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This is not an offer for credit and should be used for estimation purposes only based on the information you provided. You should not base your decision on this estimate alone. Title, registration, tax and other fees, and personal circumstances such as employment status and personal credit history, were not considered in the calculations.
3,600 lbs. at bucket pin
2,400 lbs. at 19.7 in. ahead of bucket pins
5,100 lbs. at bucket pin
3,600 lbs. at 19.7 in. ahead of bucket pins


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Jewellery Care & Cleaning
Proper care and handling of your jewellery can help it maintain its beauty and sparkle for years to come, and we recommend an annual inspection to promote early detection of wear and tear, which may assist in avoiding gem loss, clasp failure, etc. All jewellery should be treasured and worn with care as an adornment. Avoid contact with household cleaners or chemicals, chlorine, bleach, salt and chlorinated water, perfumes, hair-spray and cosmetics. Do not wear jewellery when showering or cleaning, and never wear jewellery to bed or while participating in sport, as this may cause kinking, snagging or breakage.
Even diamonds, although durable, may chip if impacted. Pearls should be restrung once a year. Store jewellery separately, to avoid tangling and knocking together, and use a jewellery roll when travelling. Between professional beauty treatments, we offer specialist cleaning products for use at home, with advice on which gems and jewellery are suitable for these products, or we suggest a soft toothbrush and a mild detergent.
For more infromation on how to care for your jewellery, click here.

subset: commoncrawl


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Kuan Yin: Goddess of Compassion & Healing (cast resin wall plaque)
ON: STARFIRE MAGIC Page (click*on*photo)
Kuan Yin, bodhisattva of
Compassion, is shown here balancing on A full moon like hoop in a meditative
pose. Quan Yin : or Kuan Yin (also spelled Kwan Yin, Guan yin or Quan Yin
and known as Kuan Shih Yin), is known as the Goddess of Compassion & Healing.
She is one of the most popular deities in all of Asia. Her name in Chinese
roughly translates as " The One who Hears the Cries of the World ". She is the
most beloved and revered of the Chinese deities. Kuan Yin is the Divine Mother
we all long for: merciful, tender, compassionate, loving, protecting, caring,
healing, and wise. Shown in striking detail this wall plaque can be hung
anywhere you wish to bring the influence of her quiet and selfless compassion.
Metal wall hanger embedded in the
back. Cold Cast Resin. 13" x 10" x 2 1/2"
Item Number891-170433824
| Starfire Magic | Pipe
Dreams | Relaxation
Tips | Bed
& Bath Comforts | Speciality
Carved Meerschaum Pipes | Bookshelf
& Bookshelf
Two | Pipe
Dreams 2 | Meditation
Pipes and Pipe Racks | Hot
Tub Robes | Web
Log | Exquisite
Tea Gifts and Organic Teas |
Figurines | Gourmet
Goodies | Combination/Links
| Mellow
Link Elements | Romantic
Music | Flavored
Scripting is required to use this site. Please ensure scripting is enabled in your browser before continuing. If you have questions about enabling scripting on your browser please contact customer support at MyQuickResponse.


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Hello SOTGCY community,
It is an honor to introduce the SOTGC readers to Marissa Tager. Marissa is the daughter of Dr. Mark Tager who has been a professional mentor to "Alex" and me as we have started our journey into entrepreneurship. He has always spoken of Marissa as a woman who was going to take over the world one day. I have yet to have the pleasure of directly meeting her, however, this interview has been an amazing peek into what her father sees, and I wholeheartedly agree with his summation.
Marissa and her brother grew up in San Diego and she recently graduated with a business major and music industry minor from USC. From there Marissa landed a position at the Mercedes-Benz Driving Academy.
What impresses me immensely in this interview is how self aware Marissa is for her age. She has obviously learned from and adjusted to issues that most people don't conquer until farther into their careers. Her zest for life, enthusiasm for the course she has set for herself, and dedication to those that depend on her is remarkable. I hope you enjoy this interview as much as I have.
What is the one trait you admire most in others?
First, I'd say the ability to balance one's social, work, and home life. It is extremely hard to manage a booming social life and to be very effective at work. There is a big transition between college life and working full-time, and I think that people who manage their time effectively have a much easier transition.
Second, people who can compartmentalize well. When they are at work, they focus on work. When they are home or in social settings, they live in the moment and don't carry over the pressures of the day.
Thirdly, I am in awe of people who can stay calm under fire. The woman who heads public relations for our company's western region exemplifies this. No matter how carefully you plan, things will go wrong….and when they inevitably do, the ability to stay positive, focused, and to reframe any negatives is an incredible trait.
What is the one trait you admire most in yourself?
Tenacity. I don't give up. I don't accept "no" for an answer. When confronted with what seems to be insurmountable obstacles, I work hard to find a way to overcome them.
Which quality or attitude internal to women have you observed that sets them back in the workplace?
I think that when women use their sex appeal to advance within a company, it detracts from their true abilities. It reflects poorly on our gender. That being said, I have found myself not carrying heavy boxes and letting some of the men in my office carry them. I justify this by thinking that, with my combination of clumsiness and high heels, I would plummet to my death on the stairs.
What is the hardest lesson for working women to learn?
The lessons differ depending upon the type of person you are. Many women need to be particularly observant about how their emotions are being perceived by co-workers. Expressing some emotion can enable you to work harder, better, and faster, however, expressing too much emotion can land you with a label for being "weak" or "high strung."
There is also the inverse of this, where they suppress their emotions, flattening their affect. The downside to this extreme is that they come across as cold, impersonal, and lacking the empathy to relate well to others. These women rarely inspire co-workers to do their best.
What book is on your nightstand?
Mockingjay by Suzanne Collins. I was a little late to the "Hunger Games" excitement, but when I found some time for myself, I picked up the first book, and haven't been able to stop.
The quality you admire most in a successful man…or in a successful woman?
I don't think that the traits I admire are colored by gender. In my job, I am fortunate to come in contact with many strong, successful women. I admire my direct boss because she is one of the most caring individuals I have ever known. She invests enormous time and energy in understanding what motivates her people, and then she helps provide what each one needs to be successful.
The culture of Mercedes-Benz Driving Academy is one of hard work. It takes enormous focus, in great part because we are an entrepreneurial group within a larger, established, and well-respected company. Oftentimes, we find ourselves in situations where we have to find solutions to unexpected challenges. This requires a blend of creativity, positive attitude and a willingness to take some risks. I was fortunate to be involved in the start up process and to work closely with my boss's supervisor. It was a real treat to see the strength of her will power as she dealt with the problems that start-ups encounter. She was indefatigable. When you see the person at the top work as hard as she does, it inspires you.
A virtue you believe is underrated?
One's opinion. I love opinionated people. Don't give me a compliment if you aren't genuine. If you think my idea is going to be a disaster, speak up. Question me. My ideas can only improve if challenged and fully developed. If I didn't want anyone's opinion, I would work from home and stay off the phone. I think opinionated people can thrive in the right environment.
What is your idea of happiness at work?
I have a job that allows me to do something meaningful and important. I work as a Marketing and Sales analyst for the Mercedes-Benz Driving Academy in Los Angeles. The company takes enormous pride in our culture of safety. We make the safest vehicles on the road, and now we are teaching new drivers—most of them teens—to drive safely.
Most people my age know of a teenager who has died or been seriously injured in a driving accident. Many of these accidents are the result of distracted driving. Every day that I go to work, my co-workers and I save lives. It's great to feel passion for your work.
What do you value most in friends?
Honesty. I talk to my family on a regular basis, but it's my friends who see me most often. I need them to provide me with a reality check every once in a while because I can get too wrapped up in my own life. Listening to stories about their work helps me gain perspective on whether or not I have realistic expectations about my own job. This helps me maintain my perspective.
What, in your mind, would be the greatest of misfortunes?
Interpersonal Failure. I think that failure is necessary in order to grow, but I think the greatest travesty I could face is if I failed in my personal relationships. In no way do I believe that I am going to be flawless in any facet of my life. I am going to sometimes fail in tasks at work. My ideas will fail. My instincts may fail me at times, but I do not want to fail in the eyes of my friends, family and in any other meaningful personal relationship.
Which words or phrases do you most overuse?
"Like," "I know, but," "No," "Um," "But"
What do you think is the greatest difference between our mother's generation and our own?
My mother had the luxury of being able to choose whether or not she wanted to work or stay at home with my brother and me. I do not think our generation has that option to the same extent. Working is deeply ingrained in our character, so I don't see another option for my future.
One piece of advice to young woman in the workplace.


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FDA Approves 'Bionic Eye'
The Food and Drug Administration has a very special Valentine's Day surprise for the visually impaired. For the first time ever, a new treatment has been approved that will give blind people limited vision. This exciting new device—which involves something called the "artificial retina"—will give some the ability to detect things like stove burners, cars, or people in front of them, and crosswalks on a street. In some cases, patients who receive the artificial retina may also be able to detect oversized numbers or letters.


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Mount Nyiragongo
Lava lake at Mount Nyiragongo © Cai Tjeenk Willink
Mount Nyiragongo is an active volcano in the Virunga National Park, about 12 miles (20km) north of Goma. The main crater contains a boiling lava lake which is one of the Congo's most mesmerising attractions, if you have the courage and stamina to reach it. Details on volcanic activity are a bit sketchy due to the long-term chaos in the Democratic Republic of Congo, but the volcano has erupted at least 34 times since 1882.
In 1977 lava breached the crater walls and flowed down the slopes at a frightening speed destroying villages and killing at least 70 people. Again, in 2002, there was a serious eruption which killed 147 and did massive damage to property in Goma, despite the evacuation beforehand of hundreds of thousands of residents.
Nyiragongo is an extremely dangerous volcano, mainly because the speed with which the liquid lava moves makes it almost impossible to escape without warning. Currently the volcano is active, but the activity is confined to the lava lake in the crater; usually eruptions are preceded by months of increased seismic activity and warnings should be issued well in advance as the volcano is under constant supervision. Travellers hoping to climb the mountain should keep a wary eye on volcanic activity in the region and consult local experts before embarking.
The hike up Mount Nyiragongo begins in Goma and is guided by armed park rangers, with porters to carry provisions. Most people prefer to stay overnight on the mountain, in the newly built cabins just beyond the crater rim. Staying overnight allows you to see the dramatic red glow of the lava in the darkness and it is a magical experience.
The landscape becomes increasingly otherworldly and the terrain increasingly challenging as you progress higher up the mountain and it is not an easy hike. The trek to the top takes about five hours but the going is tough. Thermals and waterproof gear are a good idea no matter what time of year you attempt the trek, as it can get cold and rainy on the mountain in any season.
Website: https://virunga.org/


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The Food Group That Might Turn Off Cancer Genes
A new study in the journal Current Pharmacology Reports found that cruciferous vegetables like broccoli, cauliflower, Brussels sprouts, cabbage, kale, and broccoli sprouts have the ability to regulate the genes that cause cancer cells to proliferate.
The scientists at the University of Alabama Birmingham state that "The mis-regulation and over-expression of (certain) genes are responsible for the uncontrolled cellular proliferation … of various types of cancer cells. Regulating the cells' ability to proliferate at the genetic level is an important step in preventing the disease. The study notes, "The answer to chemoprevention has perhaps been available to the general public since the dawn of time. The epigenetic diet is of extreme interest, for research suggests that cruciferous vegetables are not only an important source of nutrients, but perhaps a key to eliminating cancer as life threatening disease."
Cruciferous vegetables contain medicinal plant compounds known as indole-3-carbinols (I3C) and sulforaphane, both of which have been linked to an anti-cancer ability. Broccoli sprouts are a particularly rich source of these compounds, as well as glucosinolate and glucoraphanin, which can increase the amount of sulforaphane in the body. By some estimates, broccoli sprouts contain fifty times more sulforaphane than mature broccoli.
Sulforaphane is well-established as having the ability to fight cancer and estrogen-dependent cancer like breast cancer in particular. It has been shown in multiple studies to have anti-cancer properties against bladder cancer, prostate cancer, and leukemia.
Another study published in the medical journal Cancer Prevention Research explored the ability of a beverage made with broccoli sprouts to assist with the body's detoxification of airborne pollutants, including the well-established carcinogen benzene. Researchers at Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, University of Pittsburgh, University of Minnesota, and the Qidong Liver Cancer Institute in China assessed the ability of the broccoli sprout beverage to increase excretion of the air pollutants. They found that over the twelve-week study period the broccoli sprouts significantly increased the excretion of some air pollutants, especially benzene.
Benzene has been linked to cancer and leukemia as well as anemia. It is found in many sources including motor vehicle fuels, solvents, and cigarette smoke. The World Health Organization (WHO) declares benzene a major public health concern. WHO suggests that automobile exhaust accounts for the largest amount of benzene in the general environment. Oil, heat and some consumer products are the primary sources of benzene indoors.
Study doses of broccoli sprouts vary; however 1.7 ounces (approximately 100 grams) or more daily is usually recommended for therapeutic purposes. Broccoli sprouts are available in most health food and grocery stores in the refrigerated produce section. You can also grow your own. Here are my directions for growing your own sprouts. Also, check out my article, "10 Reasons to Eat Sprouts." Broccoli sprouts can be eaten on their own with your favorite salad dressing, or added to a sandwich or wrap.
EPA Classified Roundup as Carcinogen 30 Years Ago…But Mysteriously Reversed Decision
The Natural Breast Cancer Breakthrough


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With national unemployment figures still high and an election looming, members of Congress are increasingly holding job fairs back in their home districts.
Minnesota lawmakers have announced several this year. While the fairs may not lead to jobs, they might make good politics for lawmakers eager to try to help constituents.
U.S. Rep. Chip Cravaack, a Republican who represents Minnesota's 8th District teamed up with U.S. Rep. Sean Duffy of Wisconsin to host a job fair last week at the University of Wisconsin-Superior.
Inside a big arena on the campus, dozens of job seekers are introduced themselves to recruiters for a variety of companies -- from car dealerships to health care networks. They chatted, left a resume, and moved to the next booth.
"I'm extroverted, so it works out OK," said Tom Furman of Duluth.
Furman was laid off from his job as a business developer for the Northeast Entrepreneur Fund over a year ago, and he's hungry for a new one.
"You know that the benefits are going to run out at some point, and you hate that idea, because it's your livelihood," he said. "I'm married, I have kids. I have responsibilities to these people, and I feel like I'm failing."
Cravaack said the economic recovery hinges on two things -- restoring the confidence of small business owners and connecting employers with potential workers.
"This is one of the ways we're going to do that," he said of the job fair.
Cravaack is not alone, according to Norm Ornstein, a political scientist and resident scholar at the American Enterprise Institute. Ornstein, an expert on Congress, said across the country, politicians are organizing job fairs.
"It's for the obvious reasons," he said. "What better way do you have to show that you are concerned about unemployment and trying to do something about it."
Job Fairs are on the rise among Minnesota's delegation even as the state's jobless rate has fallen to levels last seen four years ago. In March, Minnesota's jobless rate was 5.8 percent, down from 8.5 percent in May and June of 2009.
Members of Minnesota's congressional delegation, particularly the Republicans, have held or announced at least five job fairs already this year, more than either of the prior two years.
Congressional job fairs have grown more popular at the same time there's been a decline in more traditional, town hall style meetings. According to CQ Roll Call, the total number of congressional town halls nationwide has dropped.
Among House members, Democrats on average held about half as many town halls last year as they did in 2009. House Republicans, on the other hand, held more.
Cravaack, for example, has hosted 28 town halls across his sprawling northeastern Minnesota district.
Ornstein said vocal critics have made town halls dangerous territory for politicians. Democrats learned that in 2009 during the debate over the federal health care overhaul, and last year Republicans were bombarded with calls to raise taxes on the wealthy. As a result, Ornstein said job fairs are a much safer venue.
"It's much better to show that you're visible and active in the community by doing a neutral job fair, where no one's going to be asking you tough and embarrassing questions," he said.
The problem is that job fairs rarely lead to job offers.
"Job fairs are usually not a great way for people to match up with companies," said John Challenger, CEO of the big outplacement firm Challenger, Gray and Christmas.
He said 150 human resources executives his firm surveyed in 2009 ranked job fairs as the least effective way to search for a job.
"There's often a lot of people there, and it can be an exercise in filling out applications," Challenger said. "That's why a lot of people go home from them frustrated."
An annual survey of big companies by the consulting firm CareerXroads indicates only two to three percent of new hires come through job fairs.
But that doesn't mean they're a waste of time for job seekers, CareerXroads co-founder Gerry Crispin.
"So if I haven't been out of the house and been pounding the computer and applying to a bunch of stupid companies that never respond to me, getting out of the house and going to a career fair and actually talking to people and engaging them, probably makes them a little more hopeful," Crispin said.
Still, Ornstein said, there's just not much politicians can do to create jobs.
"We've tried tax incentive [and] they can have some modest impact," Ornstein said. "We use the fiscal policy, but companies are going to respond to their own needs and figure out when it makes sense for them to hire new people."
A spokesman for Cravaack questioned the fairness of citing the CareerXroads survey, which involves large companies, noting the large number of small businesses at the Superior campus.
During the career fair, Cravaack was upbeat that the event would result in jobs.
"We just talked to several people," Cravaack said. "One guy, a veteran, said he had four good leads, so that's pretty exciting."
Cravaack is planning a second jobs fair in Brainerd, where the unemployment rate is 10 percent. His GOP colleagues, Reps. Erik Paulsen and John Kline have fairs slated for later this month.


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Aftersales Options
Service & MOT
Did you know that Tyre Rotation is an important part of maintaining your vehicle? It provides a more uniform wear of tyres and extends their overall lifespan. At Border Cars, we recommend that this is completed every 6 months.
Don't forget, your tyres work when hot, cold, wet, covered in grit, oil and mud. So why not treat them to a bit of TLC? It only takes an hour!
For just £24.00 we will not only rotate your tyres but we will also:
- Advice on tyre wear
- Adjust the pressure as necessary
- Clean dirt from the valves
- Remove stones or other foreign objects
- Wash & Vac your vehicle
- Complete a Vehicle Health Check


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Fintech Storm is providing a full day workshop for developers to learn the basics of smart contracts.
The event 'Distributed Ledger & Smart Contracts' will be a training course for those interested in understanding the code of smart contracts as well as other distributed ledger technologies. Some of the courses include recognizing the differences between Ethereum and other blockchains, understanding the use of Oracles, and how to use Solidity programming language.
"Between the 7 speakers, they will cover a gamut of technologies from Ethereum Smart Contracts, Solidity, Bigchain DB and also a practical perspective from a Developer at a bank which has built a blockchain application for Digital Wallet internally," Fintech Storm states in their press release.
This is not just a usual sit and listen conference. Developers will have a hands-on experience by participating in building decentralized applications. Throughout the day, attendees will be trained by Edward Ruchevits (former Ethereum contract programmer), Thomas Bertani (Founder and CEO of Oraclize), Marc Simpson (Distinguished Engineer for Royal Bank of Scotland), and Dr. Dimitri De Jonghe (core developer for BigchainDB). Developers will also hear from Dr. Marc Pilkington (Chief Trainer - Zero Field Labs), Eddy Travia (CEO Coinsilium), and Arifa Khan (CEO Zero Field Labs).
Fintech Storm has successfully held more than 30 events all around the world focusing on Blockchain training. Upcoming events will take place in Geneva, Switzerland and New Delhi, India.
This all-day event will be held on September 5 at the Grange Tower Bridge Hotel in London.


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Prior to working for MiraVista Diagnostics, Ms. Raymond held a variety of management positions with health care administration, life science and industrial service organizations where her innovative customer solutions and strong interpersonal skills resulted in better relationships with clients. Her professional expertise includes sales, large account management, strategic planning, project and contract management, customer service, employee training and public speaking. Before joining MiraVista, Ms. Raymond served as an Account Executive at Mid America Clinical Laboratories and a Program Manager at InteCare, Inc., a URAC accredited and 501 (c) non-profit managed care organization for the Indiana Medicaid Administrative Claiming Program. Earlier in her career, she also served as one of the highest performing sales representatives, Regional Manager and Operations Manager at K+S Services in Detroit.
Ms. Raymond studied speech communication and business at the University of Tennessee-Knoxville where she received a bachelor's of science degree. In addition, she has augmented her education and professional experience with extensive training in business leadership, sales, management and customer service.


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Hi everyone!
Today is your last chance to grab the $1 USD new releases at Pickleberrypop.
The Pickle Barrel will be closed today at midnight EST... so don´t delay!
Here are some inspirational layouts using
Lara´s Digi World Easter fun elements and papers.
layout by Michelleluke
layout by Nibylandia
layouts by AnikA
layout by Brigit
layout by Leila_Ingmar
layout by Scrapippi
And finally a little freebie for you.
Our whole family is very sick and the cold´s caught me to, so it´s only very simple cluster, but I hope you´ll like it. Only for personal use.
Download HERE (4shared), password is freebies
or HERE (mediafire), password is freebies
Enjoy and I hope I see you soon!


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Bon Vivant Wine Tours provides customized wine tours to Washington's Finest Wineries in Seattle, Woodinville, Bainbridge Island, Columbia Valley and Walla Walla. Tours of 2-40 guests, are focused on the guests' wine preferences, and include visits to large flagship wineries as well as smaller boutique hidden gems. Each tour is led by a wine knowledgeable guide. You don't want to do all wine, all day? Try our Art and Wine Tour or our Garden and Wine Tour. Either way, you will go home with happy memories.
Book Your Trip
Partner Advertisements


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Site Search
Top Stories from CNN
Lorinda Olson - May 16, 2012
Lorinda Maxine Olson, 94, passed away May 16, 2012, at the home of her daughter in San Clemente, Calif.
Lorinda was born March 20, 1918, near Axtell to Arthur and Tillie Anderson.
She was baptized and confirmed in Bethany Lutheran Church near Axtell.
She attended rural Kearney County schools and graduated from Minden High School in 1935.
After graduating from high school, she went to Lincoln to find employment where she worked and went to school eventually working for the state of Nebraska. In 1944 she moved to Columbus, Ohio, to work for the ALC Church as secretary of the International Luther League.
On July 24, 1946, she married Warren Olson in Columbus, Ohio, after which they moved to Sparta, Mich., where she lived her entire married life until 2009 when health problems caused her to move and live with her daughter.
She is preceded in death by her husband of 57 years and son, Allen.
She is survived by her sister, Arlene Andersen of Omaha; children, Greg Olson and wife, Joan, of Philadelphia, Pa., Patricia Hadjibabaie and husband, Farhad, of San Clemente, Calif., Clark Olson of Sparta, Mich., Marcia Kawashima and husband, Hidetoshi, of Tochigi, Japan; grandchildren, nieces and nephews.
Memorial services were held at Mamreland Lutheran Church in Kent City, Mich.
Interment of ashes was at the Sparta Cemetery following the services.


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In order to prevent this from happening the URL should be placed at the beginning of the text notification. To adjust the location of the URL follow the steps below.
1. Go to Core > Communication > Notification > Notifications
2. Choose the appropriate Category
3. Select Edit next to the Notification
4. In the Text Notification field move [url] to the beginning of the notification.
Blackbaud Community
Connect and collaborate with fellow Blackbaud users.


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Search the Community Services Directory below, give us a call at 972-237-8000 (Monday-Friday 8 a.m.-5 p.m.), or use an online form or mobile app to request service or report an issue to city staff.
City of Grand Prairie Mailing Address: P.O. Box 534045, Grand Prairie, TX 75053
Employment with the City
- Departments:Human Resources
- Divisions:Alphabetical, City Services & Programs
- Email:email@example.com
- Phone:(972) 237-8192
Return to full list >>
Human Resources Office Location: 318 W. Main St., Grand Prairie, Texas 75050
Visit the City of Grand Prairie Jobs Website for more information.


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LOUISVILLE, Ky. (AP) Louisville announced that junior center Gorgui Dieng is out four to six weeks with a broken left wrist.
Dieng will have a screw inserted into his scaphoid bone Tuesday at the Kleinert Kutz Hand Center. The 6-foot-11 junior broke his wrist on Friday against Missouri.
Cardinals coach Rick Pitino said in a statement Monday that ``with a little luck'' Dieng will return for the start of Louisville's Big East schedule in January.
With Dieng sidelined, 6-10 sophomore center Zach Price, 6-9 senior forward Stephan Van Treese and 6-8 freshman center Montrezl Harrell will try to fill the void.
``We will miss his defensive presence and passing ability, but it's time for other guys to step up their performances,'' Pitino said.
Dieng fell taking a charge during the Cardinals' 84-61 victory in the semifinals of the Battle 4 Atlantis tournament in the Bahamas. He returned with his wrist taped and played 24 total minutes but missed Saturday's loss to Duke in the championship.
Dieng is averaging 8.2 points, 8.0 rebounds and 2.0 blocks for No. 5 Louisville (5-1). He set a single-season school record with 128 blocks as a sophomore to lead the Big East.


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Tonight Grace and I went looking at glasses. She's going to be getting some soon. We looked here, there, four stores maybe, trying red and purple ones on in mirrors. Ladies helping that work there.
Then we tromped to the back of Sears in the mall to find the eyeglass store. Found patio furniture first. We relax and pretend we're in our mansion.. and would you like to join me for some tea she says.. and I act the part and say, well certainly....
Then up and sitting at a bar, she on one side, me on the other, I order a drink from her. She pretends to make it, but we don't know the names of many drinks… so she says a martini, and I say dry, yes…and she says how can a drink be dry.. and I say two olives please and act like it's been a long day.
* * *
It was difficult for Grace to stick with our week-on, week-off parenting schedule now that Mary was living with me full-time. Grace was living at my house every other week, like she always had, but Mary was now living with me all the time. And the two of them together, all the time, didn't always work. Mary would sometimes lose her temper around Grace, especially if Grace was telling her to quit eating in the living room or quit playing her music loud, or for whatever reason. And Grace is younger and smaller than Mary. One day the two of them got into a fight, and Mary grabbed Grace by the hair and pushed her into a wall. That was it for Grace, and she told me.
"Dad, I can't stay over here anymore! I'm scared to death of this girl!"
I understood.
Grace and I had a long talk about this, and she assured me our relationship wouldn't change even if our schedule did.
"I'm sorry, Dad, but I think I'll just stay at your house on your days off from now on. I mean, this won't hurt our relationship any. We'll still be as close as we always were. Don't worry about that, Dad."
"I know, Grace. I understand."
It was difficult for both of us. We were going to see each other less, and we thoroughly enjoyed hanging out together, talking about everything and anything under the sun, making up silly games, and laughing 'till our sides hurt. Really. Grace is amazing and has a killer sense of humor. Really. And Grace knew I didn't prefer Mary over her. She was just afraid of being home alone with Mary when I was at work, and I didn't blame her. After that day, she stayed at my house only on my days off.
I was still involved in her life, of course, in every way, and I would still see her throughout the week, even when I was working — quite a bit actually. If I was running an errand or something, I'd give her a call, and she and I would hang out. We were still together a lot, just not as much as we had been when she lived with me every other week. This was hard for both of us. We had never been separated like this before, but Mary was a priority now, and we needed to arrange our schedules for her.
It was one of the sacrifices Grace and I would make for Mary. I knew we would make up for this loss of time together soon and I was sure this wouldn't affect our relationship in any way.


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Arsenal, Man City, Chelsea and Spurs eye FA Cup final, United at Burnley
As well as Premier League action, there's two huge FA Cup semifinals this weekend as Arsenal, Manchester City, Tottenham and Chelsea eye the final.
Elsewhere, the fight for the top four intensifies as Manchester United face a tricky trip to Burnley while Liverpool host Crystal Palace.
Predict the outcomes in our match polls.
CHELSEA: After the meek defeat to Manchester United last Sunday, Chelsea could not meet a rampant Spurs side at a worse time. But Antonio Conte's side have reacted well to setbacks this season so if David Luiz can keep Harry Kane quiet at one end, Eden Hazard could well make the difference at the other.
Prediction: Chelsea 2-1 Tottenham -- Phil Lythell
TOTTENHAM: This is tough to call, with the Premier League's top two sides going head to head after winning one meeting apiece this season. But Tottenham are in sensational form after winning their last eight matches in all competitions, most recently securing two consecutive 4-0 victories. Meanwhile, Chelsea have lost two of their last four games, including their last one, which may affect their confidence.
Prediction: Chelsea 1-2 Tottenham -- Ben Pearce
ARSENAL: Arsenal are grappling with a new formation and a decidedly sticky run of form; neither are favourable pre-conditions for a match against Pep Guardiola's Manchester City. Any gaps in or around the three-man defence could be punished to the full and a win at Middlesbrough on Monday does not a resurgence make. Wembley will be much tougher.
Prediction: Arsenal 1-2 Manchester City -- Tom Adams
MAN CITY: With both sides arriving at Wembley on the back of much needed away wins, the stage is set at the Last Chance Saloon. City's recent form is more convincing, but Arsene Wenger's need for a win is more acute. Vincent Kompany's resurgence may make the difference in the battle of the leaky defences.
Prediction: Arsenal 2-3 Manchester City -- Simon Curtis
BURNLEY: With Manchester United having played Anderlecht in the Europa League on Thursday night, Sunday's game represents a genuine opportunity for the Clarets to collect a big result. They have been strong at home all year and can pick up a second point of the campaign against United.
Prediction: Burnley 1-1 Manchester United -- Jamie Smith
MAN UNITED: Manchester United have picked up more points per game than any team in the league away from home. They've needed to as well, given how many games they've drawn at home. United will have even more confidence of getting a result on the back of outplaying Chelsea last weekend. However, Burnley have been brilliant at home and, despite being clear of the relegation zone, will be keen to take points off United. Mourinho may well put his faith in Marcus Rashford to lead the line again, with him scoring two goals in his last two league appearances. With just weeks remaining until the end of the season, United have to win every game.
Prediction: Burnley 2-1 Manchester United -- Scott Patterson
LIVERPOOL: With their notorious struggles against so-called lesser teams temporarily eased by recent wins, Liverpool have a chance to consolidate third while others play in the FA Cup. Palace can be awkward and will fight for their lives but without Mamadou Sakho, they may struggle to keep Liverpool's forwards at bay.
Prediction: Liverpool 2-1 Crystal Palace -- Dave Usher
CRYSTAL PALACE: Liverpool appear to be susceptible to pace. Andros Townsend and Wilfried Zaha have this in abundance, so should prove to be difficult opponents. With Palace's continued resilience in the face of difficult opposition, they will have no fear going into the match at Anfield.
Prediction: Liverpool 1-1 Crystal Palace -- Rob Sutherland
HULL CITY: Hull City held their nerve to beat Swansea, West Ham United and Middlesbrough in consecutive home games, so there's every reason to expect another big win for Marco Silva's side. Watford should not be underestimated as they target a top-half finish with a strong end to the season but the Tigers' needs are greater. City can take a big stride towards survival.
Prediction: Hull 2-0 Watford -- Phil Buckingham
WATFORD: This will be a fascinating test for Watford, who having reached the 40 point mark can travel to Hull safe in the knowledge their Premier League safety is assured. On the flipside, their opponents will be fighting for their lives and will have identified this fixture as the perfect opportunity to pick up three valuable points. With no new injury worries, this match provides a great chance for the embattled Walter Mazzarri to prove he can get the most out of a talented Watford squad despite them having achieved their primary objective.
Prediction: Hull 2-0 Watford -- Mike Parkin
SWANSEA: Paul Clement has finally dared to slap the "must-win" tag on Swansea's next game, a fixture against Stoke in which the home side usually prevails. A good thing, then, that Swansea are at home. Clement had better hope the trend continues on Saturday.
Prediction: Swansea 2-1 Stoke -- Max Hicks
STOKE: While Swansea are far from a one-man team it's not unfair to suggest that stopping Gylfi Sigurdsson will do Stoke no harm in their quest to secure all three points. The Potters enjoy making hard work of things, though, so a low-scoring draw with a goal from one of either Marko Arnautovic or Xherdan Shaqiri is the more likely outcome.
Prediction: Swansea 1-1 Stoke -- James Whittaker
BOURNEMOUTH: While the home team are admittedly in a small patch of poor form, Middlesbrough's recent run of results is even less impressive. The Cherries are solid at home, claiming seven wins and three draws from 16 matches, and another tally mark to the victory column is more than likely.
Prediction: Bournemouth 2-1 Middlesbrough -- Will Kent
MIDDLESBROUGH: The Cherries go into Saturday's game knowing that three points will keep them in the Premier League for another season. Boro's fate looks far more negative and they will likely struggle to make ends meet on this tough away trip to the South Coast.
Prediction: Bournemouth 3-1 Middlesbrough -- Catherine Wilson
WEST HAM: Romelu Lukaku (on track for the Golden Boot with 24 goals) looks to extend his incredible record of scoring in nine straight matches against West Ham, as bogey-side Everton visit a London Stadium that's hardly been a fortress for the Hammers this campaign. This is only going to end one way.
Prediction: West Ham 0-2 Everton -- Peter Thorne
EVERTON: Excellent at home but disappointing away, Everton are five matches and three months without a win on the road. While a strong finish could yet dislodge one of the teams above them, three points away from home are a must on Saturday as the Blues try to improve on seventh place.
Prediction: West Ham 0-1 Everton -- Luke O'Farrell
There's two huge matches at the bottom as Hull, currently outside the relegation zone, face Watford at home and Swansea host Stoke. Time is running out in the race to survive, with Sunderland all-but down and Middlesbrough likely to join them.
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text:
- Research
- Open Access
Safety of primaquine given to people with G6PD deficiency: systematic review of prospective studies
- Olalekan A. Uthman1, 2Email authorView ORCID ID profile,
- Patricia M. Graves3,
- Rachel Saunders1,
- Hellen Gelband4,
- Marty Richardson1 and
- Paul Garner1
© The Author(s) 2017
- Received: 21 April 2017
- Accepted: 9 August 2017
- Published: 22 August 2017
Haemolysis risk with single dose or short course primaquine was evaluated in glucose-6-phosphate dehydrogenase (G6PD) deficient people.
Major electronic databases (to August 2016) were searched for single or short course 8-aminoquinolines (8-AQ) in (1) randomized comparisons against placebo in G6PD deficient people; and (2) observational comparisons in G6PD deficient compared to replete people. Two authors independently assessed eligibility, risk-of-bias, and extracted data.
Five randomized controlled trials and four controlled observational cohorts were included. In G6PD deficient individuals, high-dose (0.75 mg/kg) PQ resulted in lower average haemoglobin levels at 7 days (mean difference [MD] −1.45 g/dl, 95% CI −2.17 to −0.74, 2 trials) and larger percentage fall from baseline to day 7 (MD −10.31%, 95% CI −17.69 to −2.92, 3 trials) compared to placebo. In G6PD deficient compared to replete people, average haemoglobin was lower at 7 days (MD −1.19 g/dl, 95% CI −1.94 to −0.44, 2 trials) and haemoglobin change from baseline to day 7 was greater (MD −9.10%, 95% CI −12.55 to −5.65, 5 trials). One small trial evaluated mid-range PQ dose (0.4–0.5 mg/kg) in G6PD deficient people, with no difference detected in average haemoglobin at day 7 compared to placebo. In one cohort comparing G6PD deficient and replete people there was a greater fall with G6PD deficiency (MD −4.99%, 95% CI −9.96 to −0.02). For low-dose PQ (0.1–0.25 mg/kg) in G6PD deficient people, haemoglobin change from baseline was similar to the placebo group (MD 1.72%, 95% CI −1.89 to 5.34, 2 trials). Comparing low dose PQ in G6PD deficient with replete people, the average haemoglobin was lower in the G6PD deficient group at 7 days (−0.57 g (95% CI −0.97 to −0.17, 1 trial)); although change from baseline was similar (MD −1.45%, 95% CI −5.69 to 2.78, 3 trials).
Falls in average haemoglobin are less marked with the 0.1 to 0.25 mg/kg PQ than with the 0.75 mg/kg dose, and severe haemolytic events are not common. However, data were limited and the evidence GRADE was low or very low certainty.
- Malaria
- Primaquine
- Glucose-6-phosphate dehydrogenase (G6PD)
In 2010, the World Health Organization (WHO) re-affirmed a recommendation made many years previously for a single dose of 0.75 mg/kg of PQ to be administered with primary treatment for falciparum malaria to reduce transmission [7]. In reconsidering the risks, the WHO lowered the recommended single dose for gametocytocidal effect to 0.25 mg/kg in 2012, and limited PQ's use to areas threatened by artemisinin resistance or areas of low endemicity approaching elimination [8]. Then in 2015, the policy recommendation was changed to recommend use in 'low transmission areas' and it was explicitly stated that G6PD testing was not required before single dose use [9].
The change in policy from 0.75 to 0.25 mg/kg was based partly on a WHO Evidence Review Group report [10, 11] summarizing published literature narratively, but did not use standard synthesis approaches to critically appraise the evidence. In light of the importance of the recommendation when implemented at scale, it could mean millions of people exposed to PQ or a related drug for the first time [12]. In this systematic review, a narrower objective was considered: to assess the risk and extent of haemolysis in people with G6PD deficiency given PQ or other 8-AQ, from existing research.
Inclusion criteria
Study designs Comparisons of single or short course 8-AQ versus placebo given to G6PD deficient people in randomized trials and controlled cohort designs were sought. This was supplemented with comparisons of 8-AQ given to G6PD deficient or G6PD replete people.
Participants Adults or children tested for G6PD deficiency.
Intervention Single dose or short course 8-AQ alone or added to malaria treatment. Since doses and schedules vary by country, any single dose regimens were included. The short course was defined as any regimen lasting up to 7 days. The results are expressed within two comparisons (PQ vs placebo in G6PD deficient people; and PQ in G6PD deficient people compared with G6PD replete people).
Control Comparison 1: placebo or no intervention. Comparison 2: PQ in G6PD replete individuals.
Outcomes Haemoglobin values at baseline and day 7. Absolute and percentage decline in haemoglobin.
Information sources and search strategy The following major electronic databases were searched using the criteria in Additional file 1 to August 2016: the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Scopus, Web of Science; EMBASE and LILACS. All relevant trials, regardless of language or publication status (published, unpublished, in press and in progress) were identified. The MIM Pan-African Malaria Conferences and the American Society of Tropical Medicine and Hygiene (ASTMH) (from 2004 to 2016) were also searched for relevant abstracts of unpublished trials, and researchers and other experts in the field of malaria chemotherapy were contacted. The reference lists of all retrieved articles were also reviewed [11].
Study selection and data collection RS and OU independently screened the results of the search strategy and retrieved the full text of all relevant citations. The inclusion criteria were independently applied using a spreadsheet and any discrepancies were discussed or referred to a third reviewer (PAG or PMG). RS and OU independently extracted data on study methods, participants, interventions and outcomes, and attempted to contact authors where data were missing.
Risk of bias RS and OU independently assessed the risk of bias for each study using predefined standards based on the Cochrane risk of bias tool for randomized controlled trials, and the EPOC criteria [15] for assessing risk of bias of non-randomized studies (Additional file 2). Each domain was categorized as 'low' risk of bias, 'high' risk of bias or 'unclear'. Where the judgment was that the risk of bias was unclear, attempts were made to contact the authors for clarification. The quality of evidence was assessed using the GRADE approach [16].
Summary measures The results were stratified as high (0.75 mg/kg), medium (0.4–0.5 mg/kg) and low (0.1–0.3 mg/kg) dose of PQ.
This percentage change was categorized as: greater than −5%, greater than −10% and greater than −20%. Moderate and severe anaemia were defined as haemoglobin less than 8 g/dl and less than 5 g/dl, respectively [17–21]. Where the data were not provided, all recent study authors were contacted. The author of two trials [22, 23] provided additional individual patient data, which were included in the analysis.
Mean difference in average haemoglobin values at day 7.
Mean difference in percent haemoglobin value change between baseline and day 7.
Relative risk of ≥5, ≥10 or ≥20% decline in haemoglobin concentration by day 7.
Relative risk of moderate (≤8 g/dl) and severe (≤5 g/dl) anaemia at day 7.
The dichotomous outcomes were reported as risk ratios (RRs) and continuous outcomes as mean differences. Both measures are presented with 95% confidence intervals (CIs). When standard deviations were not reported [24], we imputed these values from comparatively sized trials [22].
Synthesis of results All eligible studies of primaquine were summarized and analysed using Review Manager 5.3. Data were presented in tables and meta-analyses performed when appropriate. In the absence of statistical heterogeneity, a fixed-effects model was used. A random-effects model was used where moderate heterogeneity was detected but it was deemed still reasonable to combine trials.
This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [25, 26]. PRISMA checklist is provided in the Additional files 3. The review protocol was published a priori [3].
Study selection and study characteristics
Summary of study participant characteristics
Study name
Study design
8-AQ duration
Adult dose (mg)a
Total adult dose (mg)
PQ compared to placebo in G6PD deficient people
PQ in G6PD deficient compared to G6PD replete people
Krudsood [24]
Randomized control trial
7 days
30 mg
Primary care urban
16–51 years
Shekalaghe [22]
Randomized control trial
0.75 mg/kg
3–15 years
Shekalaghe [23]
Randomized control trial
0.75 mg/kg
1–11 years
Randomized control trial
0.1, 0.4 or 0.75 mg/kg
6, 24, 45
6, 24, 45
1–10 years
Kheng [30]
Open parallel clinical trial
0.75 mg/kg
Healthcare centres
Adults and children
Bancone [29]
Cohort study
0.25 mg/kg
North-Western Myanmar–Thailand border
Adults and children
Ley [31]
Cohort study
0.75 mg/kg
Adults and children
Mwaiswelo [28]
Randomized control trial
0.25 mg/kg
Men and non-pregnant, non-lactating women aged ≥1 year
Rueangweerayut [32]
Cohort study
100 mg (1.67 mg/kg), 200 mg (3.33 mg/kg), 300 mg (5.00 mg/kg)
100, 200, 300
100, 200, 300
Research institute
18–45 years
G6PD detection methods, phenotypes and genotypes
Study (country)
Krudsood [24]
Not reported
G6PD normal: 134 patients
G6PD deficient: 7 patients
Not tested
Shekalaghe [22]
PCR for G202A, A376G
G6PD normal: 77 patients
G6PD deficient: 30 patients
G6PD wild type: 77 patients
G6PD deficient heterozygous: 23 patients
G6PD deficient hemizygous/homozygous: 7 patients
Shekalaghe [23]
PCR for G202A, A376G
G6PD normal: 493 patients
G6PD deficient: 69 patients
G6PD wild type: 493 patients
G6PD deficient heterozygous: 47 patients
G6PD deficient hemizygous/homozygous: 22 patients
Rueangweerayut [32]
PCR RFLP for Mahidol
G6PD normal (Mahidol negative with >80% G6PD activity): 6 patients
G6PD deficient (G6PD enzyme activity 40–60% of normal): 6 patients
G6PD wild type: 6 patients
G6PD deficient heterozygous: 6 patients
FST; PCR for G202A/A376G
G6PD normal: 373 patients
G6PD deficient: 88 patients
G6PD wild type: 373 patients
G6PD deficient heterozygous: 61 patients
G6PD deficient hemizygous/homozygous: 27 patients
Kheng [30]
FST; enzyme quantification; PCR for Mahidol, Mediterranean, Coimbra, Chinese-5, and Canton
G6PD normal: 57 patients
G6PD deficient: 18 patients
G6PD wild type: 57 patients
G6PD deficient hemizygous male: 14 patients
G6PD deficient homozygous female: 1 patient
G6PD deficient heterozygous female: 3 patients
Bancone [29]
(Thai–Myanmar border)
FST; enzyme quantification; PCR RFLP for Mahidol. Chinese-4, Canton and Viangchan
G6PD normal: 1226 patients
G6PD intermediate: 50 patients
G6PD deficient: 124 patients
G6PD wild type: 1226 patients
G6PD deficient hemizygous male: 39 patients
G6PD deficient homozygous female: 5 patient
G6PD deficient heterozygous female: 65 patients
Ley [31]
FST; enzyme quantification
G6PD normal: 169
Mild G6PD deficiency: 5 patients
Severe G6PD deficiency: 1 patient
Not tested
Mwaiswelo [28]
Rapid test; PCR for G202A, A376G
G6PD normal: 184 patients
G6PD deficient: 33 patients
G6PD A wild type: 95 patients
G6PD A− hemizygous: 15 patients
G6PD AA and BA wild type: 83 patients
G6PD A−A− homozygous: 5 patients
G6PD AA− and BA−heterozygous: 22 patients
PQ compared to placebo in G6PD deficient individuals Four randomized controlled trials reported haemoglobin levels [22, 23, 27, 28]. Three out of the four studies recruited only children and adolescents [22, 23, 27] and one recruited participants of all ages [28]. Three studies were conducted in individuals with confirmed malaria (P. falciparum [22, 27, 28]).
One study used high (0.75 mg/kg), medium (0.4–0.5 mg/kg) and low (0.1–0.25 mg/kg) dose PQ [27], two studies used only high dose PQ [22, 23], and one used low dose PQ [28].
PQ in G6PD deficient compared to replete individuals Five randomized controlled trials [22–24, 27, 28] and three controlled observational cohorts [29–31] reported haemoglobin levels after PQ treatment. One of the eight studies recruited only adults [24], and four recruited participants of all ages [24, 28–31]. Five studies were conducted in people with confirmed malaria: three of P. falciparum [22, 27, 28] and two of P. vivax [24, 31]. One of the eight studies [24] administered PQ as a 7-day course and the remaining seven studies used single dose PQ [22, 23, 27–31]. Five studies used high dose PQ [22, 23, 27, 30, 31], two used medium dose PQ [24, 27] and three used low dose PQ [27–29].
One controlled observational cohort evaluated 100, 200 and 300 mg single dose tafenoquine [32]. This study recruited adults without malaria.
Baseline characteristics Six studies were classed as low risk of bias [22, 27–31]; in two it was unclear; and in one there were baseline differences that were likely to influence the results [22].
Blinding of outcome assessors One study was low risk (an RCT) [22]; six studies were classed as unknown risk of bias; two studies did not blind outcome assessors [24, 32].
Attrition and incomplete outcome data All studies were deemed to be at low risk of attrition bias.
Reporting bias and selective reporting One study was at high risk of reporting bias as stated outcomes were not reported within the results [24]. Of the five trials described as randomized [22–24, 27, 28], risk of bias due to random sequence generation and allocation concealment was low in two studies [22, 28] and unclear in the remaining three studies [23, 24, 27].
Certainty of evidence
Our assessment of the quality of evidence using the GRADE approach is presented in summary of findings tables (Additional files 5, 6, 7, 8, 9, 10).
High dose (0.75 mg/kg) PQ
PQ compared to placebo in G6PD deficient people Three randomized trials [22, 23, 27] report 0.75 mg/kg PQ versus placebo in people with G6PD deficiency, all part of larger trials. Numbers with G6PD deficiency were small, and one trial excluded those with severe deficiency [27]. Two trials were considered low risk of bias [22, 27], while one was at high risk of bias due to large baseline differences in haemoglobin concentration between groups [23].
Percent haemoglobin value change between baseline and day Three trials reported this [22, 23, 27], and haemoglobin fell further in individuals treated with PQ (mean difference −10.31%, 95% CI −17.69 to −2.92, I 2 = 64%, 134 participants, low certainty evidence, Fig. 4.2).
Risk of anaemia Two trials reported this [22, 23], with an 11-fold increase in the proportion of individuals with ≥20% fall (low certainty evidence, Fig. 4.3).
Moderate and severe anaemia at day 7 Two trials reported this [22, 23], with an increased risk of anaemia defined by ≤8 g/dl by day 7, with one individual with Hb ≤5 g/dl (low certainty evidence, Fig. 4.4).
PQ in G6PD deficient compared to G6PD replete people Five controlled observational cohorts evaluated changes in haemoglobin when 0.75 mg/kg PQ was given to people with and without G6PD deficiency [22, 23, 27, 30, 31].
Percent haemoglobin value change between baseline and day 7 Five trials reported this [22, 23, 27, 30, 31], and haemoglobin fell further in G6PD deficient people (MD −9.10%, 95% CI −12.55 to −5.65, I 2 = 0%, 778 participants, very low certainty evidence, Fig. 5.2).
Risk of anaemia Two trials reported this [22, 23] and there was a 3.4-fold increase in risk for ≥20% fall (very low certainty evidence, Fig. 5.3).
Moderate and severe anaemia at day 7 Two trials reported this [22, 23] and there was increased risk of anaemia defined as ≤ 8 g/dl by day 7, with one individual with Hb ≤5 g/dl (Fig. 5.4).
Mid-range dose (0.4–0.5 mg/kg)
PQ compared to placebo in G6PD deficient people One trial [27] evaluated 0.4 mg/kg PQ. This trial did not report haemoglobin at day 7 or risk of anaemia.
PQ in G6PD deficient compared to G6PD replete people Two controlled cohort studies evaluated changes in haemoglobin with a mid-range dose of PQ given to G6PD deficient and G6PD replete people [24, 27]. The doses used in these studies ranged from 0.4 to 0.5 mg/kg. The two trials did not report risk of anaemia.
Percent haemoglobin value change between baseline and day 7 One trial [27] reported this and found greater % change in G6PD deficient people (MD −4.99%, 95% CI −9.96 to −0.02, 113 participants, very low certainty evidence, Fig. 7.2).
Low dose (0.1–0.25 mg/kg)
PQ compared to placebo in G6PD deficient people Two trials [27, 28] provide data for this, using a single dose of PQ versus placebo in people with G6PD deficiency. The doses in these studies ranged from 0.1 to 0.25 mg/kg. These trials did not report mean haemoglobin at follow-up or risk of anaemia.
PQ in G6PD deficient compared to G6PD replete people Three controlled observational comparisons report doses ranging from 0.1 to 0.25 mg/kg [27–29]. The three trials did not report risk of anaemia.
Percent haemoglobin value change between baseline and day 7 Three controlled observational comparisons reported this [22, 23, 26] and no difference was seen (MD −1.45% g/dl, 95% CI −5.69 to 2.78, three studies, 1055 participants, very low certainty evidence, Fig. 9.2).
Tafenoquine (Table 3)
Changes in haemoglobin with different doses of tafenoquine (TQ) [32]
TQ 100 mg
TQ 200 mg
TQ 300 mg
G6PD normal
G6PD deficiency
G6PD normal
G6PD deficiency
G6PD normal
G6PD deficiency
Number of participants
Average maximum decline in haemoglobin (g/dl) from baseline
Average day of maximum decline
In this review, comparative information about effects of PQ (and tafenoquine) on haemoglobin in G6PD deficient people was summarized. The aim was to quantify the risk of adverse effects in those given single dose primaquine to reduce infectiousness of P. falciparum. Few trials to date have addressed this issue directly, so indirect evidence from trials that had the main aim of assessing impact of 8-AQ on P. falciparum gametocytes was sought. Whilst these trials generate some useful information on haemoglobin, they were not necessarily powered for the outcomes studied here.
The nine trials in this review were conducted with varying levels of methodological rigor. Nevertheless, with the 0.75 mg/kg single dose in G6PD deficient people there is an average 1.45 g/dl greater fall in haemoglobin by day 7 compared to placebo, and risks of anaemia (20% drop in haemoglobin) are increased 11-fold. For the mid-range dose of PQ in G6PD deficient compared to G6PD replete people, one trial reported a greater fall in haemoglobin of 3.92 g/dl by day 7.
For the currently recommended low dose of 0.25 mg/kg, there was no difference in the percentage fall in haemoglobin by day 7 in G6PD deficient people given low dose PQ compared to placebo. However, in one trial of PQ given to G6PD deficient compared with G6PD replete people, the average haemoglobin value at day 7 was 0.57 g/dl lower in the deficient group. No difference was seen in percent change in haemoglobin between G6PD deficient and replete people. These data are somewhat reassuring, but the total number of the trials and people in the low dose (0.1 to 0.25 mg/kg) is few, and large falls in a few individuals cannot be excluded.
The lack of sufficient data prevented any analysis stratified by G6PD type and enzyme activities. The reported genotypes varied across studies. It should be noted that one trial contributing to both comparisons [27, 33] included only G6PD 'normal' participants based on the FST test, but further genotyping showed wide variation in G6PD genotypes. Therefore, this study likely underestimated the effect in G6PD deficient participants. Individual patient data meta-analysis is needed to explore variation due to phenotypic G6PD activity, genotype or applied diagnostic method, which is beyond the scope of the present analysis.
The enduring uncertainty surrounding safety, shown clearly by low or very low certainty of the evidence, should prompt further research on the effect of lower doses of PQ in people with G6PD deficiency, including examining effects on the most prevalent genotypes. Only this additional information will enable policies to be based on an adequate evidence base and reassure national and local programme managers that the drug is safe to be used without prior G6PD testing.
Several studies on the safety of the currently recommended single low dose of 0.25 mg/kg PQ in combination with artemisinin combination therapy in G6PD deficient individuals are ongoing (clinicaltrials.gov NCT02174900; NCT02654730; NCT02535767). These studies will help refine our understanding of the safety of PQ in G6PD deficient individuals. Enhanced and continuing pharmacovigilance is needed to fully characterize the safety of PQ in the range of G6PD deficiency variants [34, 35].
The evidence assessed for this systematic review suggests that the lower single dose (0.1 to 0.25 mg/kg) of PQ given with the goal of reducing transmission of P. falciparum is less likely to cause haemolytic effects in people with G6PD deficiency than the previous 0.75 mg/kg dose, and that severe haemolytic events are not very common. However, the evidence is based on few trials and a small number of people. The roll-out and scale-up of the 0.25 mg/kg dose in countries without prior experience would greatly benefit from more reliable data demonstrating the safety of this dose.
Authors' contributions
PMG identified the question and the PICO; RS and OAU designed the detailed analytical plan. OAU carried out the analysis with RS. MR provided statistical input at all stages. PAG advised on the protocol and review, helped with the analysis, interpretation and writing. All authors contributed to the final manuscript. All authors read and approved the final manuscript.
Aileen Clarke contributed to the protocol but not the analysis. Vittoria Lutje conducted the searches. Teun Bousema provided individual patient data and commented on the manuscript.
Competing interests
The authors declare that they have no competing interests.
Availability of data and materials
All data generated or analysed during this study are included in this published article and its additional information file.
Consent for publication
Not applicable.
Ethical approval and consent to participate
Not applicable.
RS, PG, MR are supported by the Effective Health Care Research Consortium. This Consortium is funded by UK aid from the UK Government for the benefit of developing countries (Grant: 5242). The views expressed in this publication do not necessarily reflect UK government policy.
Publisher's Note
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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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- Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.View ArticlePubMedPubMed CentralGoogle Scholar
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September, the distant future, the year 2000*
2000+. I want to take up journaling again, but I fear I've lost the knack.
It's funny. Time was when I could not write about anything so easily as myself.
*Flight of the Concords, 'The Humans are Dead.'
September more, 2000+
I would like to revise my assessment of 'easily'.
It's true that what I wrote was a lot, but I wrote it so forcedly, so compulsively, and with so little regard for how wrong it felt coming out, that I may as well not have written it at all. (Did it feel wrong? I hope so—It's certainly painful enough to read.) The very avidity of my efforts proved their own sabotage.
Looking over these entries now, I note with astonishment that they are all dated. Honestly dated. Sometimes, I even went so far as to attempt a real chronicle of events. These, of course, are by far the most awkward entries: it is one thing to record impressions, but I wrote as one fleeing death.
Did you note my pun, Diary? I'm not sorry.
still September, 2000+
I think the trick of journaling, for me, is not to write about myself. I mean, I'm going to write about myself no matter what, but there's no need to hedge me in. Especially not into 'events' in my 'life'. Not that it's a bad life, as they go, but I fear that the direct chronicling events is a slippery slope that leads towards Exactly What I Hate and Detest Most In The World.*
That, or more bad writing. Or both.
God save us from bad writing. God save us from dreary autobiography—from writing what we know, from writing what we don't, and from writing what we don't yet know we don't.**
(God save us from writing. God save us from our stupid, stupid words and our miserable souls. Amen.)
*Joseph Conrad, Heart of Darkness, 1902. `You know I hate, detest, and can't bear a lie, not because I am straighter than the rest of us, but simply because it appalls me. There is a taint of death, a flavor of mortality in lies, which is exactly what I hate and detest most in the world—what I want to forget.' Clearly, a narrator we can trust.
**Joseph Fink and Jeffrey Cranor, 'One Year Later,' Welcome to Night Vale, Audio podcast (Commonplace Books: 15 Jun 2013) http://nightvale.libsyn.com/25-one-year-later.
October, 2000+
October is important, Diary, and we should remember it.
Months in general are important. That's why I note them: they're wonderfully suggestive, without being precise enough to risk a bold-faced truth. I am neither lying about my location, nor reducing myself to it. I'm just . . . hinting. At what it might be like, when I am.
And before you get on at me about the year, I think it also very important to remember that it's not the 90s anymore. Heaven forbid I should be mistake for someone writing in the twentieth century. ew.


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Show All Answers
Do I need to have a season pool pass for my children to take lessons?
No. There is a higher fee charged for those without season passes, so that they are assisting with the costs of operating the pool. If you choose to purchase a season pass, the amount of additional money spent on the lessons will be deducted from the full cost. Season passes are not required during swim lesson times, but once the pool opens for General Swim, everyone must either have a season pool pass or pay the daily admission, whether they swim or not.
How do I choose the most appropriate level for my child?
Brief descriptions have been included on this web site, as well as in a handout at the Park and Recreation Office. At the evening registration for Needham residents, the Assistant Pool Supervisor responsible for swim lesson instruction will be available to answer questions, and the office staff will assist at other times. If you have difficulty choosing between two levels, choose the "lower" level and tell the instructor on the first day of your difficulty in choosing. As soon as your child is ready to move to the next level, the instructor will discuss this choice with you.
Why can't my three-year old child be in Level One classes?
Young children learn effectively through play and exploration, and the Preschool classes are set up for that purpose. All of the activities that the children participate in are teaching them about the water and their abilities to swim, even though they appear to just be participating in "fun and games."
Can I go in the water during lessons if my child is afraid of taking lessons?
Parents are welcome to join the child on the first day, and the staff will assist with moving the parents gradually away from the water, so that the child can participate with the group and develop confidence in his/her skills.
Can my four-year old child, who loves the water but has not had swim lessons, start in Level One?
Children's success in Level One through Level Six classes is dependent on their having the physical and emotional ability for those levels. Four year olds begin their lessons in the Preschool level, which has been created to be an appropriate learn-to-swim experience for the majority of children in that age group. A few individual children each summer are reviewed by the instructor and Assistant Pool Supervisor and determined to be ready for learning to swim with older children and are moved during the session. The Red Cross does not recommend there being a large age span at any level, particularly at the younger levels.
Why are two Preschool classes, offered at the same time, combined together at the beginning?
The two classes meet together, and participate in activities with two instructors. By the end of the second day, the children are broken into two groups, with like abilities, so that the lessons over the three weeks are most effective for the participants.
Can I sign up for two classes during the same session to give my child more practice?
No, children should only be registered for one class in order for the classes to be most effective. Instruction is only one part of learning to swim, and children should spend time outside of instructional classes practicing and playing, to learn to depend on their own skills. Some children are able to develop their abilities through play, and others like to participate in the Needham Swim Team, challenging themselves with others with a variety of abilities.
What training have the swim instructors had?
All of the full-time instructors are certified by the American Red Cross as Water Safety Instructors. This is a lengthy certification program that reviews the proper form for each swim skill, and provides instructional suggestions for teaching those skills effectively. The instructors are also certified as Lifeguards, which requires the individuals to have strong swimming skills themselves. The Director of the Park and Recreation Commission has a B.S. in Early Childhood Education and a M.Ed. in Special Education and is a former teacher. She participates in additional training with the staff. Occasionally, a lifeguard who has interest in becoming a swim instructor will assist with teaching a class, under the direction of a Water Safety Instructor.
Who do I go to if I have questions or concerns during swim lessons?
The first person available to help you is your child's instructor. He/She has a few minutes before moving to the next class, so if additional time is needed, ask the instructor to contact you later in the day. The Assistant Pool Supervisor responsible for lessons will be on site, and also teaching. You can ask to meet with the Supervisor with your questions or concerns, or arrange a time outside of swim lesson time. If you still don't have answers to your questions, please contact the Assistant Director of the Park and Recreation Commission at (781) 455-7521.
What can I register for if my child has difficulty learning in a group setting?
Park and Recreation offers Adaptive Aquatics. These lessons are one-on-one for children who need individual instruction. Swim instructors are available to teach classes on weekday afternoons, and will contact the parent to set up appropriate times. Some children are able to have a lesson each weekday afternoon, but others need to have less classes available each week. The instructor will notify the parent when 15 classes have been held in the event that the parent would like to register for another set of classes. Parents should contact the Assistant Director of Park and Recreation to check on eligibility. The Assistant Director of Park and Recreation is a Certified Therapeutic Recreation Specialist and was Director of Special Needs Recreation for Newton Parks and Recreation for 16 years prior to coming to Needham.
Are swim classes cancelled when it rains?
In most instances, swim classes are held rain or shine. In the event of thunder or lightning, or when pool water conditions are not appropriate for swimming, classes are cancelled, and notification is put on the Recorded Information Line at (781) 444-7212 Press 2. The decision cannot be made until approximately 8:30 AM, when the morning staff is on duty, and all testing of the pool water and evaluations of the site and weather are completed. The Red Cross suggests that lessons be offered in 10-day sessions. Swim lessons at Rosemary Pool are offered in 14 or 15 days sessions, providing time for days off for vacations or pool closings.
Can the swim instructors help my child with the Deep Water Test?
Absolutely! Mention it to the instructor on the first day. If your child has a fear of taking the test, the instructor may try to do the test during the session.
Can my other children play in the water while one child is taking a lesson?
No, for their safety. All of the guards are in classes teaching and not available to guard swimmers, and for half of the morning, the Swim Team is using the right hand side of the pool. Other children may play in the sand areas or up in the playground area.
How can adults learn to swim or strengthen our skills?
Over the years, classes have been offered for adults, but due to low registrations will not be offered this summer. The Supervisors can offer some helpful hints for skill strengthening, and adults may sign up for private lessons at the Pool Booth. Private lessons are taught by staff who are certified to teach, and choose to teach private lessons when they are not on duty.
Why are registrations only taken in person?
A large number of children are registered for swimming lessons, and the information needs to be ready for the classes in a short period of time. In-person registration allows the staff to take care of all questions related to the registration very quickly, without the need of timely follow-up through phone calls related to mail-in registration. A large number of children participate in more than one session of lessons, and the swim instructors are able to report each child's progress towards the end of the session, so that the appropriate level is chosen for the next session. More time is spent on instruction when children are in appropriate levels, than in testing and moving children into different levels.
Why are late registrations not taken?
On the first day of classes, the instructors need to start filling out paperwork for the Red Cross and have it submitted that week. The paperwork is finalized towards the end of the 3rd week, so that appropriate changes are made. In addition, the number of children in each class changes throughout the three weeks, as individuals progress from one level to the next. Levels have a sequential curriculum for the teachers to follow. It is difficult keeping the classes progressing with constant interruptions and new students.
How can I register my child if I am not able to be at the Park and Recreation Office during registration times?
There are several options:
Ask another family to register your child when that family registers their children
Ask another family member to do the registration (we get to meet lots of nice grandparents!)
Call the Park and Recreation Office prior to registration to ask about alternative suggestions
Does the evening registration line require me to come early and wait a long time?
No. In recent years, most parents coming on the first night of registration were able to register for their first choices of classes. There is no need to come prior to 5:30 pm when numbers for place in line are given out. Prior to the 6 PM start, you can purchase pool passes, get pool pass numbers if you've forgotten to bring yours, register a birth certificate for 3-5 year olds, and ask questions about what level of lessons to choose. Once the registration starts, more than 80 families are registered prior to 7 PM, and the process is often faster than those coming during office hours during the day registrations, as a large staff is brought in to move the process along quickly. Some families join together to make it easier…one family registers the children of two families, the other family stays home with all the children!
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About Last Chance Supermarket
Help help help!! You totally forgot about Christmas and you are pretty sure your wife will kill you if you come back empty handed. Luckily this supermarket is open till very late. The only problem is, you are not alone. Move your shopping cart through the aisles and grab all the items on the Christmas list. Avoid running into the other customers!