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Salud Pública de México
versión impresa ISSN 0036-3634
Salud pública Méx vol.45 no.5 Cuernavaca sep./oct. 2003
Intestinal parasites in children, in highly deprived areas in the border region of Chiapas, Mexico
Parasitosis intestinal en niños, en áreas de alta marginación socioeconómica de la región fronteriza de Chiapas, México
Emma Marianela Morales-Espinoza, MD,I; Héctor Javier Sánchez-Pérez, MSc, PhD,II; María del Mar García-Gil, MD, PhD,III; Guadalupe Vargas-Morales, ChD,II; José Domingo Méndez-Sánchez, ChD,IV; Margarita Pérez-Ramírez, ChD.IV
IFacultad de Medicina. Medicina Preventiva y Salud Pública. Universitat Autónoma de Barcelona. Barcelona, España
IIEl Colegio de la Frontera Sur, San Cristóbal de Las Casas, Chiapas, México
IIIUnidad de Investigación. Hospital Universitario Dr. J Trueta, Girona,España
IVInstituto Nacional de Salud Pública, Centro de Investigación en Paludismo, Chiapas, México
OBJECTIVE: To assess the prevalence of intestinal parasitic infections among children in highly deprived areas, and its possible association with demographic and socioeconomic indicators.
MATERIAL AND METHODS: From March to September 1998 in a convenience sample of 32 communities of the border region of Chiapas, Mexico, selected at random based on the level of poverty and distance from the community to the nearest health care unit (<1 hour; 1 hour or more), one of every four households with children under 15 years of age was randomly selected to provide three stool samples from their children (n 1478). Bivariate and multivariate (generalized linear models for correlated binary data) analysis were performed.
RESULTS: The global prevalence of intestinal parasitosis was 67% (95% confidence interval [CI] 64-70%). Sixty percent had multiple parasites. The prevalence of Entamoeba histolytica/E dispar was 51.2%, that of Giardia lamblia 18.3%, and that of Ascaris lumbricoides 14.5%. Multivariate analysis showed that age and speaking an indigenous language were significantly associated with the presence of E histolytica/ E dispar and Giardia lamblia. Source of water and lacking a refrigerator and electricity were associated with the presence of Ascaris lumbricoides.
CONCLUSIONS: Measures should be taken to improve water quality, sewage disposal, and domestic hygiene. Furthermore, health programs should be established to promote breast-feeding, and education policies aimed at reinforcing the use of indigenous languages by physicians in the health services. The English version of this paper is available too at: http://www.insp.mx/salud/index.html
Key words: intestinal parasitosis; poverty; child health; multivariate analysis; Mexico
OBJETIVO: Estimar la prevalencia de parasitosis intestinal en niños de zonas de alta marginación y su asociación con indicadores demográficos y socioeconómicos de interés.
MATERIAL Y MÉTODOS: En una muestra de 1478 menores de edad, de entre 1 a 14 años, provenientes de 32 comunidades de la región fronteriza de Chiapas, México, de marzo a septiembre de 1998, se recolectaron tres muestras de heces fecales, seleccionadas aleatoriamente a partir del grado de marginación (alto y muy alto) del municipio al que pertenecen, y distancia de la unidad de salud más cercana a la comunidad (<1 hora; 1 hora o más). En una de cada cuatro viviendas con niños menores de 15 años de edad, seleccionadas aleatoriamente, se obtuvieron tres muestras de heces fecales de éstos. Se efectuaron análisis bivariados con la prueba de ji cuadrada y multivariados con modelos lineales generalizados.
RESULTADOS: La prevalencia global de parasitosis fue de 67% (intervalo de confianza IC 95% 64-70%). Sesenta por ciento de los niños estaban multiparasitados. La prevalencia de Entamoeba histolytica/E dispar fue de 51.2%, de Giardia lamblia, 18.3% y de Ascaris lumbricoides, 14.5%. La mayor prevalencia de E histolytica/E dispar se asoció con la edad y hablar algún idioma indígena; la de Ascaris lumbricoides con el sitio de obtención de agua y la carencia de refrigerador y electricidad.
CONCLUSIONES: Es necesario hacer intervenciones locales de salud (calidad del agua, sistemas de desagüe), programas de educación sanitaria (promoción de la lactancia materna y medidas higiénicas) y promoción del habla de idiomas indígenas entre los médicos de la región. El texto completo en inglés de este artículo también está disponible en: http://www.insp.mx/salud/index.html
Palabras clave: parasitosis intestinal; pobreza; salud infantil; análisis multivariado; México
Parasitic infections occur worldwide, mainly affecting the poorer sectors of society.1 According to the World Health Organization (WHO),2 around 1 billion people are infected by Ascaris or Uncinarius, 500 million by Trichuris or amoebas, and 200 million by Giardia lamblia. Furthermore, there is a wide variability in both inter- and intra-regional parasitoses within a given country and among countries.3, 4 These differences may be due to a variety of factors associated with the prevalence of these infections, such as soil composition, climate, and method of transmission, among others. Similarly, socioeconomic and health conditions, education and beliefs related to traditional health practices, as well as the presence of domestic animals in the home and contamination of water and food, have all been reported as factors associated with the presence of these diseases.3, 4 Finally, age is also an associated factor related to the individual's immunologic status and behavioral patterns. One should also bear in mind that intestinal parasite infections are associated with poor physical growth and development, as well as with retardation of intellectual and cognitive development in children.5,6
Several estimates indicate that over a third (34%) of the Mexican population is aged under 15 years and that more than 60% of Mexicans live in poverty.7 Within the Mexican Republic, Chiapas is one of the states with the worst conditions of poverty and socioeconomic deprivation (Table I). Additionally, Chiapas has a high proportion of indigenous population.12,13 In 1997 the death rate in Chiapas due to infectious intestinal diseases was the highest in the country, at 23.9 per 100 000 inhabitants, while the national figure was 7.8 with the same denominator.14 The data recorded for 2000 showed the same situation (17.3 versus 5.8, respectively).9
A study carried out in Chiapas during 19941 among the non-indigenous population revealed a higher prevalence of intestinal parasitosis mainly due to Entamoeba histolytica among children of poor peasants than among those of "rich" peasants. However, the few studies on parasites, which have been carried out in Mexico in recent years, have mainly focused on determining the prevalence of these infections without evaluating the associated epidemiological profile.15 Moreover, there are practically no studies addressing the magnitude of this problem in indigenous areas of high and very high levels of poverty.
In addition, Chiapas has a predominantly young population and the majority of its inhabitants live in poverty with a supply of water that is not only scarce but also deficient in quality.13,16 This population also has inadequate health coverage and scarcity of health resources. We decided to conduct a study to assess the health and living conditions in areas of high and very high poverty levels,17 in an attempt to contribute to the improvement of public health in Chiapas, Mexico. Our main objective was to assess the prevalence of intestinal parasitoses among children aged 1 to 14 years, and to determine its possible association with demographic and socioeconomic indicators in one of the regions of greatest poverty in Chiapas, the region bordering Guatemala.
Material and Methods
The study was carried out from March to October 1998 in a convenience sample of 32 communities of the border region of Chiapas, located in the Southeastern part of the state, bordering Guatemala. This area is one of the poorest regions of Chiapas. The population of approximately 425 000 inhabitants is conformed predominantly by peasants, with substantial indigenous settlements, mainly of the Mayan ethnic group Tojolabal. The majority of its inhabitants is engaged in agricultural work, has low purchasing power, and practically no social security. In fact, their health needs, as an "open population" (without social security), are satisfied only through state-provided health services, or through self-care, including the use of traditional medicine.18
A random sample of communities was drawn from municipalities with high and very high poverty levels, considering their level of access to health services, as measured by the traveling time to the nearest health facilities (<1 hour; 1 hour or more). The level of poverty proposed by the National Population Council,19 is based on an index using the 1990 census information, and nine indicators considered to be structural in nature (with little change over time), such as educational level, dwelling conditions, size of community, and monthly income. All municipalities in Mexico are classified according to this index into five levels of poverty (from very high to very low). In the border region, two of twelve municipalities are classified as having "very high" poverty levels (both of them were included in the sample), nine as "high" (five of them were selected by simple random sampling), and one is classified as having a "medium" poverty level (not included in the sample). On the other hand, the level of access to health services is one of the indicators used to measure the level of development of countries.20
Information was obtained from 1 878 of the 1 894 households that were selected (non-response rate of 0.84%). A total of 11 274 people were registered in these households. The total population in the study area (the municipalities with "high" and "very high" poverty levels) was estimated at 331 437 persons, representing 9.0% of the population of Chiapas, distributed among 885 communities.18
A standardized health questionnaire (based on previous studies carried out in Chiapas)1,21-24 was administered to all adults in the households studied, which gathered demographic (age, sex, ethnic group), socioeconomic, and health and services usage information. The fieldwork was carried out by seven interviewers: four graduate students (two chemists, one biologist, and one social worker) and three people from the same region who spoke Tojolabal (the main Mayan language of the region), to translate when necessary. Of the total number of households, those with children under 15 years of age were identified, and one in every four of these households was systematically selected. Stool specimens were obtained from all the children aged between 1 and 14 years (n=1 478) in each of the households selected. In some households more than one child provided a specimen.
Mothers or guardians of all selected children were asked to obtain three stool specimens on three consecutive days starting the day following the interview. Mothers were instructed on how to collect the stool samples and were provided with one Copropac container per child, filled with Phenol-Alcohol-Formaldehyde (PhAF) preserving solution,25 and three wooden spatulas, each one to be used to obtain one stool specimen, which was subsequently incorporated into the PhAF solution. Fecal specimen containers were retrieved by fieldworkers from the collaborating households. The containers were sealed in polystyrene foam bins using parafilm, for storage and transportation from the communities under study to the laboratories of the Malaria Research Center (Ministry of Health), in Tapachula, Chiapas, where they were processed by the Faust Method by trained laboratory personnel.26
A total of 1 160 children submitted three fecal specimens for analysis (response rate 78.5%). The main reasons for not being able to process specimens from the remaining 318 children were as follows: 224 did not respond, while the others either did not complete the three specimens, provided insufficient quantities, were currently taking anti-parasite medication, or the child was not at home during the study period. Although some indicators (locality, age and occupation of head of household) showed differences between excluded and included children, the groups were similar for gender, indigenous language spoken by head of household, and some characteristics of the households (Table II).
The study protocol was approved by local authorities and accepted by all adults in each study community (informed consent was requested at community meetings organized in each study village).
Positive enteroparasitosis was defined as the presence, whether scarce or abundant, of eggs, cysts, larvae, or parasites in the fecal specimen. To simplify the presentation of results, despite more parasites being identified, analysis was restricted to the three most prevalent and epidemiologically important (Entamoeba histolytica, Giardia lamblia, and Ascaris lumbricoides). They were analyzed separately, given that bivariate analyses showed that joint distributions of the parasites were not significant (results not shown). The Faust method does not differentiate pathogenic and non-pathogenic amoebas such as Entamoeba dispar, therefore our results are expressed as: Entamoeba histolytica/ Entamoeba dispar infection.
Bivariate relationships between the above mentioned parasites and factors possibly associated with their presence were assessed by the chi-square test, or Fisher's exact test, using the SPSS package for Windows, version 8.0. Multivariate analysis was performed using generalized linear models for correlated binary data for each parasite27-29 with SAS, PROC GENMOD. Models were adjusted for factors related to the presence of parasites in the bivariate analyses and according to epidemiological criteria. Therefore, the method used was the "enter" method.
The mean age of study subjects was 6.8 years (standard deviation [SD] 3.9), with 33% aged between 1 and 4 years, 36% aged 5 to 9 years, and 31% 10 to 14 years. The percentage of males was 52.1. With respect to socioeconomic indicators, 64% lived in houses with dirt floors, 86% used wood as the cooking fuel, only 12% lived in houses having a refrigerator, and 24% lived in houses with no sewage disposal system.
At least one parasite was found in 776 of the children studied, yielding a global intestinal parasitosis prevalence of 67% (CI 95%: 64-70%). Of these 776, 40% had one species of parasite, 43% had two, 15% had three, and 2% had four. The distribution of identified parasites was as follows: Entamoeba histolytica/Entamoeba dispar 51.2%, Entamoeba coli 32.9%, Giardia lamblia 18.3%, Ascaris lumbricoides 14.5%, Hymenolepis nana 1.5%, Trichuris trichuria 0.8%, and Iodamoeba butschlii 0.1%.
Factors associated with a higher prevalence of Entamoeba histolytica/Entamoeba dispar (Table III) were: living in a locality classified as having very high poverty; head of household speaking an indigenous language; lack of a refrigerator in the home; river as the main source of water; and child's age between 1 and 4 years.
Factors associated with Giardia lamblia infection were: locality being classified as having very high poverty, head of household speaking an indigenous language; house with dirt floor; obtaining water from either a public well or from a river; and child's age between 1 and 9 years.
Finally, Ascaris lumbricoides was the parasite statistically associated with the greatest number of factors. Practically all household-related indicators denoting greater poverty were found to be associated with this helminth: lack of electricity, lack of refrigerator; use of wood as cooking fuel; dirt floor; water supply from communal source or river; overcrowding; and, as expected, living in a locality classified as having very high poverty; head of household speaking an indigenous language; and child's age between 10 and 14 years (Table III).
Table IV shows the models including only the variables associated with the presence of parasites, and the variables of epidemiological importance (such as age or overcrowding) in the study of each parasite, as well as other variables indicating the level of poverty (living conditions and educational level). Within the three models, only the variables age and indigenous language were found to be significantly associated with the presence of Entamoeba histolytica/Entamoeba dispar, while for Giardia lamblia the significant variables were those mentioned above and, additionally, the water source (Table IV). The variables associated with the presence of Ascaris lumbricoides were: water source, and two conditions related to characteristics of the home having a refrigerator and having electricity. However, age and overcrowding were retained in the model due to their epidemiological importance in the study of this parasite (Table IV).
Finally, it should be noted that in the three models fitted, the correlation between children in the same home was below 0.2.
Study findings indicate a prevalence of 67% for intestinal parasitosis among the population 1 to 14 years of age in areas of high and very high poverty in the border region of Chiapas, Mexico, almost two thirds (60%) of whom are infected with several parasites. Thus, in this region, intestinal parasitosis infection is a common phenomenon.
This fact is very important, given that Chiapas is one of the Mexican states with the highest rates of diarrheic diseases. It has the highest rate of death associated with diarrhea (four times higher than the rate for Mexico as a whole) and 50% of these deaths occur among children aged under 15 years.30
The overall distribution of parasite prevalence is consistent with that found by most of studies undertaken in Mexico and in other countries, Entamoeba histolytica and Giardia lamblia being the most common protozoa, and Ascaris lumbricoides the most common helminth.31-34 However, the percentages do not coincide. This may be due to a variety of factors such as employment of differing diagnostic techniques (we were unable to differentiate between pathogenic amoebas and non-pathogenic ones such as Entamoeba dispar), geographical differences, or due to different demographic and socioeconomic patterns of the populations studied (age, presence of indigenous groups, rural versus urban areas).35
One of the most important factors associated with the presence of protozoa was the head of household speaking an indigenous language. This condition probably reflects, on the one hand, the poverty level of the indigenous population studied, and on the other, problems in communication between these people and the health services: many indigenous people have difficulty in speaking Spanish, and doctors at health centers do not speak the indigenous language predominant in the region (almost 100% of doctors working in health services in Chiapas speak no indigenous language). Both situations affect access to health services and to health information. At the same time, they can be associated with worse living conditions,18 as well as with habits, beliefs and health practices different from those promoted by institutional medicine.33
Age was also found to be significantly associated with the prevalence of protozoa (Entamoeba histolytica/Entamoeba dispar and Giardia lamblia). A lower prevalence of Entamoeba histolytica/Entamoeba dispar was observed in the group aged from 1 to 4 years. This could be due to the fact that generally children in the areas where the other studies were carried out are breast-fed beyond one year of age 1, and it is not uncommon for breast-feeding to continue until two years or even longer (around 50%, data not shown). Thus, children receive immunological protection through their mother's milk.36 Two additional factors must also be considered: that at this stage of infancy the child interacts less with its surroundings; and secondly that liquids other than breast milk are most commonly tea or coffee, thus ensuring that the water consumed has been boiled.
In contrast, a higher prevalence of Giardia lamblia parasitosis was found in the groups aged from 1 to 9 years, an association that has been reported by other authors.36-38 The highest prevalence was among those aged under 5, which decreased as age increased. Once again, the coexistence of two factors could explain the higher prevalence of this parasite among the younger children: on the one hand immaturity of the humoral immune response, which plays a very important role in controlling Giardia lamblia infections but not so much in the case of Entamoeba histolytica,39 and on the other hand, the presence of malnutrition, to a greater or lesser extent, which in turn reduces both cellular and humoral immune defenses.40 Several studies have shown that Chiapas, along with Oaxaca, are the Mexican states with the highest height deficit rates. For example, among first grade elementary school children height deficit is 44.1%, which contrasts with the national figure of 18.7%, and more dramatically when compared to the state of Baja California (in the North of Mexico), where only 4.3% of such children have a height deficit.41 Another study carried out in 1996, an striking prevalence (51%) of height deficit in Chiapas was found in children under five years.42
Regarding the association between Giardia lamblia parasitosis and obtaining water for domestic consumption directly from rivers, it is important to note that this practice makes it necessary to consider the possibilities of infection by this parasite. River water is an exposed source and it is vulnerable to a variety of types of contamination, not only environmental but also during its transport, usually in non-hygienic conditions.
Although it has been reported that ascariosis shows convex prevalence and intensity patterns with age,27,43,44 in our study no significant association was found between age and the presence of ascariosis. Two plausible explanations for this fact can be advanced: firstly, it has been reported that Ascaris lumbricoides is more prevalent in children than adults, but its physiopathology is not associated with an individual's predisposition related to age in terms of growth; secondly, overcrowding among the population under study could affect this association (in the present study overcrowding was at the borderline of statistical significance). It should be pointed out that the literature which we consulted27,39,43-46 revealed that age is found to be a significant factor for Ascaris lumbricoides, precisely when overcrowding is not taken into account. However, in the multivariate analysis age was retained since it is traditionally associated with the presence of this helminth.
Similarly, Ascaris lumbricoides is also more prevalent in the less favored social classes, which may be explained by their closer contact with soil and harsh environmental conditions.38,43,46 Thus, lacking a refrigerator and electricity is an indirect measure of the family's economic situation and could be related to higher probabilities of food contamination. This should be taken into account precisely because it is in populations of this type that moderate or severe ascariosis infection has been associated with malnutrition and growth retardation in children.30
With regard to bacteriological water quality, the present study is limited when it comes to analyzing the relationship between the bacteriological quality of drinking water and the presence of parasites in the child. As we reported in another article,47 difficulties in access to the study area (geographical, climatic and those specific to the armed conflict that began in 1994), as well as budget problems, meant that water samples could only be obtained from 99 of the 1,874 households under study. In 67% of these 99 households the bacteriological quality of the water was poor (three or more CFU/100 ml of total coliforms).48 This finding, although based on a small sample, reflects the problems of drinking water contamination as well as the lack of adequate water supply systems in most of the communities, which are predominantly rural. In many studies, water contamination was associated with high intestinal parasitic infection.27,33
The variable maternal education level33 has been found to be significantly associated with parasitosis in other studies; however, in our survey it was not significant, there were not enough data (information was obtained from about 377 mothers) or most of the mothers from whom information was collected had very low education levels (< three years formal education).
Even so, it should be noted that the low correlation estimated by the three models suggests that the variables included explain well enough the presence or absence of intestinal parasitosis. In other words, it would appear that no important variables have been omitted which could help to significantly explain the clustering, in this case family- or household-related, of the variable under study.
The results obtained in the present study, along with the excessive death rates due to infectious intestinal diseases en Chiapas, highlight the compulsory nature of the need for programs to be developed to reduce the observed prevalence of parasitosis and to raise the quality of life and health of these highly deprived populations.
In the particular case of enteroparasitosis, urgent measures should be taken to improve water quality, sewage disposal and domestic hygiene, and to promote breast-feeding, as well as education policies aimed at reinforcing the use of indigenous languages by physicians in the health services.
The authors would like to express their gratitude to Alejandro Flores, María Luisa Estudillo, Roberto Solís, Trinidad Pérez (El Colegio de la Frontera Sur) and David Monterde (Universidad Autónoma de Barcelona, Spain) for their participation in data collection and data analysis; also to David McFarlane for his invaluable comments to this manuscript.
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36. Islam A, Stoll BJ, Ljungstrom I, Biswas J, Nazrul H, Huldt G. The prevalence of Entamoeba histolytica in lactating women and in their infants in Bangladesh. Trans R Soc Trop Med Hyg 1988;82:99-103. [ Links ]
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38. Birkhead G, Vogt R. Epidemiologic surveillance for endemic Giardia lamblia infection in Vermont. The roles of Waterborne and person-to person transmission. Am J Epidemiol 1989;129:762-768. [ Links ]
39. Botero D, Restrepo M. Parasitosis humanas. Medellín, Colombia: Ed. Corporación para Investigaciones, 1998:27-135. [ Links ]
40. American Academy of Pediatrics. Nutrition and Immunity. En: AAP, Ed. Pediatric Nutrition Handbook. Illinois (IL): AAP, 1998:473-483. [ Links ]
41. Secretaría de Educación Pública, Sistema para el Desarrollo Integral de la Familia. Segundo Censo Nacional de Talla en Niños de Primer Grado de Primaria. México. Salud Publica Mex 1998;40:215. [ Links ]
42. Avila-Curiel A, Shamah T, Chávez-Villasana A. Encuesta Nacional de Alimentación y Nutrición en el Medio Rural 1996. Resultados por entidad. Volumen 1. México, DF: Instituto Nacional de la Nutrición Salvador Zubirán, Subdirección General de Nutrición de Comunidad, 1997:56. [ Links ]
43. Udonsi JK, Behnke JM, Gilbert FS. Analysis of the prevalence of infection and associations between human gastrointestinal nematodes among different age classes living in the urban and suburban communities of Port Harcourt, Nigeria. Helminthology 1996;70:75-84. [ Links ]
44. Ocampo-Gómez G, Salgado-Cuevas R, Román-Bobadilla J. La omnipresencia de las helmintiasis. Salud Publica Mex 1992;34:357-360. [ Links ]
45. Hagel I, Lynch NR, Pérez M, Di Prisco MC, López R, Rojas E. Relationship between the degree of poverty and the IgE response to Ascaris infection in slum children. Trans R Soc Trop Med Hyg 1993;87: 16-18. [ Links ]
46. Cooper E. Intestinal parasitosis and the modern description of the disease of poverty. Trans R Soc Trop Med Hyg 1991;85:168-170. [ Links ]
47. Sánchez-Pérez HJ, Vargas-Morales MG, Méndez-Sánchez JD. Calidad bacteriológica del agua para consumo humano en zonas de alta marginación de Chiapas. Salud Publica Mex 2000;42:397-406. [ Links ]
48. Secretaría de Salud. Norma oficial mexicana NOM 127-SSAI-1994, para la salud ambiental, agua para uso y consumo humano. Límites permisibles de calidad y tratamiento a que debe someterse el agua para su potabilización. México, DF: Diario Oficial de la Federación, 18 de enero de 1996:41-45. [ Links ]
Address reprint requests to:
Héctor Javier Sánchez-Pérez
El Colegio de la Frontera Sur
Carretera Panamericana y Periférico Sur, S/N
29290 San Cristóbal de Las Casas, Chiapas, México
E-mail: firstname.lastname@example.com
Received on: January 7, 2003
Acepted on: May 14, 2003
Our special gratitude with the Barcelona Solidaria Program (through the Barcelona Municipal Institute of Health) and to the Mexican National Science and Technology Council (CONACYT, Mexico) for funding which made the present research possible


text:
I saw 12 Years a Slave the other day, and it's a darn good movie—certainly the most visceral onscreen depiction of the peculiar institution I've ever seen, rivaling the harrowing slave ship scenes from Amistad.
One reason the film is so powerful is because Solomon Northup makes for an especially relatable protagonist. Anyone who's thought about the history of American slavery has probably sympathized with the people who were victims of it, but sympathy for someone is not the same as identification with them. Identification requires you to be able to see yourself in a character, and living your whole life as someone else's property is so foreign to the experience of most modern Americans that it's difficult to put yourself in that place.
Northup wasn't born into slavery; he had his freedom, a home, and a family before losing it all when he was abducted. You can see yourself in him. And in the movie, he's thrown into this brutal new reality at the same time you are. You're on his journey alongside him, and that lends the experience a special kind of impact.
Of course, if Northup's exceptionalness makes him a useful surrogate in approaching the subject of slavery, it also means that we have to remind ourselves of how atypical his story is. Most slaves were born into bondage, lived their entire lives in that condition, and died without publishing their stories. Peter Malamud Smith explains the dilemma:
It's just so hard for us to identify with "the regular slaves," in whatever form they may take. 12 Years a Slave is constructed as a story of a man trying to return to his family, offering every viewer a way into empathizing with its protagonist. Maybe we need a story framed on that individual scale in order to understand it. But it has a distorting effect all the same. We're more invested in one hero than in millions of victims; if we're forced to imagine ourselves enslaved, we want to imagine ourselves as Northup, a special person who miraculously escaped the system that attempted to crush him.
In other words, this individual's story can't take the place of millions of other slaves' untold stories. But it more than compensates by reminding us, as few other slave narratives can, that behind each of those untold stories was an individual.

subset: commoncrawl


text:
December 26, 2011 in Promotions (E)
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text:
Hangover Helper: Eggs Rancheros at Five Points, NYC
Just what the doctor ordered.
The wood-oven roasted Eggs Rancheros ($15) at Five Points on Great Jones Street is just what the doctor ordered: a big mess of comfort food served in a bowl big enough to send you right back to bed for a post-brunch-nap. Corn tortillas, chopped tomatoes, sharp Vermont aged cheddar, and a handful of eggs are tossed in the sweet-tart tomatillo salsa. Pretty much anything would be delicious in this sauce, but the rich cheese and crispy-edged eggs are a good choice, made even better by a mountain of crisp tortilla chips. I wish the egg yolks had been runnier, though; you may want to request that they spend a little less time in the inferno.
Wash it down with the Bloody Rosemary ($10) if you're a fan of the piney herb; the scent of a whole rosemary stalk might be enough, but this drink is based on rosemary-infused vodka, and it's potent. Served with celery and a salted rim, the rosemary balances the tartness of the tomato juice and the subtly spicy burn. Mimosas and tequila- or vodka-spiked citrus and cranberry "Morning Punch" are also available by the pitcher.
Five Points
31 Great Jones Street, New York, NY 10012 (map) 212-253-5700; fivepointsrestaurant.com
All products linked here have been independently selected by our editors. We may earn a commission on purchases, as described in our affiliate policy.


text:
What did you do on November 9th 1989? Do you remember? I was thirteen years old and sleeping snugly in my bed in Bremen, Northern Germany, West Germany, when my parents woke my younger sister and me up and allowed us to sit down in front of the television in the living room. This felt like Revolution (with a big R) in our children's world: Usually, we were neither allowed to watch TV nor to stay up late, except on New Year's Eve. But this wasn't New Year's Eve nor was the TV showing the traditional end-of-the-year comedy "Dinner for One", where an old lady celebrates her 90th birthday in a circle of friends, each of them impersonated by her butler James who is getting totally drunk. (mehr …)
Artikel-Schlagworte: "Real"
Logged in? How our daily lives have changed since 1989Sonntag, 1. November 2009
Schlagworte:1989, acceleration, Adam Michnik, annus mirabilis, Berlin, Claudio Magris, Dinner for One, Facebook, free movement, freedom, Hartmut Rosa, Howard Rheingold, Huffington Post, Ingo Schulze, internet, Jared Cohen, Karl Schlögel, Konsum, Mauer, movement, Neues Forum, Paul Virilio, Potsdamer Platz, Real, Safari, Tim Berners-Lee, Trabi, wall, World Wide Web
Veröffentlicht in Journalismus | 2.760 Kommentare »


text:
Duplicate Pad Printing Plumstead
Newstyle Print offer high quality low cost duplicate pads printing in Plumstead. Our duplicate pads are some of the cheapest you'll find in Plumstead. Get your online duplicate pad quote now by clicking above. Duplicate Pads are usually used for invoice paper and quotation sheets; widely used in varying industry. We print 2, 3 & 4 ply and finish as sheets, pads or books depending on your needs. A5 – A4 formats are supported.
Our most popular Duplicates are A4, 2 Ply, Single Colour Print and Finished as Pads.


text:
ATLANTA (AP) — Newt Gingrich's political career is coming full circle: The state that nourished his rise to House speaker could strike a fatal blow to his presidential ambitions — even by his own admission.
The former Georgia congressman has acknowledged that a loss in this state's Super Tuesday primary would cripple his campaign. He's betting he can make another comeback in Georgia and a series of Southern primaries during the next two weeks in a go-for-broke strategy to outlast his opponents and seize upon conservative unease with Mitt Romney.
"I have to win Georgia, I think, to be credible in the race," Gingrich said Thursday, responding to a question during a breakfast with business leaders. A day earlier, he said a victory here would be a "key building block that we have to have to move forward in the presidential campaign."
Gingrich told the Cobb Chamber of Commerce that Romney is "Massachusetts moderate baloney" and Rick Santorum is "Pennsylvania big labor baloney. But they're baloney. They're not going to fundamentally change Washington."
He has had perhaps the most topsy-turvy campaign of any Republican, nearly imploding last year and then rising in Iowa before facing millions of dollars' worth of negative attacks that weakened his campaign. He rebounded to win South Carolina's primary on Jan. 21, but since has been on a long losing streak, falling far behind in the hunt for delegates.
The comeback plan is fairly simple: Win Georgia and make a strong showing in neighboring Tennessee, Oklahoma and Ohio, thus picking up enough delegates in the process to compete with Romney and Santorum. He then hopes to pivot to Mississippi and Alabama on March 13 and stay in contention for large-delegate contests in Texas and California.
All bets may be off with a loss in Georgia.
"If he doesn't win in Georgia, where does he win?" said Merle Black, an Emory University political scientist. "In order to have a Southern strategy, he first has to have a Georgia strategy."
Low on cash, Gingrich's cause has been aided by the outside group Winning Our Future, a super PAC backing the campaign that recently received another multimillion-dollar injection from Las Vegas billionaire Sheldon Adelson. The fresh funding bankrolled a large ad buy in states crucial to Gingrich's strategy.
Gingrich boosters say Georgia and other states on the upcoming primary map share many characteristics with South Carolina, giving him a chance to rebound. With Romney facing questions among conservatives, the new ads on the air and a long slate of primaries ahead, Gingrich may have little incentive to exit.
"With Santorum's decline, I believe, Newt will re-emerge as the anti-establishment candidate with a record of economic success," said Rick Tyler, a senior adviser to Winning Our Future and a former Gingrich aide. "The upcoming states are receptive to him and his message."
Gingrich's campaign evokes an underdog mentality. At rallies, aides blast Rick Derringer's 1980s song "Real American" — otherwise known as wrestler Hulk Hogan's anthem — to pump up the crowd. The song's refrain: "Fight for what's right — fight for your life!"
Right now, it all hinges on Georgia.
At rallies across the state, the campaign has cut-out gas buckets to collect small donations, a reference to the energy plan Gingrich says would reduce gas prices to $2.50 a gallon. Gingrich routinely asks supporters to pass out leaflets at gas stations to spread the message and urges people to type "Newt (equals) $2.50 a gallon" in their Facebook status lines.
Although he lives in the suburbs of Washington, D.C., Gingrich has played up his local ties, making stops at the University of West Georgia, where he taught geography and history during the 1970s, and the Georgia Statehouse, where he was joined Wednesday by dozens of legislators wearing buttons that read, "I'm in Newt's Army."
Gingrich routinely criticizes President Barack Obama's policies but has sought to play up Romney's connections to the wealthy. On Wednesday, he accused Romney of receiving substantial donations from people who benefited from the Wall Street bailout. "What you get with Romney is just money. It's just Wall Street pouring money in to try to buy the election," Gingrich said.
Gingrich has led in recent polling in Georgia but faces plenty of hurdles. It has been more than a decade since he represented suburban Atlanta, and a significant portion of the state's population may have little memory of his time in government.
With so many delegates at stake — at 76, Georgia offers the most of any Super Tuesday state — Romney and Santorum are expected to compete here, too. Santorum campaigned in the state Thursday while Romney's wife, Ann, was to make two appearances on his behalf.
But a win in Georgia is unlikely to give Gingrich a clean sweep of the state's delegates.
Under party rules, Georgia has three delegates for each of its 14 congressional districts. If a candidate wins a majority of votes in those districts, that candidate gets all three of the district's delegates. But if a candidate wins by less than 50 percent, the first-place finisher gets two delegates and the runner-up is awarded a single delegate.
Three Georgia GOP party leaders — the party chair and its national committeeman and committeewoman — are automatically awarded to the statewide winner. The remaining 31 at-large delegates are allocated proportionately among candidates who get more than 20 percent of the statewide vote.
"I think he's pulling it together," said GOP strategist Matt Towery, a former Gingrich campaign aide. "The question is: Has the train left the station?"
Associated Press writer Ray Henry contributed to this report.
Follow Ken Thomas on Twitter: http://www.twitter.com/AP_Ken_Thomas
Gingrich stakes his campaign on old Georgia home
ATLANTA (AP) — Newt Gingrich's political career is coming full circle: The state that nourished his rise to House speaker could strike a fatal blow to his presidential ambitions — even by his own admission.


text: Multiple myeloma. Multiple myeloma cells are abnormal plasma cells (a type of white blood cell) that build up in the bone marrow and form tumors in many bones of the body. Normal plasma cells make antibodies to help the body fight infection and disease. As the number of multiple myeloma cells increases, more antibodies are made. This can cause the blood to thicken and keep the bone marrow from making enough healthy blood cells. Multiple myeloma cells also damage and weaken the bone.


text:
Does MAP-21 Bill Revoke Second Amendment for Unpaid Taxes?
Kurt Nimmo
Prison Planet.com
June 22, 2012
Word on the blogosphere has it that the MAP-21 transportation bill allows the federal government to revoke the Second Amendment of citizens accused of not paying taxes.
S. 1813 or MAP-21 (short for Moving Ahead for Progress in the 21st Century) was sponsored by California Democrat Barbara Boxer and passed in the Senate earlier this year. It is described as a "bill to reauthorize Federal-aid highway safety construction programs, and for other purposes."
Critics argue that "hidden legislative jargon" in the bill gives the IRS the authority to grab anybody's passport who is accused of owing $50,000 or more in delinquent taxes.
"According to the text of the bill, if the IRS Secretary is informed by the Commissioner that an individual owes $50,000 or more, the Secretary is authorized to have the head of the State Department revoke the individual's passport. In other words, get audited and have your passport revoked now, fight for your due process later,"Helen Whalen Cohen wrote in April, a month after the bill cleared the hurdles and became law. Specifically, the tax provisions of the bill are a direct violation of the Fifth and Fourteenth Amendments of the Constitution.
A post on the Franklin County Va. Patriots blog reports that gun rights activists are also concerned the government will use additional legalese in the bill to deny the Second Amendment to gun owners also behind taxes the IRS claims they owe.
According to the blog, activists are worried about pages 1320-1324 in the MAP-21 bill:
This subsection is entitled, "Firearms." While the wording is in obscure legalese, it seems to be saying that the person designated as "the Secretary" is given broad powers over permits and the revocation of permits. And this power is described under the section that specifically deals with firearms.
Lawyers may debate whether or not the wording of the bill gives the IRS the power to suspend gun rights. But government watchdogs have become alarmed over the tendency of legislation to be written in such a manner as to create broad leeway for interpretation, meaning that nebulous wording often leads to an interpretation of the law that confirms the suspicions of many citizens that the federal government is relentlessly engaged in power grabs aimed at limiting the Constitutional rights of Americans.
The Rest…HERE


text:
Rosa Acosta Says She Wasn't Feelin How Maino Was Talking To Her On Shade 45! "He Was Very Rude. It Was Too Much" + More Streching With Jeans On
Rosa Acosta on Maino
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Law School Discussion
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Online LLB
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Online LLB
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Online LLB
November 03, 2012, 07:45:35 PM »
Well here it is in black and white, yes you can qualify in California and elsewhere with an online LLB and LLM.
I find it all very distasteful - New York will accept a foreign online LLB/LLM student but refuses to permit qualified California lawyers with a California online degree to take the New York bar.
With all due respect to the University of London, English law is quite different from American law.
Secondly, how can new New York justify refusing to let California attorneys take their bar because they have an online degree yet let foreign online students and lawyers take the same bar?
Maintain FL 350
Re: Online LLB
Reply #1 on:
November 03, 2012, 08:56:46 PM »
I completely agree, it's absurd. If an individual can pass the California bar, isn't that a far better indication of their legal acumen than the fact that they hold a degree from an online foreign school? Pure snobbery, that's the issue. Bar associations tend to be archaic, fussy, and elitist. A British degree, even if it's from an online school, sounds better to the petit bourgeoisie than a non-ABA California school.
A few questions:
1) Does NY require that the applicant be a licensed solicitor first? California's rule on this particular aspect is still unclear to me.
2) Don't LL.B programs usually require some supervised training in order to earn the degree, a sort of practicum? If so, it would seem very difficult for an American to complete an LL.B online. Wouldn't they have to secure a training contract? Or is the training only required to qualify as a solicitor?
3) If an individual's only exposure to U.S. law is a one year long LL.M program, and maybe BARBRI, what are the chances of passing the CA or NY bars?
I ask these last two questions because I don't really understand why an American law student would choose to pursue an online LL.B rather than an online or correspondance J.D. (assuming they plan to practice in the U.S.). An American J.D. doesn't require the added expense of an LL.M to meet bar eligibility, and actually teaches American law (which you may encounter on say, an American bar exam).
I suppose if the individual holds dual citizenship, like my family does, and plans on eventually moving to the U.K., it might make sense. Otherwise, the chances of landing a job in the U.K. are pretty minimal.
Re: Online LLB
Reply #2 on:
November 04, 2012, 06:31:57 AM »
I can answer some of that since I am dually licnesed in the US and England:
1. One needs to complete a Training Contract with a LLB before one can be licensed as an English solcitor.
2. Based on the UoL info, it seems an online LLB plus a US LLM is sufficient to gain a bar ticket in a few states regardless of being licensed or not in a foreing country.
3. February 2012 CalBar stats showed a 17% pass rate for applicants with foreign law degrees.
Now get this, with my California license and online bar degree, I had no problem getting an English solictor license via the QLTT (bar exam).
If you have 2 years experience as a California lawyer, check out the new QLTS process. No need to set foot in England just an exam in New York or elsewhere. The English practising license is very handy even if one never sets foot in England. Permits one for example to practise before the EU General Court, European Court of Human Rights etc. and act as a commissioner for oaths.
You can also qualify as a solcitior or barrister in several of the British overseas territories - TCI, Grand Cayman, BVI, Falklands etc
Maintain FL 350
Re: Online LLB
Reply #3 on:
November 04, 2012, 09:41:13 AM »
Quote from: jonlevy on November 04, 2012, 06:31:57 AM
3. February 2012 CalBar stats showed a 17% pass rate for applicants with foreign law degrees
17% is roughly equivalent to many online/correspondance J.D. programs. However, I imagine that the majority (perhaps the vast majority) of foreign applicants attended traditional brick and mortar universities. Presumably this statistic includes Canadian law students who took American J.D. courses through various programs as well.
The pass rate for online foreign grads may in fact be significantly lower.
Although foreign online grads are permitted to seek admission, how many (if any) have actually succeeded?
Again, I'm not trying to be argumentative or overly critical, but this seems like such a circuitous route to bar admission. The statistical probabilities are stacked against the applicant.
Re: Online LLB
Reply #4 on:
November 04, 2012, 04:10:52 PM »
The whole thing makes no sense unless one becomes a solicitor first. But as we have noted that is not going to happen without a training contract which is usually not going to be extended to a non EU citizen.
On the other hand I would say that the online LLB is way better use of time than a EJD. Even w/out the solicitor license, one has options:
Maintain FL 350
Re: Online LLB
Reply #5 on:
November 05, 2012, 09:16:41 AM »
How would compare the QLTS to the bar exam, in terms of difficulty?
Re: Online LLB
Reply #6 on:
November 05, 2012, 10:27:01 AM »
I took the predecessor test, the QLTT, it was a three day exam in New York. Pretty tough but it was open book and the study outlines provided were by the company giving the exam! The material tested was all new to me: legal accounting, ethics, property conveyancing, etc.
Besides me there were never more than 4 other exam takers in the room, sometimes just two others.
QLTS info is here:
Unfortunately, looks like you would have to go to the UK to take it.
Looks like they have erected more hurdles.
Maintain FL 350
Re: Online LLB
Reply #7 on:
November 05, 2012, 10:49:03 AM »
Sorry, I meant the solicitor's exam (the QLTT?). I take it the QLTS is for barristers?
My main question is, did you find it necessary to approach the QLTT as you would the bar exam, ie; several months of studying/practicing. Was it a question of primarily learning new vocabulary, or new substantive law?
Re: Online LLB
Reply #8 on:
November 05, 2012, 01:20:49 PM »
QLTT was phased out in 2010 in favor of the QLTS.
Becoming a barrister is possible but would involve a pupilage and going through the English Bar instead of the Law Society.
I approached the QLTT like a bar exam except that the law tested was similar but different from the US. The open book aspect however made it possible to pass.
As I understand it, no more open book exams (actually you could bring in any notes etc, books, whatever) with QLTS and no more test prep materials provided by the examiner.
Obviously it is still possible to become solicitor but not so easy anymore.
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Law School Discussion
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Online LLB


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Inserting Hyperlinks to Files in Online Storage
If you have an Online Storage account, you can insert a hyperlink to one of those files in your Workspace Webmail messages.
To Insert Hyperlinks to Files in Your Online Storage
- Click the Compose button.
- Click Insert Link.
- Select Insert Online Storage Link.
Note: The folders display in the folder tree on the left. You can navigate through the folders to locate the file you want to attach.
- Locate and select the file you want to attach.
- Click OK.
- Continue composing your email message.
For more information, see Composing Email Messages.


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This page has been permanently moved. Please
CLICK HERE to be redirected.
Suppose there is a batch process running in a single serial processing stream. For some good reason, the serial process is re-architected to run as two parallel processes, that is in two processing streams. We would expect the modified batch process to finish in about half the time because we have doubled the number of parallel streams allowing the work to flow into the system at twice the rate.
Thanks, Craig.
Let's quantify this so it becomes a little more practical. Suppose a serial batch process runs in 50 minutes and processes 100 transactions. There are actually three variables in this scenario. The first is the number of parallel streams, which is 1. The second is the duration, which is 50 minutes. And the third variable is the total workload, which is 100 transactions. The general relationship between these three variables is:
duration = total workload / parallel streams
Let's think about this for a bit. If the total workload increases while the number of parallel streams remains constant, the duration will increase. And if the total workload remains the same yet we increase the number of parallel streams, the duration will decrease. So it follows that if it takes 50 minutes to process 100 transactions with a single stream, then it will take 25 minutes to process those same 100 transactions with two streams. If three streams are used, then it will take around 17 minutes, four streams 12 minutes, and five streams 10 minutes. I created a simple plot based on this situation as shown below.
There are a few things I want to highlight. First, the resulting plot of duration versus parallel streams is not linear. This can be easily seen in the above plot. This is typically surprising because the are no variables raised to a power greater than one. But if you think about it, it does make sense. When going from two streams to three, we are not doubling the work flow, instead we are increasing the work flow by one-third. To double the work flow, we would need to double the parallel streams, from two to four, or from three to six, and so on.
The second thing to notice is the duration benefit per parallel streams decreases as we add additional streams. Looking closely at the above plot we can see that once you get beyond, let's say, ten parallel streams it will take quite a few more streams to significantly reduce the process duration.
The third interesting aspect of this situation is the computing system must be able to handle the increased workload rate. Keep in mind that if we double the number of pipes, the workload will come rushing into the computing system at twice the rate. The system must be able to handle this workload increase or we will loose the benefit of the multiple streams. This is the classic rainy season or spring time snowmelt river overflow situation where the increased water flow cannot be "processed" quick enough. This topic will be explored in a future blog entry.
The fourth interesting aspect of this situation is, it is a best case scenario. We are getting the same amount of work processed per parallel stream. That is, there is no overhead or loss of power when we keep adding parallel streams. But we know in our gut this will not occur... and for a surprisingly large number of reasons. This will be the topic of my next blog entry.
So to summarize this entry, increasing parallelism will also decrease process duration because we are allowing the same amount of work to enter a system within a shorter time span. So instead of 100 transactions entering the system in 50 minutes, we are allowing those same 100 transactions to enter the system in 25 minutes. I also mentioned this is a best case scenario and there are a number of reasons which limit the continuing benefit of increasing parallelism.
Thanks for walking with me through this parallelism journey,
P.S. If you want me to respond to a comment or have a question, please feel free to email me directly at firstname.lastname@example.com. I use a challenge-response spam blocker, so you'll need to open the challenge email and click on the link or I will not receive your email.


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9 of the top 10 transfers in football history have been paid for either playmaker or strikers. Whilst a team can be drilled into defending and stopping the opposition, in the final third the extra money is paid for players who have something natural; either the vision to play a slide rule pass or the composure and ability to score. In the summer our continued lack of finance led David Moyes to turn to free agent Jermaine Beckford to boost our striking options at the club. This article will examine the impact he has made this season both individually and in comparison to the club's other forwards. We will look at his strengths and also analyse the areas of his game which are still very much a work in progress for the speedy forward….
This campaign Beckford has scored 8 goals from the 13 games he has started, albeit there has been a lot of sub appearances on top of that figure. During the times when he hasn't been finding the net his confidence has not been affected and he has a real appetite for hitting the ball early, as shown by his blockbusting volley against Blackpool this season. The below stats show his goalscoring record and shot completion stats in comparison to our other forwards currently at the club….
Throughout his career he has averaged a 1 in 2 ratio, albeit in the lower leagues. The campaign started slowly for him, failing to register a league goal until November. There are clear signs though that he is finding his feet and has now racked up goals on a regular basis since the turn of year . I think Moyes would have set a target in his mind of between 10-12 goals so this is well within reach.
His partnership with Saha also looks promising. In the 5 games they have started since the turn of the year the Blues have won 4 and drawn one, and looked much more penetrative in behind opposition defences.
"What will be different for him is other parts of his game which will be required in the Premier League. Can he link us up, hold the ball up and help us out in other situations?"
David Moyes, July 2010
This is an area in which Beckford has a great deal of ability, both inside and outside the box. His 8 goals are below loaded onto a chalkboard, all of which coming from inside the box where he really comes alive.
Moyes has been very complimentary about Beckford's movement in the press:
"His movement is as good as anyone I've seen, and it's the best of any of our strikers. His movement outside the box is good too. his movement in the box is as good as I have seen from a lot of the best. He can lose defenders and go one way and then the other. He is fantastic at that."
David Moyes, Feb 2011
A classic Beckford goal for Leeds angling a run from left to right to finish with his right
Beckford goal v Sunderland, curved run into the Mackems penalty area
Hold up/link up play
This is for me the biggest weakness in his overall game. He struggled particularly early on this campaign when he was the lone striker, his stats against Villa for instance where he only won 2 out of 7 tackles and 4/5 of his aerial challenges showed that the ball wasn't sticking. His pass completion rate of 64% is decent for a Premier League Striker in terms of linking up the play, but not spectacular. Alongside Saha however, who has the capability to hold the ball up as a targetman, Beckford is able to play in a role he is more accustomed , making runs around Saha for the ball. David Moyes said as much after the derby game in which the ball repeatedly didn't stick with Anichebe and Beckford upfront.
Beckford chalkboard for challenges vs Aston Villa, Sept 2010 – blue are those won, red are those lost
Beckford has certainly brought something to the table for the Blues this season. Our goal per game ratio with Saha and Beckford starting together in games since the turn of the year has been 2.4 (season average 1.5). With Cahill & Yakubu up top we where strong in terms of hold up play an aerially but extremely limited in terms of getting in behind defences which requires pace and movement. Beckford has this in abundance and whilst he has a lot to learn in terms of hold up play and as a link man, you cannot doubt that he brings us something we have been clearly lacking since the exit of Andy Johnson in 2008.


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Is loyalty dead? Between the increase in month-to-month offerings and health club membership buyouts and the latest flood of member lawsuits, you could easily conclude that loyalty is a thing of the past. No longer can members be expected to stick around for long, much less to rebuff tempting offers from competitors or to give club operators the benefit of the doubt when issues arise. Is this the new reality of today's economy and consumer-empowered culture?
As tough as it may seem, you should still try to develop long-term relationships with customers, but you must go about it differently now. Instead of expecting customers to be loyal, you must reward them with your loyalty and actively show that you value their business. How? By demonstrating trust, practicing transparency and thanking them for their business in tangible ways.
Demonstrate trust. In his latest book "Enchantment: The Art of Changing Hearts, Minds and Actions," Silicon Valley business leader Guy Kawasaki explains that trust is a sequence, not a chicken and egg thing. We must trust others before they trust us.
Some of the most loved companies—Amazon, Zappos, Nordstrom—have generous return policies. They have trusted their customers from the start. In return, their customers have returned the goodwill with sales, positive word of mouth and loyalty.
In the same way, you should trust your members. People generally rise to what is expected of them. Lengthy contracts, restrictive policies and demeaning placards detract from building a relationship of trust. Instead, use simple, positive communication to demonstrate your confidence that members are not going to exploit special services or to abuse member privileges. And, make sure your employees have a "yes" attitude and give people the benefit of the doubt.
Practice transparency. With the technology that is available to consumers these days, hiding behind confusing policies or a corporate façade is no longer an option. You are better off embracing transparency as a business practice.
That means being open about the various offers and promotions you are running and clear about the terms of membership. Trying to dupe people into accepting an offer or terms that they don't understand or believe is your best deal will not win you happy customers—and your swindling will probably be exposed eventually. Plus, if you find yourself frequently in the difficult position of explaining the rationale behind your practices, you may want to rethink them and replace them with fairer ones.
Transparency also requires you to fess up when you have made a mistake or have done something wrong. A sincere apology and an explanation of how you are ensuring the error will not happen again pay dividends in goodwill. Down the road, people are more likely to remember your integrity than the error.
Involving members in developing new programs and identifying solutions to problems is another way to practice transparency. Actively solicit members' input—they will feel more ownership for the results and form a stronger bond with you.
Give tangible thanks. Showing that you appreciate your customers and their business is a surefire way to facilitate feelings of loyalty.
Although simply acknowledging and thanking members for their continued patronage are important, you must also tangibly demonstrate your appreciation. Offer them both economic and emotional benefits.
Some ideas:
- extended hours and designated parking to make visiting your club more convenient
- holding the line on prices even when your costs increase
- exclusive offers and promotions for long-time members
- priority access to classes, child care, prime locker space, etc.
- "power hours" during which all employees are focused on helping guests
- phone calls or emails following up on training sessions to ensure they are satisfied
- "value-added" services such as a car wash while they work out or a coat and bag check
- occasional gifts from your retail selection
Yes, these tactics cost money, but they are wise investments because the payout is increased loyalty. And, according to some sources, acquiring a new customer can cost six to seven times more than retaining an existing one, so it makes more business sense to make loyalty a priority.
Above all, we should not take our members for granted. Today's consumers may be more promiscuous and loyalty may not be what it once was, but you will still be better off if you develop a core group of members who stay with you for the long run. If loyalty is seen as a commitment that you make to your members—in addition to one you want them to make to you—you will be better for it.
Denise Lee Yohn has been inspiring and teaching companies how to operationalize their brands to grow their businesses for more than 20 years. Health and fitness brands, including New Balance, Road Runner Sports and Designer Whey, have called on Yohn, who is an established speaker, author and consulting partner. Read more by Yohn at http://bit.ly/DLYohnArticles.


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Supervising SLPs retain full legal and ethical responsibility for the students, patients, and clients served but may delegate specific tasks to an SLPA. The SLPA may execute specific components of a speech, language, or feeding program as specified in treatment plans developed by the SLP, provided that
Speech-Language Pathology Assistant Scope of Practice includes guidance on
SLPAs who have the necessary skills in a second language may serve as interpreters when needed. Bilingual SLPAs providing clinical services in a language other than English may do so within the scope of specified ASHA-approved job responsibilities and under the supervision of an ASHA-certified SLP.
The ASHA
Code of Ethics specifies the ethical obligations of SLPs. The Board of Ethics does not adjudicate ethical complaints against SLPAs. The SLP supervisor is responsible for ensuring ethical conduct of the SLPA.
Because the ethical responsibility for patient care or for subjects in research studies cannot be delegated, the SLP or speech scientist takes overall responsibility for the actions of the assistants when they are performing assigned duties. If the assistant engages in activities that violate the Code of Ethics, the supervising professional may be found in violation of the code if adequate oversight has not been provided. Any individual who is working in a support role (technician, aide, assistant) under the supervision of an SLP or speech scientist must be knowledgeable about the provisions of the code.
Issues in Ethics: Speech-Language Pathology Assistants.
Assistants who affiliate through the
ASHA Associates Program agree to
Because the ethical responsibility for patient care or for subjects in research studies cannot be delegated, the SLP or speech scientist takes overall responsibility for the actions of the assistants when they are performing assigned duties. If the assistant engages in activities that violate the Code of Ethics, the supervising professional may be found in violation of the code if adequate oversight has not been provided.
Principles and Rules from the ASHA Code of Ethics that specifically address issues pertinent to when an SLP supervises support personnel in the provision of services or when conducting research.
Individuals who engage in the delivery of services to persons with communication disorders are potentially vulnerable to accusations of engaging in unprofessional practices. ASHA recommends that SLPAs have liability insurance. Some employers provide liability coverage for all employees, while other employers defer to the employee to acquire this insurance independently. Some universities provide coverage for students involved in practicum/field work. SLPAs should check to see if, and to what extent, they are covered by existing liability insurance, prior to providing services.
After evaluating existing coverage, SLPAs should evaluate whether or not to purchase liability insurance as a protection for malpractice. A benefit of the ASHA Associate Program is the ability to purchase liability insurance at a group rate through Mercer Consumer Group.
Educational requirements and preparation of support personnel in speech-language pathology vary considerably from
state to state and by practice setting.
ASHA does not accredit or approve SLPA education or training programs, nor does ASHA review, evaluate, or rank them in any way; however, it does maintain a list of self-identified
technical training programs for SLPAs. Placement on this list does not indicate any endorsement by ASHA, nor is this list meant to be exhaustive.
Sample course work and field work for the SLPA bachelors or associate degree programs include
General education: The general education sequence typically includes, but is not limited to, course work in
Technical content: Course content provides students with background information in communication disorders and technical knowledge to assume the job responsibilities and core technical skills for SLPAs and typically includes these categories:
Observation: Observation experiences include direct, on-site observation of an ASHA-certified SLP. Additional observation experiences may include pre-approved (by the supervising SLP) on-site or video observation of an ASHA-certified SLP.
Field work experiences (a minimum of 100 clock hours is recommended): Field work provides appropriate experiences for learning the job responsibilities and workplace behaviors of the SLPA, under the supervision of an ASHA-certified SLP. These experiences are not intended to develop independent practice.
In addition to employer-provided assessment tools, ASHA offers a
verification of technical proficiency of SLPAs [PDF], which can be used to verify achievement of core skills in the areas of clinical/administrative skills, conduct in work setting, and technical skills as prescribed by the supervising SLP.
There is the potential for a career continuum—from SLPA to SLP—depending on the state and work setting regulations in place for the intended state of practice. Traditionally, the support personnel career continuum has not been specifically intended as such because the associated course work and field work experiences required in the SLPA program may differ from those at the bachelor's, pre-professional, or master's levels.
Anyone interested in pursuing academic course work and field work as an assistant prior to entering the field of speech-language pathology should check with bachelor's degree programs and master's degree programs in speech-language pathology in his or her state to determine if any courses taken in the associate degree speech-language pathology assistant program will be credited for future studies.
Speech-Language Pathology Assistant Scope of Practice includes specific guidance for supervisors of SLPAs, including
Regulations for speech-language pathology support personnel in educational and other practice settings vary from state to state. Differences may be reflected in a number of requirements, including education, supervision, continuing education, titles used for support personnel, or the lack of regulation or laws. See ASHA's
State Support Personnel Trends chart [PDF].
state-by-state pages provide summaries of state requirements for support personnel. For the most current information, prospective SLPAs should check with the state licensure board and department of education for the requirements for specific practice settings.
Issues may arise when SLPAs or other support personnel travel across state lines. Their activity may not be recognized by various funding sources, and different states may not recognize the SLPA's credentials.
The Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004):
Section 300.156(b)(2)(iii) of the
IDEA 2004 "allows paraprofessionals and assistants who are appropriately trained and supervised, in accordance with State law, regulation, or written policy,...to be used to assist in the provision of special education and related services...to children with disabilities."
Elementary and Secondary Education Act (ESEA): Title I of ESEA, designed to help disadvantaged children, also allows the use of "properly trained paraprofessionals" who work under the direct supervision of highly qualified teachers and who may be used to "reinforce and augment a teacher's effort in the classroom." The role and use of paraprofessionals is defined in this
non-regulatory guidance paper [PDF].
The use of assistants can improve access to and reduce costs of quality services. It is appropriate to bill for the service provided; however, Medicaid reimbursement of SLPAs varies from state to state. To determine coverage in a specific state, consult the website
National Association of Medicaid Directors (NAMD) [PDF].
Medicare policy currently does not recognize SLPAs, regardless of the level of supervision and does not reimburse for SLPA services.
Private insurers may cover licensed or registered SLPAs. One must query each payer to verify coverage. Private insurers may or may not provide a different rate of reimbursement for services provided by an SLP as opposed to an SLPA.
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QLogic says it is at the front of the FCoE queue. Talking with Henrik Hansen's QLogic's EMEA marketing director, we learn that QLogic is convinced it is well ahead of Emulex and Brocade with its Converged Network Adapter (CNA) efforts.
These 8100 series cards, featuring a second generation ASIC, are available in 1- and 2-port versions using either copper wire or optical cable connects. Hansen said Cisco's Nexus requires a passive copper wire, whilst Brocade needs an active one. On the optical side, QLogic will support all the SFPs (Small Form-factor Pluggables) transceivers needed by the switch vendors. The card includes a single ASIC including processor, memory, SerDes, and FCoE offload engine. (Brocade's CNAs also include full FCoE processing).
QLogic's first generation CNA had a quite large form factor with five separate chips on it. A Nuova FCoE ASIC, an Intel 10GigE chip, a QLogic 4Gbit/s Fibre Channel HBA chip, a PCI switch, and a SerDes. These functions were combined into a single ASIC for the gen 2 CNA, the same size as QLogic's 8Gbit/s FC HBA.
CNA qualification
QLogic is working to get tier 1 server vendor qualification, meaning Dell, HP, IBM, honorary tier 1 server vendor Cisco, and also Sun, classed as a near-tier 1 server vendor in my book. It has design wins from amongst these server vendors, it says, but none can be made public yet. This is the same general stance on FCoE server qualification that Brocade and Emulex have: "Yes we have design wins; no we can't say who." Hansen did mention that Nehalem-based servers were involved though.
The company is also working on CNA qualification with Cisco switches, Brocade switches, Ethernet switches from Blade Network Technologies, and is also involved with networking vendor Juniper. However, Hansen isn't aware of any engineering engagement by Juniper.
QLogic is also working on qualification with Broadcom, Intel, and Neterion, and these three are talking about getting into the FCoE space. If they used hardware FCoE processing, via QLogic, then FCoE performance would be faster than using an FCoE software stack from Microsoft on the host server.
Hansen believes that the server vendors are getting QLogic CNA hardware months in advance of Emulex, and Brocade: "It's at least a four months lead."
Interestingly, Emulex says it has announced CNA and OEM shipment two months before both QLogic and Brocade. Make of this claim and counter-claim what you will.
He doesn't think there is any customer mileage to be gained by coupling particular CNAs and switches to gain better storage access performance or quality of service, as Brocade is promising with its FCoE products, saying: "I don't believe customers will buy CNAs unless they are complely standard. They wouldn't want to be tied down to a specific choice of CNA vendor."
He reckons that the sever vendors won't be sympathetic to a linked Brocade CNA-to-switch play, even as a counter to CIsco's UCS blade server and switch system, because they know their customers won't want to step into a Brocade walled garden. He thinks that with QLogic's greater than 70 per cent share of blade server Fibre Channel connections and 58 per cent worldwide share of 8Gbit/s HBAs, Brocade will have to link its 8000 switch to QLogic's CNAs as well as its own.


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1155 S. Dale Mabry Hwy, Suite 10
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In the Palms Plaza at S. Dale Mabry & Watrous Ave.
Hours of Operation
Monday - Friday: 8 a.m. - 7 p.m.
saturday: 9 a.m. - 4 p.m.
Sunday: Closed
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|Welcome to Mott & Hester Deli. Proudly serving the Tampa Bay area from the same South Tampa location since 1982.
Our menu features fresh homemade pasta and sauces, our famous mouth watering sandwiches, and salads served with housemade dressing.
Our "hot box" is also loaded with our delicious homemade specialties like Sicilian Chicken, Chicken Marsala, Cajun Fried Chicken, Mac & Cheese, Spinach Artichoke and Squash Caserole.
Mott & Hester Deli provides World class catering services. Let us cater your next event, party or office meeting.
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The mikroProg for 8051 is a fast in-circuit programmer that supports the Atmel AT89 family of microcontrollers (15 devices). The programmer communicates with a PC through a USB cable, from which it also draws power.
The mikroProg for 8051 is supported in mikroElektronika compilers, or can be used as a standalone programming tool with the included 8051Flash software.
For connection with a target device, mikroProg uses a 2×5-pin IDC10 connector. The pinout is the same as was used by mikroElektronika's previous 8051prog2 programmer, so any boards that were designed for the 8051prog2 can be programmed with the mikroProg-8051 too.
A nice feature of this programmer is how the ribbon cable goes into the device. It weaves through a slot on the PCB, so tugging on the cable cannot damage the internal connector.


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Can Diet Play a Role in Pain Management?
by Pamela Katz Ressler, RN, MS-PREP, HN-BC, adjunct faculty Pain Research, Education and Policy (PREP) program at the Tufts University School of Medicine, and moderator of the PREP-Aired Blog
Can diet be a tool in our pain management arsenal? According to McGill professor and researcher, Dr. Yoram Shir the answer is yes. The Pain Research, Education and Policy Program (PREP) was honored to host Dr. Shir on February 9, 2012 and hear about his fascinating research on the association of pain and diet. Dr. Shir, director of the Alan Edwards Pain Management Unit at McGill University Health Centre, related that moving his lab from Israel to the United States created an unexpected opportunity to study the effect of different standard diets on pain in animal models (lab rats). The combination of type of protein as well as type of fat suggested an influence on pain in the animals studied.
Exploring the observation of a correlation between diet and pain, Dr. Shir began testing various combinations of protein and fat. Interestingly, a diet high in soy protein and omega-3 fatty acids appeared to inhibit pain, while a diet rich in canola oil appeared to increase the pain response. Small pilot studies with human subjects, those suffering from neuropathic pain, have been promising, but larger studies will be needed to further generalize the findings.
The Pain Research, Education and Policy program thanks Dr. Shir for sharing with us his exciting research in diet and pain.
4 comments February 27th, 2012


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I'm very interested, backed Pauleta to be Golden Boot after seeing this group...*crosses fingers and hopes*
I'm very interested, backed Pauleta to be Golden Boot after seeing this group...*crosses fingers and hopes*
Never has great tournaments though, scored three against Poland in the last World Cup but other than that he has been woefully unimpressive in the big tournaments and games. However he has a chance of getting quite a few tonight against Angola, Portugal usually stick five or more away against their former colony.Originally Posted by thewizard1o1
Can't argue with that, thou this his close to his last chance on one of the 'big stages' and in this group i just think there is a good chance he could bag quite a few goals.
I wouldn't be too surprised to see Cristiano Ronaldo bring out one or two new items from his box of tricks this evening. Angola will certainly give him the opportunity.
Well, people from Central America, The Middle East or Africa might just be slightly interested.Originally Posted by Travis_Teh
Don't reveal your racist arrogance too early in the topic.
Nigel Clough's Black and White Army, beating Forest away with 10 men
Wow, 1-1 after 36'. Heaps of scoring opportunities for both sides already, Iran really should've scored earlier on.
Tough luck for the Iranians but you knew as soon as Ali Karimi departed they were just going for the draw.
Mexico have truly put the game beyond doubt now.
Sir Alexander Chapman Ferguson = Greatest Ever Manager
"One from ten leaves zero." - Eric Williams, former T&T PM
Member of Cricket Web Green
Member of Northside Power
R.I.P Fardin Qayyumi
if only Torrado had got the first, i'd be up £155
Ha, got a prediction right for once. Now for Angola to draw against Portugal.
Iran were pretty good I thought. 3-1 was harsh on them after a good first half, but in the second half Mexico dominated, and the result reflected that pretty well. Doubtful that Iran will qualify now, but Portugal will have to be careful against them anyway, as they're obviously capable of playing very well.
First half was really entertaining too. Good match.
It's cold on the outside they say
But the cold leaves you clear while the heat leaves a haze
Anyone notice how the England game was easily the most boring of the games so far? I was more interested by this game between two middle-of-the-road sides than I was by our turgid effort.
If the first few seconds are anything to go by, Angolan GK will be in for a long night.
One nil Pauleta, this could get ugly.
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