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I guess the celebration started last night when I went to dinner at Frederiks Have in Copenhagen with a few (hopefully this is nerdy enough for you people) MD, PhD ophthalmologists. Have I mentioned you need to have an impressive cv to eat at the same table as me?
Then, the real treat, the 12 mile run in torrential rain. For once I wore my Garmin, so I knew exactly how long the whole thing took and the distance. It took 3 hours and 1 minute, but I almost felt baptized afterwards. How does it feel to feel baptized, you ask? Well, like it is going to be a good year. My year honestly never starts January 1st, but always on my birthday, June 23rd.
This year I'll be the mom of another little boy.
This year I'll work 10 hours a week.
This year will be spent half in Næstved Denmark and half in La Crosse, WI.
This year The Lorax will learn English.
This year I will get to know my stepson Andreas again.
This year I will set a PR in the 5k, 10k, half marathon and marathon.
This year I will complete an Ironman (well, that might actually be in August next year)
This year I will win Voyageur.
This year I will become slightly less effective at evacuating my colon.
Okay, okay, okay. I know I won't win Voyageur. But beat my 9:43 from 2009? Definitely.
Here I is, just baptized. I don't know why I don't look wet, but trust me, I am soaking.
Wider from the sider.
And here is the birthday present SR bought me, along with birthday money from his parents. They just don't know it yet (Thank you!). A bike for every day. The child seat needs to be added, but otherwise she's ready and fast. My old bike was terrible, but don't get me started. Okay, DO get me started - you had to pedal backwards to break and that resulted in me almost dying at least 15 times when I attempted to use the broken hand break. And it was SO heavy that I couldn't even keep up with The Lorax.
(No, I didn't run over those bags, I just set them there, okay?)
And WHAT on earth is that sitting in the freezer? Nope, no mashed potatoes there. It is extremely fine-ground, very cooked cauliflower mixed with egg, tomatoes, zucchini and pasta (whole wheat pasta - anything else is crap). The soy sauce is yet to come. Ahhh! Now you all know what I like to eat for dinner - but it changes every night. This was just my birthday rendition.
So all of this was fine and good, but it was not quite the same as...
Oh, dear, I am starting to cry now.
Want to give me a birthday present? Well, you guessed it: I want a running song suggestion from you! Please! Or just a hello.
One more thing. Just because you will love it (thanks, Magnus).


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Experience an entire semester of in-depth art exploration! This compelling 16-week class, specifically designed for homeschoolers ages 9-13, will delve into drawing, painting, sculpture, sewing, clay and more. Homeschool Art will be the ideal support to the creative homeschooler with time for both open ended artistic exploration, along with building skills and learning new techniques. During this course, students will choose an in depth independent study project and will be supported throughout the process--from the idea stages through to completion. Students will also work together as we learn to support each other as artists through discussion and collaboration.
Back to All Events
Earlier Event: January 9Intro to Acrylics
Later Event: January 10Clay Makers (Ages 5-10)

subset: commoncrawl


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Is Le-Vel THRIVE legit, or is it a scam? How could 3 simple steps make such a big difference? Believe us, we've heard these questions a million times over, and they're valid. When it comes to THRIVE, the results speak for themselves. Below are real Le-Vel THRIVE reviews from real people. Whether you want to try THRIVE yourself, or learn about promoting your own business, we are a company that enables you to live the life you truly deserve and live your best life - the THRIVE life.
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�Surprises are foolish things. The pleasure is not enhanced, and the inconvenience is often considerable,� said Jane Austen.
Well, I always hate to disagree with the usually astute Miss Austen, but sometimes, surprises provide a lot of pleasure and no inconvenience at all.
Take, for instance, the new Barbra Streisand/Seth Rogan comedy, �The Guilt Trip.� Box-office and reviews have been middling. But � surprise! � the movie turns out to be not nearly as bad as the worst reviews proclaim, or the trailers indicate. Indeed, this modest (and modestly budgeted) movie is considerably more charming than the most deadly reviews insist.
There�s nothing groundbreaking here. This is a minor film, in the manner of some past Streisand comedies, such as �For Pete�s Sake� or �The Main Event.� Nobody�s going to begin a tribute reel to Streisand with anything from �The Guilt Trip.� But a grand film was not in the grand design. Barbra knew it. Her co-star Rogan (to whom I am usually indifferent) knew it, and director Anne Fletcher knew it. This is cozy cinematic comfort food; a mother-and-son road trip in which bridges are mended and a few built along the way.
The mistake of �The Guilt Trip� is not so much anything in the film itself, but rather the timing of its release. Christmas season, with its ultra-big, ultra-violent, ultra-unrealistic blockbusters was no time in which to shoehorn this small offering. It screams for a Mother�s Day release. Did director Fletcher (or Barbra) or Paramount Pictures decide that was too obvious? If so, too bad. Because what is being lost on weary end-of-the-year audiences is an appealing Mr. Rogen, and a truly charming, relaxed, and humorous Miss Streisand. The script doesn�t knock you out, the visuals are pedestrian.But this matters very little. In fact, I found the old-fashioned look of it to be rather soothing, in face of relentless CGI and spectacle.
�The Guilt Trip� is really all about the chemistry between Barbra and Seth. Yeah, I know � it seems like it couldn�t possibly work, but it does. And it does so without anything audiences might have come to expect of either star. Rogen doesn�t indulge his wacky gross-out side, and Streisand delivers a far finer-grained performance than in the hugely popular �Fockers� movies. What accounts for her unstrained demeanor I cannot say. She is certainly always better when she doesn�t burden herself with producing or directing chores.


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Dems go all in for abortion rights
This was supposed to be an election in which the economy dominated the debate, social issues took a backseat and the culture wars were put on hold.
Yet in the homestretch of the 2012 campaign, abortion politics is coloring races up and down the ticket.
Story Continued Below
And it's by design.
Democrats have gone all in for abortion rights, with none of the hedging or defensiveness they've shown in recent years — a subtle but striking repositioning with political consequences that extend far beyond Nov. 6.
( Also on POLITICO: Obama: Stay out of women's health)
The evidence of it is impossible to miss. The airwaves are choked with messaging about women's reproductive health. Abortion rights advocates had prime speaking roles at the Democratic convention. Contraception advocate Sandra Fluke is a prominent campaign trail surrogate. Cecile Richards, head of Planned Parenthood, recently introduced President Barack Obama at a Virginia campaign rally.
While Democrats have long supported a woman's right to choose, this year's full-throated embrace of abortion rights — from the president down to the most obscure House candidate — marks a historic departure that now places the party as firmly and unyieldingly in support of abortion rights as the GOP is in opposition.
( Also on POLITICO: Obama campaign pushes on Mourdock rape remarks)
The long-term implications of that shift worry some Democrats — who long shied away from being the party of "abortion on demand," in the phrase of their GOP opponents, to avoid alienating voters who favor some restrictions or find it morally troubling. But with the White House and Senate hanging in the balance, Obama and the party have replaced that political caution with a new political calculus — that it's the GOP that looks extreme and out of touch, particularly to women voters who will help decide the election.
Democrats point to controversial statements of GOP Senate candidates such as Richard Mourdock of Indiana and Todd Akin of Missouri, and a Republican legislative agenda — both in statehouses and in Congress — as the forces driving the heightened focus on abortion rights. They're especially incensed by the GOP's fight against the Obama administration's contraception rule and the drive to defund Planned Parenthood — putting new issues on the table that, in their view, shouldn't be controversial.
( Also on POLITICO: Mourdock's survival plan)
Advocates on both sides of the issue agree that a post- Roe v. Wade threshold has been crossed in this election, even if they disagree on the forces that have reshaped the debate or its implications.
"Absolutely there has been an embracing of pro-choice values to a degree we've never seen before," said Nancy Keenan, president of NARAL Pro-Choice America, who had a prime speaking role at the Democratic National Convention. "I've always felt that the issue of protecting a woman's right to choose is a winning issue. Women care about it, and they will decide this election."
Marjorie Dannenfelser, president of the Susan B. Anthony List, a group that supports anti-abortion candidates, views the Democratic strategy as "a big gamble."
"The threshold that has been crossed is that every bit of energy has been placed behind this," she said. "Strategy, messaging and tactics are all aligned with that full embrace. It's a gift for us. It's 100 percent clarity on where they stand."


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Assessment Process
Georgina Campbell's Guides - Assessment ProcessAs Ireland's leading independent hospitality guide we will lead you to the very best places to eat, drink & stay wherever you are on the island of Ireland.
Since its inception in 1997, the editorial position at Georgina Campbell Guides has always been fiercely independent – unlike many other 'guides' there are no free meals (lunches or otherwise), and no payment for our recommendations.
Our mission is simply to seek out the best places to help travellers and diners who value quality and want a range of choices to suit many different occasions (both business and leisure) and varying budgets.
Each year Georgina Campbell and her husband, the sailing journalist and author W.M. Nixon – who writes the County Introductions for the Guide, and supplies many of the photographs – lead a team of fellow food writers and other qualified hospitality professionals who travel incognito to every county in Ireland checking that standards in recommended establishments are still up to scratch while also seeking out interesting new recommendations that our readers will enjoy, ultimately providing a comprehensive critical coverage for the entire country.
Our assessment process is based on the time-honoured principle of the 'mystery shopper', so our team make anonymous visits and report back without fear or favour, truthfully and in detail.
To save your time - and the inevitable disappointments associated with trial and error - we select the best within category, describe them as we find them (which will be mainly, but not necessarily entirely, favourable), and leave out the unsuccessful ones.
Real value for money, genuine hospitality and good (preferably local) food all earn high marks on our report sheets. So do great locations, an element of quirkiness (where appropriate) and 'going the extra mile' - by, for example, welcoming your four-legged friends as much as your children.
Promising places that we've heard about 'on the grapevine', others recommended by readers, and many requests for consideration by establishments themselves - all these make it onto our annual research list. However, following initial investigations, roughly half will fall at the first hurdle and be judged unlikely to be suitable for our discerning readers. Then, of those actually assessed, a further proportion will fail to make it to the Guide.
NB: We do not promote unregistered accommodation: Accommodation establishments must be Irish Tourist Board Approved in order to be considered for recommendation.
Our assessments are holistic, based on the entire experience – so initial impressions, good or bad, may be formed long before arrival, depending on factors like ease and pleasantness of booking (online or by phone), accurate directions, road signage and the maintenance of gates, driveways or parking areas on arrival. The process continues through checking in (is the receptionist's greeting genuine? does somebody offer to show you to your room and help with luggage? are the public areas welcoming and well maintained?) and so on, throughout every aspect of our stay or dining experience.
We believe that this model is the best for consumers as it ensures that we cover all areas/regions of the island of Ireland without any vested interest, ensuring that the very best, hardest working, quality-driven hospitality establishments are being promoted to you the consumer at no cost to them ie no barrier to recommendation except for quality.
These ongoing anonymous visits, together with the information we receive from questionnaires that are sent out each year, ensure that the entries you read are constantly updated and edited as required; similarly, the system ensures that new recommendations are added as they come on stream, while those closing down or no longer making the grade are dropped.
As the longest-running independent hospitality awards in Ireland The annual Georgina Campbell Guides Awards are highly sought after. The award winners are selected based on the reports and findings of our annual assessment process - all recommended establishments are considered for all relevant awards each year and there is no charge for entry or for winners.
So who are we? Click here to find out
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IRELAND FOR FOOD LOVERSEverything the food lover in Ireland needs to know... Food tourism in Ireland enters an exciti ...more...
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Georgina Campbell's Ireland Guide (12th Edition)The most recent edition of the must have glove box bible to Irish hospitality is available here ...more...


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AM DeBrincat: Grenadine Kiss
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AM DeBrincat: Grenadine Kiss
AM's piece is oil paint, acrylic paint, and transfer print on an 12 inch by 12 inch wood panel canvas.
AM DeBrincat is a Brooklyn-based multidisciplinary artist whose work explores the hybrid nature of identity in the digital age. DeBrincat's work has been included in solo and group exhibitions throughout the US and internationally. Originally from San Francisco, California, DeBrincat received a BA in Spanish and English Literature from the University of Oregon, and received an MFA from Parsons the New School for Design. Recent residencies and grants include residencies at the Massachusetts Museum of Contemporary Art (MASS MoCA), The Wassaic Project, and Chashama, and grants from the Durst Foundation and the Deming Foundation.
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Vote scheduled on Hagel nomination; GOP filibustering
Senate Majority Leader Harry Reid, D-Nev., today scheduled a vote for Friday to attempt to break the Republican filibuster against the confirmation of former Sen. Chuck Hagel, R-Neb., President Obama's defense secretary nominee.
This is the first time in history that a defense secretary nominee has been filibustered, Reid noted on the Senate floor today. "What a shame," he said.
The Senate needs at least 60 votes to break a filibuster and officially end debate on an issue. If there are 60 votes to end debate on Hagel's nomination, the Senate will proceed with a final vote on his confirmation. Senate Armed Services Committee Chairman Carl Levin, D-Mich., said he is optimistic they have the 60 votes.
If all 55 Senate Democrats vote in favor of ending debate, they will need just five Republicans to join them. These five Republicans would not necessarily have to support Hagel's nomination -- they would simply have to oppose the filibustering of a presidential nominee. Senate tradition dictates that the president has the prerogative to nominate whomever he chooses for Cabinet positions and that nominees should not be filibustered.
Any Republicans who vote to break a filibuster might well go on to vote against Hagel's nomination, but at that point, he would only need 51 votes to be confirmed - and he can get that with Democratic votes alone.
It's very likely Hagel will have the five GOP votes needed to overcome a filibuster, but it's still unclear at this point.
So far, two Republicans have said they would vote for Hagel to be confirmed - Sens. Thad Cochran, R-Miss., and Mike Johanns, R-Neb. One would assume they would also vote in favor of breaking a filibuster.
A third Republican, Sen. Susan Collins, R-Maine, announced today that she will vote against Hagel's confirmation, but in favor of breaking a filibuster.
Sens. Richard Burr, R-N.C., and Roy Blunt, R-Mo., said last week they would not support a filibuster. CBS News is working to confirm whether or not they still hold that view -- if so, Hagel can break the filibuster. Sen. John McCain, R-Ariz., who previously said he wouldn't support a filibuster, reportedly is considering changing his mind.


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Customer Service Assistant
- Recruiter
- Compass Group UK Ireland
- Location
- Daventry
- Salary
- Up to £7.83 per hour
- Posted
- 11 Jul 2018
- Closes
- 08 Aug 2018
- Ref
- compass/TP/482829/42656/TM
- Contact
- Ms Tori Matthews
- Sector
- Foodservice Jobs
- Job Function
- Customer Service
- Contract Type
- Permanent
- Hours
- Full Time
We currently have an opportunity for a Customer Service Assistant to join our team at a busy site that caters for many people, providing excellent food and great service.Main responsibilities
The duties for this role will include, serving customers in a polite and friendly manner, basic food preparation, ensuring kitchen, service and restaurant areas are kept clean, tidy and safe. Other duties will include cashiering, vending and taking an active part in any unit sales promotions.
- Ability to promote a welcoming environment where our colleagues, clients and customers receive great service
- Polite and friendly
- Good Customer Care skills
- Neat and tidy in appearance
- Awareness of Hygiene standards
- A 'can do' attitude, prepared to help out the rest of the team in a willing and positive manner
- Able to work in a busy environment
- Good command of the English Language
Chartwells, part of Compass Group UK & Ireland, is the leading provider of catering and support services to schools, colleges and universities in the UK. Chartwells works with over 2,000 education units including primary schools, secondary schools, independent schools, colleges and universities. Central to Chartwells is its Eat, Learn, Live ethos, which helps to educate young people about how to have a happy, safe and healthy lifestyle while contributing to a sustainable world.


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Tadra is a Fiji based, family-owned business with a team of over twenty trained personnel who specialize in all types of floral arrangements, professional wedding co-ordination and themed corporate and private events.Tadra is the Fijian name for "dream" and for Mike and Helen Waters and their daughter, Araylea, the word perfectly suits their business and home in the Fiji Islands. Tadra's team includes expert florists, wedding consultants, gardeners, nursery attendants and carpenters with suppliers from across the islands in support of the local economy.
Tadra also specializes in weddings – from the initial planning stage to organizing rehearsal dinners, sourcing local wedding favours to handling guest lists and coordinating the actual ceremony and reception – working with the country's leading hotels and resorts. Tadra Weddings offers a large range of venues and create unique, personalized and memorable events. Tadra Weddings offers a range of popular, all-inclusive packages eliminating the stress for overseas couples and their guests seeking a hassle free destination wedding on our beautiful tropical island chain.
Tadra Flowers are also the representatives for Interflora and Teleflora with experience in handling floral arrangements from all over the globe. Tadra Flowers also provides fresh flowers to visiting cruise ships and private yachts at the Denarau, Lautoka and Suva ports of entry.
Weddings & EventsPreferred wedding planners at the Fiji Beach Resort & Spa managed by Hilton, Radisson Blu Resort Fiji and Worldmark by Wyndham.
Tadra also offers a selection of private garden and beach venues.
We have a variety of wedding and event decor available for hire to all hotels, resorts and venues Fiji wide. Visit our website (www.tadraweddingsfiji.com) or e-mail us at email@example.com for more information.
Flowers are a must to complete any wedding or event and we are the country's only professional, licensed, registered, Teleflora AND Interflora accredited florist.
FlowersFrom its florist centres centrally located in both Nadi and Suva, Tadra Flowers offers a variety of tropical flowers for each and every special occasion!
Visit our website - www.tadra.com.fj!
We also import flowers for that special occasion or must-have bridal bouquet! Let us know at least fifteen business days in advance so that we can acquire a quote and apply for the necessary permits!
Cruise Ships & YachtsTadra Flowers also specializes in providing fresh floral arrangements, cut flowers and imported flowers for visiting cruise ships and yachts at Port Denarau, Vuda Marina and both the Suva and Lautoka ports.
Arrangements may be prearranged via e-mail or one of our florists will meet the vessel to go over special requirements.
Please note that all import orders need to be confirmed at least fifteen business days prior to delivery as we need to apply for import permits. All orders placed using our local tropical flowers require minimal notice and can be supplied regularly year round.
ContactOur head office is located at 10 Queens Road in Martintar, Nadi - approximately a ten minute drive from the Nadi International Airport towards Denarau.
We also have a shop located in Suva and a small retail kiosk situated just outside the Esquires coffee shop in the departures hall at the Nadi International Airport.
P. O. Box 9551 Nadi Airport


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From New Jersey to the far reaches of New York City, residents of communities destroyed by Sandy expressed shock and dismay at the decision of Congressional leaders to delay a vote on Sandy relief.
"Congress is not paying attention," James Kane, who lost his home in the Breezy Point neighborhood of Queens in New York City, told NBC 4 New York. "We were devastated down here, as you can see."
A few blocks away, Marion O'Brien was coping with life without electricity and with a dangerous mold problem in her Breezy Point home that was once a place for play for her 17 grandchildren.
"They're sending money to different countries and they can't help us," said O'Brien. "That's terrible."
The lack of urgency on the part of Congress stood out for many residents hit hard by the storm.
"It's an emergency to almost everybody down here except for Congress," said Kane. "It was horrible. Horrible. Unreal."
In the tiny borough of Moonachie, N.J., population 2,900, the borough hall is still uninhabitable and will be for some time. The borough can't wait for FEMA and issued their own emergency bonds for $6 million.
"We're hoping that the government will stop dragging its feet and realize there's a real need here," said Mayor Dennis Vaccaro. "It's times like this I'm embarrassed to be part of government."
On Staten Island in New York, Shawn Johnson chased a Red Cross truck down the street so he could get free bags of groceries to feed his two kids. In order to make ends meet after Sandy, Johnson has worked two jobs, he said.
A certain degree of desperation has become the new normal for Staten Island residents wiped out by the storm and the signs are there for anyone to see, Johnson says.
"There a lot of people with signs outside their doors saying 'Help,'" Johnson said. "So that should be a sign where someone has to really open up their eyes to see what's going on. It's really ridiculous."


text: Opinion 13.7: Cosmos And Culture Energy Perception And Policy Reality October 15, 2012 Commentator Sheril Kirshenbaum says national energy strategies don't fit so neatly into red or blue compartments. The boundaries are blurry, motivated by more than a candidate's platform. Energy policies often cross party lines and she says we must open our eyes to when and where they do.


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Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods study
Asif Raza Khowaja a, Sher Ali Khan a, Naveeda Nizam a, Saad Bin Omer b & Anita Zaidi a
a. Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
b. Schools of Public Health and Medicine, Emory University, Atlanta, United States of America.
Correspondence to Anita Zaidi (e-mail: firstname.lastname@example.com).
(Submitted: 14 April 2012 – Revised version received: 22 August 2012 – Accepted: 23 August 2012 – Published online: 14 September 2012.)
Bulletin of the World Health Organization 2012;90:822-830. doi: 10.2471/BLT.12.106260
Pakistan is one of only three endemic countries in the world still struggling to interrupt poliovirus transmission and meet the target of global polio eradication by 2012. Polio supplementary immunization activities (SIAs) for the home delivery of oral polio vaccine (OPV) were initiated in the country in 2000, when 119 cases of polio were reported. Although the number of cases declined to 32 in 2007, it has been rising steadily since 2008.1 In 2011 Pakistan reported the world's highest number of polio cases and some fear the country may become the last remaining host of polio on earth. The situation clearly poses a serious threat to the Global Polio Eradication Initiative (GPEI).2–4 In Pakistan, elimination efforts have largely relied on a robust case detection system based on surveillance of acute flaccid paralysis cases and on mass door-to-door polio SIAs, of which more than 100 have been conducted since the year 2000.5,6 Every child less than 5 years of age who resides in Pakistan has to be reached during each SIA, since multiple doses of OPV are needed in countries with high endemicity for children to develop adequate immunity against polio.1-4 SIAs can vary in frequency but are usually held one to two months apart.
SIAs against polio are primarily organized by government officials with support from United Nations partners, mainly the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). SIAs are intended to complement, not replace, routine immunization against polio. They aim to interrupt poliovirus circulation through administration of the oral polio vaccine (OPV) to every child aged < 5 years in every vaccine SIA campaign, irrespective of immunization history.7 Public announcements through media coverage, posters and banners are used to create awareness about upcoming polio SIAs and encourage participation. Social marketing and community mobilization efforts are organized by UNICEF, and the staff of WHO's Polio Eradication Initiative assist local health officials in organizing, implementing and monitoring SIAs. A large cadre of vaccinators, health workers and community volunteers administer OPV to eligible children through visits to all households and at fixed health facilities.7,8
Although high coverage (> 90%) during polio SIAs has been reported in Pakistan, actual coverage is questionable. An official report of the Independent Monitoring Board of the Global Polio Eradication Initiative published in February 2012 highlighted major planning and execution gaps for polio SIAs in Pakistan.3 Several factors have made the goal of eliminating polio in Pakistan elusive. These include inconsistent quality of SIAs; failure to immunize children in many areas; inaccessibility of children due to ongoing military conflict; massive floods; poor routine immunization services; a structurally weak polio eradication programme; large nomadic and internally-displaced populations, and the refusal of some parents to have their children vaccinated.9,10 Many of these factors have led to the clustering of unimmunized children, who are at high risk of getting polio.11
Very few studies evaluating the results of polio SIAs in Karachi have been published. We chose Karachi for our study because polio is endemic in the city and the risk of transmission is among the highest in Pakistan. Karachi is, in fact, the only megacity in the world that has not yet succeeded in interrupting polio transmission. Besides, its population represents all ethnic groups in Pakistan. Given Karachi's large cultural and ethnic diversity, we studied a large representative sample of individuals living across the city, our objective being to assess parents' knowledge about polio, rates of non-participation in polio SIAs and reasons for non-participation. We ensured adequate representation of the Pashtun community, a group that comprises an estimated 35–40% of Karachi's population and yet has suffered 90% of recent polio cases in the city. This community has high rates of migration and displacement and low rates of polio vaccination.12
Data collection for our study, which had a mixed methods design, was completed in three months (November 2011to January 2012). The quantitative component of the study involved a cross-sectional cluster survey in Karachi, a megacity comprising 18 towns, 1 cantonment and 178 localities known as union councils.13 The sampling frame, developed for our previous vaccine research, consisted of 90 randomly selected clusters with a total population of 200 000 and between 200 and 250 households each. The sample was sociodemographically representative of the entire population of Karachi.14 From this sampling frame we selected 60 clusters of low- and middle-income households. Using the probability proportionate to size technique, we calculated the number of households we would need to survey within each cluster. Table 1 shows the 18 towns and one cantonment area that make up Karachi and the number and fraction of households sampled in each town.
Table 1. Fraction of households surveyed and number and percentage of parents who refused to have their children vaccinated with the oral polio vaccine (OPV), by town within Karachi, Pakistan, 2011
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In our previous work we had difficulty accessing households in affluent areas of Karachi because of tight security measures. For this reason, in the current study we selected five large shopping malls as sites for approaching and interviewing the members of affluent families from different high-income areas of the city. In total, 153 eligible families – approximately 15% of the proportionally representative sampling frame – were interviewed in malls. We posed no income- or asset-related questions to avoid affecting the response rate, but these malls, considered safe, have reserved rights of admission and are visited by affluent families for entertainment and shopping. Thus, people who frequent them are broadly representative of the upper classes.
We estimated the sample size using the formula for cross-sectional prevalence studies; we assumed a 30% rate of non-participation in polio SIAs, a 5% non-response rate, a 5% margin of error and a design effect of 2.0 for cluster sampling. We inflated the resulting sample size, 646, by 50% to ensure a large enough sampling of Pashtun households to allow us to evaluate any differences among ethnic groups in lack of participation in polio SIAs. This yielded a final sample of 1001 households.
Parents were eligible to participate in the survey if they were residents of Karachi and had children aged < 5 years in their household. Verbal consent was obtained from all parents who participated in the survey. We developed a structured questionnaire and pilot tested it in households drawn from neighbouring clusters. The questionnaire included questions on demographics, knowledge about the symptoms of polio, and number of polio SIAs in which parents had participated in the two most recent months. Two SIAs were held in Karachi (September and October 2011) just before the survey. To select the households to be surveyed, trained project staff (research assistants and field workers) spun a bottle in the main street of each town to choose the direction in which to approach the first household and then used systematic random sampling with a skip pattern of two after each eligible dwelling to select the remaining households. Any parent available (mother or father of a child < 5 years old) was interviewed. In shopping malls, research assistants invited families to participate in the survey if they reported having children aged < 5 years and living in a high-income part of the city (Defence Housing Authority, Clifton, Gulshan-e-Iqbal and North Nazimabad). A senior research assistant made spot-check visits to homes and malls and re-interviewed 5% of the respondents to ensure the quality of data collection.
For the qualitative assessment, parents who refused to have their children receive the OPV or who reported that their eligible children did not participate in the two most recent polio SIAs were purposively selected from the Pashtun population and invited for in-depth interviews. Only ethnic Pashtuns were interviewed because migration and displacement are common among them and their children have the highest rate of confirmed cases of polio in Pakistan and the highest risk among all ethnic groups. Only fathers were interviewed because they are the main decision-makers in Pashtun families. A native Pashto-speaking male medical student (SAK in his final year was trained to conduct these interviews. Data saturation was reached after 30 in-depth interviews. Written notes were transcribed and thematic analysis was conducted on emerging themes surrounding the reasons for children not having received or having refused to receive the OPV. The survey data were entered electronically in real time and analysed on SPSS version 19 (SPSS Inc., Chicago, United States of America).
Descriptive analysis was performed and proportions were compared for three groups: (i) low-income Pashtun families; (ii) low-income families of other ethnicities (non-Pashtun); and (iii) middle- and high-income families of any ethnic background. Income group was based on area of residence (Table 1). Differences between these groups in terms of knowledge about polio, participation in SIAs and reasons for non-participation are expressed as odds ratios (ORs) with 95% confidence intervals (CIs). This study received ethical approval from the ethics review committee of Aga Khan University in Karachi.
A total of 2149 parents were approached at households in the community and shopping malls, and 1116 were found eligible to participate in the study. Among eligible parents, 51 (5.6%) and 48 (24%) refused to participate in households and at malls, respectively (Fig. 1). Of the 1017 parents who agreed to participate, about 90% were mothers of the children aged < 5 years; 441 (43.4%), 423 (41.6%) and 153 (15%) of the respective families were categorized as low-income Pashtun, low-income non-Pashtun, or middle- or high-income, regardless of ethnic background.
Fig. 1. Flowchart of participants in study of parental knowledge and perceptions surrounding polio and of participation in polio vaccine supplementary immunization activities in Karachi, Pakistan, 2011
The children were 3.2 years old on average (standard deviation, SD: ± 1.5); 52% were male and 48% were female. Of the parents interviewed, 412 (40.5%) reported never having heard about "polio disease" (Table 2) and 246 (24%) reported not having heard about recent polio SIAs in their area in 2011; of parents in this last group, 193 (78% of the parents interviewed) belonged to low-income Pashtun households. Only 728 (72%) parents reported that their children had participated in both the September and October polio SIAs; 157 (15.4%) reported that their children had not participated in either SIA. There were 34 (21.6%) parents who reported having had no contact with a vaccinator in their home, 116 (73.9%) reported having refused the vaccination and 7 (4.5%) said that their child was not at home when the vaccinator had visited (Table 3). Refusals clustered in low-income Pashtun (43/441; 9.8%) and high-income (71/153; 46.4%) populations, whereas low- and middle-income non-Pashtun populations had high rates of SIA participation, with only 2% (9/423) having received no dose of OPV in both polio SIA campaigns. Pashtun parents stated as the primary reasons for refusing to have their children vaccinated fear of potential harm from the OPV (16%) and lack of permission from family elders (77%). Among high-income respondents interviewed in malls, the main reason given was the belief that the vaccine was harmful (72%) or unnecessary (8.5%) (Table 4). Vaccine refusal rates in the 18 towns and one cantonment of Karachi ranged between 0% and 70%, with the highest refusal rates reported from the high-income areas of Defence Housing Authority and Clifton (Table 1).
Table 2. Parental knowledge and perceptions surrounding polio and polio vaccination and self-reported participation in polio supplementary immunization activities conducted in September and October 2011, by ethnicity and income group, Karachi, Pakistan
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Table 3. Reasons reported by parents for their children not having participated in the two most recent polio supplementary immunization activities, by ethnicity and income group, Karachi, Pakistan, 2011
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Table 4. Reasons reported by parents for having refused to have their children vaccinated with the oral polio vaccine, by ethnicity and income group, Karachi, Pakistan, 2011
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Significant differences in knowledge about polio and in participation in SIAs were observed between low-income Pashtuns and low-income non-Pashtuns (Table 5). The odds of knowing nothing about polio were 2.2 (95% CI: 1.1–4.3) times greater among low-income Pashtun parents than among low-income non-Pashtuns (Table 5). Low-income Pashtun parents were 6 times (95% CI: 4.3–8.8) more likely to have never heard about a polio SIA campaign in their area than low-income non-Pashtuns. Moreover, children of low-income Pashtun parents were 7 times (95% CI: 3.5–14.5) more likely to have failed to participate in polio SIAs than children of low-income non-Pashtun parents.
Table 5. Results of univariate analysis comparing knowledge and perceptions surrounding polio and participation in polio supplementary immunization activities among low-income Pashtun and low-income non-Pashtun parents, Karachi, Pakistan, 2011
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Qualitative analysis
In-depth interviews revealed parental perceptions surrounding polio and polio vaccination and why some children did not received the OPV during the two most recent polio SIAs. Most of the parents thought that the polio vaccine caused sterility in adulthood. Some also considered polio vaccination campaigns to be part of a conspiracy against Muslim nations, including Pakistan. "Polio vaccine is prepared in the West and sent here. It is then given to our children in order to destroy their ability to reproduce in the future." Moreover, about one third of the parents reported "no belief" in the polio vaccine and considered it useless or ineffective against polio. "It is of no good, because one of my friends has polio even though he was vaccinated against it." Other parents felt that since their children had received several doses of polio vaccine in the past, they did not need to get vaccinated again. Some voiced doubts about the government's "disguised policy" of conducting exhaustive efforts against polio. "Why do the government and health system give so much emphasis to polio vaccine? There are so many other diseases that should be addressed first. There must be some other reason (negative reason) for their giving so much importance to polio vaccine." Another important theme was concern that the vaccine could contain religiously forbidden "non-halal" ingredients. "I was allowing my children to receive polio vaccine until last year, when I learnt that the material used is un-Islamic (haraam)…. if we are given proof that this material is not haraam, then we will allow our children for polio vaccine." A few parents also mentioned other reasons, including a bad cold chain, difficulty in communicating with the polio vaccinator because of a language barrier and fear of side-effects (fever, bloating of skin, weakness, etc.).
In Karachi, parental refusal was the most common reason given for the failure of children to participate in the two most recent polio vaccine SIAs. It accounted for non-participation in 74% of the cases. A clustering of vaccine refusals among ethnic low-income Pashtun and high-income populations was noted and varied by town. Lack of knowledge about polio, lack of faith in the vaccine's effectiveness, misperceptions about vaccine-related adverse events (e.g. infertility) and mistrust among Pashtuns make it highly likely that poliovirus transmission will continue in this population unless specific targeted activities are undertaken to promote vaccination.
Our overall findings pertaining to why some parents refuse to have their children vaccinated are in line with those of previous studies that have identified misperceptions regarding disease susceptibility and vaccine efficacy and concerns about safety.15,16 Moreover, lack of trust in vaccines and in those who deliver them (e.g. health-care providers, governments and international agencies) has been identified as an important hindrance to routine OPV immunization and polio elimination.17,18
This study was undertaken in the wake of extensive media reports of an allegedly fake vaccination campaign organized by the United States Central Intelligence Agency to try to track down Osama Bin Laden by surreptitiously obtaining blood samples from his family members for deoxyribonucleic acid (DNA) testing. The campaign was run by a Pashtun government physician from the tribal area of Khyber Agency who had worked in polio vaccine campaigns.19,20 Although we prudently avoided explicit references to this in our in-depth interviews, several Pashtun families gave distrust of government-run programmes as the reason for having refused to get their children vaccinated. The publicity surrounding the bogus vaccination campaign is probably not the only reason for people's mistrust of the polio vaccine, since vaccine refusals had been documented in the Pashtun population even before the incident. However, reports of the incident may have reinforced or perpetuated negative perceptions. The long-term impact of this incident on polio eradication efforts in Pakistan remains to be determined.
At the community level, conventional communication efforts surrounding polio are largely conducted by female workers or mobilizers who primarily target adult females in the households.21 Male family decision-makers or community and religious leaders are insufficiently engaged and are usually absent during the day time when vaccinators visit households.22 In Pashtun populations in particular males are the primary decision-makers. They have strong religious beliefs and are key to polio eradication efforts. Our interviews showed that religious authorities of two or three of the main religious institutions (madrassahs) heavily influence the opinions of Pashtun men in Karachi. To enhance social mobilization, integrated participatory interventions targeting communities at high risk for polio need to be implemented.23,24 These interventions should include parental counselling, targeted particularly at male decision-makers; the creation of community networks involving trusted religious authorities, and role modelling by parents who approve of the polio vaccine. The strategy of involving religious opinion leaders in efforts to increase acceptance of polio immunization has already been employed in northern India and Nigeria.11,25 More formative and evaluative research is needed to identify the most effective strategies.
A high proportion (24%) of eligible high-income families declined to participate in the survey at malls primarily because of "lack of time". Worth noting is the fact that vaccination refusal rates were high among those who did participate in the survey. The upper class has little trust in government services and seeks health care and immunization services in the private sector. Evidence suggests that the high-income population is adequately immunized and that most children in this group have received injectable and oral polio vaccines through private paediatric practices (Zaidi AK, unpublished data). Although children from high-income families are at little risk of contracting polio, the widespread belief in this social group that repeat doses of OPV are harmful may undermine the overall success of the polio eradication programme, since the wealthy are often opinion leaders and trendsetters.26–28
This is the first study to identify the main perceptions associated with lack of participation in polio SIAs in the ethnic group with the highest polio incidence in Pakistan. This high-risk group needs targeted educational messages and we believe that our findings will contribute to their development. Operational research on increasing polio vaccine acceptance by offering packages of health and non-health interventions during polio SIA campaigns should also be explored.
Although our study was conducted in Karachi, some findings may be generalizable to other parts of Pakistan that are important for polio eradication efforts, since outside Karachi endemic polio transmission is primarily restricted to Pashtun majority areas.
Competing interests:
None declared.
- Global polio emergency action plan 2012–13: getting Nigeria, Pakistan and Afghanistan back on track. Geneva: World Health Organization; 2012. Available from: http://www.who.int/immunization/sage/meetings/2012/april/Working_draft_Global_PolioEmergencyActionPlan_04_April_v2.pdf [accessed 10 August 2012].
- Weekly AFP surveillance update, Pakistan, week 52. Islamabad: World Health Organization; 2011.
- Ten months and counting (report of the Independent Monitoring Board of the Global Polio Eradication Initiative). Geneva: World Health Organization; 2012. Available from: www.polioeradication.org/portals/0/.../imbreport_january2012.pdf [accessed 30 August 2012].
- Wise J. Final push is needed to tackle last 1% of polio. BMJ 2011; 343: d4685- doi: 10.1136/bmj.d4685 pmid: 21778199.
- Abid N, Islam OU, Bosan A, Darwish A, Bile KM. Pakistan's fight against poliomyelitis: introducing innovative strategies to address challenges and attain the goal of eradication. East Mediterr Health J 2010; 16: S5-14 pmid: 21495583.
- Ahmad K. Pakistan struggles to eradicate polio. Lancet Infect Dis 2007; 7: 247- doi: 10.1016/S1473-3099(07)70066-X pmid: 17419137.
- Supplementary immunization [Internet]. Geneva: Global Polio Eradication Initiative, World Health Organization; 2010. Available from: http://www.polioeradication.org/Aboutus/Strategy/Supplementaryimmunization.aspx [accessed 10 August 2012].
- Key elements for improving supplementary immunization activities for polio eradication. Geneva: World Health Organization; 2000. Available from: http://www.who.int/vaccines-documents/DocsPDF00/www537.pdf [accessed 10 August 2012].
- Nishtar S. Pakistan, politics and polio. Bull World Health Organ 2010; 88: 159-60 doi: 10.2471/BLT.09.066480 pmid: 20428374.
- Shah M, Khan MK, Shakeel S, Mahmood F, Sher Z, Sarwar MB, et al., et al. Resistance of polio to its eradication in Pakistan. Virol J 2011; 8: 457- doi: 10.1186/1743-422X-8-457 pmid: 21962145.
- Chaturvedi S, Dasgupta R, Adhish V, Ganguly KK, Rai S, Sushant L, et al., et al. Deconstructing social resistance to pulse polio campaign in two north Indian districts. Indian Pediatr 2009; 46: 963-74 pmid: 19736365.
- Baloch S. Global polio emergency might be declared in Pakistan in 3 months. The Express Tribune. 27 March 2012. Available from: http://tribune.com.pk/story/355608/global-polio-emergency-might-be-declared-in-pakistan-in-3-months/ [accessed 30 August 2012].
- City District Government Karachi [Internet]. CDGK towns. Available from:http://www.karachicity.gov.pk/ [accessed 10 August 2012].
- Sheikh S, Ali A, Zaidi AKM, Agha A, Khowaja A, Allana S, et al., et al. Measles susceptibility in children in Karachi, Pakistan. Vaccine 2011; 29: 3419-23 doi: 10.1016/j.vaccine.2011.02.087 pmid: 21396902.
- Esteves-Jaramillo A, Omer SB, Gonzalez-Diaz E, Salmon DA, Hixson B, Navarro F, et al., et al. Acceptance of a vaccine against novel influenza A (H1N1) virus among health care workers in two major cities in Mexico. Arch Med Res 2009; 40: 705-11 doi: 10.1016/j.arcmed.2010.01.004 pmid: 20304260.
- Salmon DA, Moulton LH, Omer SB, DeHart MP, Stokley S, Halsey NA, et al., et al. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Arch Pediatr Adolesc Med 2005; 159: 470-6 doi: 10.1001/archpedi.159.5.470 pmid: 15867122.
- Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine confidence gap. Lancet 2011; 378: 526-35 doi: 10.1016/S0140-6736(11)60678-8 pmid: 21664679.
- Larsen HJ, Ghinai I. Lessons from polio eradication. Nature 2011; 473: 446-7 doi: 10.1038/473446a pmid: 21614056.
- Shah S. US pressures Islamabad to free doctor who helped CIA track down Bin Laden. The Guardian. 12 July 2012. Available from: http://www.guardian.co.uk/world/2011/jul/12/us-pressures-islamabad-cia-doctor [accessed 30 August 2012].
- Doctor who helped track bin Laden sacked. Dawn.com Pakistan. 29 March 2012. Available from: http://dawn.com/2012/03/29/doctor-who-helped-track-bin-laden-sacked [accessed 30 August 2012].
- Evaluation of social mobilization activities for polio eradication. Islamabad: SoSec Study; 2005.
- Obregón R, Chitnis K, Morry C, Feek W, Bates J, Galway M, et al., et al. Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan. Bull World Health Organ 2009; 87: 624-30 doi: 10.2471/BLT.08.060863 pmid: 19705014.
- Azmat SK. Mobilizing male opinion leaders' support for family planning to improve maternal health: a theory-based qualitative study from Pakistan. J Multidiscip Healthc 2011; 4: 421-31 doi: 10.2147/JMDH.S24341 pmid: 22247617.
- Bhutta ZA. The last mile in global poliomyelitis eradication. Lancet 2011; 378: 549-52 doi: 10.1016/S0140-6736(11)60744-7 pmid: 21664681.
- Renne E. Perspectives on polio and immunization in Northern Nigeria. Soc Sci Med 2006; 63: 1857-69 doi: 10.1016/j.socscimed.2006.04.025 pmid: 16765498.
- Expert offers to drink 20 vials of expired polio drops to prove point. The Express Tribune. 22 February 2012. Available from: http://tribune.com.pk/story/339864/expert-offers-to-drink-20-vials-of-expired-polio-drops-to-prove-point/ [accessed 30 August 2012].
- Nasir A. Rating race, politics may hit anti-polio drive. Dawn.com Sci-Tech. 16 February 2012. Available from: http://dawn.com/2012/02/16/ratings-race-politics-may-hit-anti-polio-drive/ [accessed 30 August 2012].
- Rana S. Globally-supported company is funding fatal polio shots. The Express Tribune. 17 November 2011. Available from: http://tribune.com.pk/story/293191/vaccine-nation-globally-supported-company-is-funding-fatal-polio-shots/ [accessed 30 August 2012].


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- Buy 6 for $81.00 each and save 5%
- Buy 10 for $77.00 each and save 10%
Product Description
They are made of 3 layers of vinyl, fused together, with a male/female snap and adjustable holes to fit various wrist sizes. The outer layer gives strong colors, the middle layer makes them tough and non–stretch, while the inner layer is a smooth soft vinyl for comfort on the skin. For safety reasons, the bands will break when strong force is applied, such that a person's hand will not be damaged if the band ever accidentally hooks to anything. These L-Shape wristbands are available in a wide range of neon, pearl, glitter and regular colors. Custom printing and consecutive numbering are available at an extra charge. Please allow up to 5 days production time for numbering or custom printing.
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Colours are random, so I'm afraid it will be a surprise, unless you send
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available are Red, White, Blue, Orange, Grey, Lime, Turquoise, Lemon,
Pink & Purple.
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At Tuffdogs Stuff we have tried to keep the delivery simple.
Most orders will be sent by Royal Mail or Parcelforce, some may be sent by other courier.
The majority of orders will be sent by Royal 1st Class Delivery, only heavier orders will be sent by Parcelforce 48 or other courier.
We are often out and about the UK attending the dog shows, country shows and game fairs so we are not always available for a same day dispatch. We will endeavor to dispatch orders as soon as we can but as a rule of the thumb the following delivery times should be expected.
At Tuffdogs Stuff we really want to have happy customers, we do not try to make money on our deliveries, in fact we pay more than we charge for some deliveries but we do not mind because we want our customers to feel they are getting a great service at a reasonable price.
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Cove death ruled accidental drowning
STAMFORD -- An autopsy performed on 13-year-old Rashad Gross confirmed that the boy was the victim of an accidental drowning at Cove Island Park on Friday afternoon.
Police Sgt. Paul Guzda said the examination did not find any cuts or bruises on the boy's head that might have indicated he slipped or fell and hit his head before disappearing into the water. Rashad's aunt had said Tuesday that she thought her nephew might have fallen into the water and struck his head.
Rashad and five of his Turn of River Middle School friends went to swim in a posted no-swimming area of the park Friday after they were dismissed from school for the summer, police said. The swift current in that section of the water pulled Rashad, who did not know how to swim, and one of the other boys into deeper water. The second boy managed to keep his head above water and was saved by the others, Guzda said.
In an interview Wednesday, Roy Wilson, 12, said he and his friends chose to swim in the no-swimming area after walking around the park and the main beach area because someone had told them the water on that side is cleaner and clearer.
It was a warm day, and they had just gotten off the school bus near the intersection of Cove and Seaside avenues.
Roy said it was the first time the boys had gone swimming in that area. "We didn't know it was deeper," he said.
He said he and one of the boys, Deandre, were hesitant to go in very far.
"Me and Deandre did not go all the way in. We just put our legs in, that's it," Roy said.
But the four other boys, including Rashad, went farther into the water. Those four for the most part were mostly on their feet, bunched together at that point, Roy said.
They played in the water for about 10 minutes before the current began to pull Rashad and the second boy, KJ, farther into the water, Roy said. At that point Rashad became worried and tried to grab hold of one of the other boys. Rashad was in the water only up to his chest when the current began to pull him into the channel, he said.
"He said `I can't swim,' " Roy said. "And his hand slipped off and he started struggling and going up and down in the water. And KJ, he started struggling too."
The boys were able to rescue KJ, but Rashad went under and disappeared.
Roy and the others began yelling, and caught the attention of a Brush Island resident who asked if anything was wrong.
"We said, `We need help. Call 911,' " Roy said.
The Brush Island woman called 911, and jumped into the channel to try to help, but she too was also swept toward Long Island Sound by the current before a neighbor was able to pull her out.
That was shortly before 2 p.m. Dozens of police and firefighters from Stamford, Darien and Norwalk, as well as Coast Guard personnel, converged on the park to search for Rashad. It wasn't until just before 5 p.m. when a Stamford dive team firefighter searching the bottom of the canal with his hands found Rashad in about six feet of water.
Rashad is survived by his siblings, Donald, Equasha, Nefretiria, Danasha, Amya, J'Quan and Jada, his aunt, Theresa Gross Holsey, who had custody of the boy, and grandparents John and Deborah Dupigny, and Lavourges and Nona Holsey. He was predeceased by his mother.
Calling hours begin 9 a.m. Friday, followed by an 11 a.m. service of celebration at Faith Tabernacle Missionary Baptist Church at 29 Grove Street. Interment will follow at Spring Grove Cemetery in Darien.
Donations may be made to passionorganization.org at P.O. Box 112069, Stamford, CT 06911-2069.


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Wall Street Has Taken A Sharp Turn Into Forest Laboratories, Inc.
Institutional investors and sell-side analysts are rather infamous for gnat-like attention spans and the capacity to dramatically change their opinions in relatively short periods of time. So, too, has it been with Forest Labs , though it certainly requires mentioning that Forest Labs has done a lot of work on its own to affect that change of opinion. Forest Labs announced a significant cost-cutting program and then followed it up with the nearly $3 billion purchase of Aptalis, both of which significantly impact the company's long term revenue and margin prospects.
I'm not totally sold on the company's "Project Rejuvenate", nor do I believe that all of the company's "Next Nine" products will live up to management's hopes. With that, I'm a little concerned that investor enthusiasm for the restructuring program at Forest Labs is getting caught up with excitement over similar programs at AstraZeneca, Valeant , Endo, and Amgen -- and perhaps overdoing things.
Strong Sales Underpin Fiscal Q3 Results
All of the charges and adjustments in this quarter and the year-ago's make it difficult to say a lot about Forest Labs' basic profitably, but the company definitely did alright on the top line. Revenue rose 23% this quarter, handily beating the average estimate by more than 6%. Namenda sales led the way, growing 16% this quarter and beating expectations by almost 6% despite the maturity of this platform. Forest's other major product, Bystolic, saw sales rise another 20%.
Within the "Next Nine", Linzess (which the company sells in partnership with Ironwood did quite well, as sales of about $51 million were 14% higher than expected. Fetzima and Teflaro also outperformed expectations by a double-digit percentage (contributing $8 million and $22 million, respectively), while Viibryrd's 28% growth and $52 million in revenue was more or less on plan. All told, the Next Nine were 44% of total sales.
Margin comparisons are comprehensively fouled by charges and adjustments, but underlying gross margin did improve more than a half-point from last year and was a little better than expected.
Aptalis Should Be A Winner
There was ample chatter out there that Aptalis was being aggressively shopped, and Forest Labs ultimately signed on the dotted line for $2.9 billion in cash - a not-so-cheap premium of 4.2x sales and a little more than nine times EBITDA. Aptalis is a GI-focused specialty pharmaceutical company with more than 60% of revenue coming from Zenpep, Carafate, and Canasa - three drugs that appear to have meaningful barriers to generic competition.
Aptalis is not only going to contribute some worthwhile drugs to Forest Labs, but it should also improve the company's efforts to establish a specialty presence in the GI treatment space. Linzess is still relatively new (launching late in 2012) and Forest Labs has to share a considerable percentage of its proceeds with Ironwood, but adding Aptalis's drugs gives the company the opportunity to drive more revenue from that existing Linzess sales force.
Restructuring Still Offers Some Risk
I'm not as sold on the company's "Project Rejuvenate" at this point. CEO Brent Saunders is looking to cut $500 million in annual expenses by FY 2016, with more than half of that coming out of the company's R&D budget and additional cuts and headcount reductions in marketing and administration.
Cutting down the sales spending could be tricky. Looking over IMS data, Forest Labs gets a sizable percentage of its revenue, around 70% or so, from primary care physicians (most of Big Pharma is in the 60%+ area), whereas companies like Valeant, Salix Pharmaceuticals, and Amgen get about a third or less of their sales from this generalist category. That could make shifting toward a more specialty-oriented sales force more challenging, particularly as the company tries to push a "hard switch" of patients over to Namenda XR.
I'm also not sold on the cut-down in R&D spending. Forest Labs has a long and uncommonly good track record of licensing early stage compounds and developing them through to approval, but this cut suggests to me that acquiring finished products (like the deal for Aptalis and the acquisition of Saphris from Merck) is going to be a bigger part of the growth plan. Management says that M&A is not its primary strategy for growth, but I don't know how to reconcile that with cutting down what has historically been an unusually good R&D effort.
The Bottom Line
I would not be surprised if Forest Labs did at least one more deal with the aim of reducing its tax rate to a level more comparable with Valeant. These tax inversion deals are certainly popular right now and it looks as though some investors are already starting to factor this in to long-term projections.
I come away thinking that the Street has gone a little overboard with its enthusiasm for these pharmaceutical makeovers, Forest Labs included. I can get on board with projections for long-term revenue growth in the high single digits and free cash flow margins in the high 20%'s, but it's hard for me to get to a fair value above the mid-$60's. A tax inversion deal would certainly boost my projected fair value, but I think there are still execution risks here with the cost cutting and the sales growth expectations for new products, and I'm inclined to stay on the sidelines for now.
The article Wall Street Has Taken A Sharp Turn Into Forest Laboratories, Inc. originally appeared on Fool.com.Stephen D. Simpson, CFA has no position in any stocks mentioned. The Motley Fool recommends Valeant Pharmaceuticals. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.
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Good Experience: Brian Ascher is Excellent
Fund: Venrock Associates
Posted by Anonymous on 2008-06-25
We worked with Venrock for nearly two months before getting rejected based on competitive issues (we are involved in the expert consulting space). Overall, it was a positive experience. Brian Ascher provided excellent guidance and feedback throughout the process. The other partners we met (including David Siminoff) were engaging, thoughtful, and respectful.
Judging from this site, Venrock seems to elicit some very strong negative opinions. However, our experience seems to have been quite different from others. The pitching process was slow compared with others we've worked with, but we would be more than happy to engage with them again for a later round.PRIVATE: Members Only (644 Characters)


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Mel Gibson has become the movie star folks love to kick around. First when he made PASSION OF THE CHRIST folks in Hollywood laughed at him...until the movie became a blockbuster. When he went through his public divorce he was ridiculed. Arrested on drunk driving charges and making anti-Semitic remarks? Screaming at an ex-girlfriend and mother of his youngest child? Yep he was guilty of all these things. And yet he continues to work and make movies. But we're a society more interested in the lifestyles of the rich and famous than their movies. Me? I could care less. I want to know if the movies he makes are good. GET THE GRINGO, his latest, is fantastic.
Gibson stars as a bank robber on the run as the film opens. With a wounded partner and the border patrol on his tail, he heads for the Mexican border and jumps the fence there. When the Mexican border guards find the money in his back seat, they take custody of him. Carted off to jail without his money (that the guards have taken for themselves), Gibson is tossed into one of the worst jails of all times.
The jail is a city unto itself. If guards exist here you never see them with the exception of the walls. Instead a crime boss named Javi controls everything in the prison from where you live to the drugs or guns you want. Living in his own mansion of sorts, he has family members run his business for him. As he navigates this prison, Gibson's character (never given a name) takes note of everything that goes on around him. He knows his only chance for survival is to make himself useful to Javi.
Gibson also gets to know someone who can help him understand what's going on and help him on this path. The Kid (Kevin Hernandez) is a low level hustler who Javi always seems to protect. There is a reason for this that becomes apparent later on (I won't surprise you here). As Gibson finds his way in the prison, he takes the kid under his wing as well. The kid's mother (Delores Heredia) isn't pleased at first, but eventually she takes a liking the Gibson.
While Gibson is making his way through this new territory the men he robbed to start the film off are looking for him. They track down the border cops and torture them to find out where he is. And with enough money behind them, the find their way into the prison armed to the teeth to take Gibson out. What follows is one bloody battle that you won't forget and the need for Gibson to make his move earlier than he intended to.
There are several things that make this movie work, first and foremost Mel Gibson. As he's aged Gibson has a weathered look about him that suits the character in this movie. This is a man who has seen hard times and in so doing knows how to accomplish his goals no matter who he has to use to do so. His character is all about self preservation and nothing more. But as the film progresses we notice his character begin to open a bit and to find a certain fondness for the kid.
The setting of the story plays a major role in the success of this film. You've never seen a prison like this before and hopefully never will in person. The core of the film was based on the true stories of prisons like this in Mexico, some of which have been closed down. How people survive here, how Gibson finds his way around and the interaction between characters in the prison adds to the film.
The last thing that makes this film stand out is the script. Well written much of the story unfolds through the sarcastic narration of Gibson's character. His world weary ways present themselves as he begins with "hello kids..." telling his tale. I once read that many found this character to be much like the character of Porter from Gibson's film PAYBACK. It is very much like that character, a hard core criminal that for some reason you seem to like. This film could easily be a follow up to that film. It would make a great double feature anywhere.
If you like Gibson you'll find this to be one of his better films. The range of emotion he displays through subtle looks and gestures makes this one of his best performances. If you don't like Gibson because of the personal problems get over it and watch the movie for the entertainment value. We all have problems in our personal lives; unfortunately movie stars have them displayed on the front page. If you can forget that for just a while, you'll be watching a good movie.
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highest reported incarceration rate in the world. We've rounded up some of the best investigative journalism on U.S. prisons and the problems that plague them. These stories cover juvenile justice, private prisons, immigration detention and other aspects of America's vast incarceration system.
Louisiana Incarcerated: How we built the world's prison capital, The Times-Picayune, May 2012
Louisiana's incarceration rate tops the U.S.'s, Iran's and China's. This eight-part series explains how it got there: lobbying from private prison companies, cash-strapped municipalities, harsh sentencing, and limited rehabilitation for those who make it out.
|Moose Lake sex offender facility, Minnesota
Programs that keep some sex offenders detained indefinitely after their criminal sentences are up have grown drastically in recent years, and so has their cost—"civil commitment" is on average four times as expensive as prison. But releasing sex offenders has proven politically fraught. (For a few state-by-state investigations, see these muckreads on Washington, Virginia, and New York.)
Bail Burden Keeps U.S. Jails Stuffed With Inmates, NPR, January 2010
Thousands of inmates are stuck in jail for petty, nonviolent crimes simply because they can't make bail. This NPR series showed how the country's bail system "exists almost solely to protect the interests of a powerful bail bonding industry."
What the Jail Guard Saw, Village Voice, July 2007
Some guards at New York City's prison island, Rikers, weren't just turning a blind eye to violence--they were encouraging it. The Voice has been covering the fallout from Rikers' " Fight Club" ever since, and five years later, they obtained gruesome photos showing rampant violence persists, despite the Correction Department's efforts.
|Pelican Bay (California) solitary confinement,
prisoner sketch
Atul Gawande looked at the U.S.'s widespread use of isolation, which has ballooned in the past 20 years. At least 25,000 prisoners are now held in isolation just in so-called super-max prisons. And their minds can quickly degrade. "The experience," Gawande writes, "typically leaves them unfit for social interaction."
Why Are Prisoners Committing Suicide in Pennsylvania? The Nation, April 2012
An investigation the effects of solitary confinement on mentally ill prisoners in Pennsylvania. Also see this account from the Arizona Republic: nineteen prisoners in Arizona have killed themselves in the last two years, many of them while in solitary confinement—a widespread practice in the state.
The Devil's Playground, Westword, February 2011
Earlier this year the Justice Department laid out new rules aimed at eliminating widespread sexual abuse in U.S. prisons. This article chronicles the ordeal of one inmate who tried to report rape in a Colorado prison.
|Juvenile InJustice, Richard Ross
America locks up children at a quicker rate than all other developed countries, with about 60,000 juveniles imprisoned on any given day. Photographer Richard Ross spent five years photographing the little-seen conditions inside 350 correction centers across the U.S.
For teens guilty of murder, penalties can vary widely, New England Center for Investigative Reporting, December 2011, and Direct Fail: Colorado's policy of sending teens to adult court, 5280 Magazine, December 2011
In light of the Supreme Court's decision this week to strike down mandatory life-without-parole sentences for juveniles, it's worth revisiting these exposes of juvenile justice in Colorado and Massachusetts, two states that often sentence teens as adults.
A Death in Texas: Profits, poverty and immigration converge, Boston Review, December 2009
Privately run immigration detention facilities have proliferated along the U.S.-Mexico border. But the small towns where they're located have rarely benefited. (Such tales aren't limited to the border, as this report from Georgia tells).
|Immigration prisoners, Arizona
The country's two largest private prison companies have spent tens of millions on lobbying in the past decade and doubled their campaign contributions, as the government launched tougher immigration rules. Since 2005, they've also more than doubled their revenues from immigration detention.
Clarification (6/29): We've clarified this story to note that the U.S. has the highest reported incarceration rate in the world. There are a few countries—notably North Korea—for which reliable prison statistics aren't available.
*Creative Commons license; reprinted with permission of ProPublica, "Journalism in the public interest."


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Hi, I'm Sunny! I recently turned 18 and got a modeling job together with my own personal site, a place for me to share the most intimate moments of my life with my online friends and fans. I am glad to welcome you here and hope you enjoy the pics and videos I got for you as much as I enjoyed making 'em.
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With the opening of our new Central Library, my first thoughts focused on how the building represented a new chapter in library service to Forsyth County. However, the more I walked through the new building and took in the sights and sounds of people marvelling at its stunning design, resources and services, the more I realized the "chapter" metaphor was all wrong. What the new Central Library represents is not a new chapter in library services but rather an entirely new book.
It's not unimaginable to say the new Central Library has been a work-in-progress since the first Carnegie Library opened its doors to the public on February 14th, 1906. Just as the library is a place for learning, so have we learned over the last 111 years what goes into building a library that supports and fulfills the wants and needs of its community.
What we learned is that great libraries are built with two key ingredients. The first is a willingness to step out of your comfort zone and enact change when change is needed. The second is to protect and honor the core values and traditions that form the very foundation of our mission of service to you.
We never want to introduce change just for the sake of change. The question of "what value does the change offer you, our end users" is always examined and debated tirelessly. We will never forget the most important asset we hold is the trust and confidence you have placed in us to provide services and resources that enrich your life and that of Forsyth County.
These truly are exciting times at the library. Coming on the heels of the re-opening of Central is the start of the new Kernersville Branch Library whose groundbreaking was held in early September, and early in 2018 we are looking forward to the official groundbreaking of a new Branch Library in Clemmons. Both libraries are expected to take around a year or so to complete.In addition, our Southside and Reynolda Manor branches as well as our Malloy/Jordan East Winston Heritage Center will undergo significant improvements to their facilities that will make your library experience better than ever.
As we move forward you can rest assured that we will always look for opportunities to improve our buildings, our resources and the delivery of our services in the same professional, timely and meaningful way you have come to expect from us.
Thanks to your overwhelming support, public libraries are alive, well, and thriving like never before in Forsyth County. The faith you have placed in us is one we are honored to have. We are privileged to serve you now and in the future.
Sylvia Sprinkle-Hamlin
Library Director


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Liberty News
Making Waves: WRVL Broadens Footprint
Nearly three decades ago, Jerry Edwards came to Lynchburg looking for a Bible study.
He found a broadcasting career.
Now, the veteran morning drive-time announcer and general manager of WRVL-FM (88.3) radio is experiencing growing pains.
WRVL, a 50,000 watt powerhouse radio station located on the Liberty University campus, has added nine active translator stations and is working toward putting its broadcast signal on the air all over Virginia and northern North Carolina. "We've always been blessed with a very good footprint," Edwards said.
A translator allows WRVL's broadcast to be transmitted to a radio station on a different frequency than the original signal.
About 18 months ago, the Federal Communication Commission opened the door to allowing non-commercial stations to apply for translators in the commercial radio bands.
"In our situation, we looked at it as we are a local radio station and that we would like to expand into certain areas," Edwards said. "We applied for 15 of the translator stations. We thought, if we could get half of those, that would be great."
As a result of those applications, the FCC approved seven of the translators WRVL was seeking.
The FCC requires the translators to be fed by a station's main signal or by another translator that is carrying that signal.
"We set out to do that," Edwards said.
The FCC rules further state that an applicant has three years to get translators on the air or the applicant will have to forfeit rights to the translator.
"Some of the organizations that had applied for hundreds of translators came to realize that they weren't going to be able to build them," Edwards said.
That opened the door for WRVL to get more translators allocated. "A lot of companies were making them available," Edwards said.
The potential for translator acquisitions caught the attention of former Liberty University Chancellor, the late Rev. Jerry Falwell, who urged Edwards to move forward quickly with the plan.
"He wanted to put WRVL in every city in Virginia and northern North Carolina," Edwards said. "It was a very aggressive vision."
Consultant and LU graduate Rob Branch helped WRVL find a company that was willing to sell 20 of the translators in the Virginia and northern North Carolina area.
"Buy them," Falwell said.
By the time the university stopped buying, WRVL owned the rights to 33 translators.
Each translator costs about $18,500 in equipment and labor, not including tower rental fees.
"Right now, we are operating nine of those 33," Edwards said, adding he expects to one day have all 33 operational.
"I fully expect to have 20 to 22 in place by the end of this year," he said.
If that happens, WRVL's footprint will be greatly expanded to include Northern Virginia, Winchester, Harrisonburg, Covington and much of Virginia's Tidewater area.
"By the end of next summer we believe we'll have all these translators built," Edwards said. "It's exciting to see this puzzle start to fit together."


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Marina Rinaldi is launching its new fragrance contained in a curved glass bottle and accented by packaging that showcases its levity, the first fragrance designed by master perfumers for Marina Rinaldi embodies a world of intense femininity, at once rich, ethereal and timeless.
Its elegant bouquet combines the vivacity and freshness of mandarin with notes of rose and peony. Its centre is soft, composed of a velvety tapestry of heliotrope and neroli, enlivened with spicy touches of pink peppercorn and ginger that offer an enveloping and decisive originality. The musky, sensual base becomes sweet, muffled in a blend of amber, vanilla and sandalwood.
Japanese artists Britney Hamada and Tsumori Chisato outline their highly personal vision of the world of Marina Rinaldi.
The essence of one flows into the other's world and vice versa. It is as if three imaginary women are having a conversation: the fantasy daughter of Manga's newest star Britney Hamada, the creation of the fashion designer Tsumori Chisato and, lastly, the Marina Rinaldi woman.
Very soon online the Tsumori Chisato for Marina Rinaldi collection and the "Pane Gyaru" manga by Britney Hamada that will be shown this evening 25th of September at the Diamon Tower in Milan.
Follow the live tweet on the Marina Rinaldi twitter profile, hastags: #funjapan #funjapanMR
Marina Rinaldi invites to the exhibition "A New Perspective" by the famous New York City photographer Amy Arbus.
Captured by Amy Arbus in her beloved Central Park are 15 portraits of women of all ages, each distinctively beautiful while far removed from stereotypes. The exhibition will be open from saturday 28th february to sunday 1st march in San Carpoforo – Brera.
"A New Perspective " 28th february – 1st march from 10am to 7pm San Carpoforo – Via Formentini, 12 Milano
The brand Marina Rinaldi, is now venturing into the world of art entrusting to the vision and the talent of artist Joana Vasconcelos the presentation of its SS 15 collection, through another, unconventional point of view.
The premises of Palazzo Bocconi, will host VALKYRIE MARINA RINALDI BY JOANA VASCONCELOS, the site specific installation arising from the collaboration between the brand and the artist who has utilised garments and fabrics from the new Marina Rinaldi collection in order to create it.
As well as this original work created exclusively for the brand, Joana Vasconcelos will make her Milan debut exhibiting three other works from her most famous repertoire: MARYLIN, a king-size shoe made of pots and pans, RED INDEPENDENT HEART#3, and CARMEN.
The event had the characteristics of a real happening, giving rise to a surprising dialogue between the monumental works of the artist, the fashion world of Marina Rinaldi and the architecture of the building.
Marina Rinaldi has chosen to open its flagship store in a George III London townhouse located in London's Mayfair district. Albemarle Street is one of the capital's most exclusive areas and the new store perfectly combines the Marina Rinaldi philosophy with the aristocratic setting of a timeless English home.
Like other recently opened Marina Rinaldi boutiques the Townhouse creates a pleasing and intimate atmosphere that makes guests feel they are visiting a private home. "Home" is a key concept in Marina Rinaldi's new mood, inspired by the idea that fashion and accessories feel completely at ease with beautiful furnishings while continuing to play a leading role.
Marina Rinaldi turns ultra glam and launches Red Carpet, a capsule collection of stunning evening gowns designed to passionately celebrate the beauty of women. To celebrate the launch of this collection, the world's most famous curvy top models (Tara Lynn, Robyn Lawley, Jennie Runk, Candice Huffine, Alessandra Garcia, Lizzie Miller and Katy Hansz) were brought together for the first time ever, and their radiant beauty was captured and highlighted by star photographer Arthur Elgort in a series of super glossy portraits. A very special stage has been reserved for the official debut of Red Carpet: in February: during Milan fashion week, the Marina Rinaldi flagship store will host all seven super top curvy models, to present the collection to the international press.


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Home > Admissions > Guidance Counselors
Guidance Counselors
The enrollment counselors and support staff at Thomas More College recognize and appreciate the many responsibilities our guidance counselors oversee. The Office of Enrollment collaborates with guidance counselors from around the country to ensure a smooth and simple transition for their students.
Thomas More College ACT code: 1560
Thomas More College SAT code: 1876