text: Still new to the site and have enjoyed and learned a lot...thanks to all...have to share...Just finished up a double water mark with my boy Hagen and lined him up for his blind, diagnol entry, 40 yard swim, and 20 yards up the bank to the bumber by a tree. Send him, veers right, handle left, veers left takes a nice handle toward the bumper. Gets out and overruns the mark, stop him call him in and he stares at the mark and then decides to take a dump!! Finishes his business, walks back to the bumper stares at it then decides to return to me! Just before reentering the water I whistle hard and back!!!! he goes back and reluctantly and very slowly picks up the bumper and heads my way. Im talking to my helper and asked if there was an ant pile or something that would have detered the retrieve. She said nope put it where you said. Im shaking my head and puzzled as to why he did that. He comes to heel I say drop, take the bumper and a tennis ball falls out with it.....still cracking up!!!


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Our Marrakesh, Morocco ecotourism will take you to some of the most pristine and protected areas in the world. You will learn about the flora, fauna, and cultural heritage of the area. Travel to the most beautiful natural destinations in the world on our eco vacations. Learn about the impact human intervention has on the environment on our Marrakesh, Morocco nature tours. Our eco tourism will educate you about the ecosystem and how you can help preserve the fragile areas of the world. Contribute and fund ecological conservation on our eco holidays and help benefit the economic and political development of the local communities. Browse our Marrakesh, Morocco eco tours and plan your vacation today!

subset: commoncrawl


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The World at Your Feet
The Revolutions International Theatre Festival
By Steven Robert Allen
If you're a lefty anarchist, you're invited. If you're a right-wing corporatist, you're invited. If you know as much about politics as Eminem knows about Gustav Mahler, you're also invited.
"Because of the title of the festival," says Joe Perrachio, the artistic director of the Revolutions International Theatre Festival, "people often ask if this is a left-wing event. This festival has no wing. There are many definitions of the word 'revolution.' In this case, we're talking about revolutionary art, art that changes the way people view the world."
The festival kicks off this week at venues all over Albuquerque and Santa Fe, bringing some of the best experimental performers from around the world right here to New Mexico. Every year it's been claimed that the festival is bigger and better than ever, and every year it's been true. This year will likely be no exception. As part of Albuquerque's year-long 300th birthday celebration, this sixth annual installment is called "a Tricentennial celebration of world theater."
While most other Tricentennial events highlight our city's distinguished Hispanic heritage, Revolutions is bringing in acts from Canada, Thailand, Israel, South Africa and across the U.S., as well as performers from Mexico and Spain. As such, the festival celebrates Albuquerque's cultural history in the broadest, most egalitarian sense.
"If we had millions of dollars," says Perrachio, "we'd have people from everywhere, but we had to do this in broad strokes. The festival opens with a Native American troupe and closes with a Spanish one. Even chronologically, this says something about the heritage of our area, by bookending Revolutions with the two dominant cultures that identify the region. In between, there are works from a multitude of cultures."
Even more important, he says, is that these are new works, not traditional works. In this way, the festival glances back at the roots of Albuquerque's cultural heritage but also looks toward the future. "We can't escape the fact," says Perrachio, "that this is becoming an integrated world. By presenting Revolutions, we simply want to inspire creative people from different cultures into a dialogue with each other."
Over its short lifespan, Revolutions has quite possibly become the best show in town. This is cutting-edge performance in the truest sense. Watch your fingers—some of this stuff will slice right through the bone. Below you'll find a roundup of events with some tips from Perrachio for making the most of the next three weeks.
Kick-off Party
Red Sky
Reptilian Lounge
Chad Brummett
Dan Guerrero
Vivian Cruz and Hebe Rosell
Acco Theatre Centre of Acco, Israel
Dean Cameron
Billy the Mime
Tricklock Company
Paul Provenza
Salon Sunday
Albuquerque Youth Poetry Slam-Off
Idris Goodwin
Kevin R. Elder
Boyzie Cekwana's The Floating Outfit Project
Witness Relocation Company/Patravadi Theatre
Teatro Titzina
Ordering Tickets
Go to www.tricklock.com for the latest information about the festival. Advance credit card ticket orders for all Albuquerque performances (except the Reptilian Lounge, which only accepts cash at the door) can be made by calling 254-8393 up to four hours prior to the start of each event. Ordered tickets will then be available at Will Call at each venue. See individual listings for Santa Fe ticket information. Tickets are also available for cash at each venue starting one hour prior to each performance. Due to demand, advance purchases are the best way to ensure seats. Multi-show passports can also be purchased for $85 general/$50 students (five shows) and $160 general/$90 students (10 shows).
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Pentimento at AirDance ArtSpace
A variety of aerial apparatuses and stilt work with interactive projections performed to a choir of women's voices.
Silver String Band • Americana, blues at Mine Shaft Tavern
Teen Science Café at Explora!More Recommended Events ››
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Mitt Romney wants the United States to get much tougher with Iran and to end what a top adviser calls President Barack Obama's "Mother, may I?" consensus-seeking foreign policy.
With the presidential nomination all but locked up, an examination of Romney's foreign policy pronouncements and the team advising him on those issues indicates Americans and the world might expect a Republican campaign that reprises the hawkish and often unilateral foreign policy prescriptions that guided Ronald Reagan and George W. Bush.
"The world is better off when the United States takes the lead. We should not be playing 'Mother, may I?' about sanctions on Iran and relations with China and Russia," said Richard Williamson, a top Romney foreign policy adviser. He has advised presidents beginning with Reagan, held many diplomatic posts in past Republican administrations and was Bush's special envoy to Sudan.


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Like I said before, I would train the dog and hunt with it... But hunting is about enjoying the outdoors and nature. What would be enjoyable about having to look at or listen to Obama for any length of time when you could be gazing out over your spread at the natural scenery without those big ears in the way? (Obama's, not the dogs)
The sight of John Kerry in Hun-ting clothes was bad enough. Can you imagine the preezy? Do they make Mom waders?


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I just saw Kill Bill. It was excellent. But damn, those Red Dots pissed me off! For those who aren't aware yet, many new movies coming out contain brief flashes of Red Dots, randomly placed, every few minutes. The theory is, these Red Dots will foul up video encoders like DivX, thus making the movies harder to pirate. What pisses me off is that 1) this is completely boneheaded from a technical perspective. Anyone with half a clue can see that this won't do squat to stop pirates. The encoders will work around the problem in the next versions. And the movie studios can't create new problems, because there is a limit to how messed up the picture can get before people stop going to see them. 2) the Dots are already totally distracting; they are visible even when you're not looking for them.
The Red Dots must have been put on the movie after production, like when the prints were being made for the theaters. I cannot believe that Tarantino or anyone with creative control of Kill Bill has watched a reel with the Red Dots in place. If they had, they would never have let it go out to the public. The Red Dots are even flashing during the scenes that are in black and white.


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More results, new and improved software
Switched from Python to Java (sigh) to improve speed. Python (besides being dynamic) has worthless threading in comparison to Java. Java version is faster, by a lot, runs on just Archaea go from 4 days to something in the range of 12 hours with Archaea + Bacteria (625 genomes).
Ran into problems with threading but learned a lot while doing it. Will definitely make this process faster. Runs are still a slow process though but not much room for improvement without moving to a cluster.
Loading full relative distributions for 9-mers is currently not possible right now without more consideration of the program. Maybe switching from Hashmap<String, Double> to an array of doubles (double[]) will save some space. Need to investigate that further, we'll see.
Results for piece sizes 36, 100, and 200 (excluding 8-mers) for 3 through 8-mers as follows:
Still waiting on a run to finish for 200 piece size 8-mers, then will run taxonomic classifier. Unsure of how well that will go in efforts to match data in db to data from files. Not sure the "species" match up between the two in the right way.
Syndicated 2008-11-06 17:24:29 from blog.zacbrown.org - just run away, now.


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Protesters have turned out in Northland to voice concerns at the potential health risks associated with mining in Puhipuhi.
Puhipuhi Mining Action Group, Nga Kaumatua Kaitiaki o Ngati Hau, Minewatch Northland and other supporters protested on the corner of State Highway 1 and Puhipuhi Rd, 30km north of Whangarei yesterday. It is likely the roadside campaign will continue through the week.
PMAG convenor Jenny Kirk said the group and local iwi Ngati Hau had an ongoing strategy to raise public awareness about the dangers mining poses. High on that list is the area's complex underground aquifers being broken into by drilling.
Puhipuhi mountain holds Northland's biggest gold and silver deposits, encased in mercury-laden rock. Australian exploration firm De Grey Mining says the work required just to determine Northland's mining potential will boost the economy, with opportunities for local contractors. Last year, the Government transferred a gold and silver exploration licence over Puhipuhi, with the largest known gold deposit in Northland, from Newmont to De Grey Mining Ltd.
De Grey said the Government's support, the "low risk" country and good infrastructure made the Puhipuhi acquisition an excellent addition to its portfolio.
"Puhipuhi is an excellent advanced greenfields epithermal system with defined and untested drill targets," De Grey executive chairman Peter Batten said.
However, Ms Kirk raised health concerns.
"Mercury is spread throughout the rocks and soils. It's very poisonous, and it causes really nasty diseases. These range from birth defects in infants to painful early death in adults and mental illnesses," Ms Kirk said.
"Local people talk about their older relatives who developed Minamata disease from mercury poisoning when the now disused mercury mine was functioning."
De Grey Mining had said it wouldn't discharge into surface waters but that it would drill into groundwaters, Ms Kirk said.
"There are no guarantees contamination won't happen. This could lead to mercury dissolving into groundwaters which come to the surface as springs all around Puhipuhi that local people rely on for their personal drinking water, the healing springs and for farming purposes."
For more articles from this region, go to Northern Advocate


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Tinyfolk Creates Eco-Friendly Cardboard Playspaces and Puppetboxes For Imaginative Play
filed under: eco play, green design, green family, green gifts, green kids, kids entertainment
Tinyfolk's puppetbox is a charming theatre that comes with a light, a screen, and a choice of shadow puppets: a moon theme with moonrock landscape, rocketship, astronaut, alien, robot and planet, and a forest theme that comes with tree forest landscape, haunted house, fairy, monster, ghost and moon. The shadow puppets, created through an artistic collaboration of Genevieve's husband and her sister (we told you Tinyfolk was a family affair!), are also available for purchase separately!
Little ones will be clamoring to create and imagine in their new little playplaces. The only problem: Tinyfolk products are currently only available for shipping within Australia. But fear not, parents: we'll keep you posted when Tinyfolk makes their stateside debut.


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thousand feet below, an intensely blue Caribbean Sea dashes against the volcanic Piton Mountains. Faintly scented tropical breezes cool your skin. Your private plunge pool beckons. Each offers fine linens, luxurious amenities and four-poster beds made of polished tropical hardwood. And each, deliberately without a fourth wall, invites the spectacular sunsets and astonishing views right inside, to be a part of your very private, very special retreat.
Ladera is the only resort in St.Lucia located on the UNESCO World Heritage Site, overlooking the Pitons and the Caribbean Sea. It is located on the Soufriere Volcano.
Ladera St Lucia Resort offers a unique design in luxury guest accommodations. The Caribbean resort villas & suites all have an
"open wall" - the west side of each unit is left open to expose the breathtaking views overlooking the Pitons and Caribbean Sea.


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Army veteran Aaron Bennett says he was banned from an Old Navy store in Jacksonville, Florida, after he pointed out a teen employee improperly wearing a Marine Corps uniform dress jacket complete with rank insignia, ribbons and a weapons badge, News4Jax.com reported Wednesday.
Bennett, who comes from a military family, knows that United States Code makes it illegal "to falsely represent oneself as having received any U.S. military decoration or medal." The law making that illegal is known as the Stolen Valor Act.
According to Bennett, when he informed the store manager, he was approached by a deputy and mall security, who said he was banned from the store.
Bennett said he was trying to honor the uniform, especially considering that Jacksonville is a Navy town.
"It's disgraceful, men have worked hard trying to earn that uniform and have died wearing that uniform," he said.
The story has also made it to the Stolen Valor website and Facebook page as well as Old Navy's Facebook page, where a number of people have expressed disgust with the company.
"My 'Marine Family' will no longer shop at your stores. Our veterans deserve better than the way Aaron Bennett was treated," wrote Susan Howell Parsons.
"Shame, shame Old Navy. I'm so sad your company would ban a veteran who was only pointing out YOUR mistake! Your staff needs to be educated!" exclaimed Judy Yoder.
According to New4Jax.com, Old Navy's corporate parent, Gap, Inc., released an apology:
"Old Navy has the utmost respect for the military and we're proud of our longstanding tradition of supporting American troops, including our own employees and their family members who serve. We believe there was a misunderstanding between a customer and a store employee and are looking into the matter. We're truly sorry for any misunderstanding or offense caused by this incident."
Bennett, however, says he doesn't accept the apology.
"It wasn't about the jacket. I was willing to let it go. I was done with it," he said. "The fact that they wanted to ban me from the store because I pointed out a total discrepancy, this being a Navy town, it dishonors a lot of people."
Visitors to Old Navy's Facebook page also rejected the apology.
"This so called 'apology' is no where near enough to make up for a former service member to be kicked out and banned for stating a Federal Law to a store manager so they could take the matter up with the employee," wrote Kevin Goff, who said that his wife would no longer shop at Old Navy.
"As an Army Combat Vet also if I had seen this employee and his so called 'fashionable coat' you would have had a completely different and much more public display," he added.
"Banning a VET for calling attention to inappropriate attire is unacceptable. I won't be shopping with them anymore. Nor Gap, Banana Republic, & Piperlime. You know they're owned by the SAME corporation," added Tacinta Connor.
Old Navy customer service representatives were busy responding to the messages, claiming to have "the utmost respect for the military."
"We believe there was a misunderstanding between a customer and a store employee and are looking into the matter. We're truly sorry for any misunderstanding or offense caused by this incident," Old Navy said.
frick OLD NAVY!!!
Why do people always seem to take beef with the ENTIRE company and want to boycott them when it's an issue with a SPECIFIC STORE MANAGER.
I side with the vet on this.
quote:Sounds like he banned himself
"My 'Marine Family' will no longer shop at your stores. Our veterans deserve better than the way Aaron Bennett was treated," wrote Susan Howell Parsons.
Regardless, this is much ago about nothing
Regardless, this is much ago about nothing
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InStyle.com: Celebrity Couples With Matching Style
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|"I'd probably pay good money to get some of those pictures off the Internet," Timberlake told Playboy in 2011 of the denim-on-denim matching looks he and then-girlfriend Britney Spears wore to the 2001 MTV Video Music Awards.
(Photo: LUCY NICHOLSON/AFP/Getty)
See the Full Story
|In August 2011, the royal couple wore matching purple sweaters over white collared shirts in Edinburgh's Holyrood Park.
(Photo: Fame Pictures)
See the Full Story
|While Aniston and Theroux share a taste for chic motorcycle jackets, Aniston is quick to point out she didn't steal his look. "He has great style—it's very specific, and it has been his style forever," she told InStyle for our March 2012 issue. "Has it influenced mine? No, but I know people say it has. 'Oh, look, you're dressing alike.' And I'm thinking, no I'm not. I've had this jacket for three years!"
(Photo: CWNY/Fame Pictures)
See the Full Story
|The pop singer and his "Wizards of Waverly Place" girlfriend took a trip to the Los Angeles Zoo last fall in matching, oversize polo shirts.
(Photo: DMac2/Rocstar2/flynet)
See the Full Story
|This fictional "Hunger Games" couple is supposed to match. They both wear coordinating outfits to represent District 12 pre-arena for training and interviews, as well as in the arena itself.
(Photo: Lions Gate ; Murray Close)
See the Full Story
|The actor and actress—who have been dating since 2006—were completely in sync when they landed in Saint-Tropez in matching blazers, jeans, and fedoras.
(Photo: Ramey Photo)
See the Full Story
|Sexy soccer star David Beckham had some missteps in his sartorial career, and he's not afraid to admit it. The time he wore matching Versace head-to-toe leather with wife Victoria was one he'd like to forget—but can't. "That's one where I look back, like, 'What were we thinking?' We laugh about that one," he said.
(Photo: Nikos Vinieratos/Rex USA)
See the Full Story
Catch "Keeping Up with the Kardashians."
The 10 worst places to start a business.
Contest winners show sky's fragile wonders.
Greatest undrafted players in NFL history.
Here are the 5 steps you need to know.


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Theater Review: 'Admirable Chrichton' just misses
SPRING GREEN, Wis. - The premise of American Players Theatre's production of "The Admirable Chrichton" is amusing.
An English aristocratic family, served by a class conscious butler, William Chrichton, is shipwrecked on a desert island. Chrichton turns out to be a mechanical genius and even equips the island with electric lights. He becomes the head of the family, served by the very snobs he once served.
Alas, the survivors are rescued and servants and masters alike resume their old roles, though those at the top seem less happy to do so than do those at the bottom.
The play, by James Matthew Barrie, is, thus, satire of the British class system, though it doesn't quite work. Or, maybe it does work: the difference depends on whether one is willing to accept the premise that servants are just as haughty and petty as their masters.
Chrichton, played by veteran APT actor James Ridge, just misses the mark. Ridge looks like our stereotype of an English butler but he isn't quite convincing as a snob. It may just be that I've been watching him perform for years, but Ridge just comes across as too nice a guy to be sufficiently haughty.
Colleen Madden, who can play any role, might have been a bit more convincing as Chrichton. Instead, she plays the role of Tweeny, a housemaid who is Chrichton's love interest when things go well but who loses her role in favor of Lady Mary when the family is shipwrecked.
As the lowly housemaid in the big house, Madden resembles no one so much as Agnes Gooch -- if any of you reading are young, check out "Aunty Mame" -- but transforms into a confident, beautiful woman on the island, all to no avail because Chrichton, in power, has lost interest.
Another bright spot in the play is Steven Haggard, who plays the foppish role of the Honorable Ernest Wooley, who is neither earnest nor honorable.
Susan Shunk plays Lady Mary, who, on the island, is able to run down stags for the family table and delights in Chrichton's eye, but who, on returning to London, resumes her engagement to Lord Brockelhurst, ably played by John Taylor Phillips.
All in all, "The Honorable Chrichton" is a pleasant play; it could be a touch better.
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Romina Pelagatti
Drawings by Romina Pelagatti. Paris.
via: picdit
Drawings by Romina Pelagatti. Paris.
via: picdit
Paintings inspired by various mythologies and ancient poetry by Los Angeles-based artist Carl Baratta. More images below.
A selection of recent work by artist Frank Gonzales. Click here for previous posts. See more images below.
Wish I'd known about Antoine Marchalot sooner! The Paris-based illustrator has so many wild ideas, even the older work feels fresh. Check out more below.
A selection of work by Brooklyn-based SVA grad Jackson Epstein. Love this stuff. More images below.
A selection of work by illustrator Kelsey Borch. More images below.


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A one day seminar providing a broad overview of ethical and professional issues designed for new lawyers in fulfillment of phase 1 of the Basic Skills Coure Requirement.
The Florida Supreme Court in The Florida Bar Re: Amendment to Rules Regulating The Florida Bar, Rule 6-12 (Basic Skills Course Requirement, 524 So. 2d 634 (Fla. 1988), made Practicing with Professionalism, mandatory for attorneys admitted to The Florida Bar after October 1, 1988.
Effective on May 12, 2005, the Supreme Court of Florida amended Rule 6-12.3 and Rule 6-12.4. These amended rules state that in addition to attending Practicing with Professionalism, new admittees must attend three "basic" level substantive continuing legal education programs presented by the YLD. The Basic Skills Course Requirement must be completed within the initial 3-year continuing legal education cycle after admission to The Florida Bar or within 2 years after the expiration of any exempt status. The Practicing with Professionalism requirement must be met within the first year of admission to The Florida Bar or one year prior to being admitted to The Florida Bar.
Out-of-State Practitioners, Military lawyers and Governmental lawyers may be exempt from the Basic Skills Course Requirement and should refer to Rule 6-12.4 to determine eligibility for an exemption
8:30 a.m. – 8:45 a.m.
Opening Remarks
8:45 a.m. – 10:15 a.m.
Professionalism/Ethics Presentation
10:15 a.m. – 10:30 a.m.
10:30 a.m. – 11:15 a.m.
Young Lawyer Professionalism Panel
11:15 a.m. – 11:45 a.m.
Overview of the Disciplinary System
11:45 a.m. – 12:15 p.m.
LOMAS/Generational Communication
12:15 p.m. – 1:30 p.m.
Lunch (on your own)
1:30 p.m. – 2:30 p.m.
Chemical Dependency/Stress Management
2:30 p.m. – 2:45 p.m.
The Florida Bar YLD/Local Bar Associations
2:45 p.m. – 3:00 p.m.
Pro Bono/One Campaign Video
3:00 p.m. – 3:15 p.m.
3:15 p.m. – 4:30 p.m.
Judicial Panel Discussion on Professionalism
4:30 p.m.
() max. price = $ () max. price = $ () max. price = $
[Revised: 06-01-2008]


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Daily Archives: March 12, 2012
String Orchestra of New York City comes to Marathon!
Presented by the Florida Keys Concert Association, Marathon welcomes the String Orchestra of New York City for a March 19th performance. A conductor-less chamber orchestra now in its 12th season, the SONYC has established itself as one of the leading young ensembles in NYC. Through a collaborative rehearsal process, each member of the orchestra is invited to impart his or her own artistic flair to the performance, creating a modern, vibrant take on the age-old string quartet template.
Tickets are $30, purchased at the door. Seasonal tickets available for $85 general admission and $150 preferred seating; visit www.floridakeysconcerts.com for details. Performance takes place at the San Pablo Catholic Church of Marathon, 550 122nd St. oceanside, off U.S. Highway 1 at mile marker 53.5. Doors open 7 p.m., showtime 7:30 p.m.
For more information, contact Lynda Berrigan at: 305-743-4687
Posted in Tranquility Bay Resort Tagged Florida Keys, Marathon, Marathon events, Tranquility Bay


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Afghanistan: My Last Tour
U.S. Air Force Senior Master Sgt. Rex Temple has 28 years military experience. He's deployed to the Middle East and Afghanistan four times and served a total of 10 overseas tours. In May 2009, Temple left for what he said would be his last tour of duty. But it was unlike any other he's experienced.
During his final deployment to Afghanistan, he blogged about his daily life at Afghanistan My Last Tour.
Hundreds follow him – including members of the military at all levels who want the real story of what's going on. He's seen firsthand the corruption in dealing with the Afghan government, and tried to fight it. He's a supporter of the strategy to win "hearts and minds" of the Afghan people – but understands the frustrations and difficulties of troops trying to implement that policy.
Between May 2009 and April 2010, the Tampa airman spoke weekly to WUSF's Bobbie O'Brien, who brings his story to our audience. Temple is based at MacDill Air Force Base's 6th Air Mobility Wing. He's married to Liisa Hyvarinen Temple, a University of South Florida adjunct professor who teaches journalism and multimedia. She helps him with his blog and an ongoing school supply drive for Afghan children.
WUSF 89.7 FM has been telling you about how Air Force Senior Master Sergeant Rex Temple and his wife, Liisa, are trying to help children in Afghanistan through a school supply drive here at home. This week's University Beat tells you how USF is getting involved in the effort.
Air Force Senior Master Sgt. Rex Temple spent the last year working in Afghanistan. Re-trained to supplement the Army and Marine troops on the ground, Temple has been focused on humanitarian missions and supply convoys as well as mentoring a couple of Afghan National Army soldiers. Along the way, he has talked to us weekly about his experiences...


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Recall -- Firm Press Release
FDA posts press releases and other notices of recalls and market withdrawals from the firms involved as a service to consumers, the media, and other interested parties. FDA does not endorse either the product or the company.
Price Chopper Voluntarily Recalls 3 Varieties of Burst Brand Cookies
Mona Golub
(518) 379-1480 or
(518) 210-6629
FOR IMMEDIATE RELEASE - June 25, 2013 - Schenectady, NY: Price Chopper Supermarket is voluntarily recalling three varieties of Burst Cookies- Brownie, Almond and Raspberry- a frozen cookie produced by Jacqueline's Wholesale Bakery and baked off in all of the chain's in-store bakeries, due to the presence of milk, a known allergen, which was not declared on the ingredient label. The product is not harmful in any way to those who are not allergic to milk products.
The presence of milk in this product was discovered by one of Price Chopper's corporate quality assurance agents who traced it back to inaccurate ingredient label information submitted by Jacqueline's Wholesale Bakery to the chain in September 2012, providing the impetus for the recall to include product with sell-by dates of September 5, 2012 through June 21,2013.
In addition to alerting the media, Price Chopper initiated its SoundBite recall notification procedure, which uses purchase data and consumer phone numbers on file in connection with the company's AdvantEdge (loyalty) card to directly alert those households that may have purchased the product in question.
Customers are encouraged to return any packages of Burst cookies to the store for a full refund.
Customers with questions may speak to a Price Chopper Customer Service Agent by calling the chain's in-house Customer Communications Center at 1-800-666-7667 X3 between 8:30AM and 7:00PM Monday through Friday or between 1 O:OOAM and 4:00PM on Saturday and Sunday.
RSS Feed for FDA Recalls Information [what's this?]
Recalled Product Photos Are Also Available on FDA's Flickr Photostream.


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Sewell Stipend 2009 APHA – Call for Applicants
Sewell Stipend 2009 – Call for Applicants
Do you work with public health professionals? Are you interested in public health? Are you interested in attending the American Public Health Association Annual Meeting?
This year's APHA meeting will take place in Philadelphia, PA from November 7-11, 2009. Its theme will be Water and Public Health.
The Grace and Harold Sewell Memorial Fund, Inc. is offering stipends to librarians and other information professionals to help cover the costs of their attending and/or participating in this meeting. Successful applicants from the greater Philadelphia area will receive a stipend of at least $650. Successful applicants from outside greater Philadelphia will receive at least $1,000. This amount covers most of the APHA Membership at $195 and Early Bird (pre-August 28, 2009) Member Registration at $395. Though significant, these amounts will NOT cover all costs, so stipend recipients will need to find additional monies to cover remaining costs.
Completed applications are due July 24, 2009–just over a month from today. To apply, read and complete the application form attached or download the Word application form at http://www.phha.mlanet.org/blog/. Add all required application materials to the completed form and send as an email attachment to Joey Nicholson at email@example.com.
For more information, contact Joey Nicholson at firstname.lastname@example.com
Please forward this message to others who may be interested.


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Share your style: #myonepieceAdd Your Photo
Classical Revival 2-Light Pan Fixture w/Satin Opal Shades, c1922 Item # R3048
The 1920s saw the convergence of two popular trends – the Colonial Revival and the stamped pan light. Combined in countless ways, Colonial pan lights were ubiquitous in all types of houses – from bungalows to foursquares to Dutch Colonials – yet they always felt right at home with their clean lines, restrained detailing, and casually formal character.
Small two-light oval flush pans like this example were "bread-and-butter" fixtures suitable for a wide range of rooms. The Colonial Revival borrowed heavily from Classical Revival motifs like the lovely stamped pattern on the pan on this fixture delightfully molded satin opal shades. It might have hung in an entry, a stairway, a breakfast nook, or a bedroom.
- Historical Style: Classical Revival
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IMHO Ertz is the best TE in the draft. In round 3 he would be an absolute steal.
As the sleeper of the bunch, I think we need to try to draft that Jordan Reed. I see him as an upgrade to the Clay role. He has better open field ability than Clay.
At RB, Gillislee is the sleeper IMHO. In round 4, he is a steal.
The only 2 QBs I kinda like in this draft are Nassib and Wilson.


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Trying to get the NJ gobbler hunters up and running.
This was my very very Spring turkey season, no luck but enjoyed the hell out of it. Can we say addicted!!!
Looking foward to fall season, going to try and get down to millville WMA..
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The new figuration in underground contemporary art known as Pop Surrealism emerged in California in the late 1980s and early 1990s and has since spread around the globe, spawning unique local flavours and styles in each geographic location. In Australia, the local neo‑Pop phase emerged with a transition from modern graffiti forms based in the gestural and the written word to street stencils and posters based on sampled and appropriated pop cultural images and icons. The explosion of new technology over recent decades has fuelled the production of this art form. Ned Kelly, Yoda, science-fiction monsters, subhumans and robots, media celebrities and pop-cultural icons such as Diana and Charles have become the subject matter of artists who have enthusiastically embraced the infiltration of television, computer games, magazines, comics, films and animation and harnessed the disseminating power of the internet, digital photography and quick‑copy scanners and printers.
Stencilling, as one specific form of street art, peaked in Australia in 2004: many of the now iconic Australian street stencils were created during the astonishing influx of neo‑Pop works appearing between 2003 and 2004. The street-stencil images held in Australia's national art collection were created for the street, where they have long since decayed, been painted over, buffed and destroyed. In 2004, the National Gallery of Australia intervened, asking artists to print their street stencils on paper. Once put to paper, collected, preserved and displayed in a completely different context, these works of art essentially become important documents or records of imagery originally intended for the street. The collection of street stencils at the Gallery—only a portion of which is on display in Space invaders—is now a time capsule of what was happening on Australian streets at a particular moment of collective creativity. It is also potentially the only permanent record of the national stencil phenomenon that peaked around 2003–04.
Zap and I started working together in 2004. It took us a while to find what we both wanted to do with the posters because there was no precedent, there was absolutely nobody doing them, in a way that was more exciting and in a way nobody in Sydney really is still doing it which is good it makes what we do unique. We use a lot of found images and we assemble them in a spontaneous way, I'll see a body of a villain that I like and put it with the head of another character . . Zap is much the same but he uses different references...that doesn't matter though,, we are working towards a similar goal, to use images in a cut-up style like Dada where you are free to merge and combine separate forms.
I have been working under the name ZAP since 1996. However my first tag was SHAZAM which came from comic books and that was in 1986, this led to me using the name ZAP. Also what inspired the name ZAP was all the comic speech bubbles which had ZAP in them, and graffiti art from the 70s. The name ZAP made me think of a superhero character which fights bad guys and rains an array of cosmic colours across city walls.


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EHC Component
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Topic Title
- Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence
Full Report
- Research Review Nov. 20, 2013
Related Products for this Topic
- Research Protocol Jul. 31, 2012
Executive Summary – Nov. 20, 2013
Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence
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Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.
Table of Contents
The Agency for Healthcare Research and Quality (AHRQ) sponsors research to improve the quality, effectiveness, and safety of health care in the United States. Evidence reports and technology assessments generated through AHRQ's Effective Health Care Program provide science-based information about common, relevant health conditions and technologies to serve the needs of patients, clinicians, insurance payers, and other end users. Findings from clinical, health services, and comparative effectiveness studies—especially as assembled for systematic reviews and similar documents—need to be communicated and disseminated effectively to influence optimal and timely practice and health policies.1
Because systematic reviews evaluate multiple studies, they are inherently complex. Nuanced descriptions of benefits, harms, strengths of evidence, and uncertainties often make findings from evidence reports difficult for intended audiences to understand and use in decisionmaking. Evidence reports typically target scientific researchers in related fields, rather than the patients or clinicians who ultimately make health-related decisions. For this review, we view the evidence as moving along a continuum beginning with its collection and systematic review, followed by communicating and translating it for audiences as needed, diffusing and disseminating it, adopting and implementing it, and sustaining and evaluating its impact, with adjustments as needed. We define evidence as data that have been assembled, reviewed, and presented by evidence developers and that have been used to make recommendations. Our review included only the second and third phases in the evidence continuum: communication and dissemination.
Clear communication and active dissemination of evidence to all relevant audiences in easy-to-understand formats are critical to increasing awareness, consideration, adoption, and use of evidence, and to accomplishing AHRQ's mission. By evaluating the comparative effectiveness of communication techniques and dissemination strategies, this review informs efforts to make evidence reports summarizing current research both more easily accessible for evidence translators, health educators, patients, and clinicians and more likely to be used to influence individual decisions, change practice, and inform future research.
Due to the complexities of our topic, we present separate results for the three separate systematic reviews—one for communication, one for dissemination, and a third for uncertainty—each addressing a separate but related Key Question (KQ). Combined, these three separate reviews provide information on how to best translate and disseminate research-based evidence reports.
This systematic review has three related components; all focus on promoting informed decisions about health-related behaviors and decisions among patients and clinicians. First, it addresses the comparative effectiveness of communicating evidence in various contents and formats that increase the likelihood that target audiences will both understand and use the information. Second, it examines the comparative effectiveness of a variety of approaches for disseminating evidence from those who develop it to those who are expected to use it. Third, it examines the comparative effectiveness of various ways of communicating uncertainty associated with health-related evidence to different target audiences, including evidence translators, health educators, patients, and clinicians.
Key Question 1: Communication Strategies To Promote the Use of Health Care Evidence
Key Question 1:
- What is the comparative effectiveness of communication strategies to promote the use of health and health care evidence by patients and clinicians?
- How does the comparative effectiveness of communication strategies vary by patients and clinicians?
Government agencies and institutions, advocacy groups, media organizations, researchers, and other interested stakeholders can all carry out communication activities. They use various strategies to communicate evidence so that target audiences can better understand it; the strategies are meant to increase the probability that recipients pay attention to the messages conveyed.2 Health communication, defined as "the study and use of communication strategies to inform and influence individual and community decisions that affect health,"3 is increasingly recognized as a necessary element of efforts to improve personal and public health.
For purposes of our review, communication strategies fall into the broad area of "health communication" and focus on making evidence interpretable, persuasive, and actionable. The John M. Eisenberg Center for Clinical Decisions and Communications Science translates AHRQ's Comparative Effectiveness Review information to create a variety of materials ranging from evidence summaries to decision aids and other products.
To our knowledge, no overarching framework of communication strategies exists to guide this part of our review. Multiple systematic reviews, however, have explicated key communication strategies that are of interest to the field. Key Informants for this review helped us select the most important communication techniques for comparison. These core constructs are:
- Tailoring the message—Communication designed for an individual based on information from the individual
- Targeting the message to audience segments—Communication designed for subgroups based on group membership or characteristics such as age, sex, race, cultural background, language, and other "psychographic" characteristics (e.g., a person's attitudes about a particular subject matter)
- Using narratives—Communication delivered in the form of a story, testimonial, or entertainment education
- Framing the message—Communication that conveys the same messages in alternative ways (e.g., emphasizing either what is gained or what is lost by taking an action or making a choice)
Key Question 2: Dissemination Strategies To Promote the Use of Health Care Evidence
Key Question 2:
- What is the comparative effectiveness of dissemination strategies to promote the use of health and health care evidence for patients and clinicians?
- How does the comparative effectiveness of dissemination strategies vary by patients and clinicians?
Dissemination of health-related information is the active and targeted distribution of information or interventions via determined channels using planned strategies to a specific public health or clinical practice audience.4-6 Dissemination has been characterized as a necessary but not sufficient antecedent of adoption and implementation. In contrast to diffusion, which is a passive informal process, dissemination is a formal planned process with the intent of spreading knowledge and associated evidence-based interventions to stimulate adoption and enhance the integration of the evidence, information, intervention, or combinations of these into routine practice.4,5,7-9
Existing dissemination models and approaches identify several very broad goals or outcomes for the dissemination of evidence and information:10
- Increase reach to a variety of audiences—Distributing evidence widely to many audiences and across many settings (e.g., postal and electronic mail; electronic/digital, social, and mass media) to increase the reach of information
- Increase motivation to use and apply such information—Increasing interest in the evidence through champions (also known as "cheerleaders"), opinion/thought leaders, or social networks
- Increase ability actually to use and apply evidence—Providing additional resources about the evidence, such as how it can be incorporated into current practice or specific suggestions for change, to enhance a traditional dissemination strategy (e.g., providing additional resources or information; skills-building efforts)
In addition, it is common practice to combine multiple dissemination strategies to address a combination of reach, motivation, or ability goals. These combination strategies are labeled as multicomponent strategies in this review.
Key Question 3: Explaining Uncertain Evidence
Key Question 3: What is the comparative effectiveness of different ways of explaining uncertain health and health care evidence to patients and clinicians?
Uncertainty is inherent in health care and evidence about health care.11 It stems from multiple sources, including imperfect knowledge about scientific evidence, patients' and clinicians' preferences and circumstances, and ways to apply judgment in decisionmaking.11-14
To date, the vast majority of work on communicating uncertainty has focused on the narrow realm of stochastic uncertainty (i.e., the likelihood or probability of an event occurring), with little research focusing on broader concepts of uncertainty related specifically to evidence translation. For our review, we developed a framework of uncertainty as it relates to evidence translation. This framework builds on concepts enumerated in multiple prior taxonomies of uncertainty,11-18 but aligns these concepts with the information that AHRQ's Evidence-based Practice Center19 (EPC) Program communicates about the quality and overall strength of evidence, including risk of bias, consistency, directness, and precision.20 The framework also enumerates uncertainty related to key concepts used by guideline developers in deciding whether to recommend health care services: net benefit, applicability of evidence, and overall strength of recommendation. Uncertainty concepts addressed in this review are:
- Overall strength of evidence—Degree of confidence that the estimates of effects are correct and represent the true effect. When overall strength of evidence is insufficient or low, uncertainty is high.
- Risk of bias—Degree to which individual studies are protected from systematic errors or bias. When risk of bias is high, the quality of evidence is poor, leading to uncertainty.
- Consistency—Degree to which studies present findings similar in direction of effect, magnitude of effect, or both. Evidence lacking consistency includes studies with greatly differing or conflicting effect estimates.
- Precision—Degree of random error surrounding an effect estimate with respect to a given outcome. Studies express dispersion around a point estimate of risk, such as a confidence interval, which indicates the reproducibility of the estimate.
- Directness—Degree to which the evidence either directly links the interventions to the outcome of interest or directly makes the comparison of interest. When evidence indirectly links interventions to the outcomes most of interest, evidence is uncertain.
- Net benefit—Balance or tradeoffs in benefits and harms for prevention or treatment services. When the balance of benefit and harm is too close to call or when evidence is lacking, the appropriate course of action with regard to prevention or treatment is uncertain.
- Applicability—Whether a study intervention is expected to have the same effect in populations and settings where it was not studied but might be applied.
- Overall strength of recommendation—The overall judgment of policymakers that evidence should be applied in particular populations and settings.
Analytic Framework
We present our analytic framework in Figure A. As noted in the box to the far left, we examined studies that used research-based evidence as the source of information for their communication strategies (KQ 1) and dissemination strategies (KQ 2). For all KQs, we struggled with the need to define the evidence base for the studied interventions. In the end, because our review was designed to assist evidence developers, we decided that interventions for KQs 1 and 2 must be based on evidence that was assembled, reviewed, and presented by evidence developers and that has been used to make recommendations. This allowed us to define a clear set of studies for communication and dissemination, and provided a measure of assurance that we captured all relevant literature pertinent to our questions. Further, it acknowledged the likely differences in the impact of studies designed using evidence from established guideline developers versus other single studies or composites of studies. For KQ 3, in contrast, we accepted any type of evidence presented, given the paucity of overall literature. Thus, we included studies that based their interventions on evidence from systematic reviews, consensus guidelines, randomized controlled trials (RCTs), cohorts, or quasi-experimental studies.
Figure A. Analytic framework for communicating and disseminating strategies and explaining uncertainty
KQ = Key Question.
Figure A also details outcomes that we included in our review. We included studies that examined both intermediate and ultimate (distal) outcomes. Intermediate outcomes can be awareness of the evidence, knowledge of the evidence, discussions about the evidence, self-efficacy (or confidence) to use the evidence, and intentions to use or apply the evidence (behavioral intentions). Ultimate outcomes include the following: for patients—health-related decisions or behaviors and clinical outcomes; for clinicians—behaviors. We expected that most studies would be focused on intermediate outcomes because they occur sooner and thus are more practical to study. Further, we felt that these outcomes represented the key outcomes related to a spectrum of effective and preference-sensitive health care services.
Criteria for inclusion and exclusion of studies address both the PICOTS model (population, interventions, comparators, outcomes, timeframes, and settings) and other important study design and publication issues. The inclusion/exclusion criteria common to all three KQs is shown in Table 6 of the full report. Also, specific inclusion criteria were applied to admissible research evidence for KQ 1 and KQ 2 (shown in Table 7 of the full report) and other KQ-specific inclusion/exclusion criteria (shown in Tables 8–10 of the full report).
Literature Search and Retrieval Process
We systematically searched, reviewed, and synthesized the scientific evidence for each KQ separately. Databases included MEDLINE®, the Cochrane Library, Cochrane Central Trials Registry, PsycINFO®, and the Web of Science. We did not conduct additional searches for gray literature.
We used a variety of medical subject headings (MeSH terms) and major headings, and used free-text and title and abstract text-word searches. Search results were limited to studies on humans published from January 1, 2000, to March 15, 2013, for communication and dissemination. Given the lack of prior reviews related to communicating uncertainty, we searched from January 1, 1966, to March 15, 2013.We hand-searched bibliographies of included articles. In addition, in an effort to avoid retrieval bias, we manually searched the reference lists of landmark studies and background articles on this topic to look for any relevant citations that electronic searches might have missed.
Article Review and Data Abstraction
We used standard EPC methods for dual review of abstracts and full text of articles to determine article inclusion. After determining article inclusion, one reviewer entered data about studies into evidence tables and a second, senior member of the team reviewed all abstractions against the accompanying article(s) for completeness and accuracy.
Risk-of-Bias Assessment of Individual Studies
Two reviewers independently rated the risk of bias of studies (low, medium, or high) using criteria designed to detect selection bias (including attrition bias), measurement bias (such as performance bias and detection bias), confounding, and inadequate power. We also assessed potential biases in reporting. Reviewers resolved all disagreements about risk-of-bias ratings by discussion and consensus or by consulting a third, senior member of the team. We did not retain studies with high risk of bias for analysis, presentation in the results chapters, or strength-of-evidence grading. Studies with a high risk of bias were those with at least one major flaw that was likely to cause significant bias and thus might have invalidated the results. Major flaws preclude the ability to draw causal inferences between the intervention and the outcome.
Data Synthesis and Grading Strength of Evidence
Studies included in our review compared a wide range of interventions and a plethora of outcomes; they were sufficiently heterogeneous to preclude meta-analysis. Thus, we synthesized the data qualitatively by KQ. We paid particular attention to moderators of study effects as a way to explain any seemingly disparate findings. Possible moderators of interest for all KQs included risk of bias, study size, and target audience.
The investigative team jointly discussed and graded the overall body of literature and generated recommendations for future research. We graded the strength of evidence on the basis of guidance established for the EPC Program.21,22 The EPC approach incorporates four required domains: risk of bias (including study design and aggregate quality), consistency, directness, and precision of the evidence. Two reviewers independently rated the four domains for each intervention for each key outcome (listed in the analytic framework depicted in Figure A). Conflicts were resolved by group consensus. Two reviewers also independently derived the overall strength-of-evidence grade, resolving conflicts in the same way.
Search Results and Included Studies
We identified 4,152 articles from all sources (after removing duplicates) for all three KQs. After we applied the inclusion and exclusion criteria, 445 articles were retained for full-text review. The majority of the full-text articles were classified to one or more KQs: 106 articles pertained to KQ 1, 163 articles pertained to KQ 2, 84 articles pertained to KQ 3, and 98 articles were classified as overlap. Each overlap article potentially applied to two or more KQs and was not classified into one KQ category. Of the full-text articles, we excluded 386, leaving 61 articles for data abstraction. Nine articles (representing 7 studies) are relevant to KQ 1; 42 articles (representing 38 studies) are relevant to KQ 2; and 10 articles (representing 9 studies) are relevant to KQ 3.
Key Question 1: Communication Strategies
Of the 106 articles pertinent to KQ 1, we retained nine articles after full-text review that met inclusion criteria.23-31 The investigators tested these interventions in study populations in the United States and Hong Kong. Sample sizes ranged from 174 participants to 5,500 participants. Several trials used convenience samples. They reported on seven unique trials about communication strategies. Some trials compared two strategies directly with each other (e.g., targeting vs. tailoring); others used a combination of strategies (e.g., targeting and tailoring vs. tailoring).
Specifically, the trial testing various approaches to framing against either targeting audiences or using narrative (i.e., anecdotal) or statistical evidence did not show long-term differences between groups, and evidence was insufficient for drawing any conclusions. Four trials tested targeting against tailoring messages for individuals or groups or against a combination of both targeting and tailoring, but none produced statistically significant differences between groups in obtaining screening or changing diet and nutritional behaviors. All received grades of low or insufficient strength of evidence (SOE).
The included trials chiefly involved targeting and tailoring. Investigators hypothesized that tailored interventions would be more effective than targeted interventions in promoting screening because they are more personalized. Three trials directly compared the effectiveness of targeting to tailoring,26,28, 29, 31 but they produced mixed results. One trial26 expected that the combination of tailoring and targeting would be more effective than targeting alone, but this was not the case.
In several cases, investigators used some combination of the four communication strategies when developing their interventions instead of comparing only a single strategy with another single strategy. Because comparisons were not one to one, it was more challenging to isolate the effects of each strategy. Additionally, in one trial, investigators enhanced the communication strategy by also varying the communication channel for the intervention (i.e., using a lay health worker). While this tactic creates the potential for a more powerful effect, it also complicates determining the effect of each strategy relative to the other.
Key points for communication strategies are as follows:
- Framing (gain/loss) versus narratives (yes/no)—Loss-framed messages used in conjunction with narratives were more persuasive than (1) loss-framed messages in conjunction with statistical information alone or (2) gain-framed messages in conjunction with either narratives or statistical information (1 trial; insufficient SOE).
- Framing (gain/loss) versus targeting (yes/no)—The loss-framed message used in combination with nontargeting (i.e., a broader appeal either culturally or societally, such as a collectivist appeal) was most persuasive relative to any other combination of framing and targeting, but the results held only in the short term for one of the trials and the targeting was done on different factors across the trials (2 trials; insufficient SOE).
- Targeting (yes/no) versus tailoring (yes/no)—Findings were mixed; that is, they were nonsignificant or counterintuitive for the three studies that compared targeting with tailoring. In all three studies, investigators hypothesized that the tailored version of the intervention would have a greater effect on the outcome than the targeted version. However, there were no significant differences in outcomes between those receiving the targeted or tailored version of the intervention in two studies. In a third study, the targeted version was associated with greater likelihood of self-reported screening relative to the tailored version. The authors attributed this unexpected finding to either a possible "boomerang effect" (because the tailored letter may have been too alarming) or insufficient customization of the tailored version. Across the three studies, investigators targeted and tailored the interventions based on different factors (3 trials; insufficient SOE).
- Targeting (yes/no) and tailoring (yes/no) versus targeting only—Investigators found no statistically significant differences when they targeted an intervention to the subpopulation and personally tailored it to each study participant compared with a version of the intervention that was only targeted. They attributed the lack of differential impact to a possible "ceiling effect" in the study population, given the fairly high baseline screening rates, about 80 percent (1 trial; low SOE).
Key Question 2: Dissemination Strategies
We included 42 articles reporting on 38 studies that focused on evidence dissemination to clinicians or patients (broadly defined) and that used strategies that focused on increasing reach, ability, or motivation, or used a multicomponent approach to enhance health-related decisions or behaviors, clinical outcomes, or knowledge. We divided the trials by dissemination strategies and by outcomes for clinicians and patients.
Some trials compared strategies directly with each other (e.g., ability strategies vs. motivation strategies) and can be regarded as head-to-head trials for comparative effectiveness analyses. Some trials compared strategies with a usual-care or no-treatment control group, but we included them in our analysis if they had at least two trial arms that addressed our inclusion criteria and if we believed that we might glean information about the relative effectiveness of one strategy versus another. In many cases in which there was not a direct comparison, significant tests or confidence intervals were likely also not reported, and we note this in the summary tables in the full report.
The 38 trials reported a wide variety of primary and secondary outcomes that spanned a range of health-related or clinical problems. The trials were conducted in the United States, Canada, England, Germany, Finland, the Netherlands, Scotland, and Spain. Sample sizes ranged from 114 participants to 3,293 participants. For the cluster RCTs, cluster sizes ranged from 9 to 249.
Evidence was low, inconsistent, or not statistically significant for many comparisons for clinicians and patients related to behaviors, clinical outcomes, and knowledge, resulting in a low or insufficient SOE judgment for most categories we compared. In addition, the SOE often was low or insufficient because only a single trial addressed a specific comparison. However, by and large, the most successful strategy identified in this review was the use of a multicomponent dissemination approach for clinicians when trying to change their behaviors. The findings about the positive impact of multicomponent dissemination efforts is consistent with earlier research and prior reviews showing that dissemination strategies that are passive or involve only a single component do not perform as well as more active multicomponent approaches.28,32,33
We did not find evidence that any particular single strategy directed at increasing ability or motivation was better than reach strategies. Here again, there were many single studies in these categories that influenced the SOE ratings.
Key Points: Disseminating Evidence to Clinicians
- Ability strategies are not more effective than reach strategies related to clinician behavior (4 trials; low SOE).
- Multicomponent strategies that address a combination of reach, ability, or motivation appear to be more effective than one strategy alone for affecting clinician behaviors, particularly guideline adherence (7 trials; moderate SOE) and for clinical outcomes, although many comparisons examining clinical outcomes were not significant (6 trials; low SOE).
- The SOE is low or insufficient for most comparisons related to clinical outcomes and knowledge for clinicians because we had only single trials in each case.
Key Points: Disseminating Evidence to Patients
- Evidence is inconsistent for determining the benefit of reach, ability, motivation, or multicomponent approaches for patients focused on changing health-related decisions and behaviors (12 trials; insufficient SOE).
- Evidence is insufficient for determining the benefit of reach, ability, motivation, or multicomponent approaches for patients focused on changing clinical outcomes (2 trials; 1 low SOE, 1 insufficient SOE due to 1 trial in each category).
- Evidence is insufficient for determining the benefit of reach, ability, motivation, or multicomponent approaches for patients focused on changing knowledge outcomes (3 trials; insufficient SOE due to inconsistent findings or 1 trial in a category).
Key Points: Disseminating Evidence to Patients and Clinicians
- Evidence is inconsistent for determining the benefit of reach, ability, motivation, or multicomponent strategies that target both providers and patients for health-related decisions and behaviors (6 trials; insufficient SOE).
- Evidence is inconsistent for determining the benefit of reach, ability, motivation, or multicomponent strategies that target both providers and patients for health-related decisions and behaviors or clinical outcomes (1 trial in each category; insufficient SOE).
Key Question 3: Uncertainty
We found 10 articles reporting on nine unique studies that met our inclusion criteria, had low or moderate risk of bias, and examined alternative ways to communicate the precision, directness, and net benefit of evidence, and overall strength of recommendations. We found no eligible studies on overall strength of evidence, risk of bias, consistency, or applicability. Of included studies, two were RCTs, four were factorial RCTs, one was a noncontrolled trial, and two were quasi-experimental studies. One reported on the effects of alternative wordings of the overall strength of recommendations.34 Four studies reported on various presentations of precision;35-37 one tested alternative ways of communicating directness;38 and four investigated different ways of communicating net benefit (with some studies making more than one comparison).38-43 No studies reported on alternative presentations of overall strength of evidence, risk of bias, consistency, or applicability. Three studies reported the effects of alternative nonnumeric presentations of uncertainty;34,38,40 three on alternative numeric presentations;,35-37 one on numeric versus graphical presentations;37 one on alternative graphical presentations;37 and two on framing.41,43 Only one was directed to providers; all others were directed to patients.
Interventions were tested in study populations in the United States, Canada, and Switzerland. Sample sizes ranged from 120 participants to 2,944 participants. Outcomes studied included knowledge, perceived risk, accuracy of perceived risk, appropriate choices regarding care (e.g., selecting medications, obtaining screening, guideline-concordant care), and decision satisfaction.
Key points for conveying uncertainty are as follows:
- Communicating precision—Studies found mixed effects of presenting numeric risks as point estimates versus 95% confidence intervals (CIs), depending on the studied outcome, width of the CI, and presence or absence of comparative information about average population risk. Only a single small study examined the effects of changing the format in which 95% CIs were presented (numeric vs. graphical) on perceived risk of colon cancer; this precludes definitive conclusions (1 study, insufficient SOE). Further, only a single small study examined the effects of using clean versus blurry bar graphs to convey information about uncertainty (1 study; insufficient SOE).
- Communicating directness—Choice of a cholesterol medication with direct evidence of benefit was better for patients receiving nonnumeric advice or factual information encouraging consumers to choose the drug with direct evidence than for patients receiving usual care. However, medication choices did not differ by type of instruction (1 study; low SOE).
- Communicating net benefit—Choice of a heartburn medication that was more likely to have net benefit was better for consumers receiving nonnumeric advice or factual information encouraging consumers to choose the drug with greater net benefit than for patients receiving usual care, but medication choices did not differ by type of instruction (1 study; low SOE). Receiving additional nonnumeric information about benefits had little effect on refusals of cancer screening tests, but receiving more nonnumeric information on harms significantly increased test refusals and significantly decreased decision satisfaction (1 study; low SOE). Compared with usual care, giving men prostate cancer screening information alone or framed in the context of information about other, more beneficial screening services significantly increased prostate cancer knowledge (low SOE). However, giving prostate cancer screening information alone versus framed in the broader context of more beneficial services had differential effects on patient involvement and screening (2 studies; insufficient SOE).
- Communicating strength of recommendations—Only a single small study examined the effects of different ways of wording recommendations to convey strong or weak recommendations for care; this precludes definitive conclusions (1 study; insufficient SOE).
This report presents three separate, but topically related, systematic reviews. The overarching topic involves providing health-related evidence effectively to patients and clinicians. Specifically, we were asked to examine various strategies for communicating and disseminating evidence to these target audiences. Finally, we were charged with exploring ways to explain uncertainty in evidence. Many aspects of this review cut across more than one KQ, and some across all three KQs. Below we set findings from our research into the broader context of evidence translation and highlight key cross-cutting issues that might advance the field. We also discuss limitations of our own review that should be considered in interpreting our results. Finally, we see certain commonalities in implications for future research and ramifications for patients, clinicians, and other stakeholders and end users.
Issues That Cut Across All Key Questions
- Evidence continuum—In the context of our review, we view the evidence as moving along a continuum, beginning with its collection and systematic review, followed by communicating and translating it for audiences as needed (Figure B). The communication and translation processes are often commingled with the diffusion (passive spread) and dissemination (active spread) of the information. Our review included only the second and third phases in the evidence continuum shown in Figure B. Some trials seemed to conflate communication and dissemination—perhaps not surprisingly, given how difficult cleanly defining these concepts can be. Several other trials also seemed to mix or merge dissemination with implementation. This conceptual overlap complicated our analysis in at least two stages: creating meaningful classifications of strategies reported in the literature and examining appropriate relevant outcomes for those strategies.
- Definitions of concepts and terms—Consensus is lacking regarding definitions of key terms pertinent to this review and the research efforts more generally. We saw this lack of consensus across studies especially for definitions of three key terms: dissemination, adoption, and implementation. Greater unity in the field in terms of concepts and terms would be beneficial. With respect to KQ 2, the lack of consistency in how dissemination strategies are referenced and classified hampered our efforts to classify a strategy into one of our domain groupings.
- Use of theoretical frameworks and models—Many studies (but not all) lacked any apparent theoretical or conceptual framework to inform or organize the research questions and focus interventions on essential processes of behavioral and systems change.
- Methodological considerations—In the included trials, there was sometimes a mismatch between study design and necessary methodology. This mismatch may partly explain why many of our included studies showed little or no effect of specific intervention strategies. Many of the studies only employed descriptive statistics and did not capitalize on more recent methodological advances (e.g., multilevel modeling) that could have improved their analytic approach. Other studies did not factor in potentially important moderating variables such as self-efficacy and health literacy.
Figure B. Evidence continuum in implementation science
Limitations of the Literature Specific to Key Questions
Major gaps across the KQs include (1) testing communication strategies (e.g., targeting, tailoring, or narratives) with clinicians; (2) testing dissemination strategies that are not confounded by mode of delivery, are informed by the target audience's needs, and are supported by theory; (3) testing communication studies that address uncertainty for clinicians or examine communicating risk of bias, consistency, or applicability of the evidence. Limitations for KQ 1 trials included the following:
- The evidence base for addressing comparisons of communication strategies of interest was extremely sparse (i.e., only 7 trials of direct comparisons).
- Trials focused disproportionately on screening interventions. In particular, many trials focused on screening for breast cancer, for which the evidence basis has changed in the recent past. As new evidence emerges in the media, the result can be confusion among patients and the new evidence may produce interference with the impact of interventions.
- Several trials used convenience samples, so unmeasured confounding may exist because of selection bias with the sample.
- All trials used self-reported data, which can be subject to social desirability bias.
Limitations for KQ 2 trials included the following:
- Trials often confounded the mode of distribution with other variables. Therefore, we could not tease apart the effect of mode, channel, and other variables on the outcome of interest.
- Many studies did not consistently compare strategies directly with each other, but instead compared with a usual-care or control condition, or at times made direct comparisons for only some outcomes. This limited our ability to draw conclusions about the comparative effectiveness of one approach versus another.
- The included studies were very heterogeneous with regard to the behaviors, outcomes, targeted populations, and dissemination strategies used. The resulting heterogeneity reflects a commonly encountered attribute of dissemination research. To address this heterogeneous and complicated body of work, we classified the trials in broad terms. Nonetheless, this effort still left too few studies in some categories for making meaningful conclusions about the relative impact of a particular dissemination strategy.
Limitations for KQ 3 trials included the following:
- Trials did not directly test alternative ways to communicate the uncertainty concepts that are relevant to evidence about health and health care. Few studies addressed any type of uncertainty of interest, and none examined ways to communicate risk of bias, consistency across studies, or applicability.
- When acceptable studies were present, we determined that they manipulated relatively limited comparisons. For instance, few alternative wordings were tested for communicating strength of evidence, and few graphical presentations were tested for communicating precision.
- Few studies were directed toward clinicians.
Future Research
Research teams should try to address not only the conceptual and study limitations noted for each KQ, above, but also the methodological recommendations noted below:
- Relying more on accepted theoretical constructs and models when designing interventions and studies
- Conducting some prior-needs assessments with target audiences, focusing on audience subgroups with greatest needs
- Designing robust trials or observational studies
- Using an array of proven data collection methods that can include, but might go beyond, self-reported attitudes, levels of knowledge, and behaviors
- Describing and defending choices of intermediate and ultimate outcomes
- Applying modeling or other advanced statistical and analytic techniques to account for confounders, interactions, and similar complications in data, and addressing temporal aspects of outcomes
- Thoroughly describing all aspects of study design and conduct, especially for interventions
Implications of This Report for Clinicians and Policymakers
Our findings offer some guidance for clinicians and policymakers as to the most effective strategies for communicating and disseminating evidence but leave many questions unanswered. For example, as was the case with other reviews, we found that multicomponent strategies addressing a combination of reach, ability, or motivation appear to be more effective than one strategy alone for affecting change in clinician behaviors, and particularly clinician guideline adherence (KQ 2). Our findings offered us no or insufficient evidence, however, to determine the comparative effectiveness of each dissemination strategy within a multicomponent strategy. We also found different combinations of strategies with different intended audience(s) and setting(s), and few head-to-head comparisons of single strategies, further limiting our ability to recommend a specific strategy or policy for a specific target audience and/or setting.
While clinicians and policymakers may use our findings to guide choice of a specific communication and/or dissemination strategy, they should also carefully consider other factors shown to affect awareness, adoption, and use of evidence in various settings and by individuals working in or receiving services in those settings. For example, evidence use by individual clinicians or an organization is dependent on factors such as the definition and source of evidence, the methods used to construct evidence, ways intended audience members use and retain information, characteristics and expressed needs of the intended audience(s), and organizational as well as individual constraints and enablers specific to various settings. Clinicians and policymakers should gather and use information on these and other factors relevant to their situation or setting as they consider adoption and use of specific communication and dissemination strategies to guide patient-centered care and/or develop and implement systems-level policy.
More research is needed to better understand the current barriers to translating the findings of comparative effectiveness research into community and clinical practice.44 Further, ongoing funding for interdisciplinary communication and dissemination sciences research is needed to promote the uptake and use of evidence and ensure quality of care.
In closing, this was the first systematic review that attempted to compare the effectiveness of communication strategies and look at communicating uncertainty. Finding the appropriate "comparative" studies was challenging. The number of eligible studies was limited for KQ 1 and KQ 3, but more substantial for KQ 2. The review provides a helpful foundation in setting the research agenda to address key gaps in the literature.
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Full Report
This executive summary is part of the following document: McCormack L, Sheridan S, Lewis M, Boudewyns V, Melvin CL, Kistler C, Lux LJ, Cullen K, Lohr KN. Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence. Evidence Report/Technology Assessment No. 213. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQ Publication No. 13(14)-E003-EF. Rockville, MD: Agency for Healthcare Research and Quality; November 2013.


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Critical and Analytical Thinking
Pandora's Box
Maybe you have already heard that someone, a journalist, your teacher or parents, refer to a complex situation as a "Pandora's box".
What is a Pandora's box? Who is Pandora and how did she get that box? Did she open the box? Can you think of an example where you can use the phrase "to open a Pandora's box"?
Do your research about this topic, and then send your answers here.
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|I got a little puppy so cute and little but when we got to the house it was Pooping all over the carpet ran outside. Got muddy and went to the carpet Shook his fur . And mud went every were it was like opening the pandora Box!!! and if you don't know what a pandora box is I am going to tell you It is a Greek myth it's a box and every time you open it ,it releases evil and crazy and it goes out fast so by the time you try and close it fast that's It , it's already out


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By Sam Mamudi
The Dow Jones Industrial Average set another record Thursday, gaining 62.9 points, or 0.42%, to close at 14,865.14. The Dow is on a four-day win streak, during which it has risen 2.1%. Today's mark is the 14th record close this year; the benchmark is up 13.4% year-to-date.
Not to be left out, the Standard & Poor's 500 index also set a record, rising 0.36% to close at 1,593.37. The S&P is also riding a four-day win streak, and has gained 2.6% in that time. Thursday was the index's fourth record close of the year.
The Russell 2000 index also rose today, rising 0.1% to 947.05. The Russell set a number of record closes earlier in the year before dropping back; today's level is still 0.63% from the record of 953.07, set on March 14.


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Libya: Critical shortage of long-haul flights leaves thousands stranded at borders
IOM estimates that some 22,500 people remain stranded at the Libyan borders, with over 16,000 being Bangladeshis. An expected 40 to 50 long-haul flights will be needed to repatriate all the migrants. According to UNHCR, increasing accounts of violence and harassment in Libya against sub-Saharan Africans are alarming. The accounts come from eastern and western areas. They include beating, intimidation, sexual violence, and theft of personal property and immigration documents.
"All parties to the conflict in Libya must take care to ensure that civilians are protected from harm," ERC Amos said today. "I am deeply concerned about the reportedly indiscriminate nature of the fighting, and particularly the use of heavy artillery and aerial bombardments. We are also hearing reports of hospital closures at the very time when people most need medical care."
At the Tunisian border with Libya, the number of arrivals has dropped considerably compared to a week ago, with 2,485 people arriving on 7 March. The reduced numbers coincided with intensified fighting in western Libya, which has reduced mobility.
Accounts from people who have arrived during recent days describe numerous military road blocks along the road to Tunisia. The majority of people reported that they were searched for mobile phones, memory cards and sim cards. Satellite imagery shows there are two functional security checkpoints along the main road between the Tunisia-Libya border crossing at Ras Edjir and the town of Abu Kammash 19km to the east.
While checkpoints are actively controlling road traffic, there are no associated large concentrations of people or vehicle traffic. This suggests that these sites are not responsible for the reduced number of people reaching the border at Ras Edjir, according to satellite imagery from 3 and 4 March. It is possible that there are additional security checkpoints or temporary roadblocks located east of Abu Kammash, which could be responsible for the reduction in traffic. IOM sources in Libya indicate that there are thousands more foreigners, including Bangladeshis, who may decide to leave if conditions deteriorate.


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Eli has never had a full elite season, how is he elite? the man threw 25 INTs 2 years ago, missed 2 of the last 3 postseasons, led giants to 9 wins in weak division. He's really good right now, if he keeps it up I'mm put him on my elite list but playing well for a few games in jan/Feb doesn't make a QB elite. Elite ones are consistently great, not just in the 4th qtr, not just in january. I'd rather have Eli in a big game or big moment than almost any other QB but he's still not elite.
ur really telling me no one can make an argument on how those 3 qbs can be better than eli manning now? i understand u like eli manning, but the main reason u think he is elite is bc the giants have 2 superbowls with him, its not his great regular seasons hes amassed over the past decade or so.
big ben in his career has won 2 superbowls, appeared in 3, his overall record as a starter is 83-36, and now that the guy has a formidable wr group, hes looked real legit. also, hes prob the best qb in the nfl at keeping the play alive
drew brees since joining the saints in 06 has won a superbowl, has had 4 11 plus win season, 5 if counting his charger days, and has made the saints a contender year after year, and has also put up much better numbers in doing so.
peyton manning i think speaks for himself, and id take him as an overall qb anyday as he can make any wr look good.
im not saying these guys are leaps and bounds better than eli, im just saying its deff debatable, its not a no brainer that eli manning is better than these guys.
Last edited by Ilovemyfins4eva; 10-25-2012 at 07:03 PM.
u know who is as far from elite as can be? TONY ****ING ROMO. GUY BLOWS.
The elite one the last 4 weeks has 2 TDs and 4 INTs
coming off an elite performance of leading the Giants O to 13 pts(7 were on bogus calls so he didn't really lead them to any TDs) a week after getting 6 TOs and only leading his O to 17 pts.
yep he's elite, the elite QBs always have stretches like this
As a lifelong fan of the Miami Dolphins, it's hard enough being in the shadow of a team like New England all the time.
But it must suck something awful to be in the shadow of a team in your own city.
I can't imagine having to defend my own team in such a way just to stay interested in them.
If Mark Sanchez played as well as Eli does, he'd be the GOAT QB in Jets history probably. Yet you still hold out hope for Sanchez in New York.
I still defend Sanchez to a degree, but that dude is D-O-N-E in New York. He needs to get out while he still has some talent left. Real talk.
Meanwhile, in Miami, Ryan Tannehill looks like the second coming of Dan Marino.


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Mac Chef's Line
From Japan
Mac "Chef's Line uses the same steel and handle but without a forged bolster. Same great edge.
Hollow Ground Chef's Knife
Grooved on both sides. 10" blade.
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