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In an online article, Crosscut profiles School of Social Work alum Krystal Koop who launched University District Medicine, an innovative effort to provide health care to the homeless. The story details how Koop's harrowing personal experiences as a homeless youth and her recent studies in social work contributed to her vision and skill in creating the program. The School of Social Work and the School of Medicine provided early project funding.
School alum Krystal Koop spotlighted for work with U-District homeless
Partners for Our Children develops technology to reduce ponderous paperwork
Partners for Our Children, a group out of the UW's School of Social Work, is trying to solve the problem of Washington state child welfare workers overwhelmed by ponderous paperwork.
Art of Transformation explores trauma and healing among prostitution survivors
The Art of Transformation is a select body of work that represents three years of art created by Organization for Prostitution Survivors participants. The exhibits features a range of visual works and poetic testimonies, reflecting the strength, individuality and collective force of women at OPS.
Nicole Vallestero Keenan named UW School of Social Work 2016 Early Career Achievement Award for workers' rights and racial justice
Nicole Vallestero Keenan (MSW '11) has received the UW School of Social Work's Early Career Achievement Award for 2016. A social worker and champion of racially just, community-centered policy, Vallestero Keenan is executive director of the Fair Work Center, a hub for workers to better understand and exercise their legal rights, improve their working conditions and connect with community resources.
Sue Eastgard receives UW School of Social Work 2016 Moya M. Duplica Distinguished Alumni Award for suicide-prevention leadership
Sue Eastgard (MSW '88) is the 2016 Moya M. Duplica Distinguished Alumni Award recipient from the UW School of Social Work. Eastgard is co-founder of Forefront, a School-supported initiative that educates and empowers individuals and communities to improve mental health services and suicide-prevention policy.


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Welcome to THE LOFT Restaurant
Located upstairs above the SandyView Deli in Spruce Grove, The Loft Restaurant brings the taste of homestyle breakfast and lunch to satisfy your appetite. Come on in, check out our menu and enjoy the warm and inviting atmosphere at SandyView Farms!
Mother's Day Breakfast Buffet:

subset: commoncrawl


text:
Paediatric First Aid Parent Workshop (Christies)
Kids Allowed - Christie Fields, Chrisite Fields
Kids Allowed are a family owned, multi award winning, Ofsted Outstanding childcare provider.
We offer various workshops for parents to empower them to provide their children fun experiences that help them learn through play.
We also offer workshops to other providers, including lunch and tours. The most popular one being around Planning, observations, learning journeys and tracking and how we have it down to a fine art!


text:
This data is used for geographic masking by
function in
HiClimR package.
WorldMask is a list with two components:
info and
info is an (
284 rows by
10 columns) matrix. The rows are for
areas or countries while the columns are for codes required by
mask is an (
3601 rows by
1801 columns) matrix with integer
values from
1 to
284 for the areas defined in
This data is used internally by
geogMask function for geographic masking
HiClimR package. The user is adviced to refer to the function manual for more
details. The world mask is available in
0.1 degree (
10 km) resolution. The
info data provides information for continents, regions, and country codes).
The data are based on the Humanitarian Information Unit (HIU) Large Scale International Boundaries (LSIB) dataset.
Hamada S. Badr, Zaitchik, B. F. and Dezfuli, A. K. (2015): A Tool for Hierarchical Climate Regionalization, Earth Science Informatics, 1-10, http://dx.doi.org/10.1007/s12145-015-0221-7.
Hamada S. Badr, Zaitchik, B. F. and Dezfuli, A. K. (2014): Hierarchical Climate Regionalization, CRAN, http://cran.r-project.org/package=HiClimR.
LSIB Data: https://hiu.state.gov/data/.
1 2 3
Questions? Problems? Suggestions? Tweet to @rdrrHQ or email at email@example.com.
Please suggest features or report bugs with the GitHub issue tracker.
All documentation is copyright its authors; we didn't write any of that.
Add the following code to your website.
For more information on customizing the embed code, read Embedding Snippets.


text:
Cheryl's experience in the food industry includes work in commercial kitchens such as the Sheraton at Bradley International Airport, Windsor Locks, Connecticut, and as a line cook in an upscale Italian restaurant. In both places, Cheryl worked as a line cook, but also helped in other areas of the kitchen, including the bakery and food prep.
Cheryl enjoys creating new recipes and though she hasn't worked in the food service industry for many years, keeps her skills up at home and when she entertains.
Cheryl's writing experience includes recipe articles and articles about food prep, food care and kitchen skills.


text:
Welcome to 8tracks radio: free music streaming for any time, place, or mood. tagged with punk rock, rock, Rage Against the Machine, and Disturbed. You can also download one of our free apps to enjoy internet radio on your favorite device.
Published January 09, 2016 by 6stringhero
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text:
Company Overview of A Cardoso S.A.
Company Overview
A Cardoso S.A. distributes perfumes and cosmetics. The company was incorporated in 1981 and is based in Seville, Spain. As of February 13, 2008, A Cardoso S.A. operates as a subsidiary of Joaquim Alberti, SA.
Poligono Su Eminencia calle C 16
Seville, 41006
Founded in 1981
34 95 463 68 98
34 95 463 69 20
Key Executives for A Cardoso S.A.
A Cardoso S.A. does not have any Key Executives recorded.
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Our data partners will research the update request and update the information on this page if necessary. Research and follow-up could take several weeks. If you have questions, you can contact them at firstname.lastname@example.com.


text:
EU, FDA to share inspections data; EU signs off on Optimer, Astellas, diarrhea …
Story > Optimer Pharmaceuticals ($ OPTR) and Astellas Pharma have gained marketing approval in Europe for DIFICLIR (fidaxomicin) tablets to treat adults with Clostridium difficile-associated diarrhea. Optimer release > Takeda will begin Canadian …
The European Commission Grants Marketing Authorization for DIFICLIR …
Optimer Wins EU Approval for New Antibiotic
- First Listen: Diarrhea Planet, 'Turn To Gold' – NPR
- Pneumonia, diarrhea major causes of child mortality in Punjab – Pakistan Today
- People Are Apparently Using This Anti-Diarrhea Drug To Get High – Elite Daily
- 5 medicines that can cause diarrhea or loose motions (Laxatives not included!) – TheHealthSite
- Oscar-worthy? Comedian cast in role of diarrhea – Arizona Daily Star
- Minnesota farm linked to outbreak of diarrhea in school kids – WDAY
- Google uncovered 'America's Top Spelling Mistakes,' and 'diarrhea' is on the list – Washington Post
- Litchfield farm linked with outbreak of diarrhea in school groups – West Central Tribune
- Malaria, diarrhea, sun stroke on rise – Business Recorder (press release) (registration) (blog)
- Dehydration a danger during diarrhea distress – Albuquerque Journal


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For the 8 1/2 x 11 book how much per page over the 20 pages?
Marilyn L. asked on Nov 25, 2012
Hi Marilyn,
Extra pages in an 8.5x11 Classic book are $0.99 per page. You can view all photo book and extra page pricing here.
Hope this helps!
Picaboo Support
Picaboo S. from Merchant replied on Nov 25, 2012


text:
Baxter working on the textured range
|Ply-wood, nails, pieces of bark, bits of wire, and all manner of materials were used to create prototype moulds. The moulds were re-made in more durable cast iron. They had to be made in 3 parts due to the complexity of the designs. The same moulds were usually used for the entirety of the production run, so by looking at how defined the texture on the piece is, its possible to estimate how early the example. Due to the fact that moulds wear with age. However the temperature of the mould at the time of blowing also has an effect on the crispness of the finished piece, i.e. glass flows more readily into a hot mould.
This new glass was to become known as the Textured range, and was released in 1967 initially in three colours, cinnamon, indigo, and willow. More colours such as tangerine (a new colour developed by Whitefriars) and blue were added two years later, mainly from demand by retailers. In 1963 the factory changed it's name to "Whitefriars Glass Ltd" and re-designed its logo to the stylized monk at the top of this page.
|The factory sadly hit hard times during the next decade, mainly because their parent company Zeal's, switched orders for industrial tubing to the American owned Corning. Whitefriars made their tubing by hand and could not compete with Corning's machine made counterpart. Tubing had represented about a quarter of the overall gross production so this had a very damaging effect on the fortunes of the company.
The Thermometer Tower
|The old thermometer drawing tower, used to pull out tubes for clinical thermometers by gravity was made redundant by, the invention of the digital thermometer. So it was converted to draw millefiori canes for use in high quality paperweights which became increasingly popular during this period. Especially for the Queens Silver Jubilee in 1977.
Whitefriars continued to make textured domestic glass, notably the new Glacier range of 1972, limited edition paperweights and traditional cut glass, for the rest of the seventies, but sadly the stained glass studio closed in 1973 due to lack of demand.
The sad but inevitable end came in 1980 when the factory closed, Interest rates, high fuel costs plus the fact Britain was in the tight grip of a recession had all played their part in the demise of the factory. The furnaces were extinguished, staff laid off and factory was quickly demolished to make room for new developments. The records and contents of their museum were given to the Museum of London, (where they can still be viewed by appointment). The trademark "Whitefriars" was purchased by the Scottish glass maker Caithness, which they still use today as part of their paperweight range.
Geoffrey Baxter sadly died in 1995 but its heart warming to know that before he died the momentum had already begun for his glass to gain it's now cult status. His glass had become collectable and he was well aware of the historical importance of his designs before he died.
Whitefriars glass has over the last fifteen years had somewhat of a revival especially the textured ranges by Geoffrey Baxter which have increased in price tenfold.
As for the earlier pieces, they too are becoming extremely collectable and more difficult to find, but I think they are yet still to achieve the status they truly deserve .
This leads to a fantastic opportunity for collectors, to gain a world class collection, for a relatively small investment. The North American and Japanese markets are yet to discover this wonderful glass, I think that when they do, prices are likely to rocket!. My advice would be to, buy glass from between the wars, especially the simple designs with geometric wheel engraving, ribbon trailed pieces, which can be bought on ebay quite cheaply and of course any pieces which obviously represent the period in which they were designed.
Finally this brief history, is indeed brief. I have just scratched the surface on the merits of this company. It is work i.n progress, if you would like to contribute anything, please Contact Me
|© www.whitefriars.com 2010


text: Motorhead Take on London Bankers Posted on July 2, 2011 by G.I. Joe In the music video for a song called Get Back in Line the band gate-crash a bankers' club and attack them with fists, a baseball bat, a chair and trays of their own broken champagne flutes. Meanwhile the band belt out their song from a rooftop overlooking the Square Mile. What do you think of this post?Awesome (0)Interesting (0)Useful (0)Boring (0)Sucks (0) Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) Related


text:
Arkansas football fans can see some future Razorbacks and some potential ones playing in a trio of All-Star games this weekend.
Arkansas commitment Hunter Henry (6-6, 240) of Pulaski Academy is one of the top prospects at Under Amour All-Star game, which is being played Friday afternoon at 4 p.m. in Orlando and will be televised by ESPN.
He also had invites to play in the Semper Fidelis All-American Bowl and the U.S. Army All-American Bowl, but chose the Under Armour one that has former NFL coaches Steve Mariucci and Herm Edwards leading the teams.
"That was the one I watched on TV (last year) and it just seemed where a lot of the top guys were going," Henry said. " It's also fun to go down to Orlando anytime you can. It just seemed like the right one for me."
He's joined by wideout Stacy Coley (6-1, 173) of Oakland Park (FL) Northeast High School, who has already visited Miami and has plans to take one of his final four official visits to Arkansas.
Fayetteville quarterback and Arkansas pledge Austin Allen is one of the signal callers in Friday night's second annual Semper Fidelis All-American Bowl, which will be televised by the NFL Network at 8 p.m.
One of the running backs involved in the game is Plantation (FL) South Florida five-star Alex Collins (5-11, 205), who announced this week that he will be taking his final official visit to Arkansas on Jan. 25-27.
Another future official visitor to Fayetteville playing in the Semper Fidelis game is Phoenix (AZ) Brophy Prep wide receiver Devon Allen (6-1, 190).
Saturday will bring the 13th annual U.S Army All-American Bowl, which is televised by NBC at noon and features at least a pair of prospects that have scheduled Arkansas visits for later this month and another that is considering one.
North Little Rock tailback and current Alabama commit Altee Tenpenny (6-0, 210) is set to visit Alabama on Jan. 11-13 and then Arkansas on Jan. 18-20.
He'll be join in the game by Honolulu (HI) St. Louis High offensive lineman Reeve Koehler (6-3, 330), who has his list narrowed down to Kansas and Arkansas, where he will visit on Jan. 18-20.
Koehler said earlier this week that he might announce his decision during Saturday's game.
Arkansas is also known to be recruiting Richmond (VA) Hermitage tailback Derrick Green (5-11, 220), a five-star prospect in the game who is the second-best back in the country according to Scout.com.
Razorback tight end pledge Dee Skinner (6-3, 220) of Patterson (LA) High and Arvada (CO) Ralston Valley offensive lineman Dan Skipper (6-10, 295) – a Tennessee soft commit who is setting up a visit to Arkansas – both played in the Offense-Defense All American Bowl at Houston's Reliant Stadium.
That game also involved Denham Springs (LA) tailback Kaleb Blanchard – who scored a touchdown in his team's 20-9 win - and Plantation (FL) American Heritage quarterback Tyler Cogswell – both former Arkansas commits that were not retained by the new Razorback coaching staff.
Hunter Henry
Austin Allen
Altee Tenpenny
Dee Skinner
Arkansas' All Americans
Hawgs Daily Top Stories
Monday Tidbits - April 24Here are a couple notes about the Razorbacks left over from head coach Bret Bielema's Saturday press conference.
Hawgs Daily5:26 PM
Bielema talks Saturday's practiceArkansas Coach Bret Bielema touched on a wide variety of topics following Saturday's practice.
Hawgs DailySaturday at 2:55 PM
Arkansas football injury report - April 22There are a few players dealing with minor injuries.
Hawgs DailySaturday at 2:55 PM


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|21 Aug 2015, 14:00
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|Windows, Mac, Linux, Android, IOS
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|18 Aug 2015, 07:12
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Today, we gathered to ordain and install Eddie Clark as Associate Pastor of TIBC. He will work closely alongside Pastor Ted Lam.
We also shared in a potluck lunch and celebrated Isaac's birthday.
Eddie, Emily, Caedmon, Isaac, and Blaize are bilingual, speaking English and Mandarin.
Eddie can be contacted via email at email@example.com


text:
We recommend that book cover images should be set to 72 pixels per inch (PPI) resolution. The recommended size in pixels for the cover image varies based on the book style you have chosen. For a table setting out the recommended pixel sizes for the different book styles, please go here.
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Follow These Tips To Health And Fitness
Too often, people decide to get physically fit without knowing how to start. This article offers great advice and useful tips to help you get started on your journey. If you want to be successful, then keep this advice in mind and you'll be able to get the most out of your efforts.
A good tip for proper maintenance is to sign up with a club or some other gym that requires upfront payment. This way, you'll be more likely to use the gym because of how you'd feel if you don't use something you have already paid for. If you don't follow through with your workouts, paying your fees upfront can end up wasting a lot of money, so only use this tactic if you've tried everything else.
Varying your exercises can boost the benefits your body gets from your workouts. If you usually exercise indoors, try playing basketball or walking outside. They will achieve different results from running up some hill versus running on the sidewalk. By adding variety to workouts, one can avoid the body becoming too accustomed to any given exercise, which keeps weight loss steady.
Be creative with your fitness routines. You do not have to go to the gym to workout; you can get exercise anywhere! If you have never done this you should try it to stay motivated.
When exercising, make sure your clothing is comfortable. If you use a gym, there is some pressure to wear new, high end workout clothing but this is unnecessary. The clothing you wear should permit you to move freely without embarrassment. This can help you to shift your focus on your workout regimen and not the discomfort.
If you control your breathing, it can help you improve your workouts. Exhale hard when you have your shoulders up while doing situps. The powerful exhale causes your stomach muscles to contract forcefully, giving you added workout benefits for the same amount of work.
Whenever you workout make sure that you have comfortable clothes on. There's a lot of pressure out there, especially at gyms and fitness centers, to wear the trendiest workout clothes around. Buy some clothes you feel good about working out in. Appropriate clothing can help you concentrate on working out and not on how your clothes appear to others.
If there are some exercises you don't enjoy, make sure you push yourself to get them done. The reason is that many people try to avoid the exercises that are hardest. So add those dreaded exercises to your daily routine and do them regularly.
Try box squats to increase the size of your quadriceps. Box squats are designed to increase the power with which you perform regular squats. You just need to put a box behind you. Squat like normal, but pause before sitting on the box.
The following information provides you with a strategy that tennis and racquetball players discovered that helps them improve their forearm strength. Spread out a piece on newspaper onto a table or any other flat surface. Use the hand you write with to crumple the paper with as much force as you can muster for 30 seconds. When you have done this twice, change hands, do it one more time, and then switch back to your dominant hand.
Make sure to schedule exercise into your day around the meals that you eat. When you lead an unorganized life, it's far too easy to be forced to eat unhealthy things from a vending machine, fast food chain or to forgo working out. If you figure out your schedule beforehand, you can pack yourself healthy meals and plan workout times.
Although crunches are beneficial, incorporating legitimate sit-ups into your regimen can be a real asset. Sit-ups carry a negative reputation. To prevent injury, you should avoid doing sit-ups with your feet anchored. This particular variety of sit-ups can seriously strain your lower back.
Rollerblades are a great way to keep physically fit. Rollerblading is a great activity to help work out your legs and burn fat. Rollerblades are readily available in many local stores that carry sporting goods.
These tips will help you get started in a new fitness routine. It is critical that you make fitness part of your everyday lifestyle, as opposed to a weekly habit. Living a fit and healthy lifestyle can help you feel great and conquer and issues that may come up.Workout Clothes


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'Skin Wars' contestant Avi Ram brings Israeli army training to body painting
The 29-year-old told JTA that painting naked bodies on U.S. reality TV is no sweat after being a soldier and struggling artist in Israel. More ▸
The 29-year-old told JTA that painting naked bodies on U.S. reality TV is no sweat after being a soldier and struggling artist in Israel. More ▸
Specifics and winding story lines aside, Don Draper's story was at its heart a complex metaphor for Jewish life in 20th-century America. More ▸
CBS will adapt a British sitcom about a Jewish family, called "Friday Night Dinner." More ▸
Kippah-clad Josh Orlian, 12, cracked up the TV show's celebrity judges with his sexually charged jokes, but his suburban New York day school was less impressed. More ▸
The playwright has signed a contract to develop a seven-hour series based on the Christian concept of the seven deadly sins. More ▸
With more haredi Orthodox Israelis joining the army and going to college, how do we define the community? One think tank's answer relies on TV sets and the ballot box. More ▸
In an excerpt from the forthcoming book "Free Spirit: Growing Up On the Road and Off the Grid," Joshua Safran writes about reconsidering his worldview after a seventh-grade assignment: watching the nightly news as homework. More ▸
In case you were worried about the all-new Arrested Development being any less brilliant and hilarious than previous seasons, the lovely folks at Netflix have evidence that will put you at ease. In this just-released clip, Lucille, the matriarch of the Jewish Bluth family, enlists the help of her son Buster to get around her… More ▸
Let's face it fellow Sarah Silverman fans: While her Twitter feed is wildly entertaining, it's just not enough. Which is why we were thrilled to learn that in the fall HBO will air the comedy special "Sarah Silverman: We Are Miracles." While the comedienne has an impressive, eponymous body of work, including "The Sarah… More ▸
No matter how you feel about the way "Mad Men" dealt with race in last night's MLK assassination-focused episode, one thing is indisputable: It was a big night for the Jews on the show. All three of them. Dr. Rosen, Don's cuckolded neighbor, ended up in the heart of the action while at a conference… More ▸
WatchAlbert Einstein was a sex magnet? 4 surprising facts about the Jewish genius
WatchAlbert Einstein was a sex magnet? 4 surprising facts about the Jewish genius
Also From 70 Faces Media


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The biggest mistake I have found in regards to bottle feeding calve milk replacer is failure to feed calf starter. I have bottle fed hundreds of calf through the years of dairy farming and cattle ranching. My love of cattle has always provided me with little calves to bottle fed.
People have always asked what was the one must do when bottle feeding calves. The answer is simple- feed calf starter grain right from the start. There are special formulated grain feeds for new born calves. The stomach of newborn calves are different than those of older calves.
Calves under two months of age should be fed this special feed called: calf starter. It is just a different blend of grains that are completely digestible by newborn and young calves. Not everyone understands the importance of feeding the correct fed for this age.
My local feed store will not stock calf starter. I have to call in my order and wait until they get in from the mill. Which I find this really odd since they have no problem stocking milk replacer for bottle feeding baby calves.
I questioned if they knew that milk calf replacer is formulated to be fed with calf starter and that calf starter feed should start at two days old. They assure me that they did, but noone else purchases calf starter.
There are other feeds that can be used in place of calf starter such as 12% all stock. Any feed that can be using for horse and mule all work in place of calf starter in a pinch, but only true calf starter is formulated for the use with bottle feeding calves milk replacers.
The complete vitamin and minerals that a new calf needs is split up between the milk replacer and calf starter. By only feeding horse and mule feeding the calf is getting only half of what it needs. The best health condition for the calf is supplied when feeding calf starter along with milk replacer.


text:
Henman hoped the transition to grass at the Artois Championships would spark a change in fortunes but instead he was left to reflect on an embarrassing 6-7 (5-7) 6-2 4-6 defeat to 18-year-old Croatian wild card Marin Cilic.
Henman has exited six of his seven tournaments this season in the first round and the British number two admitted: "I think first and foremost it's a confidence thing. Obviously not playing enough matches and not winning them doesn't help."
He added: "I would love it if there was one specific magic ingredient I could change, but it doesn't exist.
"I'm in a rut right now and I've lost a lot of matches. I would love to play horrendously and win.
"I don't want to keep hitting the ball well and losing. People talk about getting on a roll, when winning becomes a habit, but the same is true with losing.
"I've been doing a lot of losing recently and I've got to try and break through that. The only way I can achieve that is by winning."Reuse content


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Infrastructure Which Sustains Civilised Life Engineering Essay
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Civil Engineers create the infrastructure which sustains civilised life, yet the public often perceives construction projects as affecting the natural environment
Civil Engineers create and build infrastructure that is necessary in order for civilised life to occur as we know it at present day. If we take a normal Londoner as an example, majority of his actions throughout the day will have reliance on some form of civil engineering infrastructure. This can be seen from a first thing that a person does in the morning, which is the use of a toilet. Water running from a tap and ability to flush the toilet are all possible thanks to infrastructure that is created by Civil Engineers. Adequate sewerage systems allow for dirty water to be distributed away from such places as households, and allowing for water to be treated making sure that other water sources such as rivers are not polluted by the dirty water. Sewerage systems have contributed a great deal to sanitary issues preventing water borne diseases such as cholera, typhoid and many others. It is disappointing to say however, despite knowledge how to solve and deal with dirty water that around four children die every minute in developing countries because of diseases developing from inadequate sanitation and unsafe water [1]. This problem is mainly due to lack of finance to create infrastructure that can deal with sanitation issues. Cities such as London and people that live in them often take these things for granted. In developed countries such as United Kingdom, water supply is treated as a basic human right and funding is allowed wherever the demand for it occurs. As population is constantly increasing, ever growing demand for water supply also increases as people become lavish with use of water for indoor toilets, baths, washing machines, washing their cars, garden hoses and many other purposes.
Apart from infrastructure that deals with supply and disposal of water, there are many other examples where Civil Engineers have contributed to sustaining civilised life. This can be portrayed by mentioning the building of roads, rail links, bridges, canals, tunnels, airports and docks, all which help commuting for people easier, either it being from home to work or leisure to other countries. However, it does not just stop here, diversity of projects is enormous which sustain life as we know it, and for purpose of this paper alongside other infrastructure already mentioned, energy is the one issue that particularly has to be pointed out. Taking only electricity as an example, amount of places it can come from, is also very diverse. Coal power and nuclear stations are just an example along with many renewable sources such as hydro (i.e. dams), wind and solar. Civil Engineers would most definitely be involved in building any of these facilities that can generate electricity. It would be impossible to think of a present life as we know it today without electricity. Everything that we do, either it being at home, work or outside our home (i.e. commuting by train) will involve use of electricity.
Therefore, if our every day activities comprise and rely on use of infrastructure that helps maintain civilised life as we know it at present, why do people object when there is a proposal to build something that will help us go about our every day activities. Could a typical Londoner imagine his life without electricity and water to flush his toilet or water to drink and shower? If building a dam can help address these issues and bring with it many other benefits why would he or anyone else as a matter of fact object to it and perceive it as a bad idea? Answer to this question is not easy because there are many aspects that have to been taken into an account arising particularly from political and sustainability issues as well as economical and social reasons. The remaining content of this paper will be to evaluate negative issues with building a large scale project such as a dam, and also evaluate why society should consider and allow building of such a project.
Benefits of Dams
Firstly, let us concentrate and evaluate some of the benefits that dams can bring and have brought to societies. They can provide them with water to drink and use, protect from flooding (both river and marine flooding), create recreational area, irrigate water necessary to grow food and in some cases enhance the environment.
Dams have been constructed for many thousands of years, and during different times, needs of societies has changed and so has the dam construction. In the past basic concept would have been to build some form of a barrier across the river. Because of lack of knowledge and materials, majority of the past dams would have been some sort of an embankment dam. Typically they would have been on small scale and constructed of excavated natural materials (Earth dams). In United Kingdom small reservoirs constructed from such dams were by medieval monasteries to provide supplies of fish, generally carp [2]. Back then fresh food could have been a main reason, hence the nutritional benefit from entrapped fish.
As time went on discovery of concrete and better understanding of engineering principles allowed for bigger dams. Most of dams today are multipurpose for reasons mentioned earlier. Arch dams are concrete or masonry dams, which are curved upstream to transmit the major part of the water load to the abutments. Their shape has the benefit that it can hold back large amount of water. Hydropower dam uses the difference in water level between the reservoir pool elevation and the tailwater elevation to turn a turbine to generate electricity [3]. These are just two of many other more modern dam design concepts.
Coming back to benefits that dams bring, we need to look at back particularly around time of industrial revolution in late 18th century, to see how much death rate has fallen by introducing domestic water supply. Provision of clean water supply and disposal of sewage brought down many deaths related to dirty water. In Britain in 1832 there were 30,000 deaths from cholera and in 1849 60,000 [2]. This just comes to show how bad the problem was at that time because of lack of sanitation, as overcrowding occurred since people were coming into cities for jobs. Larger towns such as Manchester, Liverpool and London than started constructing upstream reservoirs to supply ever increasing population with clean water. The benefit of this can be seen by looking at Enteric deaths (high fever illness) in Figure 1 [4], in England and Wales.
Figure 1
It can be seen that introduction of clean water supply, death rate fell sharply right across the country and that by 1940's it was virtually at zero.
One of the other benefits that dams provide is the flood protection from river flooding. This can be achieved in two ways. One of them is by direct protection while second is by routing the flood through a reservoir provided for other means, hence reducing the peak flow in the river downstream of it [2]. At present EA (Environmental Agency) in United Kingdom is particularly pointing out that it does not want new development to increase flooding downstream. By constructing a dam and having and empty reservoir, allows for storage of water to be provided at crucial times when there is high precipitation, and the storage reservoir acts as a flood defence. Constructing a dam without having increased flooding downstream can be possible therefore fulfilling Environmental Agency's request.
Good example where construction of a dam has brought flood protection to a very large population is The Three Gorges Dam in China. The Yangtze River on which the dam is constructed has claimed 300,000 lives of people that have drowned due to floods in the last century. It has also displaced millions of people. At the moment, dam provides flood protection to fifteen million people that live in the flood plain [2].
Land reclaimed from sea can be used for either agricultural purposes or for land development. This can only be achieved by keeping sea water out and only way to this is by constructing dams, called sea defences.
Water from reservoirs can be used for irrigation. This is when water from the reservoirs is supplied to land where crops and plants are, enabling them to grow. This is particularly important in countries with hotter climate and which suffer great deal from dry seasons, hence relying throughout the entire season on irrigation water. In 1877, low Nile flood failed to irrigate adequately, causing famine and death among the six and half million Egyptian population [2].
Reservoirs created from dams can offer Sites of Special Scientific Interest. Creating manmade (artificial islands) which allows for birds to rest free from predators such as foxes, and lagoons can be found along the offshore to maintain shallow wetlands for wildlife even during drawdown. Woodland plantations along the shore can prosper thanks to supply of water offering spectacular and very beautiful habitats that can support very large number of wildlife that can find it difficult to survive in wider countryside.
Commercial benefits arise from recreational opportunities that can be created. Since reservoirs allow for fish to thrive, fishing on such lakes is a huge potential and source of tourism. Not only this but since most reservoirs are quite big, they offer a safe environment to sailing clubs, also boating and even swimming. Such activities as bird watching, bicycle riding, nature walks, camping and others can be possible around the reservoir, all which can enhance tourism.
One of the main benefits associated, for purpose of this paper is the hydro power induced from building dams. Since turbines that generate electricity are fuelled by water, it is a clean fuel source offering no emissions. Because it relies on water cycle, which in turn relies on series of events in nature one of them being the sun, it is considered as a renewable power source. The reservoir behind the dam can be used to turn the turbines especially when the demand for electricity jumps [5].
Taking United States as an example, 80% of the renewable energy is accounted by hydroelectricity. This is because no emissions are released by burning of fuels which is the problem with nuclear and coal fired power stations. Just to demonstrate how much carbon dioxide released into the atmosphere is saved by use of hydropower, National Hydropower Association (in USA), estimates it to be at 77 million metric tons. This amount would be equivalent to emissions released from driving sixty two million cars for one year [6]. Production of electricity from hydro power is non polluting for other reasons too. Since no chemicals are involved with production, none have to be disposed of which is another great benefit to the environment. In addition, noise pollution is not of a major concern since many dams are located in isolated areas.
Negative aspects of Dams
Despite benefits that dams have brought, they have also caused major environmental impacts. Even though they are regarded as non polluting source of electrical power and very important in water supply systems, better understanding over the years of environmental impacts it causes makes many people want to oppose their construction. Not only does the environment suffer from constructing dams, there are also major economic, social and political issues or concerns.
Perhaps the best way forward to describe negative side of building a dam would be to focus on one of the most controversial dams ever built. This is undoubtedly The Three Gorged Dam in China. From the very first stage, at proposal, it raised all of the concerns already mentioned. It has to be noted however, benefits are always much easier to identify and quantify, where as costs on the other hand manifest themselves over many years and in variety of ways.
Three Gorges Project
Before we proceed onto describing disadvantages of the Three Gorges, we need to understand more about the actual project. The dam stretches 2.3 kilometres across the great river Yangtze. The height of the concrete wall reaches almost 200 metres, has a volume of 40 million cubic metres, and has created a reservoir 600-kilometres long with a total storage capacity approaching 40 billion cubic metres [7]. The reservoir is about twice the size of the Isle of Weight. So far twenty one generators have been installed, generating around 62 billion kWhr of electricity and this is only two thirds of the maximum level that is being aimed at achieving [7]. Under original plans, the power generated from The Three Gorges was meant to satisfy some 10 percent of total electricity consumed in China. This target hasn't actually been realised because demand for electricity in China has gone up at a higher rate than it was estimated for during design stage. This figure would seem to be at about 4 percent satisfying current demand.
Economic aspect in terms of cost is hard to quantify. Latest estimates of the total construction say that total cost has been around $30 billion. Funding has come from four internal sources in China and a number of international financiers. This is a very large amount of money that has been plugged into the project and its estimated that after 2010 when all the proposed 26 turbines are installed and power production is at full capacity, it will take ten years to repay the loans [7]. However, actual cost are hard to compute because of after treatment works and threats such as landslides and earthquakes, political corruption and massive relocation and ecological losses, all which might require substantial amount of money for remedial action.
Ecological problems include impacts on the fisheries of the Yangtze River basin and sedimentation issues. The basin contains thirty six percent of all freshwater fish species in China. Twenty seven percent of all of China's endangered freshwater fish are in the Yangtze basin [7]. Fish population are subject to fluctuations because of the disruption that the project has on chemical and temperature composition of the water. Dam blocks migration of fish and access to spawning grounds, and also blocks food resources available to those fish. The major dynamics of how river works are altered by the dam and as a consequence fish are not being able to adapt to change in environment.
From WWF's Living Planet Report, from 1970 to 2000, freshwater fish species have declined drastically. Fifty four percent of 195 indicator species have exhibited a population decline, which can be seen in Figure 2 [9].
Figure 2
Dams are called up as one of the most influential in this decline because they impact fish migration and downstream wetlands. Data released from Three Gorges Dam corresponds to issue as after construction annual harvest of carp was somewhat fifty percent below pre-dam statistic [7].
River sedimentation and sediment flow is another problem. Traditionally Yangtze river has transported large amount of sediment from its upper reaches all the way to China's sea. Completion of the dam calls cause of concern for operational issues as well as environmental. Sediment has decreased at Yangtze delta by thirty three percent of what it was before dam construction. Decrease in sedimentation flow to the delta, allows for problem of coastal erosion. How big the problem is can not be determined at present but will be problematic most certainly in decades to come [7].
China has about 83,000 reservoirs that are built for various purposes, and 330 of these are major in size. Sediment deposition in 230 of them have become a significant problem, resulting in a combined loss of 14 percent of the total storage capacity. Some have even lost up to 50 percent of potential storage capacity [10]. Increased sedimentation levels can greatly influence hydroelectric power output and flooding prevention.
Seismicity and Geological Instability
Filling up of large reservoirs can cause seismic activity and also due to pressure it builds up on local faults. Such an action was predicted for Three gorges Dam alongside increased landslides which are related to seismic activity. Major landslide occurred shortly after the reservoir was filled near town of Qianjiangping on the the Qianggan River near its confluence with Yangtze mainstream. Twenty four million cubic metres of rock and earth slid into the Qinggan river, killing, destroying property and blocking path for boats. In 2007 officials and experts have admitted that Three gorges reservoir has caused more frequent landslides. Mayor of Chongqing, said that the shore of the reservoir had collapsed in ninety one places and total of thirty six kilometres of shoreline caved in. as danger zone extends new resettlement of the people have to be made which not only affects the societies but the cost to the government of relocation.
Water pollution
Pollution of water in Three Gorges reservoir also has to be accounted for when looking at negatives of constructing a dam. According to the Chinese Academy of Sciences, Yangtze river has become the biggest sewer system in China. Around Three Gorges reservoir area, there are around three thousand industrial and mining enterprises which release more than one billion tons of wastewater annually, containing more than fifty different pollutants. Included in the waste water are such poison elements as mercury, cadmium, chromium, lead and cyanide. Industrial sources account for the majority of the pollution, but large amounts also come from agricultural run off, residential wastewater, urban sewers and pollution from ships. Studies that are curried out for pollution do not even consider township-level enterprises. There is very little treatment of industrial wastewater flowing into the reservoir area, and no treatment of residential wastewater. Everyone so far has been relying on the rivers capacity to flush pollutants out to sea to keep it clean. Following construction of the Three Gorges dam, the rivers flow is greatly reduced and with it the flushing capacity of the river [10]. What is also alarming is that there are a number of unknown diseases that have afflicted local workers on the river, possibly from the increased pollution within the river. Worrying also is the issue of these harmful pollutants spreading further into the surrounding environment especially into other water sources, since settling of pollutants in the reservoir has potential for underground water movement.
The biggest cost of the construction of Three Gorges dam is the resettlement not only in terms of financial cost but in loss to societies and cultures as well, since 1.6 million people had to be abandon their homes or otherwise be flooded. The problem is that one third of those people that had to be moved are farmers, and finding new land for them that can be used for farming is difficult. Chinese government has tried to persuade farmers to give up farming and move into urban housing and take up employment in cities [8]. Over 100 towns have been flooded completely and some 100 archaeological sites have been lost to the reservoir. Some of the cities have had a cultural history going back to well over one thousand years. With new problems not accounted for such as increasing danger zones from landslides new estimate suggest that further four million people are to be effected with resettlement [7].
It is not just the loss of home that is an issue, tensions and conflicts regularly occur with local population and new migrants that have arrived. Inadequate planning has left people with bad farming land, food insecurity, joblessness and social status.
Other issues
Although the world is becoming a more peaceful place, the threat of an attack on the Three Gorges dam cannot be dismissed. If it were destroyed by military attack, the consequence for military, and for the entire nation, would be disastrous especially because its built in central China. Large cities, nuclear power plants, and hydro projects are routinely considered prime military targets. Looking back at history, British have bombed Germany's Mohne and Eder dams during WWII and the US has bombed North Korean dams during the Korean War [11].
Another issue that will just be mentioned and not greatly elaborated on is the dam failures. Failure of a very large dam carries with it a much larger potential to cause death than any other major man made structure/facility. Due to sudden collapse, flood wave can be generated that can be very disastrous.
Finally, it has to be mentioned that in many democratic countries such a project as The Three gorges would have never been approved. Human rights of the people to be resettled and more importantly many intellectuals would have been taken into an account which can not be said to be the case with construction of Three Gorges in China. It can be comfortably said that the only reason project was ever allowed is because of Chinese Communist leadership, which lacks listening and debating. By controlling the media and news blackouts problems and devastations are not known and minimised from a full scale. Such a regime is determined to prevent the full truth from being revealed. If people speak against the decision they risk loosing their jobs or worse. This is all due to the one-party system (communism), where politicians have characteristics of authoritarianism, and no regard for individual allowing no democratic discussion at all [12].
Responsibility of Civil Engineers is to provide people with suitable infrastructure that will allow people and societies they live in to carry out their activities. Societies should decide, preferably through democratic progress, whether they want development to progress or not [13]. They should not be forced to accept development of any project.
Building of dams has many benefits that have been described most important of those is that they have potential for clean non polluting production of electricity and provision of water for sanitary purposes. In some parts of the world, such as China it can have a huge potential for preventing flooding. One of main drives for construction of Three Gorges Dam was flood prevention for 15 million people. If 1.6 million had to resettle, but 15 million people guaranteed that chance of flooding is one in a thousand many would argue for it to be a good idea.
Although there are number of benefits, it is mostly environmental impacts that concern majority of people. Because dams flood large amount of areas, it can affect ecological stability in rivers, especially for fish, local climatic conditions (i.e. extra water evaporating from the reservoir), and it can cause landslides and seismic activity. These are just some of many environmental issues. Social, economic and political aspects are of the same importance and must not be overlooked.
As long as adequate steps are taken to minimise the environmental impacts, making sure that environment can sustain the infrastructure, and people to be affected in majority agree to take resettlement compensation, it is a good idea to build dams, but perhaps not on such a large scale as the Three Gorges.


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To investigate the longitudinal pharmacokinetics, safety and efficacy of lopinavir/ritonavir (LPV/r) in HIV-infected infants initiating combination antiretroviral therapy (cART) between 2 weeks and 6 months of age.
A prospective, open-label, multicenter Phase I/II study of LPV/r-based cART at a dose of 300/75 mg/m2/dose LPV/r twice daily. Intensive pharmacokinetic sampling at 12 months of age and quarterly predose LPV concentrations were collected and safety, virologic and immunologic responses were monitored every 4–12 weeks up to 252 weeks.
Thirty-one HIV-infected infants enrolled into two age cohorts, 14 days to <6 weeks and 6 weeks to <6 months; 29 completed ≥48 weeks of follow-up (median=123 weeks, range 4–252). At 12 months of age, median LPV area under the curve was comparable for both age cohorts and similar to older children and adults. At week 48, 22 of 31 patients (71%) had HIV-1 RNA <400 copies/ml and 11 of 15 (73%) had <50 copies/ml; 29 of 31 achieved HIV-1 RNA <400 copies/ml on study treatment and 19 (66%) remained durably suppressed until the end of study; viral suppression correlated with a higher percentage of predose time points exceeding the LPV target of 1 μg/ml (92 vs. 71%, P=0.002).
LPV/r at 300/75 mg/m2/dose as part of a cART regimen resulted in viral suppression through 96 weeks of treatment in >65% of young infants. Due to initially low LPV exposure in infants <6 weeks of age, frequent dose adjustment for weight gain is advisable and consideration should be given to studying a higher dose for very young infants.
Despite tremendous progress in the scale up of prevention of mother-to-child transmission programs in resource-limited countries, up to 1000 HIV-infected infants are born worldwide every day [1]. Multiple studies have demonstrated the benefit of early initiation of combination antiretroviral therapy (cART) resulting in decreased disease progression, immunologic decline, long-term neurologic sequelae and mortality [2-4]. On the basis of the accumulated data, the World Health Organization (WHO), the Pediatric European Network for Treatment of AIDS and the United States Department of Health and Human Services Working Group on Antiretroviral Therapy have recommended initiation of cART as soon as a diagnosis is established for all HIV-infected infants less than 12 months of age [5-7]. Data from South Africa showed that initiation of protease inhibitor-based therapy before 12 weeks of age was associated with a 76% reduction in mortality when compared with deferred therapy [3]; however, only a limited number of potent antiretroviral agents have been well studied in this age group. Our study was designed to investigate the pharmacokinetics, safety and efficacy of cART including the liquid formulation of the protease inhibitor lopinavir/ritonavir (LPV/r) in HIV-infected infants starting therapy between the ages of 2 weeks and 6 months. Pharmacokinetics performed at 2 weeks on treatment and safety and efficacy during the first 24 weeks of treatment was published previously [8,9] and showed that half of the infants who started LPV/r under the age of 6 weeks had significantly lower LPV levels than older children. These results make it important to report longer follow-up to identify subsequent pharmacokinetics data and any enduring consequences of these younger infants' low drug exposure. This report presents pharmacokinetics results at 12 months of age as well as virologic outcomes and safety data at the conclusion of the study at 48 weeks after the last enrollment, with follow-up ranging up to 252 weeks.
Pediatric AIDS Clinical Trials Group (PACTG) protocol 1030 was a prospective multicenter, Phase I/II open label trial of a high dose (300 mg LPV/75 mg ritonavir/m2/dose twice daily) of LPV/r-based cART in HIV-1 infected infants <6 months of age. The study was approved by each United States (USA) clinical site's Institutional Review Board (IRB) and by the National IRB in Brazil (CONEP); written informed consent was obtained from each patient's legal guardian before enrollment. Two age cohorts were enrolled based on age at study entry (Cohort 1, ≥14 days to <6 weeks and Cohort 2, ≥6 weeks to <6 months of age). Patients were followed until 48 weeks after enrollment of the last patient, except that follow-up discontinued when a patient discontinued study treatment before this time. The study design including evaluations to 24 weeks has been reported previously [8,9]. The following methods pertain to data collected after 24 weeks.
Patients were evaluated every 4 weeks from weeks 24 through 48, then every 6 weeks through week 96, and every 12 weeks thereafter until study closure. Physical examination and nonfasting laboratory evaluations (including electrolytes, glucose, blood urea nitrogen, creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, calcium, phosphorus, triglycerides, cholesterol, total amylase, complete blood count with differential and platelets, and HIV-1 RNA level) were performed during each visit. Lymphocyte surface markers were evaluated every 12 weeks.
An intensive pharmacokinetic study of LPV/r therapy was performed at the first visit after the patient reached 12 months of age and consisted of blood samples obtained prior to the morning dose and 2, 4, 8 and 12 h following an observed dose. Area under curve (AUC) at the intensive pharmacokinetics visit was determined using the linear trapezoidal method. After 24 weeks, predose samples were also drawn every 12 weeks. All samples were stored at −70°C and batched for analysis.
The lower limit of HIV-1 RNA detection was 400 copies/ml, except when an ultrasensitive assay was performed, for which it was 50 copies/ml; Roche Amplicor Version 1.5 microwell assay was used for both assays. Durable viral suppression was defined as the absence of confirmed virologic rebound (i.e. not having two consecutive HIV-1 RNA levels >400 copies/ml) after achieving the first HIV-1 RNA <400 copies/ml; missing viral load data at any time point was assigned the value of the next viral load drawn after the missing sample.
Wilcoxon's rank sum test was used for comparing the percentage of LPV predose concentrations exceeding the target value of 1 μg/ml between children achieving vs. not achieving durable viral suppression at week 96. Virologic endpoints were analyzed using an 'intent-to-treat' (ITT) approach in which children who discontinued study treatment for any reason were considered to be failures and an 'as-treated' approach that only included measurements obtained while a child was taking study treatment. Association between age and LPV predose concentration was evaluated using the Spearman correlation coefficient. Age and sex-specific weight and height Z scores were calculated using CDC Child Growth Standards [10]. Formal analyses of changes in virologic, immunologic and growth parameters are restricted to the first 96 weeks of treatment as the number of patients followed thereafter is small, particularly in Cohort 1.
Thirty-one children from 17 clinical centers in the USA and Brazil were enrolled and treated with a high dose of LPV/r (300 mg LPV/75 mg ritonavir/m2/dose orally twice daily) between August 2002 and September 2006; baseline demographics by cohort, adverse events, virologic and immunologic responses through 24 weeks and baseline genotypic resistance were previously reported [8,9,11]. The median duration of study treatment and follow-up was 123 weeks (range 4–252 weeks). Because Cohort 1 took longer to enroll, the median follow up for this cohort was shorter (103 weeks, range 43–181 weeks) than for Cohort 2 (124 weeks, range 4–252 weeks). Ten infants (32%) permanently discontinued study medications prior to study closure, including four before 12 months of age: two patients met protocol-defined criteria for discontinuation when their HIV-1 RNA level rebounded to >50 000 copies/ml (weeks 43 and 176), three discontinued after parents' refusal to attend study visits and/or administer study medications (weeks 2, 42, and 145), three had nontreatment-related confounding conditions (disseminated perinatally acquired cytomegalovirus (CMV) infection resulting in death at week 8, failure to thrive due to severe food allergy at week 70, and severe iron-deficiency anemia at week 120), and two patients were removed from the study because their research sites closed (weeks 73 and 120).
An intensive pharmacokinetics study was performed in the 26 patients taking study medications at 12 months of age and results were evaluable in 20 patients; among the six patients not evaluable, four had samples collected at ≤3 of the five required times, one was nonadherent with medications, and one whose dose was escalated after the week 2 pharmacokinetics evaluation was analyzed separately. For the 20 evaluable patients, the median age at which the 12-month intensive pharmacokinetics study was performed was 12.4 months (range 12.0–15.5) and the median body surface area was 0.43 m2 (range 0.33–0.50). The median AUC of the two cohorts was comparable at 12 months of age (99.1 μg h/ml [interquartile range (IQR) 82.4–124.5] vs. 112 μg h/ml [IQR 95.0–148.8], P=0.93). In addition, a significant association was found between age and LPV predose concentration (P < 0.0001) (Fig. 1).
Virologic responses through 24 weeks were previously published [8,9]. At week 48, by ITTanalysis, 22/31 (71%) had HIV-RNA <400 copies/ml (6/10 in Cohort 1 and 16/21 in Cohort 2). Among 15 patients from the combined cohorts who were on study treatment at week 48 and evaluated using the ultrasensitive assay, 11 (73%) had HIV-RNA levels <50 copies/ml. Only one of the five patients who had discontinued prior to week 96 did so because of virologic failure. Overall, 29 of 31 patients achieved an HIV-1 RNA <400 copies/ml while on study treatment; one patient discontinued study treatment by 8 weeks due to progressive CMV infection, and the other patient's mother declined to continue the study at week 2. Among these 29 patients, 19 (66%) patients (6/10 in Cohort 1 and 13/19 in Cohort 2) remained durably suppressed until the end of study at a median of 123 weeks (range 42–252). Of the 10 patients who did not remain durably suppressed, four had periods of poor antiretroviral adherence with confirmed viral rebound, but when adherence improved, these patients re-suppressed and maintained HIV-RNA levels <400 copies/ml for 32–124 weeks in duration before discontinuing the study. The remaining six patients either immediately discontinued study therapy after viral rebound or did not resuppress after confirmed viral rebound. There was no significant difference in the AUC's obtained at either week 2 of study treatment or at 12 months of age between patients who did or did not have sustained viral suppression. However, those who sustained viral suppression had a higher percentage of time points at which predose concentrations exceeded the LPV target of 1 μg/ml (92 vs. 71%, P=0.002).
Measurements were obtained in patients taking study medications. The median CD4 percentage prior to starting study treatment was 35% (n=31, range 11–59%). Twenty-four patients with data available at 48 weeks had a median increase from baseline of 4% (95% confidence interval (CI) −4 to +13%, P=0.12), and 23 (96%) CD4 percentage >25%. The median entry CD8 percentage was 23% (range 14–57%) and at week 48, the median change in CD8 percentage in 24 patients was −3% (95% CI follow-up −5 to −1%, P=0.03). Among patients with follow-up through 96 weeks (n=19), the median CD4 percentage increased 8% (95% CI −2 to 13%, P=0.15), and the CD8 percentage changed by −2% (95% CI −9 to 3%, P=0.21).
There were no new symptoms, signs or diagnoses after 24 weeks of study that were considered related or possibly related to study treatment and no patient experienced clinical progression of disease after 24 weeks of study. Nonfasting lipid values by cohort are shown in Fig. 2. The median total cholesterol for the combined cohorts was 95 mg/dl at baseline (95% CI 90–118 mg/dl, n=29) and increased to 170 mg/dl (95% CI 130–186 mg/dl) in paired samples from 26 patients at 8weeks (P<0.001); thereafter it remained higher than baseline in both age cohorts through 96 weeks (n=20, P<0.001). The median triglycerides levels were 138 mg/dl (95% CI 86–221 mg/dl, n=28) at baseline (n=28), and 130 mg/dl at 96 weeks (95% CI 79–194 mg/dl, n=20), showing no significant change from baseline at any time point.
Growth measurements were obtained in patients taking study medications. Across the combined cohorts, the median change in height Z score showed significant increases at nearly all measurement times. The median increase in height Z score among children still on study treatment was 0.88 at week 48 (P=0.004) and 0.82 at week 96 (P<0.001), and was of similar magnitude in both cohorts. (Fig. 3) In contrast, there was a modest median increase in weight Z score during the first 12–16 weeks on study, particularly in the younger cohort, but no significant increase thereafter.
This study demonstrates that 94% of infants <6 months of age initiating combination antiretroviral therapy with a high dose of LPV/r (300/75 mg/m2 per dose twice daily) were able to achieve HIV-RNA <400 copies/ml and 66% maintained viral suppression for a median of 123 weeks on cART. This occurred despite low LPV levels at 2 weeks of therapy, with the lowest exposures in infants <6 weeks of age, in whom the median AUC was approximately half of that seen in children >6 months [8,9,12]. However, by 12 months of age, the younger cohort caught up with the older cohort, with comparable median LPV AUCs and similar to the mean (±standard deviation) values for children 6 months to 12 years of age taking 300/75 mg/m2/dose of LPV/r (116.4±57.1 μg h/ml) and adults taking 400/100 mg/dose LPV/r (92.6±36.7 μg h/ml) [12,13]. Longitudinal median predose LPV levels, which were also initially low, increased throughout the study, meeting or exceeding levels similar to mean values reported for older children (6.53±4.57) and adults (7.1±2.9 μg/ml) [12,13]. It should be noted, however, that = the LPV dose of 300 mg/m2 used for the duration of the study is higher than the currently recommended dose for children over 6 months of age.
Despite the initially low LPV exposure, the overall virologic efficacy was good with 71% (by ITT analysis) of the combined cohorts having HIV-1 RNA <400 copies/ml at 48 weeks; of note, 80% of the younger cohort achieved virologic suppression during the time when the LPV concentrations were lowest [8]. This compares favorably with other cohorts of early initiated cART regimens: The Italian Register for HIV Infection in Children reported that 22 of 30 (73%) infants treated under 6 months of age had virologic suppression with a variety of cART regimens, five of whom received LPV/r [14]. Prendergast and colleagues initiated treatment of 49 South African infants at a median of 42 days of age (range 7–397) with a nelfinavir-based cART regimen and found that approximately 90% had achieved a viral load <400 copies/ml by 24 weeks [15]. In contrast, more than half of our enrolled patients did not achieve viral loads <400 copies/ml until after 24 weeks. This delay may be due in part to the high median baseline viral load of 5.8 log10 copies/ml, but the slow viral load decline may also be related to initially low LPV concentrations, leaving the two NRTI's responsible for most of the antiviral activity. This concept may be supported by the observation that patients with a higher percentage of predose concentrations over the target level of 1 μg/ml throughout the study were more likely to have durable suppression, but this correlation could also be explained purely by better medication adherence. Almost all infants in this trial were naive to protease inhibitors and 21 of 21 with baseline genotypes performed had LPV-sensitive HIV strains [11]. It is unknown whether similar virologic efficacy will be achieved in infants born to heavily pretreated mothers who transmit resistant virus.
Among patients treated for longer than 8 weeks, all achieved HIV-RNA <400 copies/ml and 66% maintained viral suppression for the duration of the study; however, several other infants had periods of confirmed poor adherence with viral rebound to >400 copies/ml. This is consistent with an observational study of 112 HIV-infected children by Giannattasio et al. [16] who noted that adherence to antiretroviral therapy is a dynamic phenomenon with individual children gaining and losing adherence over time. In addition, patients taking LPV/r therapy had a significantly higher rate of nonadherence in their cohort than patients taking other agents. Notably, even with periods of poor adherence, our patients' ability to re-suppress the viral load when adherence improved is encouraging and suggests that LPV/r has a high barrier to resistance.
The median CD4+ T-lymphocyte percentage was stable throughout the study, spanning an age range during which infants generally experience a natural decline in both CD4 percentage and number. Among patients still on therapy, 96% had CD4 >25% at 48 weeks, similar to the Italian cohort of infants treated before 6 months of age, in which 97.5% of patients had >25% CD4+ T-lymphocytes at a median follow-up of 5.96 years [17]. Furthermore, the median CD8+ T-lymphocyte percentage in our patients remained stably low throughout the study; this finding has been reported in other infants treated before 6 months of age, in contrast to elevated CD8 percentages in patients whose therapy was deferred [14].
LPV/r was generally well tolerated with only one patient discontinuing treatment due to complaints of mild vomiting and loose stools [9]. Patients' linear growth improved during the course of the study whereas weight Z scores remained relatively stable. None of the infants in our study reported symptoms of immune reconstitution. In contrast, one-third of a South African cohort of 48 infants initiating therapy <6 months of age developed the immune reconstitution inflammatory syndrome (IRIS); however, all had WHO stage III or IV disease or CD4 <25%, thereby representing a more severely affected group of patients [18].
Our patients had a significant increase in nonfasting total cholesterol by 8 weeks which persisted through 96 weeks; these nonfasting values fall into the 75–90 percentiles of fasting serum total cholesterols in US children between 0 and 4 years of age reported in the Lipid Research Clinics Prevalence Study [19]. Data from normal infants show that cholesterol levels rapidly rise from approximately 70 mg/dl at birth to between 100 and 150 mg/dl during the first weeks of life; thereafter, levels slowly increase to an average of 160–165 mg/dl at 2 years of age [19]. Our patients progressed through this age range during the course of the study, making it difficult to differentiate the expected rise in cholesterol and the effect of antiretroviral therapy. The National Cholesterol Education Program of the National Heart, Lung, and Blood Institute established abnormal cut-points of total cholesterol for children 2–18 years of age in 1992 which have been adopted by the American Academy of Pediatrics; a total cholesterol level at the 75–95% (170–199 mg/dl) is considered borderline, whereas cholesterol at the 95%, or >200 mg/dl, is considered elevated and should be treated. Although it is widely accepted that atherosclerotic cardiovascular disease (CVD) begins early in life and has both genetic and environmental factors which determine the disease course, data do not exist which correlate a particular level of childhood cholesterol that predicts adult CVD [20]. The long-term implications of nonfasting cholesterol levels in the range of 170-200 mg/dl in young infants will require more study and focused follow-up. It is interesting that there was no elevation in triglycerides throughout the study, in contrast to that observed in adults treated with LPV/r [21].
Recent publications substantiating the benefit of early initiation of antiviral therapy including protease inhibitors combined with superior efficacy among infants exposed to nevirapine for prevention of mother to child transmission suggests that LPV/r will be used more commonly in very young infants [3,4,21,22]. In many countries, LPV/r is now the standard protease inhibitor used as the initial antiretroviral regimen for infants with a previous exposure to nevirapine [5,22,23]. As the largest database of pharmacokinetics and efficacy among infants treated within the first 6 months of life, this study will help guide dosing and use of LPV/r in this age group. Our study found that the high dose of 300/75 mg/m2/dose of LPV/r seems appropriate for most infants <6 months of age, especially those who are treatment-naive, however, the lower LPV concentrations observed in the first months of life suggest that studying a higher dose of LPV/r in very young infants should be considered. Although improved drug exposure cannot be guaranteed with higher dosing, especially if there is limited absorption of LPV/r in very young infants, this could also allow investigation of whether more rapid decay of virus could be achieved and have an impact on longevity of viral suppression. Frequent monitoring of young infants receiving LPV/r is advisable, to provide both guidance to the family on successful drug administration techniques and to adjust the dose for weight gain to maintain maximal drug exposure during periods of rapid growth. Careful attention to these details should optimize the early efficacy of LPV/r-based antiretroviral therapy for young infants and build the foundation for prolonged virologic suppression.
Overall support for the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) was provided by the National Institute of Allergy and Infectious Diseases (NIAID) [U01 AI068632], the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Mental Health (NIMH) [AI068632]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This work was supported by the Statistical and Data Analysis Center at Harvard School of Public Health, under the National Institute of Allergy and Infectious Diseases cooperative agreement #5 U01 AI41110 with the Pediatric AIDS Clinical Trials Group (PACTG) and #1 U01 AI068616 with the IMPAACT Group. Support of the sites was provided by the National Institute of Allergy and Infectious Diseases (NIAID) and the NICHD International and Domestic Pediatric and Maternal HIV Clinical Trials Network funded by NICHD (contract number N01-HD-8-0001/HHSN267200800001C). Abbott Laboratories supplied the study drug.
Conflicts of interest: E.V.C. has served as a consultant to GlaxoSmithKlein, Bristol-Meyers Squibb and Johnson & Johnson. E.G.C. has had consultancies with Pfizer and Bristol-Meyers Squibb, and has owned stock+/-stock options in Abbott Labs, GlaxoSmithKlein, Merck Inc., Bristol-Meyers Squibb and Schering Plough. M.D.H. received grant support from Roche, honoraria or consultancies with Abbott Labs, Boehringer Ingelheim, Bristol-Meyers Squibb, Chiron, Medicines Development, Roche, Pfizer, Tibotec and Vironyx. R.Y. has served on the Speaker's Bureau for Merck Inc. and GlaxoSmithKlein. All other authors have no conflicts.
The study team wishes to thank Kimberly Hudgens MSHCA, MBA; Marisol Martinez-Tristani, MD; Katherine Luzuriaga, MD; Mary Elizabeth Smith, MD; Lynette Purdue, PharmD; Leslie Serchuck, MD; Adam Manzella, MA; and John Rodman, PharmD for their contributions to the performance of the study, and Abbott Laboratories for donation of the study drug, and the patients and families who participated in this study.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


text: ColorFashionMy Stylescarves written by Jade October 8, 2012 Jacket: Jcrew | Sweater: Jcrew | Jeans: Levis | Boots: Sam Edelman | Scarf: TJ Max | Clutch: Nine West was last modified: October 8th, 2012 by Jade 1 comment 0 Facebook Twitter Google + Pinterest Jade previous post next post You may also like Lazy Sunday January 11, 2010 Navels March 24, 2010 There it is October 25, 2010 1 comment Ria October 12, 2012 at 5:21 am You hair as always is beautiful. Love your booties. Reply Leave a Comment Cancel Reply Notify me of follow-up comments by email. Notify me of new posts by email.


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How to Make Your Infographics Seen and Shared
A successful infographic provides compelling information that is attention-getting, quickly understood and shareable.
United Mine Workers of America protects mine workers' health, safety and benefits. Some of the challenges faced by the coal industry are depicted in this GO! Creative designed infographic. We utilize statistical data attributed to the source, simple, brief language and engaging colors and graphics to inform the reader. The size is easily shared for websites, social media and print.
When developed with the reader in mind, infographics are a powerful tool.
GO! Creative tells your unique story with words and images
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Corrosion can be destructive to your car battery. Preventing car battery corrosion can save you a lot of money in repairs and car battery replacement. Luckily, the common household product Vaseline can help save you the headache of dealing with premature corrosion.
Find a clean wire brush used for car cleaning and repair. Grab a regular tub of Vaseline from your medicine cabinet.
Conduct regular battery service on your car battery. Make sure your car battery is working properly and isn't in need of major repairs. If your car battery needs to be changed, replace it with a new one.
Locate the terminals on the car battery.
Disassemble the terminals.
Use a wire brush to painstakingly clean them. Clean each crevice and side so that no corrosion accumulation remains.
Reassemble the car terminals with car battery.
Coat the terminals generously with Vaseline so that all parts of the terminals are protected against corrosion.
Clean your hands with soap and water. Pat dry.
Turn on your car after awhile to verify that your car functions as it should.
Tips & Warnings
- Do not use grease to coat the car terminals. Using grease is an undesirable method to try to prevent car corrosion and may damage the terminals.
- Avoid coating the terminals with too much Vaseline. Coat the terminals with just enough Vaseline to prevent car corrosion but not to impair terminal function.
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text: Comments0 New Episode HaZe RaiN July 23, 2011 User blog:HaZe RaiN Memory of Memory looks interesting... Retrieved from "http://adventuretime.wikia.com/wiki/User_blog:HaZe_RaiN/New_Episode?oldid=71608" Ad blocker interference detected! Wikia is a free-to-use site that makes money from advertising. We have a modified experience for viewers using ad blockers Wikia is not accessible if you've made further modifications. Remove the custom ad blocker rule(s) and the page will load as expected. Category: Blog posts


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This is the full research report for 188.8.131.52, which is an IP address.
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Ibiza Nights Printed Cushion Cover
Brand New Design! Now in Stock!! Inspired by hot summery nights in Ibiza
This cushion has a hidden zipper so the cover is removable for machine washing and makes the cushion fully reversible.
Dimensions: approx 50 X 50 cm
Postage category B for cover only.


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2017 Legislative Agenda
The Pharmacy Patient's Right to Care
Transforming access to healthcare for the pharmacy patient in New York State
Expand Patient Access to Care:
Protect Patients from the High Cost of Prescription Medications:
Protect the Safety of Patients:
Legislative Update (November 2016):
2016 Legislative Session Update (Sept 2016)
Focus areas:
Current Action Campaigns:
Recently passed legislation:
MAC Appeals Passes Into Law March 10, 2016
(members log-in required for full info)
Among the first bills to be transmitted to the Governor when the 2015 session ended was S4739-A Hannon, the bill that adds Tdap and moves the sunset to July 1, 2019 among other provisions. When he signed it into law it became Chapter 46 of the Laws of 2015.
'Outsourcing Facilities' that compound drugs for office use. This was adopted as emergency regulations effective June 29th, 2014. Click here to read the Regulations adopted June 24, 2014.
Other Focus Topics:
S2809 Lanza/A4036 Quart
Legislation amending the NYS Insurance Law requires insurers to cover prescriptions that are partially-filled when the pharmacy is synchronizing a patient's medications so that refills are all due on the same day each month. The bill requires the co-payment to be pro-rated but the full dispensing fee paid for each prescription. PSSNY support memo is available.
Remember Me
3/17/2017CALL your State Senator and Assembly member about TWO budget items
2/21/2017PSSNY's 2017 Legislative Agenda: The Pharmacy Patient's Right to Care now available
1/12/2017Governor Cuomo proposes PBM registration and licensure in 33rd budget proposal
5/2/2017PAWNY - Regulatory Impact on Compliance Issues with Medicaid & PBMs
5/7/2017WRCPS - Meeting & CE
5/7/2017CAPS - Continuing Education Day
5/7/2017PAST CE - CPR & Oncology Pharmacy
PSSNY, 210 Washington Avenue Extension, Albany, NY 12203 * 800-632-8822 * firstname.lastname@example.com


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Hotel Kailash Lodge is situated in the city of Gwalior. This three-floored establishment is truly an ideal stopover for fun-filled family holiday. This budget accommodation welcomes the tourists in 30 comfy rooms. Relishing the scenic beauty of the city, guests can also avail the benefits of facilities like a parking space, front desk facility, airport transfers, in-house cafe, complimentary newspapers, backup generators, fine-dining restaurant and laundry facility.
Attractions travelers recommend


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Africanfarms Nigeria Limited is located in Ogudu, Kosofe, Lagos. Our company is mainly into Agricultural Product,Agriculture & Farms,Manufacturing and offering Gum Arabic, Kolanuts. If you have any questions, do feel free to contact us on the details in our profile or view our website for more details.
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Annual Convocation of Priests
All active priests of the Archdiocese are required to attend the Convocation of Priests which will take place on Wednesday, October 5. After I complete the 6:30 a.m. Mass at St. Ann and then the 7:30 a.m. Mass at Sacred Heart, I will be on the road to Centerville. As all Archdiocesan priests are required to attend the Convocation, I will not be able to have a funeral on Wednesday! I will be back in time for RCIA on Wednesday evening.
Blessing of Pets for Sacred Heart and St. Ann
In honor of the Feast of St. Francis of Assisi, we will have a blessing of pets on Sunday, October 2 at 2:00 p.m. in the afternoon in the west parking lot and grassy area of Sacred Heart. Please feel free to bring your "well behaved Catholic" dogs or cats with or without muzzle or cage. If your pet is a more exotic animal, not easy to transport; or if the dog or cat is older and might be harmed by the trip and excitement, feel free to come with a picture of your pet and carry the blessing home. Please make certain as you position yourself for the blessing that your pet won't eat or be eaten by the pet next to you. Feel free to bring a muzzle or cage as necessary. We don't want any tragedies, just a fun blessing for the pets which bring so much joy into our lives.
Women's Day of Reflection
St. Ann and Sacred Heart women have joined forces to create an annual retreat day called the Women's Day of Reflection. The event is scheduled for Saturday, October 8. More information is available in this bulletin.
Reflection on Scripture
What does God owe you? Does God owe you a happy life? Does God owe you health or wealth? Since God created reality and time itself; isn't our very conscious existence a magnanimous gift from God? Of course we can always compare ourselves to the very wealthy and say, "Wow, I wish I had been born with a silver spoon in my mouth!" But wealth does not equate with happiness. And then we can always compare ourselves to the less fortunate and humbly count our blessings. In the final analysis, we should all count our blessings, if we can breathe air and be cognizant we are alive.
In truth, we owe God! We owe God for life, for talents, for everyday blessings, and for everything. The only way we can show appreciation to God is through prayer and service. This does not repay God for our blessings. It just shows that we, in humility, appreciate them.
Many in Judaism at the time of Jesus felt that, if one obeyed all six hundred and thirteen commandments of the Jewish Law, God owed them something. Even Jesus' own disciples say to him in the gospels, "Jesus, do you realize what we have given up to follow you?" But think about it. If I gave you a cup, brewed the coffee and poured it for you, would you be justified in expecting me to pay you for drinking my coffee?!! Hardly! Therefore, how can we criticize God for not giving us everything we want?
Jesus tells us in today's gospel to be grateful to God for everything. Only when we acknowledge that existence itself is a gift from God can we really say we are counting our blessings.
Readings for the Twenty Eighth Sunday in Ordinary Time
2 Kgs 5:14-17
2 Tim 2:8-13
Luke 17:11-19
Theme: Why do we forget to show gratitude to God?
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Love my Powersteps
Posted by
Richar G
on 2/20/02 at 01:25 (074369)
Have been wearing powersteps for a couple of weeks and have noticed gradual improvement. I stuck them in my Birkenstocks today and felt even better! Have also been doing ultrasound treatments and stretching and chiropractic adjustments. Have been suffering with PF for over a year and am finally starting to notice improvement


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Wednesday, April 27, 2016
Oakland baseball beats Riverdale 8-3 – The Daily News Journal
Oakland baseball beats Riverdale 8-3The Daily News JournalMURFREESBORO — Oakland pounded out 10 hits to beat cross-town rival Riverdale 8-3 Wednesday. Grayson Preston went 2 for 4 with three RBIs to pace the Patriots. Teammate Zach Lemerand was 3 for 3 with two runs scored and two RBIs. And teammate … and more …read more […]
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