sense to train your bakers not to make wrecks instead of trying to prevent people from seeing them, so what do I know?
Oh, and while we're at it, I hear the bakery-which-shall-not-be-named doesn't make those popcorn cakes anymore, so kudos there, guys!
Now, about your spaghetti cakes...
Thanks to Dara, Gabriele, Lisa S., Chelsea M., Jennifer J., Bill, & Jessica A. for the picture perfect moments.
UPDATE: Dara G., our wreckporter on the scene, has recently contacted me to amend a few details in her story. She tells me the bakery employee was very polite in advising her of the photography ban, and while Dara did feel pressured to delete her photo, she was never actually ordered to. She also tells me the ex-employee who credits/blames CW for the photo ban doesn't know that for sure; it was just his/her personal theory. (Drat. Now I have to return that merit badge I just ordered for myself!)
Anyway, just wanted to include those corrections to be as accurate as possible!


text:
Beyond Batting Average
Paperback, 152 Pages
Price: $14.00
Prints in 3-5 business days
Over the past few decades, a multitude of advanced hitting, pitching, fielding and base running measures have been introduced to the baseball world. This comprehensive sabermetrics primer will introduce you to these new statistics with easy to understand explanations and examples. It will illustrate the evolution of statistics from simple traditional measures to the more complex metrics of today. You will learn how all the statistics are connected to winning and losing games, how to interpret them, and how to apply them to performance on the field. By the end of this book, you will be able to evaluate players and teams through statistics more thoroughly and accurately than you could before.
Ratings & ReviewsLog in to review this item
2 People Reviewed This Product
May 4, 2010This book is highly recommended for those seeking an overview of all the latest sabremetric methods. Mr. Panas sets out of provide an overview of current statistical approaches used to evaluate batting, pitching, and fielding by the sabremetric community. Mission accomplished. This is not a breakthrough work with a bunch of new TLAs (Three Letter Acronyms). Rather it is a summary of the state of the art. As someone who followed Bill James and Pete Palmer very closely, but admittedly did not monitor some of the more recent developments of the past several years this was a great book. If you are looking for Bill James-like wit then this is not your book. However, if you want sabremetric concepts explained in clear, accessible language, then this is the place to start.
Mar 29, 2010Review deleted.
There are no reviews for previous versions of this product
Product Details
- 9780557312245
- Copyright
- Lee Panas (Standard Copyright License)
- Published
- May 2, 2010
- Language
- English
- Pages
- 152
- Binding
- Perfect-bound Paperback
- Interior Ink
- Black & white
- Weight
- 1.09 lbs.
- Dimensions (inches)
- 8.5 wide x 11 tall
- Product ID
- 10663690
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text:
Welcome to Ethical Traveller. I have been writing about ethical, green, responsible, eco, sustainable travel, call it what you will, for the last eight years, after completing a Masters degree in Responsible Tourism Management. During this time I have written about the issues of ethical travel not only in my columns in National Geographic Traveller Magazine, The Irish Times and Green Parent Magazine, but also in many other newspapers and magazines. For me, responsible tourism is as much about people as it is about place,and giving a voice to people who have created exemplary, exciting responsible tourism products is one of the best aspects of my job.
I am currently working as full time writer at Responsible Travel, devising destination and activity online travel guides, including one to New York State where, after discoverning a world of mountains, hiking, biking and kayaking all on Manhattan's doorstep, I was delighted to persuade the the tourist board to turn their iconic 'I ♥ New York' heart green. The world of a more ethical form of travel is always full of surprises. And people who are willing to think about the box and create change. I also manage to fit in some freelance travel writing, with trips to go cycling in Northern Portugal, climbing on Clare Island, Mayo and discovering the green lights of Amsterdam some recent highlights.
Thanks for checking out Ethical Traveller. For frequent news of my travels or general eco travel updates, please check out my own Twitter page.
Happy travelling. Catherine Mack


text:
New Market Introductions Fall 2013
American Woodcrafters is introducing eight new products for the Fall 2013 High Point Furniture Market. Six are new master bedroom collections, two are youth. New bedroom collections include:
- 900-910 Transformers-Youth-Affordable modern entry for the youth market.
- 1000 Essentials -Master-Modern, easily fits into other rooms of the house.
- 1500 Abington Road -Master-Rich, deep, massive country collection.
- 2310 Color Combos-Youth-Flexible and interchangeable colored drawer fronts, a spin off our well received 5310-20 series.
- 2500 Modern Amenities -Master-Modern, strong lines, great rich finish with geometric patterns.
- 3800 Modern Amenities 2-Master-Similar to 2500 with different headboard and hardware options lighter finish.
- 7710-20 Snap Shots-Master-Comes in an off-white finish and ebony finish. Unique, hand carved trim on headboard and top drawers of cases.
- 9000 Horizons-Master-Modern, 3 interchangeable headboards, lighted, touch panel night stand with tempered glass.
- 9800 Stone Hill-Master Transitional, heavy massive look. Splattered, rich finish.
Come see our new introductions at High Point Market on at 233 S Main Street.
Contact info:
Andrew Doss
Marketing Manager
336.861.0003, ext. 222


text:
A food security and nutrition programme is making use of a herd of goats to improve the health of most HIV positive children at a school.
Read the full article on News 24 here!
Our Bok-E-Naters won bronze at the World Competition in England on 14 November!
The Geluksfontein Team attended the DuPont Qualité Awards Dinner:
Jaco, Christo & Munya.
© Copyright 2011-2019 - Geluksfontein Goat Cheese FarmPrivacy Policy | DisclaimerDesigned by DANNEL WEB DESIGN


text:
Hello to all of my visitors, and thank you for you continued comments and support. You may have noticed that I have not posted in a long time. I have recently become a mother to a beautiful little boy, my husband is about to start medical school, and I am finishing up school myself. Needless to say, I have very little time for regular research right now, so any updates will be very sporadic.
Good luck to all on your genealogy adventures!


text:
Feature Name
Add basic support for some key provers, solvers, and formal methods tools. These tools let you prove that some facts are true (given other facts) and/or model systems using mathematics, and can be used to greatly increase the reliability of software and hardware.
- Name: David A. Wheeler
Current status
- Targeted release: Fedora 31
- Last updated: 2008-08-07
- Percentage of completion: 80% (MiniSAT packaged, but reviewer out of country)
Detailed Description
No realistic software or hardware can be exhaustively tested; exhaustively a program that adds two 64-bit numbers would take more than 10^100 years. So for decades people have worked to develop tools that can apply mathematical techniques to prove that software and hardware does or does not do something. These tools can be used for other purposes where proving something is true, or solving for values given a large number of constraints, are important.
Here are some of these kinds of tools, along with packages of programs that perform them:
- Automated Theorem Provers: These take mathematical facts and attempt to prove a goal, completely automatically. Packages: prover9 and Zenon.
- Interactive Theorem Provers: These let humans take mathematical facts and attempt to prove a goal, in cases where the automated tools can't manage. Package: Coq
- Program Provers: These take software programs and break them down into verification conditions (VCs) for the above to solve. Package: Why (which can handle annotated C and Java)
- Boolean Satisfiability (SAT) solvers: These take boolean equations and solve for them; they are a basic building block for some implementations of the above. Package: MiniSAT
- Formal specification languages: These let people describe software or systems using a mathematically rigorous language, such as Z. Package: tex-zfuzz
Do not assume that you can just take a program prover on a big existing program and start using it effectively. Scale can be a problem, all such tools have limitations, and these tools are just starting to become mature. Nevertheless, for those who are interested in the technology or who wish to help it mature, these are a great place to start.
Benefit to Fedora
This enables developers to start using these kinds of programs in a variety of circumstances.
Developers have had to package a number of programs, most of which have not been packaged before. In some cases, we've had to address integration problems (e.g., Zenon changed its input format, but the Why developers didn't know that). It has no effect on those who don't wish to use these tools.
Test Plan
No special hardware or system preparation is required; simply install the packages listed above. Many of the toolsuites include some checking. In addition, the "Why" suite can use many other tools; we have used its "binary-search.c" example with gwhy to test integration with Zenon and Coq.
User Experience
Target users will notice that they can easily install these tools.
There are no special dependencies.
Contingency Plan
None necessary, revert any undesirable packages.
Documentation on these tools is notoriously bad; some packages don't have any documentation at all. We have written some brief documentation in some cases, and tried to include some documentation with the tools. We expect this to improve in future releases.
Release Notes
No special release notes.


text:
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The Governor's Scholars Program of Kentucky has announced that three Spencer County High School students have been selected to participate in their prestigious summer program this year. The selected students are Taylor Carden, daughter of Jeff and Mary Ann Carden, Kevin Herndon, son of Carol and Doug Herndon and Alex Poole, daughter of Lisa and Ronald Poole. These students were, first of all, nominated by SCHS after a very competitive process at that level. Their applications were then sent on and used to compete with other top students from across the state.&n
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text: HomeCheap FlightsPortugal Cheap flights to PortugalFlightsHolidaysWhether your flight to Portugal is for a family holiday by the sea, a relaxing sun-soaked break for two or a trip with friends, one of our cheap flights to Portugal will cater for your every need and help save you money.When you travel with us you will enjoy fantastic customer service, a generous baggage allowance and the opportunity to reserve your seat prior to travel. Get prices for cheap flights to Portugal with Flybe.com and youre sure to find what youre looking for. You could be relaxing on one of the Algarves many idyllic beaches in no time!Our flights to PortugalFaroCheap flights to Portugal for sun and moreFly to Portugal with Flybe.com and you will arrive in Faro, one of the most popular tourist areas in the country. Located on the Algarve, with its luxurious beaches and warm weather, even late in the season, this is a perfect setting for a summer break.The picturesque coastline offers so much more than just a simple beach holiday and visitors will be amazed by the attractions and sights to see when they grab one of our cheap flights to Portugal.There are plenty of landmarks and stunning buildings to admire when you travel to Portugal with Flybe.com. The small city of Faro is steeped in history and the surrounding areas are full of things to see and do. Anyone looking for a beach holiday with a little extra will not be disappointed.Cheap flights to Portugal for things to doThere are plenty of fine places to eat, drink and be merry as well as opportunities to explore the local culture in the Algarve and with a low cost flight to Portugal with Flybe.com, you can be there in just a few short hours.A break in Portugal doesnt always have to be about relaxing on the beach and anyone travelling to Portugal with Flybe.com will find plenty of opportunities to enjoy a spot of retail therapy. There are small markets, shopping centres and marinas for visitors to explore and you will find plenty to do in a friendly environment.The Algarve may be known as a popular destination for a beach holiday but this region is also rich in history and culture so why not explore the ancient streets, museums and galleries Portugal has to offer when you travel with Flybe.com.


text: AOSIS OpenJournalshttp://email@example.com://www.curationis.org.za0379-85772223-6279The needs of health promoters on a health promotion programme for families with adolescents orphaned by HIV and AIDS The South African communities has shown to have a challenge in accessing health services especially in rural areas; hence the national strategic objective 1.7 aimed at strengthening community systems to expand access to services using the community-based care programmes (NSP 2012–2016). The programmes enhance access to health services whilst promoting health and educating the community to improve health knowledge and work towards attaining a healthy living (NSP 2012–2016). However, the health promoters from the rural Hammanskraal region in the North West Province of South Africa often found themselves rendering the health promotion services in their communities with limited resources. This study aimed at exploring and describing the challenges faced by health promoters in implementing health promotion programmes for families with adolescents orphaned by HIV and AIDS. The study followed a qualitative design. Data was collected using focus group interviews. Participants were purposely selected by the social worker and the health promotion coordinator working at Hammanskraal. The process of data analysis was adapted from the eight steps of Tesch method of data analysis where categories, sub-categories and themes were isolated. The following categories emerged as the needs of health promoters on health promotion programmes for families with adolescents orphaned by HIV and AIDS, (1) financial needs, (2) resources, (3) basic life needs, (4) educational needs and (5) health promoter's needs. It is therefore recommended that equal distribution of resources: including medicine, equipment and finances, should be maintained in order to ensure non-interrupted services. Maseapo P. Mthobeni1 1Department of Nursing Science, University of Pretoria, South Africa Mmapheko D. Peu1 1Department of Nursing Science, University of Pretoria, South Africa Maseapo Mthobeni email@example.com PO Box 17218, Witbank 1035, South Africa 3617010.4102/curationis.v36i1.70 15 Oct. 201113 Oct. 201201 Feb. 2013Mthobeni, M.P. & Peu, M.D., 2013, 'The needs of health promoters on a health promotion programme for families with adolescents orphaned by HIV and AIDS', Curationis 36(1), Art. #70, 8 pages. http://dx.doi.org/10.4102/curationis.v36i1.70© 2012.The Authors. Licensee: AOSIS OpenJournals. This work is licensed under the Creative Commons Attribution License.Introduction HIV and AIDS were denoted one of the highest causes of death in South Africa claiming about 314 000 people in 2009 (Department of Health 2010:2). The impact of the disease contributed in a growing trend of orphans in South Africa, estimated at 1.95 million AIDS orphans in 2009 (Department of Health 2010:3). Though there is evidence that new HIV infection rate has stabilised for the past 3 years to below 30%, there is still a greater need for health education and a health promotion programme (NSP 2012–2016:22). According to Huff & Kline (2008:5); health education programmes encompasses any planned combination of learning experiences designed to predispose, enable and reinforce voluntary behaviour conducive to health individuals, groups or communities. Even though health promotion emerged from the health education programme, the health promotion programme designates a broader level of outcomes. Whilst the health education programme targets a certain group of individuals living in a specific geographical area; the intervention of health promotion goes beyond the education programme and focuses on the need to establish and sustain a more accessible and equitable distributed system of all poor and underserved groups in a particular community (Huff & Kline 2008:5). Therefore, there is a need to achieve different levels of health outcomes from the individuals, families, groups, organisations and communities through a combination of health promotions and health education programmes; hence this study aimed at determining the challenges faced by health promoters in implementing the health promotion programme for families with adolescents orphaned by HIV and AIDS. Problem statement Most adolescents orphaned by HIV and AIDS experience psychological trauma due to parent's illnesses and death; absence of adult guidance and mentoring; unmet needs for love and security; dropping out of school and obtaining social grants (Maqoko & Dreyer 2007:725). A Health promotion programme seeks to create an awareness of the disease and to prevent the spreading of the condition through promoting safe sexual behaviour aimed at protecting the family, partners and the community; establishing support groups; conducting counselling of contact families; giving specific health education related to problems experienced by sufferers (Acutt & Hatting 2003:275). Sobuce (2007:74) outlined experiences faced by health promoters whilst rendering health promotion as: lack of resources and infrastructures, poor working relations, increased workloads, and economic burden. It is, however, disturbing that the infection rate in the North West Province remained unchanged over a period of 3 years. The infection rate ranged from 30.6% in 2007, 31.0% in 2008 and 30.0% in 2009 (Department of Health 2010:31). The health promoters of rural Hammanskraal, were studied to establish the challenges and factors that seemed to constrain the effective health promotion programme from families with adolescents orphaned by HIV and AIDS. Aims of the study This study aimed at exploring the challenges faced by health promoters; therefore describing their needs in a health promotion programme; to isolate possible factors that improved or constrained the effectiveness of health promotion in the families with adolescents orphaned by HIV and AIDS. The results of this study will assist the researcher to determine the needs of health promoters whilst recommending strategies to close any possible gaps towards achieving the effective health promotion strategies. Trends Whilst the numbers of HIV infected individuals increased, access to medical services became difficult to the infected and uninfected individuals in South Africa, especially in the rural areas (NSP 2012:32). When parents fall ill, especially in poor families, children become emotionally affected and the effects of this continue in different ways for the rest of their childhood (Maqoko & Dreyer 2007:718). Though the epidemic HIV new infection rate seemed to stabilise globally, AIDS-related illnesses remain one of the leading causes of death globally (UNAIDS 2009:8). South Africa contributes to the 71% of new infection rate in Sub-Saharan Africa (UNAIDS 2009:8). The impact of the HIV new infection rate and the existing infected individuals were mirrored by 46% of AIDS orphans in 2009 in South Africa (Department of Health 2010:3). Challenges met by orphaned adolescents ranged from economic hardships; having to leave school; malnutrition and illness; loss of inheritance; fear of isolation; increased abuse and risk of HIV (Maqoko & Dreyer 2007:719); whilst engaging in early sexual activities in attempts to create their own life story and to redefine themselves (Burns & Porter 2007:225). Therefore, the health promotion programme should target the activities such as: awareness campaign, lifestyle changes in supportive environment such as families, communities and the health care providers, in this case the health promoters (Acutt & Hatting 2003:270). The success of a health promotion programme depends on the effective, competent skills of the health promoters. Research objectives The objective of this study was to: 'Explore and describe the challenges met by health promoters in implementing a health promotion programme for families with adolescents orphaned by HIV and AIDS.' Definition of key concepts Health: It is defined by the World Health Organization (1948:100) as 'a state of complete physical, mental and social well-being and not merely absence of disease or infirmity'. The complete state of health was expected from the families with adolescents orphaned by HIV and AIDS. Health promotion: It is defined by O'Donnel as the science and art of helping people to change their lifestyle and move towards a state of optimal health (Edelman & Mandle 2002:16). World Health Organization (WHO) views health promotion as 'a unifying concept for those who recognise the need for change in the ways and conditions of living, in order to promote health' (Dennil, King & Swanepoel 2007:122). In addition health promotion is also defined as the process of enabling people (individuals) to increase control over the determinants of health, and thereby improve it (Dennil et al. 2007:122). In this study the art of helping people to change their lifestyle will be directed to families with adolescents orphaned by HIV and AIDS. Health promotion programme: It was defined by Huff and Kline (2008:5) as the aggregate of all purposeful activities designed to improve personal and public health through a combination of strategies, including the competent implementation of behavioural change strategies, health education, health protection measures, risk factor detection, health enhancement and health maintenance. HIV and AIDS: Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease caused by Human Immunodeficiency Virus (HIV) (The free dictionary.com n.d.). The advanced stage of AIDS is fatal, leading to the high mortality rate of adults, specifically in South Africa, hence the increasing number of orphaned adolescents. This study aimed at exploring the perception of health promoters regarding health promotion programmes for families with adolescents orphaned by HIV and AIDS. Significance of the study This study aimed at identifying the challenges encountered by the health promoters in rendering health promotion to the families with adolescents orphaned by HIV and AIDS. This will point out possible factors that improved or constrained the effectiveness of health promotion in the rural Hammanskraal community. Given the results of this study, health planners will be able close any possible gaps regarding the effectiveness of health promotion strategies since health promotion is viewed as the key solution in combating HIV and AIDS. Thus far, the battle against HIV and AIDS is still at large as featured by the infection rate of 1.9 million HIV newly infected in 2008 (UNDAIDS 2009:83). Literature review Health promotion is seen as the science and art of helping people to change their lifestyle through health promotion and move towards a state of healthy living behaviour that will assist in prevention of diseases including HIV and AIDS (Edelman & Mandle 2002:16). In addressing this statement, the South African Department of Health invited all the stakeholders, governmental and non-governmental organisations to join hands in the fight against HIV and AIDS by rendering health promotion in the communities (Peu, Van Wyk & Botha. 2008:15). Whilst the World Health Organisation views health education as a unifying concept for those who recognise the need for change in the ways and conditions of living, in order to promote health (Dennil et al. 2007:122), the art of helping people to change their lifestyle will be directed to families with adolescents orphaned by HIV and AIDS. It is, however, alarming to note the massive increase of HIV and AIDS deaths estimated at 91% between 1997 and 2006; claiming 350 000 lives in 2007, which nearly amounts to 1000 people every day' (UNAIDS update 2009). It is the highest rate when calculated against South Africa's total population. It is, therefore, important to consider research of this nature because it will help close gaps in health promotion services by identifying the areas where health promotion is ineffective or non-existent. This will assist policy makers to come up with better and effective health promotion strategies. The World Health Organisation (2009) states that 'the responsibility for health promotion in the health services is shared amongst individuals, community groups, health professionals, health service institutions and government'. Therefore the purpose of health promotion is to raise awareness in a community about its own health status, and to help a community to recognize the existence of its health needs that they may have previously ignored. It is recommended that 'health education should be provided continuously in order to conscientise families with adolescents about their health promotion needs and behaviours' (Peu et al.). Communities, therefore, do need an empowering resource (health promotion) to enable them to attain the state of complete health. This may be done by identifying their own health needs and participating in health enhancing activities and taking responsibility for their health needs. Research method design Design This study was qualitative in nature. The researcher's interest in this design was the interpretive, in-depth approach done in a holistic fashion, through the collection of rich narrative material that is thought to produce more of a subjective science using a flexible research design (Polit & Beck 2008:763; Burns & Grooves 2005:24). Materials A focus group interview was the method used to conduct this study. The researcher chose the focus group method for its ability to obtain many viewpoints of different individuals in a short time (Polit & Beck 2008:395); in the context of the study participant's work place. Population consisted of government and non-governmental health promoters, males and females working under the North West Department of Health in rural Hammanskraal, directly and indirectly involved in promoting health care to families with adolescents orphaned by HIV and AIDS. A total of ten participants, four males and six females, ages ranging from 19 years to 38 years, were purposely selected as they met the criteria of the population required. All participants had high school education and two had tertiary education (Table 1). Two people assisted in hand picking the study participants, the health promotion coordinator from the hospital in Hammanskraal, and the social worker working closely with the health promoters involved in the families with adolescents orphaned by HIV and AIDS. Data collection methods Data was collected using the focus group interviews. The study was conducted at the participant's workplace. A briefing session meeting was arranged with the hospital management, the health promotion coordinators and the local hospice centre. The meeting was attended by the representative from both the hospital and the hospice centre and information about the study and the ethical considerations were addressed. An information leaflet with the consent forms for the study participants were issued to the health promotion coordinator and the social worker who assisted in selecting the study participants. Participants were required to bring the signed consent forms on the next meeting as arranged. Two focus group discussions were conducted on different days with the same study participants. The researcher facilitated the interviews as she asked the question: 'What are your needs on a health promotion programme for families with adolescents orphaned by HIV and AIDS'. Using interpersonal skills the researcher probed paraphrased and followed on clues to elicit more information from the study participants. The researcher used a tape recorder to record the interviews and field notes were collected by both the researcher and the senior researcher. Data analysis Data was analysed using the adapted Tesch version as described in De Vos (2005:334) and Cresswell (2003:192). As the researcher collected data using the tape recorder, transcriptions of the interviews were done regularly and accurately, according to the descriptive method. Both the researcher and the senior researcher discussed and agreed on the categories, sub-categories and themes to be included in the analysis. Direct quotations were used to support every category and sub-category as themes. The researcher read through the transcribed information and got a sense of what was said and compiled a list of topics whilst reading through the transcription. The researcher then clustered together similar topics into columns, and arranged them as major– and unique topics. The researcher, using a highlighter, coloured the topics with similar meaning with the same colour, finding the most descriptive word for those topics, turning them into categories. Each category was assembled with the topics similar to the category as sub-categories, and each sub-category with a theme that represented the quote of exact words from the transcription. Both the supervisor and the researcher met and discussed the findings; and reached a consensus about the categories, sub-categories and themes that have been identified. The expertise of the senior researcher acted as the independent coder as she was supervising the entire study. Ethical considerations Ethics is the branch of philosophy that deals with morality (Burns & Groove 2005:62). This study was conducted for academic purposes; ethical clearance to conduct this study was obtained from the University of Pretoria Research Ethics Committee. Permission was also requested from the North West Department of Health to conduct the study in their province. Regarding participants this study used the following principles to protect them from ethical misconduct: beneficence, respect for human dignity and justice. Potential benefits and hazards The study's intension to explore and describe the needs of the health promoters was aimed at documenting the challenges faced by health promoters to address them and improve the health promotion programme. Participation was completely voluntary. Participants received a full preview of the study stating the purpose, objectives and the research method to be used. The supervisor's involvement was explained in order for them to make an informed decision. Consent was given by participants at home under no duress. Those who chose not to participate they were treated with dignity and respect as well. Participants were also informed of their right to withdraw at any point when feeling emotionally drained. Recruitment procedure The first contact meeting was held at a hospital at Hammanskraal where the researcher introduced the purpose of the study and issued the information leaflet with the consent forms. The health promotion coordinator from the hospital selected the participants according to his knowledge, whilst a social worker from the hospice centre, working closely with the health promoters, handpicked the participants according to her knowledge of their involvement in the families with adolescents orphaned by HIV and AIDS. A total of ten participants, which constituted four males and six females, were purposely selected as they met the criteria of the population required. Informed consent The information leaflet that consisted of the details of the study, the contact numbers and the consent forms were issued to the study participants a week before the interview. They were required to read and sign these at home and bring them with at the next meeting, as arranged. Data protection The data that was collected in the field was captured on audio cassettes and on field notes by the researcher and the senior researcher. These audio cassettes and the field notes were handled and only accessible to the researcher and the senior researcher. Data transcriptions were done soon after each interview and the cassettes were properly labelled and kept safe. The researcher used her field notes and compared these with the data transcription from the audio cassettes. After data analysis, the analysed transcribed documents were forwarded to the senior researcher for confirmation, together with the field notes collected. Trustworthiness Trustworthiness refers to the degree of confidence qualitative researchers have in their data using the criteria of credibility, transferability, dependability and confirmability (Polit & Beck 2008:196). The strategies applied are outlines (Table 2). Discussion of results A total of five categories and fourteen sub-categories emerged from the data when analysing the needs of health promoters on a health promotion programme for families with adolescents orphaned by HIV and AIDS. The categories identified were financial needs, resources, basic life needs, educational needs and health promoter's needs (Table 3). Financial needs Under the financial needs category: benefits, living wage, and continuous funding, assisted the researcher in understanding the needs of the health promoters on the health promotion programme for families with adolescents orphaned by HIV and AIDS. Participants were made aware that they were volunteers and were only entitled to a stipend: 'We are not asking for too much, but if we could be considered for bonuses or an equivalent acknowledgement to show that we are worth something'. Participants required a monthly salary that will cater for all their needs and a yearly increment on the stipend based on the interest rate. The researcher got the impression that the participants were fighting to make ends meet as confirmed by the following: 'We all know that prices have gone up: food, transport and everything else except for our salary. It remains the same, no increment, nothing'. Interrupted funding from sponsors had a huge impact on the participants as they were the ones who suffer most whenever there are no funds: 'We need continuous funding to be able to sustain our programme and maintain ourselves as staff members'. Medicine SANS Frontier (MSF) reports that adequate salaries and benefits are essential to retaining staff, especially in the health system (MSF 24, May 2007). Similar studies confirmed that a lack of incentives for health workers posed a threat to the health workers' motivation to work (Prasad & Muraleedharan 2007:21). There are countries like India that employ community health workers on a contract basis, or as regular employment with a fixed monthly salary paid by the government, with required benefits (Prasad & Muraleedharan 2007:5). Adequate funding was seen as a challenge by community health workers in the study conducted by Prasad & Muraleedharan (2007:21). Consequently, there were increased volumes of funding for the fight against HIV and AIDS from developed countries through the Global Fund (Avert n.d.). However, it is vital that sustainability and self-sufficiency in the health sector be encouraged for sub-Saharan African countries to deal with their HIV and AIDS epidemics even if donor funding dries out (Avert n.d.). Thus far it is evident that these funds are making a significant difference, but more money is still needed given the massive scale of the HIV epidemic (Avert n.d). Resources The resources category explored and described buildings and equipment as the sub-categories. Adequate buildings for patient care and a step-down facility will enable the participants to take care of their clients in totality. During the home visits, health promoters came across orphaned adolescents who had to drop out of school to take care of their ill families. Health promoters felt that a hospice facility would admit the ill client and allow these children to study. Quotes such as 'If we could have a place to admit our sick patients, like in families where a parent is ill and children are left to take care of them ...' Working equipment is necessary in order to get the work done. Participants felt marginalised by the limited resources at hand. The BP machines they have are either not working well or not there for others; and the mercury in the thermometers does not respond as required 'The BP machines are either not working well, or the mercury does not go up; it takes time with one patient.' Failure to secure the ideal building structure was an obstacle to an organisation planning to establish a home-based care facility (Mohapi 2005:9). Privacy and confidentiality during consultation and counselling by healthcare providers were some of the possible explanations that led participants to good adherence (Mthembu & Van Wyk 2010:96). Similar studies revealed that in the preparation for the establishment of a home-based care step-down facility for HIV and AIDS victims, advanced health technology such as X-rays, laboratories, and computers were listed as part of their requirements to run the facility (Mohapi 2005:13). Step-down facilities provide the in-patient care for patients who no longer require acute intervention (National Department of Health 2006:10). These facilities cater for terminally ill patients requiring palliative care or respite care, and patients may be discharged from hospital into off-site units or they may be referred from their homes by the community health workers (National Department of Health 2006:11). Lack of equipment, furniture, surplus and surplus materials was identified as material obstacles in running the home-based care facility (Mohapi 2005:11). Herman et al. (2009) acknowledged that adequate material support is necessary to enable community health workers to function fully (Hermann et al. 2009). Basic Life Needs The basic life needs category generated two sub-categories that better explained the needs of health promoters, namely, food and transport. There is sporadic availability of nutritional supplements which the participants were not impressed with '… there are families that are so poverty stricken and it does not feel right to leave them in the same situation' … ' it would relieve much burden on our clients' Transport was mentioned by a lot of health promoters as most of their tasks require transport support. 'Resources such as transport, late orders and delivery of food supplements impact on our service delivery'. Transport is needed to collect and distribute nutritional supplements and educational material, to conduct home visits and attend meetings. Their work revolved around the need for transport. The research results for the study conducted on orphaned children reveal a 22% chance of a shortage in basic needs such as food in these families (Heymann & Kidman 2009:36). According to Cluver, Gardner & Operario (2009:735) AIDS-orphaned children are more likely to report food insecurity and household unemployment. The impact of the AIDS epidemic on South African families has resulted in increased household poverty, food insecurity and unemployment (Cluver et al. 2009:733). The NGO home-based caregivers delivered the much needed material (such as groceries) even though it was regarded insufficient by the community (Orner 2006:239). The South African strategy in poverty alleviation includes programmes such as school feeding schemes, sustainable food and gardening projects, employments initiatives and targeted assistance for grant application (Cluver et al. 2009:736). The nurses rendering TB treatment and care regard the lack of transport as a major challenge encountered when rendering TB activities at community level (Znavamwe & Ehlers 2008:60). In a study by Heymann and Kidman (2009:36) transport was identified as a pitfall as indicated by 22% of those studied. Related reports revealed that trained field officers visit patients on motorcycles every month to deliver drugs and provide adherence support (API 2009). A study by Mthembu and van Wyk (2010:55) views transport as a contributory factor on adherence. Educational Needs Educational needs were identified with skills development and health education as the sub-categories. The participants wanted support in the form of in-service training and skills development: 'We need to be trained and developed especially in this HIV and AIDS field. "We need our organisation to develop us into professionals'. Informative educational materials are in high demand. The participants prefer to leave the informative educational material with clients when the clients are not prepared to listen to them. They felt that the young people would better recall if they saw and listened to a DVD than being taught verbally Marquis and Huston (2006:398) reflect that managers have a greater responsibility for seeing that staff is properly trained than they do for meeting educational needs. Williamson (2007:133) believes that providing continuing education opportunities could make an impact on patient care and improve the care that homecare nurses provide. A lack of adequate knowledge regarding HIV and AIDS is evident and the traditional HIV health educational programme has proven to be inefficient in communities in the United States as is shown by an increase in HIV new infection rates (Djokic et al. 2009:25). Likewise Anthony, Williams and Avery (2008:157) in realising the possibility of poor reading comprehension, considered alternative education in the form of videos, pictorials or verbal explanation, and culturally appropriate education by lay health educators. Health promoters' needs Health promoters' needs were identified as: respect, personnel, debriefing and standardisation of services. The need for respect elicited a lot of emotions from the participants: 'We request respect from our management (emotional)'. Recognition by management and the need to be consulted in decision making were mentioned during the interviews: 'We need to be involved in decision making and be consulted in issues involving us'. The participants were of the opinion that they are overloaded with work, and that additional health promoters (personnel) were required to cover the shortage: 'We need more employment of staff to cover the workload and get work done'. In addition the participants felt they were mentally overloaded by the activities and the services they render to the community: '…At times we meet difficult situations in the homes we are visiting and they keep playing back in our minds…'. Also the participants had the feeling that there was duplication of services between them and government health promoters. Prasad and Muraleedharan (2007:21) noted, in similar studies, managerial issues as part of the challenges faced by community health workers. Regarding the discussion on the perception of home healthcare with nurses on empowerment, the participants commented that the organisation should allow nurses to have the ability to sit on committees and have a voice on issues that are meaningful to them (Williamson 2007:146). It was also cited by Mthembu and van Wyk (2010:96) that decision making is an integral part of behavioural change. In response to the increasing HIV epidemic and limited human resources, trained community volunteers have been utilised in HIV-related service delivery at a community level (Tolle 2009:669). Delobelle et al. (2009:1066) identified that continuous care of HIV and AIDS clients, puts a strain on the caregivers and creates even more stress. Similar studies on debriefing reveal that unresolved stress can lead to decreased productivity, post-traumatic stress disorder, and in some cases even death (Hokanson & Wirth 2000:255). The purpose of debriefing individuals who experience stressful or traumatic events is to reduce any possibility of psychological harm by allowing people to talk about their experience (Wikipedia2012). Elimination of duplication of activities and enhancing cost-effective planning and delivery of services is part of the South Africa's goals and objectives of home-based care (Department of Health 2001:9). Standardisation of services and poor relations between government staff and non-government staff are seen as a threat and weakness to community health workers (Prasad & Muraleedharan 2007:21–22). Limitations of the study The study was conducted and limited to the health promoters in a rural area, and the results therefore, cannot be generalised to all health promoters, especially those in urban area. Secondly, the sample size used in one province could not be generalised to all health promoters of other provinces. However, health policy makers can make use of these findings to improve the available policies and guidelines regarding home-based care and health promoters. Recommendations Based on the findings of this research, it can therefore be recommended that: The integration of the governmental and non-governmental health promotion services should be pursued, in order to prevent duplication of services, therefore ensuring continuity of care. An inter-sectoral collaboration within the different departments is needed to standardise the services. Equal distribution of resources: including medicine, equipment and finances should be maintained in order to ensure non-interrupted services. The service level agreement made between the government and the non-government organisation on the condition of service for the health promoters need to be clearly defined whilst absorption of all voluntary health promoters into the fulltime workers, according to the conditions of basic employment act, should be the ultimate goal. Conclusion A qualitative study was conducted and followed an exploratory, descriptive and contextual design. The research question, 'what are your needs as health promoters on the health promotion programme for families with adolescents orphaned by HIV and AIDS' pivoted the researcher's focus in this study. Literature control validating the findings was conducted for the 14 identified sub-categories. Health promotion programmes are said to be a pro-active way of empowering the lives of individuals to make healthy choices about their lives. The challenges that the health promoters are faced with in rendering health promotion activities, will delay this whole process. Multiple challenges have been identified in this study as constraining the rendering of health promotion activities to families with adolescents orphaned by HIV and AIDS. Given the results on the needs of health promoters, health policy makers still have a great challenge of improving resource allocations by equally distributing to all organisations to relieve the currently overloaded health system. Acknowledgements The authors' would like to acknowledge the University of Pretoria, Nursing Department for presenting the learning opportunity for academic development. We acknowledge the Sunrise Hospice Centre and the North West Department of Health for permitting us to conduct the study in their region. To the study participants, this study would not be successfull without their participation. Competing interests The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this paper. Authors' contributions M.D.P. (University of Pretoria) and M.P.M. (University of Pretoria) were responsible for writing this article.M.D.P. made the conceptual contribution of this study. This was one of her post doctoral mentoring project and she supervised the study to its completion. M.P.M. conducted the study under the supervision of M.D.P. 1. Acutt, J. & Hatting, S.P., 2003, Occupational Health: Management and Practice for Health Practitioners, 3rd edn., Juta & Co, Ltd., Lansdowne. 2. African Press International (API), 2009, Africa: Home-based care as effective as clinical care - home visits help patients save on costly transport to clinic, viewed 14 August 2012, from http://www.africanpress.in.mht 3. 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Maqoko, Z. & Dreyer, Y., 2007, 'Child-headed households because of the trauma surrounding', HIV/AIDS, HTS 63, 2, 717–731. 24. Marquis, B.L. & Huston, J.H., 2006, Leadership roles and management functions in nursing: Theory and application, 5th edn., Lippincott Williams & Wilkins, Philadelphia. 25. Mohapi, M.E., 2005, Establishment of home-based care (HBC) step-down facility (Hope for life) for HIV/AIDS victims at Pelonomi Hospital in Mangaung Community by 2005, University of Free State, South Africa. 26. MSF article, 2007, Retaining health workers: The basic, viewed 16 October 2010, from http://www.msf.org 27. Mthembu, T.G. & Van Wyk, B., 2010, 'Knowledge, attitudes, beliefs and adherence to antiretroviral therapy among people living with HIV/AIDS receiving treatment at Shongwe Hospital, Mpumalanga Province', Master's Thesis. University of Western Cape. 28. National Department of Health, 2006, Health facility definitions, Government Printers, Pretoria. 29. Orner, P., 2006, 'Psychosocial impacts on caregivers of people living with AIDS', AIDS Care 18, 3, 236–240. http://dx.doi.org/10.1080/09540120500456565, PMid:16546784 30. Peu, M.D., Van Wyk, N.C. & Botha, A.D.H., 2008, 'Health promotion needs of Hammanskraal families with adolescents orphaned by HIV/AIDS', Health SA Gesondheid 13, 1, 14–28. http://dx.doi.org/10.4102/hsag.v13i1.254 31. Polit, D.F. & Beck, C.T., 2008, Nursing research: Generating and assessing evidence for nursing practice, 8th edn., Lippincott, Philadelphia. 32. Prasad, B.M. & Muraleedharan, V.R., 2007, 'Community health workers: A review of concepts, practice and policy concerns', UK Government Department of International Development, viewed 15 August 2010, from http://www.crehs.Ishtm.ac.uk/ 33. Sobuce, N.W., 2007, 'The experience of volunteers involved in the Home-Based care of people living with HIV and AIDS', Masters Dissertation, Department of Social Development and Planning, Nelson Mandela Metropolitan University, South Africa. 34. South Africa, Department of Health, 2001, Policy guideline for youth and adolescent health, Government Printers, Pretoria. 35. South Africa, Department of Health, 2010, National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa 2009, Government Printers, Pretoria. 36. South Africa, Department of Health, 2012, National Strategic Plan on HIV, STI's, and TB 2012–2016, Government Printers, Pretoria. 37. The free dictionary.com, n.d., viewed 09 June 2009, from http://medical-dictionary.thefreedictionary.com/HIV+AIDS) 38. Tolle, M.A., 2009, 'A package of primary healthcare services for comprehensive family-centred HIV/AIDS care and treatment programs in low-income setting', AIDS Care 14, 6, 663–672. 39. Williamson, K.M., 2007, Home healthcare nurses' perceptions of empowerment, Journal of Community Health Nursing 24, 3, 133–153. http://dx.doi.org/10.1080 /07370010701429512, PMid: 17650984 40. World Health Organization, 2006, World Health Statistics, WHO Publications, Switzerland. 41. World Health Organization, 2008, Towards universal access: Scaling up priority HIV/AIDS intervention in the health sector, WHO Publication, Geneva. 42. World health Organisation, 2009, 'AIDS epidemic update, December 2009', in UNAIDS, viewed 03 October 2011, from http://www.unaids.org 43. Zvavamwe, S. & Ehlers, V.J., 2008, 'Implementing a community-based tuberculosis programme in the Omaleke region of Namibia nurses' perceived challenges', Health SA Gesondheid 13(3), 54–68. http://dx.doi.org/10.4102/hsag.v13i3.286


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Blackhawks, Bruins set for Stanley Cup rematchby Brian Hedger / Chicago Blackhawks
|Bill Smith / Chicago Blackhawks
CHICAGO -- The word "respect" was used liberally at Johnny's IceHouse West on Saturday after back-to-back practices for the Chicago Blackhawks and Boston Bruins.
There were times it felt like Aretha Franklin might walk through the door wagging her finger and singing the famed song of the same name. That song, though, wouldn't have really fit the mood of the Blackhawks and Bruins, who will face each other Sunday at United Center (12:30 p.m. ET, NBC) for the first time since Game 6 of the 2013 Stanley Cup Final.
The song "Respect" is about not getting enough of it. These former Stanley Cup Final foes have plenty of it for each other after engaging in a hard-fought, entertaining series last June.
"I think there's always going to be intensity the first time teams play each other [after a Cup Final], but intensity ... it depends what you mean by that," Bruins coach Claude Julien said. "If you're talking about a lot of cheap shots and all that, I don't think that's the case here."
Last season's Final between the Blackhawks and Bruins featured a number of big hits going each way, but they were clean and the hockey played was memorable. The series had physicality, emotion, three overtime decisions (including a triple OT thriller in Game 1) and, of course, those stunning back-to-back goals by Bryan Bickell and Dave Bolland late in the third period of Game 6 in Boston.
Scored 17 seconds apart, those goals ended the game and series in Chicago's favor, becoming the final ebb in a series full of ups and downs. A few things have changed for both sides nearly seven months later, but the respect factor remains.
Chicago forward Patrick Kane discovered that late Friday night in Chicago, when he grabbed a bite to eat after helping the Blackhawks win a big game against the Anaheim Ducks.
"There's going to be respect," Kane said. "I saw some of those guys after the game [against the Ducks]. I went out to dinner and they were there too. A lot of them are respectful and come up and just say, 'Hi,' to you and different stuff. Once you get on the ice, it's totally different. The rivalry kind of renews and reignites itself."
That means the on-ice chatter from the Final will probably return, with each side eager to participate. Kane said the series against the Bruins probably had more "chirping" than Chicago's 2010 Cup victory against the Philadelphia Flyers, but that shouldn't be mistaken for disrespect.
"It's good," he said. "Sometimes that gets you into the game and you have fun with it. It was a fun series to be a part of."
Told of Kane's assessment, Bruins center Patrice Bergeron nodded his head.
"I think he's right," said Bergeron, who played through a number of painful injuries in that sixth game against Chicago. "I've also talked to a couple guys who played on their team, as well, and that's what we basically said. It was a great series, a hard-fought series but still lots of respect on both sides."
It's different to what played out between the Bruins and Vancouver Canucks in 2011, when Boston won the Cup in a very physical series that lasted seven games. Hard feelings developed that still linger now.
Neither the Blackhawks nor the Bruins expect anything like that Sunday.
"There isn't as much talk of that coming into this game, but we both know what's on the line," Boston forward Milan Lucic said. "I wouldn't say there was any other series where there was that mutual respect. I'm sure once the puck drops and we get going, that emotion level will get back pretty quick."
Will it dredge up any lingering issues from last June?
"Well, I guess we'll find out," Blackhawks defenseman Duncan Keith quipped, while coyly flashing a smile. "I think at the end of the day it's a new year and what happened last year was last year. At the same time, you know you're playing the Boston Bruins and you remember that jersey that you were playing against last June. It's going to be exciting to play these guys again."
It's also a big game for each team in terms of the standings.
The Blackhawks, who trail the Ducks for the lead in the Western Conference and NHL standings, are trying to get back into top gear after going 4-1-5 in their past 10 games.
Boston, sitting atop the Atlantic Division with 62 points, is learning to play without defenseman Dennis Seidenberg. The Bruins are 4-5-0 in the nine games they've played since Seidenberg tore the ACL and MCL in his right knee, ending his season.
Otherwise, from a sheer hockey standpoint, the game Sunday will be a chance for each side to pick up where it left off last June. As Julien put it Saturday, "I think it [was] one of those Final [series] where both teams respected each other right to the end and it was decided on the game of hockey, nothing else."
Expect more of the same Sunday. While some might look at this as just another game in a long regular season, at least one significant player doesn't think so.
"There's going to be that history there," Blackhawks captain Jonathan Toews said. "I think it's fresh in their memory and it's definitely fresh in ours, that we still want to prove we're the defending Stanley Cup champions. I think there's a lot of respect between both teams, considering the way that series was played, but [this] is a game that we want to win ... probably more than any other game throughout the season."
Author: Brian Hedger | NHL.com Correspondent


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Languages: DE - ES - FR - IT
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Citalopram (brand names Celexa, Cipramil, Citrol, Seropram, Talam, Citabax, Citaxin, Citalec, Recital, Zetalo, Celapram, Ciazil, Zentius, Ciprapine, Cilift, Citox, Citopam, Akarin, Cipramis) is an antidepressant drug used to treat major depression associated with mood disorders. It is also used on occasion in the treatment of body dysmorphic disorder and anxiety. Citalopram is an antidepressant medication that affects neurotransmitters, the chemicals that nerves within the brain use to communicate with each other.
Generic Celexa 10mg / 20mg / 40mg
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CITALOPRAM (Celexa) is a medicine for depression and other related problems. You may have to take citalopram for up to 4 weeks or longer before you begin to feel better. Generic citalopram tablets are available.
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They need to know if you have any of these conditions:
heart disease
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receive electroconvulsive therapy
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an unusual or allergic reaction to citalopram, the related drug escitalopram, other medicines, foods, dyes, or preservatives
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aspirin, warfarin, or nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen or naproxen
certain diet drugs (dexfenfluramine, fenfluramine, phentermine, sibutramine)
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medicines that treat depression or other mood problems
medicines that treat HIV infection or AIDS
migraine headache medicines (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan)
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prescription pain relievers (codeine, hydrocodone, meperidine, morphine, tramadol, oxycodone)
St. John's Wort
Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines. Also tell your prescriber or health care professional if you are a frequent user of grapefruit juice, drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.
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skin rash, itching (hives)
fast talking and excited feelings or actions that are out of control
suicidal thoughts
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agitation, anxiety, or restlessness, especially in the first week of treatment or when doses are changed
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blurred vision
difficulty sleeping
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indigestion, nausea
increased or decreased appetite
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sexual difficulties (decreased sexual ability or desire)
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What should I watch for while taking citalopram?
Visit your prescriber or health care professional for regular checks on your progress. Continue to take your tablets even if you do not immediately feel better. It can take about 4 weeks before you feel the full effect of citalopram.
Patients and their families should watch out for worsening depression or thoughts of suicide. Also watch out for sudden or severe changes in feelings such as feeling anxious, agitated, panicky, irritable, hostile, aggressive, impulsive, severely restless, overly excited and hyperactive, or not being able to sleep. If this happens, especially at the beginning of antidepressant treatment or after a change in dose, call your health care professional.
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Do not treat yourself for coughs, colds, or allergies without asking your prescriber or health care professional for advice. Some ingredients can increase possible side effects.
Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.
If you are going to have surgery, tell your prescriber or health care professional that you are taking citalopram.
Where can I keep my medicine?
Keep out of reach of children in a container that small children cannot open.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.
Frequently asked questions:
What is a generic medication?
Wikipedia gives the following definition: "Generic drug (pl. generic drugs, short: generics) is a drug which is produced and distributed without a brand name. A generic must contain the same active ingredients as the original formulation. In most cases, it is considered bioequivalent to the brand name counterpart with respect to pharmacokinetic and pharmacodynamic properties. By extension, therefore, generics are assumed to be identical in dose, strength, route of administration, safety, efficacy, and intended use. Mind that the pills you will receive from us differ in appearance from the brand name ones. The looks of medications as well as brand names are the intellectual property of the brand manufacturer. Thus to avoid any accusation of copyright infringement we have to change the shape and the color of the generic pills as well as use the name of the active ingredient (generic name) instead of the brand name for printing on pills. Please be aware that the generic pills differ in appearance from the brand name medications. Our pills are round shaped and blister packed (10 pills per each blister). The name of the active ingredient as well as the weight are specified on the pill itself.
Why are generic pills cheaper than the brand name ones?
The principal reason for the reduced price of generic medicines is that the creation of the generic drug runs up less cost and therefore a lower price can be offered and still maintain profitability.
Manufacturers of generic drugs are mainly able to avoid the following three costs that brand name pharmaceutical companies incur: (1) costs associated with the research and development of the drug; (2) costs associated obtaining regulatory approval (i.e. proving safety and efficacy of a drug); and (3) marketing costs.
First, Generic manufacturers do not incur the cost of drug discovery and instead reverse-engineer existing brand name drugs to allow them to manufacture bioequivalent versions.
Second, generic manufacturers do not bear the burden of proving the safety and efficacy of the drugs through clinical trials - rather, generic manufacturers must prove the generic drug's bioequivalancy to the existing drug.
Third, these companies receive the large benefit of the marketing and advertising that goes into pushing the innovator drug. The brand name drug has to prove itself in the eyes of the consumer, generic ones do not. The drugs that generic manufacturers are selling have been on the market for usually a decade or more and do not need additional advertising. For the same reason, generic manufacturers also do not give away sample doses to promote their products. The significant research, development and marketing costs incurred by the large pharmaceutical companies in introducing a new drug to the market is often cited as the reason for the high cost of new agents - they wish to recover these costs before the patent expires. Generic manufacturers do not incur these costs, with bioequivalence testing and manufacturing costing relatively little, and are able to charge significantly less than the brand. Buy discount Citalopram (Celexa) online. Order cheap generic Celexa (Citalopram) . Purchase Citalopram (Celexa) - low cost and price, but high quality.
Do you require a prescription?
However we would strongly recommend you to consult your doctor before taking a medication. You may have some diseases contra-indicated for taking certain kinds of medicines and your doctor will advise you what you can or cannot take.
Do you guarantee the quality of pills?
High quality of the medications we offer is the subject of our primary concern. The logic is very simple: the better the quality of goods is, the more customers we have. Thus we are very attentive and selective in the choice of the supplier, the quality of goods is thoroughly tested and the documentation is closely checked.
How do you ship orders? Will I have to sign for the package?
If sent by the standard unregistered mail the order will come in a plain envelope without any reference to content. The envelope will be left in your mail box. There is no need to sign for it. If sent by a courier, the recipient needs to sign for the package. All orders are shipped in discreet packaging. There is no mention on the outside of the package as to what is contained inside. Furthermore, your name or any other personal information will never be given or sold to any other company. Your privacy is our utmost concern.
Will my order be delivered in one package or you will divide it in case the order is large?
If an order includes 90 pills (or more) or if there are different types of medications in one order we will have to send the pills separately. Thus the delivery will take longer than 3 weeks since the packages are sent with the interval of approximately 7 days one by one. This is done to secure the delivery.
All the information you provide is confidential and is not given to any third parties.
On our site, you fill in a form to order your medications. Your personal information inserted is used for the delivery of goods and for and orders confirmation message. This information is also used to contact the customer if needed. The information is not used for any spam or promotional messages etc.
Our stuff does not have any access to the customers' credit card information. Customer support operators can see only the last four digits of your credit card in the database.
All the data from the "checkout page" is directly transferred to the secure server of the payment system.
Payments security is ensured by encrypting your personal information during its transfer from the customer to the bank for the processing. We use 128 bit Secure Sockets Layer (SSL) software to encrypt the information you input.


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From the New York Times
The news from Europe, particularly from within the euro zone, seems all bad.
Interest rates on Italian government debt continue to rise. Attempts to put together a "rescue package" at the pan-European level repeatedly fall behind events. And the lack of leadership from Germany and France is palpable – where is the vision or the clarity of thought we would have had from Charles de Gaulle or Konrad Adenauer?


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Anthony Edwards on His TV Return: Zero Hour Excited Me the Way ER Did
Feb 13, 2013 10:00 PM EST
Nazis. Kidnapping. Secret religious societies. Doomsday. And clocks. So many clocks.That's Anthony Edwards' new drama Zero Hour (premiering Thursday, 8/7c, ABC) in a nutshell, one that's as far away from the halls of County General as you can get &md… Read more


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Toronto Neighborhoods • St. Lawrence
St. Lawrence Pictures
The St. Lawrence neighbourhood of Toronto, Ontario, Canada although still part of downtown Toronto, was the actual downtown centre and city hall location during the late 18th and entire 19th century. The first parliament buildings in Upper Canada in 1793 were constructed on the southwest corner of Parliament and Front Street. A Saturday farmers' market began operation in St. Lawrence in 1803. The city of Toronto's first city hall was located on the southwest corner of King St. East & Jarvis St. at the old 'Market' building from 1834 to 1844. This building was later burnt down during the great fire of 1849 and replaced with the grandiose St. Lawrence Hall and north section of the market, referred to today as the 'North Market'. In the 1970s it was decided by mayor David Crombie to turn the area into a new residential neighbourhood, but one that would not make the same mistakes of the housing projects of earlier decades. It would contain a mix of commercial and residential as with both subsidized and market oriented housing, mostly rowhouse or low-rise apartments. The neighbourhood was planned by Alan Littlewood and the influence of American urban planner Jane Jacobs played a crucial role. Many of the developments were not completed until well into the 1990s. Since that time, the St. Lawrence neighbourhood has been critically acclaimed as a major success in urban planning. In many ways, it has become the model for the design and planning of new urban communities across North America. Some of the most interesting architecture in the city can be found in St. Lawrence, one notable landmark is the Flatiron building, known for its distinct narrow, wedge shape where Wellington St. merges with Front. Built in 1892, it was the first of this type of building constructed in North America.
How to get to St. Lawrence Neighborhood
King Station on the Yonge-University-Spadina Line; walk eastbound 10 minutes on Wellington street.
Last edited by Parent on Sat May 31, 2008 12:20 am, edited 4 times in total.
Neighborhoods Nearby St. Lawrence - Pictures by Parent
Financial District Neighborhood by Parent. The Financial District is a business district in Toronto, Ontario, Canada, within the downtown core. It is the main financial district in Toronto, and is the financial heart of Canada. It is bounded roughly by Queen Street West.. Distance from St. Lawrence: 0.7km W, 16 pictures.
Dundas Square Neighborhood by Parent. Yonge-Dundas Square (commonly called Dundas Square) is a public square in Downtown Toronto, Ontario, Canada. It is located on the southeast corner of Yonge Street and Dundas Street. It was opened to the public in November 2002,.. Distance from St. Lawrence: 0.9km NW, 19 pictures.
Entertainment District Neighborhood by Parent. The Entertainment District is an area in downtown Toronto, Ontario, Canada with about 300 night clubs. Located immediately west of University Avenue, the majority of the night clubs can be found on Richmond Street West. The.. Distance from St. Lawrence: 1.4km SWW, 35 pictures.
Harbourfront Neighborhood by Parent. Harbourfront is a waterfront tourist, residential and cultural real estate development on the northern shore of Lake Ontario within the downtown core of the city of Toronto, Canada. Harbourfront extends west from Yonge Street to.. Distance from St. Lawrence: 1.5km SW, 16 pictures.
Cityplace Neighborhood by Parent. CityPlace is the name given to a large section of former railway land in Downtown Toronto, Canada. The term is more recently being used for a large multi-tower condo development near the Toronto harbourfront and central business.. Distance from St. Lawrence: 2km SWW, 16 pictures.
Chinatown Neighborhood by Parent. This is one of the largest Chinatowns in North America. It is centred around the intersection of Dundas Street West and Spadina Avenue, and extends outward from this point along both streets. It has grown significantly over the.. Distance from St. Lawrence: 2.1km NWW, 12 pictures.
Discovery District Neighborhood by Parent. The Discovery District is an area of downtown Toronto, Ontario, Canada that is noted for its concentration of hospitals and scientific research facilities, particularly in biotechnology. The district is roughly bounded by Bloor.. Distance from St. Lawrence: 2.1km NW, 28 pictures.
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Day Students
The Summer Institute for the Gifted Day Program provides instruction in almost 40 courses during its regular academic schedule. Courses are taught at levels appropriate for gifted students who are ages 5-12, covering humanities, mathematics, sciences, and multi-disciplinary courses, as well as recreation, fitness, art, and drama. Please see individual campuses for ages specific to each campus.
Half-day options include a morning-only program (8:45 a.m. - 1:00 p.m.) and an afternoon-only program (12:00 - 4:00 p.m.).
Extended-Day Supervision
SIG will provide supervised play, social, study, and rest time before and after the regular program. The extended day schedule is available to SIG Day Program participants as follows:
7:45 a.m. - 8:45 a.m. daily
4:00 p.m. - 5:00 p.m. daily or
4:00 p.m. - 6:00 p.m. daily
The cost for this three-week service is $150 for morning supervision and $150 for each one-hour segment of afternoon supervision. Arrangements and payments for the service are to be made prior to the start of the program through the Summer Institute for the Gifted office. With 24-hour advance notice and program confirmation, hourly drop-in care is available at $15/hour.


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Robin Bower, associate professor of Spanish and comparative literature and culture at Penn State Beaver, is one of only two University faculty members to receive the 2012 Milton S. Eisenhower Award for Distinguished Teaching.
The award recognizes excellence in teaching and student support among tenured faculty who have been employed full time for at least five years with undergraduate teaching as a major portion of their duties. Milton S. Eisenhower, brother of former U.S. President Dwight D. Eisenhower, served as president of Penn State from 1950 to 1956.
Since joining the Penn State Beaver faculty in 2000, Bower has immersed her students in the Spanish language, insisting that even those taking their first Spanish class converse in the language. 'The beauty of Dr. Bower's classroom is that she opened the world of Spanish to us through conversation, not mere lists of vocabulary that had to be memorized,' one student said.
Bower has received a Bayer Corporation Award for Excellence in Teaching at Penn State Beaver and the Penn State Beaver Advisory Board Michael Baker Corporation Faculty Excellence in Research Award. She is the campus Honors Program coordinator and chairs the Penn State Beaver Retention Task Force and its subcommittee on pedagogy.
"While most faculty touch the imaginations of many students each semester," one nominator said, "Dr. Bower's reach extends more broadly. In her classes, I observed students beginning to wonder, asking their own questions and framing reasoned reflections."
During the University's 2011 spring break, Bower and students from her Iberian Civilization and Culture class traveled to Madrid, Spain, where they toured the Prado Museum, the Reina Sofia Museum Thyssen-Bornemisza Museum, and studied the works of Joan Miro and Juan Gris.
In addition, Bower served as a visiting professor in the Department of Romance Languages at Duke University during the 2009 spring semester and taught an upper-level undergraduate seminar and a graduate seminar in medieval Spanish literature. In 2007 she participated in Columbia University's prestigious Literature Humanities Luncheon Speaker Series with a presentation entitled 'Augustine's Confessions.'
She taught at Columbia from 1990 to 1993 and from 1995 to 2000. While there she received the President's Fellowship, a Literature Humanities Preceptorship, and a Dissertation Research Fellowship. Bower holds a doctorate from Columbia as well as a master's degree in Medieval and Golden Age and a master's degree in Latin American Literature. She received a bachelor's degree from West Chester University and also studied at St. Louis University in Spain.
Bower can be contacted at email@example.com or 724-773-3886.