text:
- Research article
- Open Access
- Open Peer Review
Quality of hip and knee osteoarthritis management in primary health care in a Norwegian county: a cross-sectional survey
- Gudmund Grønhaug1Email author,
- Nina Østerås1 and
- Kåre Birger Hagen1
© Grønhaug et al.; licensee BioMed Central Ltd. 2014
- Received: 10 May 2013
- Accepted: 12 November 2014
- Published: 25 November 2014
Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care.
A cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables.
A total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1-11) and pharmacological (QIs 13-16) treatments were 50% (IQR 25-75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate.
Considering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.
- Osteoarthritis
- Quality indicator
- Primary care
- General practitioner
- Knee
- Hip
Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population [1]. The prevalence of OA is related to age and body weight, and due to an increase in age and body weight in the population, the prevalence of OA is expected to further increase. Furthermore, it is estimated that 15-25% of visits to the general practitioner related to musculoskeletal conditions are due to OA [2]. Evidence-based guidelines have been consistent for more than a decade [3]-[6], advising patients to make use of core treatments such as exercise and weight reduction. Transferring guidelines into practice is not easy and knowledge and adherence to guidelines in daily practice is limited [7],[8], thereby resulting in suboptimal OA treatment [9]-[11]. It is further estimated that OA alone results in greater costs than all other rheumatic diseases in relation to sick leave and comorbidities [12],[13]. If OA patients were given evidence-based care to manage their everyday problems associated with OA, it may help to contribute to reduced disability and sick leave. Hence, both the cost to society and the burden of disease for the individual may be reduced.
One way to assess the adherence to guidelines and the quality of the treatment given is to use quality indicators (QIs), the fulfilment of which can be evaluated by the patients or health-care providers or by extracting data from patient records or other sources of information such as quality registries. A small number of QI sets for OA exist [14], including Assessing Care of Vulnerable elders (ACOVE) [15] as a part of the total care given to people 65 or older, in addition to Arthritis Foundation Quality Indicators [16], which is a checklist for the general practitioner (GP). In this study we used a recently developed instrument for patient-reported quality of OA care, the OsteoArthritis Quality Indicator questionnaire (OA-QI) [17], which assesses both the pharmacological and non-pharmacological aspects of OA treatment.
The Norwegian health care system provides universal access to primary and hospital based medical care. There is also universal access to community based physiotherapy services. Traditionally, persons with OA have received treatment in both primary and secondary care, with the Norwegian Directorate of Health recently placing the main responsibility for OA management in primary health care [18]. Thus, the main aim of this study was to capture patients' assessment of the quality of OA care in a primary health-care setting, while we also wanted to explore factors associated with the perceived quality of OA care.
The study was designed as a cross-sectional survey, in which patients completed a questionnaire after a GP consultation.
Study participants
The respondents were recruited at six GP offices during a consultation (two in Namsos, two in Verdal and two in Levanger, all of which are situated in Nord-Trondelag County in the middle of Norway), with the inclusion period lasting from 10 January 2012 until 1 October 2012. The county of Nord-Trøndelag is considered to reflect the national characteristics regarding population demographics. The area where the study was obtained is comprised of minor cities and their rural surroundings, reflecting the variety of the population's socio-economic and sociocultural background.
Patients with either radiologically diagnosed OA, according to ICPC codes L89 (osteoarthritis of the hip), L90 (osteoarthritis of knee) or L91 (osteoarthritis, other) or clinical signs and symptoms corresponding to OA in the hip or knee were considered eligible, while patients with inflammatory rheumatic diseases, malignant illness or other conditions considered by the GP to affect the persons' abilities to complete the questionnaire were excluded. The ICPC codes are used in primary care in most countries in Western Europe. The ICPC coding is based on conceptual constructs, and is focused on health problems, as compared to the ICD framework which is based on historical constructs and is focused on disease.
Data collection
During a consultation, the collaborating GPs handed out an envelope to all eligible patients that contained information on the study, a questionnaire and a prepaid envelope for returning the questionnaire. Both the doctors and the secretarial staff at the GP offices were involved. The medical secretaries were asked to remind eligible patients about the study after the consultation with the GP and to hand out questionnaires to those who had not been included by the GP. The offices were monitored with telephone follow-ups and personal visits by one of the researchers (GG). The personal visits were organized as lunch meetings where the recruitment procedures and number of included patients were discussed. The process of handing out questionnaires, including where to fill them in and how to return them, was not standardized due to differences in patient consultation routines, the reasons for visiting the GP, the time schedule of the treatment and how they organized their transportation. Although some respondents completed the questionnaire in the GP's waiting room and returned them there, most brought them home and returned the envelopes by post.
The questionnaire covered areas related to the respondents' demographic characteristics, symptoms and health status use of health-care services and quality of OA treatment.
Demographic and lifestyle variables
Respondents were asked about age, height/weight, sex, occupational status (full time, part time, age retired, disability pensioner, sick leave, other), education (lower secondary school, upper secondary school, university ≥ one year), smoking habits and self-reported comorbidities.
Location, symptoms and health related quality of life
Respondents were asked about the site of OA (knee right/left, hip right/left, hand right/left), whether OA was their most prominent health problem and for how long they had the OA diagnosis (<one year, one-three, four-six, seven-10, >11 years). Depending on the main affection of OA as decided by the GP, disease-specific, health-related quality of life was assessed using the Hip Osteoarthritis Outcome Score (HOOS) or the Knee Osteoarthritis Outcome Score (KOOS). HOOS/KOOS consists of six subscales: symptoms (KOOS: five questions, HOOS: three), stiffness (two questions), pain (KOOS: nine questions, HOOS: 10), function in daily living (ADL) (17 questions), function in sport and recreation (Sport/Rec) (KOOS; five questions, HOOS: four) and hip/knee-related quality of life (four questions). Standardized answer options were given on a five-point Likert scale (from 0 to four points), and the results were summed up for each subscale separately and presented as a normalized score (0 indicating extreme symptoms, 100 indicating no symptoms). The HOOS questionnaire is shown in Additional file 1.
Use of health services
Respondents were asked about the use of health-care services during the last year, including who they had visited (GP, orthopaedic surgeon and physiotherapist) and how many consultations they had during the last year using six categorical response options, as well as how satisfied they were with the OA treatment in general on a five-point scale from very unsatisfied to very satisfied.
Quality of OA care
We used the OsteoArthritis Quality Indicator questionnaire (OA-QI) to further investigate what type of treatment the respondents had obtained (shown in Additional file 2). The questionnaire was developed in Norway using published QIs, expert panels and patient interviews, and was tested for reliability and validity in a Norwegian OA cohort [18]. Support for content validity was confirmed by two patient research partners and two expert panels. All ten predefined hypotheses relating to construct validity were confirmed. Test-retest Kappa coefficients ranged from 0.20-0.80 and the percent of exact agreement from 62% to 90% [18]. The OA-QI assessed whether 17 different aspects of OA treatment had been obtained using three response options (yes, no, do not remember/not relevant). The questionnaire included QIs related to patient education and information, regular provider assessments, referrals and pharmacological treatment.
Statistical analyses
Mean and standard deviation (SD) were used to describe the participants and their characteristics for continuous variables, whereas counts with percentages were used for categorical variables. Group comparisons were performed by Chi-square for categorical data and independent sample t-tests for continuous data.
QI pass rates were calculated for each QI separately (with a 95% CI) for the study sample as a whole, in which the numerator represents the number of indicators passed (those reporting "yes") and the denominator represents the number of eligible persons (those reporting "yes" or "no"). Correspondingly, summary pass rates for each person were calculated as the total number of QIs they passed divided by the total number of QIs for which they were eligible. Summary pass rates hip- or knee OA, as well as for the total sample, were calculated. Additionally, summary pass rates for pharmacological (QIs 13-16) versus non-pharmacological (QIs 1-11) treatments were also calculated, though due to the skewed distributions of the summary scores, the percentages are presented as a median with interquartile ranges (IQRs). Missing data were ignored in analyses; therefore, the number of persons included in the analyses varies.
Lastly, we explored sources for variation in QI pass rates in bivariate regression analyses, employing the following independent variables: demographic (age, sex, education), disease related (health-related quality of life measured by the five Koos/Hoos subscores), health-care utilization (number of visits to GP/orthopaedic surgeon/physiotherapist) and overall satisfaction with care.
The study sample received written information about the study, and written consents were given. The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (Ref. no. 2011/16779).
During the nine-month inclusion period, 283 questionnaires were handed out to patients by the collaborating GPs and 119 (42%) were returned. Seventy-one persons (59.7%) reported that the main affection of OA was the knee(s), while 48 (40.3%) reported hip(s) as the most affected joint.
Participant characteristics
Knee N = 71
Hip N = 48
All N = 119
Age, mean (SD)
66 (10)
65 (10)
BMI, mean (SD)
28 (5,3)
26.4 (7.62)
27.4 (6.3)
Females, n (%)
48 (68)
39 (81)
87 (73)
Occupational status, n (%)
13 (18)
Age retired
28 (39)
Disability pensioner
13 (18)
16 (23)
Education, n (%)
Lower secondary school
17 (24)
6 (13)
23 (19)
Upper secondary school
34 (48)
24 (50)
58 (49)
20 (28)
15 (31)
35 (20)
3 (6)
3 (3)
Smoking, n (%)
14 (20)
7 (15)
21 (18)
56 (79)
40 (83)
96 (81)
1 (1)
1 (2)
2 (1)
Comorbidity, n (%)
Other chronic diseases than OA
50 (70)
36 (81)
86 (72)
Localization, time since osteoarthritis (OA) diagnosis, treatment satisfaction and impact of OA
Knee N = 71
Hip N = 48
All N = 119
Localization of the osteoarthritis disease
Unilateral vs. bilateral (%)
44% vs. 56%
53% vs. 47%
47% vs. 53%
Unisite vs. multisite, (%)
49% vs. 51%
57% vs. 43%
52% vs. 48%
OA as the most prominent health problem, n (%)
34 (48)
64 (54)
Yes, sometimes
29 (41)
14 (29)
43 (36)
8 (11)
3 (6)
11 (9)
Time since OA diagnosis, n (%)
<1 year
12 (17)
7 (15)
19 (16)
1-3 years
16 (23)
6 (13)
22 (19)
4-6 years
17 (24)
12 (25)
29 (24)
7-10 years
11 (15)
9 (19)
20 (17)
>10 years
14 (20)
12 (25)
26 (22)
1 (1)
2 (4)
3 (3)
HOOS/KOOS subscores, mean (SD)
52 (17)
48 (18)
60 (15)
48 (17)
Function in daily living (ADL)
52 (22)
54 (19)
Function in sport and recreation
21 (20)
42 (22)
Hip/Knee-related quality of Life
36 (19)
44 (17)
Health professionals visited last 12 months because of OA
1-3 visits
4-6 visits
7-9 visits
10-12 visits
> - 12 visits
General practitioner, n (%)
39 (55)
31 (65)
15 (21)
15 (31)
4 (6)
3 (6)
2 (3)
1 (1)
10 (14)
10 (21)
Orthopaedic surgeon, n (%)
17 (24)
9 (19)
4 (6)
1 (2)
1 (1)
1 (1)
48 (68)
38 (79)
Physiotherapist, n (%)
5 (7)
3 (6)
2 (3)
1 (2)
3 (4)
3 (6)
5 (7)
4 (8)
23 (32)
7 (15)
33 (46)
30 (63)
Self-reported treatment satisfaction
Knee N = 71
Hip N = 48
All N = 119
Very pleased, n (%)
6 (8)
3 (6)
9 (8)
Pleased, n (%)
24 (34)
19 (40)
43 (36)
Neutral, n (%)
29 (41)
18 (38)
47 (39)
Unpleased, n (%)
4 (6)
4 (3)
Very unpleased, n (%)
2 (3)
3 (6)
5 (4)
OsteoArthritis Quality Indicator Questionnaire
OA-QI items
Knee pass rate (% yes)
Hip pass rate (% yes)
All participants (% yes)
Disease development
Physical activity
Referral physical activity
Weight reduction
Referral weight red.
Functional assessment
Walking aid assessment
Other aids assessment
Pain assessment
Stronger pain killers
Referral orthopaedic surgeon
Mean QI pass rate
The mean QI pass rate for all 17 QIs was 45%, and the median score for summary QI pass rates was 47% (IQR 33-65%). The median summary QI pass rates for both non-pharmacological (QIs 1-11) and pharmacological treatments (QIs 13-16) were 50% (IQR 25-75), and there were very low levels of missing data for the individual QIs.
In the explorative regression analyses, only overall treatment satisfaction was significantly associated with QI summary pass rate (p = 0.001), with unstandardized B = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in the pass rate. In addition, the number of physiotherapy consultations over the last year was borderline significant (p = 0.061), with unstandardized B = 1.7 (95% CI -0.8 to 3.6). The other 10 independent variables were not associated with the QI pass rate.
Discussion and conclusions
In the present study, we found that the median summary OA-QI pass rate was 47%, which is higher than the study by Østerås et al., which recruited participants from a population based survey and also included persons with hand OA [18]. Also, we found no difference between pass rates for the non-pharmacological and pharmacological treatments, which is contrary to Østerås et al. Nevertheless, the fact that the referral for weight reduction had the lowest pass rate and that having received information about the importance of physical activity and exercise had the highest pass rate is similar to the findings by Østerås et al. [18]. The fact that very few of those who self reported being overweight had not been referred to weight reduction might simply reflect that there is currently no community based service for moderately overweight people in Norway, but also that this question is prone to recall bias. Similarly, the high pass rate for physical activity and exercise might reflect that that the importance of exercise is emphasized by health authorities and in mass media, that mean people will remember and respond to advice in this area but may be not for weight loss. Despite the relatively low pass rates on OA-QI, the OA patients were quite satisfied with the treatment they had received. We also found a significant bivariate association between OA-QI pass rate and satisfaction. However, this association may be confounded by other variables, for example number of GP consultations, and should be interpreted with caution.
The present study has several limitations. Firstly, we cannot know that the patients that returned the questionnaire were representative of the OA patients normally treated by the GPs. The study sample may be have been subject to selection bias related to the GPs' recruiting participants. Although the GP offices were monitored with telephone follow-ups and personal visits, we don't know exactly how many eligible patients who attended the clinics. Secondly, the response rate was relatively low, though still comparable to a similar study [19]. The low response rate, as well as the possible selection bias related to recruitment, limited the generalizability of the results since we cannot be certain that the respondents were not systematically different from those not invited and non-responding. Also the fact that the respondents reported a relatively low BMI and a high education level suggests recruitment bias in the present study. Thirdly, we did not standardize the procedure for completing and returning of the questionnaires, and the fact that some patients completed the questionnaire at the GP offices might have biased the responses toward higher pass rates. Because patient self-reported data could be biased due to recall bias, as well as patient factors such as illness perception and treatment beliefs, this may also have affected the responses. For example, there is evidence that overweight and obese people tend to underreport their BMI, whereas very few, if any over report their BMI. Thus, we can assume that those who reported overweight in the present study actually are overweight, whereas there might be a proportion of `false negatives' that have not responded to the question about advice and referral for overweight.
The OA-QI questionnaire has not been validated against medical records. It has been suggested that self-reported assessment tools tend to score the same or higher than medical records and QI assessment made by care providers [20]. If this overestimation of the care given has influenced the results in this study, it may have caused the pass rates from OA-QI to be overrated. Finally, we assumed the 17 items to be of equal importance when we calculated the overall pass rate. Since most evidence based clinical guidelines employ a system with grading the strength of recommendations, this may also be reflected by giving the items different weight in the overall pass rate. Also the patient perspective should be included, when considering a weighted overall pass rate.
One strength of the study was the use of the OA-QI questionnaire. Assessing care directly from the patients, either via interviews or using patient reported QIs, makes it possible to assess the care received and/or perceived, although this is not necessarily the same as what the GP or others have been given and what is stated in the patient records. We think that assessing what the patient remembers or perceived of the care given is vital due to the compliance of the care. Another strength of the study is that the inclusion of patients was made directly by the GPs, as this method of inclusion yielded a very high compliance rate regarding fulfilment of the inclusion criteria since none of the returned questionnaires were regarded as being outside the inclusion criteria. A third strength of the study is the assessment of the patients' comorbidities. Although self-reported, this provides a better understanding of the complexity of the patients and everyday choices the GPs have to make regarding what care to prescribe. Furthermore, the comorbidities may also help explain some of the variations in the fulfilment of different QIs.
Others have assessed the quality of the OA treatment using different QI sets than what we used in the present study. For example, Ascari et al. [21] reviewed the use of the ACOVE QIs in 17 studies and found that the interquartile range score of 29-41% for OA was the lowest score among the diseases reviewed [22], while Li et al. [19] reported the pass rate on four QIs to be 22%. However, comparing QI pass rates should be done with caution because the study samples, settings and methods may differ. It is also worth mentioning that comorbidity is common among persons with OA and may affect the QI pass rates due to the fact that patients may not remember for which disease they achieved information, and there may be conflicts between recommendations for comorbidities and OA care, thereby making it difficult for the GPs to choose between different recommendations [22]. In this study, 72% reported having at least one chronic disease other than OA, though the rates of comorbidities in the other studies assessing QIs were not reported.
In our study the summary QI pass rate was 47%, which is a higher pass rate than what others have reported, and which may be due to the characteristics of the participants in the present study. Most studies assessing OA patients report the patients as having a higher BMI and lower education than the average population, and in our study sample the average BMI was 27.4. Although a BMI>25 is regarded as being overweight, it is the same as the average BMI for the adult population in Norway [23]. Our respondents have a higher education level than average, with 20% reporting having a university education, while the average for Nord-Trøndelag County is 3.9% [24]. Thus, the differences in characteristics between the respondents in the present study and respondents in other studies may help explain some of the differences in pass rates.
Even if our study sample might not be representative for all OA patients in Norway, and may be overestimating the quality of OA care, the overall pass rate was only 47%, leaving substantial room for improvement. Guidelines for OA care have been available for more than a decade, yet implementation in daily practice is revealed as lacking in more than 50% of the QIs assessed, including in both pharmacological and non-pharmacological OA care. Future research and efforts for improving OA care should be directed towards the implementation of existing guidelines.
Authors' contributions
All of the authors contributed to the planning of this study, and all participated in the different phases of the research process. GG organized the data collection and wrote the first draft of the article. All of the authors read and provided feedback on the draft versions of the article, and approved the final version. GG is the guarantor. All authors read and approved the final manuscript.
Additional files
The Norwegian Fund for Post-Graduate Training in Physiotherapy provided a research grant (id #: 21369) to the first author, which is gratefully acknowledged.
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The most fundamental question to consider is whether a certain type of user needs a stateful desktop image or a stateless desktop image. Users who need a stateful desktop image have data in the operating system image itself that must be preserved, maintained, and backed up. For example, these users install some of their own applications or have data that cannot be saved outside of the virtual machine itself, such as on a file server or in an application database.
These images might require traditional image management techniques. Stateful images can have low storage costs in conjunction with certain storage system technologies. Backup and recovery technologies such as VMware Consolidated Backup and VMware Site Recovery Manager are important when considering strategies for backup, disaster recovery, and business continuity.
You create stateless desktop images by using View Composer and creating floating-assignment pools of linked-clone virtual machines. You create stateful desktop images by creating dedicated-assignment pools of either linked-clone virtual machines or full virtual machines. If you use linked-clone virtual machines, you can configure View Composer persistent disks and folder redirection. Some storage vendors have cost-effective storage solutions for stateful desktop images. These vendors often have their own best practices and provisioning utilities. Using one of these vendors might require that you create a manual dedicated-assignment pool.
You can standardize on stateless desktop images for task workers so that the image is always in a well-known, easily supportable configuration and so that workers can log in to any available desktop.
Knowledge workers must be able to create complex documents and have them persist on the desktop. Power users must be able to install their own applications and have them persist. Depending on the nature and amount of personal data that must be retained, the desktop can be stateful or stateless.
These users can check out a View desktop and run it locally on their laptop or desktop even without a network connection.
Kiosk users might include customers at airline check-in stations, students in classrooms or libraries, medical personnel at medical data entry workstations, or customers at self-service points. Accounts associated with client devices rather than users are entitled to use these desktop pools because users do not need to log in to use the client device or the View desktop. Users can still be required to provide authentication credentials for some applications.

subset: commoncrawl


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Also from Steve Yegge's talk:
[W]hen we talk about performance, it's all crap. The most important thing is that you have a small system. And then the performance will just fall out of it naturally.
Also from Steve Yegge's talk:
[W]hen we talk about performance, it's all crap. The most important thing is that you have a small system. And then the performance will just fall out of it naturally.
One permatopic across programming blogs is the good ol' static-vs-dynamic languages debate. Static languages (like C, C++, C#, C--, Java, etc.) require variables to have type declarations primarily to generate compiled code and secondarily to catch errors or emit warnings at compile time. Dynamic languages (like Perl, Python, PHP, Ruby, Tcl, Lisp, Scheme, Smalltalk, etc.) do away with all those needless keystrokes, allow programmers to be more productive, and generally aren't as dangerous as the C-programmers would have you believe. Furthermore, dynamic language programmers are quick to point out that any real program in a static language requires typecasting, which throws all of the "guarantees" out the window, and bring in all of the "dangers" of dynamic languages with none of the benefits.
However, this debate isn't limited to these opposite points of view. There's another perspective, which I heard from Mark-Jason Dominus about a decade ago: static typing in languages like C and Pascal isn't really static typing! (Correction: Mark actually said that "strong" typing in C and Pascal isn't really strong typing.)
The kind of static typing supported by C, its ancestors and its descendants, dates back to the 1950s and Fortran (or, rather FORTRAN, since lower case letters hadn't been invented yet). Type annotations in these languages are guides to the compiler in how much storage to allocate for each variable. Eventually, compilers began to emit warnings or compiler errors mixing variables of incompatible types (like floating point numbers and strings), because those kinds of operation don't make sense. If the irksome compiler gets in your way, you can always tell the it to shut up and do the operation anyway and maybe let the program crash at runtime. Or maybe silently corrupt data. Or maybe something completely different. None of which makes much sense, but there you go.
Modern static typing, on the other hand, uses a strong dose of the Hindley-Milner type inference algorithm to determine (a) what values a variable may contain and (b) prevent the use of incompatible values in expressions. Furthermore, Hindley-Milner prevents values being cast from one type to another on a whim (unlike C), and thus prevents odd runtime errors through abuse of the type system. This leads to an strong, unbreakable type system that is enforced by the compiler, and prevents a whole class of loopholes allowed by lesser type systems. Because types can be inferred, explicit type annotations aren't always needed, which leads to an interesting property: languages that are safer than "safe" static languages like C and Java, and programs that are free of those troublesome, noisy type declarations, just like dynamic languages.
Use of the Hindley-Milner type system comes to us through ML, and descendants like Haskell, OCaml, SML, F# and the like. It's such a good idea, that it's slowly making its way into new programming languages like Perl 6, Fortress, Factor, Scala, and future versions of C++, C#, and VB.Net.
So, really, the whole static-vs-dynamic languages debate is both misleading and moot. It's misleading, because it's not about static vs. dynamic typing, it's about weak compile-typing vs. runtime-typing. It's moot, because the writing is on the wall, and weakly typed languages are on the way out, to be replaced (eventually) by strongly-typed languages of one form or another. (It also tends to be a meaningless "debate", because it's typically a shouting match between C/C++/Java/etc. acolytes who are uncomfortable with Perl/Python/Ruby/etc., and Perl/Python/Ruby/etc. acolytes who have a strong distaste for C/C++/Java/etc., and neither group has a hope of persuading the other.)
Normally, I would avoid topic entirely, but today, I couldn't resist. Steve Yegge posted a transcription of his talk on dynamic languages, where he covers both sides of the debate, and moves beyond the two-sides-talking-past-each-other and uncovers the core issues. He covers the meat of the discussion, not the typical push-button issues that go nowhere and convince no one. (I think he misses the point behind Hindley-Milner, but that's an insignificant side issue.)
Steve's talk is long and rambling, but certainly worth the time read or at least skim through.


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There has several names in the frame to direct "Black Panther" at Marvel Studios, with "Selma" director Ava DuVernay previously heavily linked and more recently rumors of "Creed" and "Fruitvale Station" helmer Ryan Coogler, that news is now official.
After the massive success of "Creed" Coogler has been linked for several weeks, but the studio made that link official when Marvel president Kevin Feige released the following statement:
"We are fortunate to have such an esteemed filmmaker join the Marvel family, The talents Ryan showcased in his first two films easily made him our top choice to direct 'Black Panther.' Many fans have waited a long time to see Black Panther in his own film, and with Ryan we know we've found the perfect director to bring T'Challa's story to life."
Chadwick Boseman is set to play the title character AKA T'Challa in the film which is set for release on February 16th 2018 release.
Source: Marvel.com


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Various stakeholders have implemented strategies to drive various components of the biotechnology sector in Malaysia. This is a snapshot of some of the active strategies and activities in the country at this time.
The BioNexus status is conferred by the Malaysian Biotechnology Corporation (BiotechCorp) and endows fiscal incentives, grants and access to capacity building programs and research facilities to qualified Malaysian and international biotechnology companies.As of 2012, there are more than 200 BioNexus companies in various stages of development. The BioNexus program has had a positive impact in attracting foreign biotech investors to set up operations in Malaysia as well as easing the start-up and expansion of local biotech companies.The BioNexus Bill of Guarantees allows such companies a series of incentives that increase the ease of doing business in Malaysia as well as a range of services and support from BiotechCorp:
For more information, please visit http://www.biotechcorp.com.my/bionexus-new/
The BioNexus Partners program was established to grant biotech companies, whether with BioNexus status or with significant relevance, open access to laboratory facilities in publicly-funded institutions, such as:
BioNexus Partners also hold regular networking sessions to facilitate business matching, knowledge sharing and promote mutual understanding.For more information, please visit http://www.biotechcorp.com.my/services/
The BioEconomy Initiative Malaysia (BIM), launched at BioMalaysia 2011 by Prime Minister Najib Tun Razak, is expected to spearhead the application of biotechnology to primary industries in Malaysia, such as agriculture, healthcare and manufacturing.The initiative is currently being discussed in a series of laboratories and workshops co-organized by the Ministry of Science, Technology and Innovation (MOSTI) and BiotechCorp.The BIM is expected to be announced as a National Key Economic Area in mid- 2012.
The National Biomass Strategy was launched by Agensi Inovasi Malaysia (AIM) at BioMalaysia 2011 and is designed to leverage on the high volume of oil palm biomass currently being produced by the Malaysian agriculture sector for further downstream processing and the production of biofuels.The strategy touts that this could translate into RM 30 billion in gross national income, and 66,000 jobs by 2020.For more information, please visit http://www.innovation.my/programmes/wealth-creation/bio-mass/
MBIO is the local biotech industry organization that seeks to bridge the gap between the public sector and the industry. Membership in the organization is open to all biotech companies and supporting industries as well as academics and researchers.\MBIO focuses on providing support to biotech companies through networking opportunities, workshops and stakeholder engagement.\For more information, please visit http://www.mbio.org
2012 has been inaugurated as the Year of Science and National Innovation Movement (SGI2012) by MOSTI. This initiative was launched to coincide with the ASEAN-EU Year of Science 2012.The SGI2012 program serves as a platform to encourage Malaysians to adopt a culture of science and innovation; and raise public awareness on Malaysian innovations who have managed to develop products for the market, in lieu of Malaysia's efforts to realize a knowledge economy by 2020. The program will encompass several Science and Innovation Carnivals to be held in 6 zones across the country and several competitions targeting all levels of society, particularly school students, youths and women.For more information, please visit http://sgi2012.mosti.gov.my/
The National Bioethics Council of Malaysia was launched on May 22, 2012 and is tasked with providing advice to the Malaysian Government, as well as resolving and managing bioethical issues in the country.The Council will also be involved in disseminating information and promoting public awareness on bioethical issues to the general public.Though the Council will be primarily focused on emerging technology applications such as stem cell research, genetically modified organisms, synthetic biology and animal testing, the purview of the Council could also be extended to matters of academic integrity and conflict of interest.For more information, please visit http://www.bioetika.gov.my/
Malaysian Biotechnology Information Centre (MABIC) 2-5-51, Monash University Malaysia Jalan Lagoon Selatan, Bandar Sunway 46150 Petaling Jaya Selangor D E MALAYSIA
Tel: +603-5514 6178 | Fax: +603-5514 6184


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Granite Countertop Colors » Kitchen Countertop Ideas
|Bacuo White Granite
Name Product : Bacuo White Granite
Also Known As: Baku White Granite, Bacuo White Granite Slab, Super White Quartzite
Stone Type: Natural Stones Granite
Thickness : 2cm and 3cm
Finish : Polished, Brushed and cascade
Colors: White
Pattern: _
Price: $35 per square foot
Origins : China
Suggested Use: Kitchen Countertops, Terrace, Interior Walls, Granite Monument, Tombstone, Slab, Countertop, Tiles, Marble, Pavement, Sculpture, Exterior paving stone, Kitchen Backsplashes, Floor Tiles, Fireplace surrounds, Accent Tiles, shelves Bathrooms, Stone wall cladding, Cover cabinets, Stair treads, Interior Floors and all other Architectural Applications
Home Designer Comments : Bacuo White Granite stone is the best choice for those who want enjoy an elegant and classy look in their interior or exterior areas, This incredibly versatile stone can be used in in exterior or interior building construction include Kitchen Backsplashes, slabs,Accent Tiles, Interior Walls, Interior Floors, furniture, Cover cabinets, and all other architectural applications. Besides, Bacuo White Granite stone easy to blended with various colors combination such as snow white, Beige, coffee brown or dark grey and this stunning stone is perfect choice for Interior walls, kitchen countertops, and even Interior floors.
You May Also Like This : Fantasy Brown Granite Kitchen Countertop, Slab and Price


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Get Rid Of Your Acne For Excellent
Source: Flickr
If you can understand the root cause of any problem, you can battle to get rid of it. Info is constantly your finest device when fighting anything. That specifically is true when you're attempting to obtain rid of blackheads and imperfections. If you have to do away with your pimples, here are some acne-fighting suggestions.
If you're looking to get ride of acne as an adult, attempt a medication various from the ones targeted towards teenagers. A lot of acne medication developed for teenagers is formulated for lessening the appearance of big pimples overnight, and can be harsh to delicate skin. Look for solutions made for grownups, which usually contain sulfur as the active acne combating active ingredient.
Diet plan plays a considerable role in the control of acne. Try to included foods that are high in selenium and zinc. Brazil nuts are a good source of selenium, and pumpkin seeds consist of zinc. Fresh fruits and vegetables, either whole or in smoothie mixes, likewise contribute to a healthy diet and clear skin.
Treat moderate acne scarring. If you have mild acne scarring, use creams or creams which contain retinol or alpha hydroxyl acid. Other products that are effective are scar reducing creams such as Mederma. Natural treatments include rosehip seed oil and lavender oil. Remember never ever to apply more than one product at a time, as this might cause inflammation or soreness.
Try not to squeeze or pop your pimples to make them heal. Instead of risking soreness, swelling and even marking try rubbing a slice of potato (peeled) over your newly washed skin. Do not rub hard, a gentle touch is all you need to utilize the healing equipment of the potato!
Make sure to exercise for at least half an hour every day to obtain your heart pumping and your blood circulating. This will benefit your acne because good flow assists get rid of contaminants from the system. Routine perspiration also eliminates toxins from the skin. Just make certain to shower or bathe after exercise so toxins do not sit on the surface area of the skin.
Use green clay to help clear acne. Green clay is also called bentonite clay. It is easily discovered in many natural food shops. The clay is fantastic for drying up excess oil. It also dries imperfections, assisting them to disappear. Mix the clay with water and apply it directly to your skin as a mask.
In the winter season, attempt to avoid places that normally include dry air. When there is little wetness in the air you are around, there is a good chance for your skin to respond adversely and dry out. This can lead to excess acne and red imperfections, due to the inflammation that dryness causes.
If you are an acne victim, try not to wash your face excessively. Any more than 3 times daily, and you run the risk of making the problem worse. Wash your face in warm water, utilizing a mild soap. Gently pat your skin dry. This will prevent the acne-causing bacteria from spreading, minimizing future breakouts.
As noted here, it's everything about the right details if you wish to get rid of your acne. Look out for that misinformation out there. Instead, use exactly what you have actually found out here to obtain rid of your blemishes and to help keep your skin looking youthful and healthy.


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Continental Tide employees working around the globe took part in raising awareness of breast cancer by wearing pink Continental Tide T-shirts to work. October is Breast Cancer Awareness month. Breast cancer is the most common form of cancer in the United States only behind skin cancer. Although this disease primarily affects women (1 in every 8), statistics show that the lifetime risk for men to develop breast cancer is 1 in 1,000. A group of employees at Continental Tide's Virginia Beach office took time to show off the Breast Cancer Awareness T-shirts while an AIT department crew working at a base in Japan pose in front of the USS Blue Ridge LCC-19. Join us and show your support! Let's spread awareness!!
Mr. Avery Scott was named Employee of the Month for October. His efforts during the electrical portion of the oily water separator installs have been instrumental in Continental Tide's success onboard USS BLUE RIDGE (LCC-19). This award is a special thank you to Mr. Scott for his continuing dedication and work hard as part of our AIT team.
To close out 2015, we would like to recognize Cedrick Clayton, Subcontract Manager, for his hard work during the month of December. Mr. Clayton's efforts in the Finance, Accounting and Contracts (FAC) department have been crucial to the organization in terms of development, implementation, and advancement. He has been an important member of the team reviewing and editing subcontractor and purchasing QP's for our Quality Management System (QMS). In addition, Mr. Clayton has assumed the role of Subcontract Manager developing the Subcontract Management System to continue maintaining compliance, strengthening subcontractor relationships, and identifying areas for improvement. His efforts in taking on this role while maintaining his traditional workload deserve to be recognized.
Continental Tide would like to recognize Mr. Edward Kabak as the Employee of the Month for the month of November. In addition to Mr. Kabak's outstanding support of the Engineering Department, including the USCGC MACKINAW Program and other on-going engineering efforts, he has been crucial to the organization in developing, organizing, reviewing, and archiving our QA/QMS Program and Documentation. Mr. Kabak's efforts in taking on this additional effort while maintaining his traditional workload deserve to be recognized.
Ms. Amanda Metzinger, pictured here with Keith Reidinger (President) was recently recognized as the Employee of the Month (June). Over the past month Amanda lead the way on numerous policy and procedures programs including; new hire processes, corporate compliance initiatives and the Virginia Ship Repair Association QA audit preparation and response. Amanda's hard work and patient, professional approach is a model to all employees and we are grateful to have her on our Team.
Continental Tide
Philadelphia, PA
Corporate Office
531 Canal Street, Suite 401
Reading, PA 19602
Phone: 484-577-4070
Fax: 484-577-4077
Continental Tide
Norfolk, VA
1457 Miller Store Road,
Suite 104
Virginia Beach, VA 23455
Phone: 757-410-7611
Fax: 757-410-7211
Continental Tide
San Diego, CA
205 West 35th Street, Suite K
National City, CA 91950
Phone: 619 781-8658
Fax: 619 781-8672


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Well Saturday was Saint Patrick's Day and to honor the holiday I made my first Corned Beef Brisket and Cabbage meal.
This was the meal I decided to make following our whirlwind weekend trip to Columbus, OH for a wedding. While visiting Columbus for the first time, we decided to venture out after driving all day for some food. We eventually ended up at Claddagh's Irish Pub (granted a chain, but not one I've ever visited). The food was grand and the Great Lakes Brewing Company's Irish Ale even better, therefore I had to give the dish a try at home.
It was pretty simple to make. Put the brisket in a large pot and added water until it was covered by about an inch. Added the spice pack and brought it up to a boil. Once boiling reduced the heat to simmer, covered. Let the brisket simmer for about three hours.
After the three hours, remove the brisket to a cutting board and allow to sit. Meanwhile, cut a medium head of cabbage into quarters (after removing the core). Add the cabbage and a bag of baby carrots to the pot the brisket just came out of. Return to a boil. Once boiling, reduce heat to medium heat and continue to cook for 20 minutes or until the carrots are tender.
Remove and drain. Cut the brisket and serve with Horseradish Cream Sauce.
Horseradish Cream Sauce:
1 Tbsp. Inglehoffer Extra Hot horseradish (more if desired)
2 Tbsp. Fat free sour cream
1 Tbsp. Dijon mustard
1 tsp. black pepper
Stir and serve - Enjoy
The reason I have not been posting lately is because my mother has been ill. She is currently doing better and back in her room at the nursing home. She is in a total care facility since her stroke 7 years ago.
|Mom and Dad in 1957
|Mom and I in 2009


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"Erdogan the Wankerer", said the Foreign Secretary…Shortlink
July 13, 2016 | Culture, Politics | No Comments|
There was a young fellow from Ankara, Who was a terrific w**kerer,
Till he sowed his wild oats, With the help of a goat,
But he didn't even stop to thankera.
What could possibly go wrong? :D
The next few years are going to be rather interesting…
If somebody wants to make a joke about the love that flowers between the Turkish president and a goat, he should be able to do so, in any European country, including Turkey.
(It should be noted that BJ wasn't foreign secretary when he wrote the poem)


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Alyson Brown (Ladybob)
What committees do you want to work with?
Communications/Tech Ops, Home, Conduct, Not so much an additional interest as a specific interest within Communication/Tech Ops... I have two specific reasons for my interest here. I'm not particularly tech savvy, though I am not tech illiterate, either. But my passion for this side of involvement centers on how we nurture our community and member involvement, as well as how we present ourselves both internally and externally. I'm interested in building up our culture, and I feel strongly that how we communicate and put ourselves out there are the foundation upon which that culture is built. Also under this umbrella is my strong desire to unify and improve onboarding, training, and retention of leadership candidates.
What burns have you been to?
All FAI burns for the last three years, plus To The Moon 2017; Bylaws Not Read
Why do you want to be a board member?
Because our local burns have come to mean the world to me. Because any group of people who want to do the thing can only accomplish as much as they are willing to invest their time and effort into. Because I believe in the principle of Civic Responsibility, that it upholds the others by creating the space for continued growth through community involvement.
If elected to the board, what will your priorities be?
In my mind, I see three priorities that hold a sort of primacy based on the way that I feel they uphold everything else. First, a reliable and long-term home. Second, consolidation and review of the org's documentation to better normalize the experience of incoming new leadership, to help nurture a cohesive approach, and to standardize our responses to challenging situations. Third, supporting and building up our culture and finding ways to engage with our members and our host community year round.
What is your long-term vision for the future of Flashpoint Artists Initiative?
I envision an ever expanding community that encourages the best of intentions in our own lives and events, that can come to recognize that positivity in each other even when we disagree, that can encourage that engagement with those outside our community as well, acting as (cliche as it sounds) a force for good.
What would you most like to contribute as part of the FAI BOD?
My experience with event leadership. My desire to mediate and always encourage cooperation and understanding. An extra drive behind the impetus for developing a cohesive approach to expanding community and expanding our understanding of that community outside of the specific framework of our events.
Please tell us about the experience (professional, burn world, or otherwise) that you can contribute to the FAI BOD.
Having worked in retail management, professional team management, and burn leadership, I feel that I have cultivated an ability both broad and deep to relate to multiple needs and perspectives and to encourage the peaceful reconciliation necessary to move toward a common goal. I love building enthusiasm and understanding, and I have no problem doing the work necessary, public facing or behind the scenes, to get it done.
What roles have you served in at Alchemy and/or Euphoria? In leadership positions at other burns?
Co-Lead for Connexus (Euphoria and Alchemy 2016), Information Department Lead (the Euphoria that wasn't), and Information Department Co-Lead (this coming Alchemy). Additional volunteer work for First Aid, Tranquility Base, LNT, Traffic, and to fill assorted needs. Feeding volunteers. Participation in a funded art project.
Please describe your leadership style and experience (in detail).
Encouraging mutual understanding at every turn, because there is no such thing as an issue that doesn't effect everyone in some way. Balancing overarching goals with relative prioritization in the moment. Always presenting a friendly face and approachable demeanor to members of the community and to those outside the community with whom we engage.
Please describe a time you experienced a team conflict and the steps you took to peacefully resolve it (in detail).
When I was a billing team supervisor, I had a couple of employees who were always trying to make what should have been teamwork into a competition instead. I met with them and came to understand what about their personalities gave rise to the most problematic of their behaviors. We discussed at length how they could perceive the mismatch between their approach and what they knew was best for the team and company, and we set up personalized goals that they could strive towards without provoking rivalry in place of cooperation, and the team really grew as a result. They even became two of my best trainees and motivators for new hires.
Are you ready to learn how the sausage gets made?
Nervous, but yes.


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Ok – so if you guessed in the last Guessing Game you will want to know the answer – quite easy really ladies! Its just a Home Face Mask Making Kit!
Its good for powder masks that need to be mixed with liquids and anythign generally too messy. Can you just use a normal bowl? Erm, yes. Can you just use a normal spoon? No. Why not? Because I said so, that's why.
I have a harder one for you this time another one of my eBay hauls:
Another view:
Yes its beauty related.


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CodeTwo Outlook Sync has been designed to let you synchronize Outlook items between two computers. The program works in a local network and is especially useful in home or small business scenarios. You can use it to share Outlook between your two PCs (e.g. laptop and desktop), cooperate with your workmate and stay up-to-date with your family members. The free version of the program is time unlimited and there is no adware.
The following scenarios illustrate the feature set of the add-in;
Sync Outlook between two computers
With CodeTwo Outlook Sync, you can sync all Outlook data between two computers in a local network with just a few clicks. Owing to this, your home desktop and business laptop can always stay up-to-date, so nothing ever escapes your notice. Every email, calendar entry, task or a document are always present on both of your machines.
Sync Outlook calendar and contacts between you and your secretary/assistant
CodeTwo Outlook Sync allows your secretary to view and edit your calendars and share Outlook contacts (as well as other Outlook folders) with you. Can you imagine how greatly it facilitates your cooperation?
Assign Outlook tasks to your partner and keep track of them
The application lets you assign tasks to your co-worker or business partner and keep track of them in Outlook. Just select or create a tasks folder and sync it with your partner's machine.
Let your wife know what you've been up to recently
It's not only about business – it's also about life. If you sync your PC with your wife's machine, she will be much happier.
Extremely easy to use / simple installation
The installation of the program should not take longer than a New York minute. The application is very straightforward so you don't waste any time learning new software.
Unlimited free version + no adware
Use a freeware version as long as you need – it never expires and is totally adware-free. Get a full version whenever you want to sync more.
This description is not a review but information provided by the product vendor or obtained from the vendor's website.


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Press Release
RNP Press Release
December 17, 2014
Washington Governor Inslee Demonstrates Additional Climate Leadership
Today, Governor Inslee announced a climate initiative that will help Washington reach its carbon emissions reduction goals and support a clean energy economy. Broadly speaking, the plan places a cap on carbon emissions in a way that generates revenue to fund education, transportation and emissions reductions programs. Renewable Northwest commends Governor Inslee for his leadership on climate and his determination to make renewable energy part of the solution.
"We look forward to working with Governor Inslee on energy policies that achieve our mutual vision of a clean energy future and a healthier Northwest," commented Rachel Shimshak, executive director of Renewable Northwest.
Governor Inslee's bipartisan Climate Legislative Executive Workgroup (CLEW) found that Washington's Clean Energy Standard I-937, was the most effective, existing policy at reducing carbon. The Governor's proposal will build on that success.
Learn more about Governor Inslee's climate plan: http://www.governor.wa.gov/issues/climate/waleg15.aspx
For more information contact:
Amy Baird, Communications Manager


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Even in Los Santos, there are some oddballs who have very strange beliefs. Take Ernesto, who's convinced the chicken is the most beautiful and perfect animal in the whole of creation. And feeling that these noble foul are not sufficiently respected, he's created the character of Mister Pollo to defend their honor. But over time, all he's achieved is to become a point of reference for bad taste and moodiness!
Game Details
: 2013-07-26
: n/a
: 0ctz (0,0%)
: 1160
Ability of Mister Pollo :
Stop: +3 Life
If Mister Pollo wins the fight, the player controlling Mister Pollo will win 3 Life points at the end of the round.


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The Parachute Band have taken home the Peoples Choice Award at the Vodafone New Zealand Music Awards, held in Auckland last night. Out of the 100 plus artists nominated for awards, the New Zealand public has voted the Parachute Band their favourite.
Parachute Music Founder & CEO, Mark de Jong, says To be recognised by the people of New Zealand is such an honour for the Parachute Band. Our aim has always been to take NZ written worship songs to the world. To receive accolades for our music is icing on the cake.
The band was formed in 1995 to lead worship at the Parachute Music Festival and their successes in the Christian music circuit have turned their love of music into a full time endeavour.
The re-invigorated band, who came together in 2006, consists of Omega Levine (vocals), Sam de Jong (drums), Rhys Machell (bass), Alister Wood (keyboards) and Simon Moore (guitars)
The award was received by Parachute Musics A&R Manager, Brendan Vucich on behalf of the band who is currently touring South Africa.
The Parachute Band will be taking the stage at Parachute 09, the Southern Hemispheres largest four day music festival. The festival will be held at Hamiltons Mystery Creek over Auckland Anniversary weekend (23-26 January 2009), boasting a strong suit of international headliners as well as some Kiwi favourites including Dave Dobbyn and Nathan King.
For more information head to parachutemusic.com.
View Latest Music News Articles


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As challenging as it is to make green choices in our everyday lives, it all becomes exponentially more difficult when travelling. Options are limited and we find ourselves making compromises, sacrificing belief for convenience.
I recently travelled from Halifax to Vancouver and although it was prior to the start of the Halitrax project, the goals of this challenge were ever present in my mind.
I present to you my top 4 travel confessions:
1. The drive to and from the airport.
- There's likely public transit available. I didn't even check.
2. Waiting in the terminal, prior to my flight, I purchased a delicious smoothie.
- Like I said, it was delicious, but the secret ingredient was probably not its Styrofoam container.
3. Flying.
- Yes, it's the most efficient way to travel. It's just hard to ignore the huge carbon footprint of a cross-country flight.
4. During a layover, I purchased water.
- Bottled water. Those who know me know that I have strong feelings on the issue of water privatization. (Seriously. I regularly lose sleep over the current state of fresh water availability for the world's population.) Suffice it to say that bottled water is never my drink of choice.
I don't think anything on this list is extraordinary, but was it all necessary? Probably not.
My hope as this summer continues is that I'll explore alternatives to these decisions, and occasionally I'll make the best choice, instead of the most convenient one.
If you're looking for something to do on Saturday night, and feel like supporting the arts, get some tickets to Symphony Nova Scotia's Beer & Beethoven! For more info, click here.


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Serving Rochester's Ninjas since 2011!
Ninja Training, Parkour, Fun...
Call it what you want, but the training is the same: Strength, Coordination, Balance, and Adaptability.
We do it best!
Open Gym Tuesday's 8-9pm
You can train during any open gym, but on Tuesday's we specifically set up our space for more focused ninja training.
Modular Gym. Modular Training.
Only 25% of our gym is made up of permanent structures. Everything else changes from week to week and month to month.
You'll never get bored!
Classes for Kids and Adults!
Every class we offer incorporates running, jumping, climbing, swinging, and vaulting.
Parkour is the method,
Ninja Warrior is the expression.
Unleash Your Inner Ninja!
Ninja Training Every Tuesday 8-9pm!
Did you know that most of the ninjas you see on American Ninja Warrior train Parkour?
Parkour is the ultimate cross-training discipline for any sport. We improve balance, coordination, strength, and precision in fun and interesting ways. The most valuable skill for any Ninja is ADAPTABILITY. You never know what the course will be and most of the time, you've never practiced the particular skill needed to succeed. Those that do well are those that can adapt on the fly.
All of our Parkour classes are Ninja Training classes. We teach all the techniques you see on TV including Tic-Tacs (Quintuple Steps), Balance on bars (Balance Logs), Lache's (Swings from bar to bar), Bracchiation (Monkey Bars), and Wall Passes (Warped Wall).
Rochester's very own Carl Fantauzzo built our replica 14'6″ warped wall for our community to practice on. Additionally, our gym has seen a lot of familiar faces over the years:
Carl Fantauzzo
Pavel Fesyuk
Kristy DeVincentis
Elet Hall
Jereme Sanders
We currently have one open time-slot for Ninja Warrior Training on Tuesdays from 8-9pm. This�special open gym is dedicated to Ninja Training and lets anyone come to try out our obstacles. Instructor Charles is always available to run a quick tutorial or give you some more guided direction on how to train on specific obstacles.


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Dancer Photos
Event Posters
Club 390
390 E. Joe Orr Road
Chicago Heights, Illinois 60411
Average drink price: $2.00
Cover charge: $5.00
Lap dances: $0.00
Private dances: $0.00
Minimum age: 21
Dress code: Casual
Visit our website:
Club Website
Follow us on Twitter:
Club Twitter
Follow us on Facebook
Club Facebook
Hours of OperationMonday11 AM-4 AM
Tuesday11 AM-4 AM
Wednesday11 AM-4 AM
Thursday11 AM-6 AM
Friday11 AM-6 AM
Saturday7 PM-6 AM
Sunday7 PM-4 AM
Club Information
Club is Nude
VIP Dances
Stage Performances
Lap Dances
Private Dances
Couch Dances
Kitchen and BarSnacks Lunch
Dinner Beer and wine
Full bar
Guest Services
ATM on premises
Limousine service
Credit cards accepted
SCN VIP card accepted
Come on down to Club 390 in Chicago Heights, Illinois. Club 390 strip club is known for offering the best nude vip dances in Chicago Heights, Illinois. To enter Club 390 there is a $5.00 cover charge. Exotic dancers and drinks.
Club 390 is an upscale strip club that combines sexy entertainment with great food, liquor, and fun you will not find any place else! Newly remodeled, Club 390 offers you a luxurious and elegant environment, with stadium seating, three stages, a full liquor bar, VIP rooms and more! The party never stops here; we are open until 6 am and serve a full menu all night.
We have an impressive roster of Chicago's finest fully nude strippers and when you are in the mood for something more intimate, pick out one of your favorite 390 showgirls and experience the ultra-privacy and luxury we have to offer. We offer lap dances, semi-private and private full contact dances; the choice is yours!
The staff at Club 390 is here to serve you; we make sure our guests never need to ask for anything, and whether you are with a large group of people or just on your own, we will cater to your every need. From our Managers, hostesses to the wait staff, our goal is for you to have the best time of your life.
Club 390 events
Dance Special


text: Should Antonio Pierce be released or traded? Is that even a valid question? Today while searching for Giant information over the internet I stumbled across an article from Giants Insider. The Headline immediately caught my attention as it read "Reese must release Pierce". I am in total disagreement with their opinion. I've read how Pierce is too fat, too slow, and how he doesn't get any sacks. My reply to all these comments are Zach Thomas has always been in great shape and is a Speed Demon at Linebacker. Ravens Linebacker Ray Lewis is a sack Machine especially during his MVP season. That season when they beat the Giants in the Super Bowl he had a whopping 3 ½ sacks. Can you believe that? Continue reading


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Katy, TX News – Local Support Group Learns How Cancer Affects the Brain
Katy, TX News (August 27, 2014) – This month, Katy's Breast Friends Support Group participated in an educational presentation from Sarah Prinsloo, Ph.D., on the ways the brain reacts to various cancer treatments, followed by a group discussion about their current challenges.
The breast cancer support group meets at the MD Anderson in Katy on the second Tuesday of every month with the goal of empowering, uplifting and supporting patients as they go through this challenging time. The meetings are open to all breast cancer patients, regardless of where they receive or received treatment.


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22272 Pepper Road #E
Lake Barrington, Illinois 60010
$7 / sq. ft.0 USD
Listing Office: GC Realty and Development
Disclaimer: The data relating to real estate for sale on this website comes in part from the Broker Reciprocity Program of Midwest Real Estate Data, LLC. Real estate listings held by brokerage firms other than @properties are marked with the Broker Reciprocity thumbnail logo and detailed information about them includes the name of the listing brokers.
Lake Barrington
Lake Barrington is located in Lake County, Illinois. It has a population of about 5,000 residents. The community is in Northeastern Illinois, about 40 miles northeast of Chicago.Learn More
Union Pacific Northwest
at Fox River Grove Metra (1.86 miles away)


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Grady Elementary PTA VP of Volunteers, Michael Gaines, won the Hillsborough County PTA Superman Award for his work in building our Grady PTA website, helping Grady PTA be able to accept online and credit card payments, and for building from scratch the online ASE club signup system. Notably, Michael is also responsible for procuring the current version of the Grady Tiger mascot/logo (the playful growling tiger) that adorns our school, t-shirts and website. Michael was completely surprised to have won the award. The Grady PTA, however, is glad that the Hillsborough County PTA has recognized Michael's innovation and hard work. To see pictures of both the Hillsborough PTA award ceremony and Mrs. Dosal's presentation of the award to Michael before the Spring Musical, please click here: PTA Awards.
Additionally, Grady PTA also won a Volunteer Award and a Golden Participation Award for parent and grandparent involvment in the school. Congratulations to our PTA.


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By Nathan M. Walters, Senior Contributing Reporter
RIO DE JANEIRO, BRAZIL – In 1969, only a few years after Gaston Lenôtre revolutionized the art of pastry making, Joe Dassin recorded the catchy French tune "Les Champs-Elysées," ten years before pasty chef Dominique Guerin would make his first visit to Rio de Janeiro.
Though Dassin may best be remembered for his French covers of English tunes ("Les Champs-Elysées" is a cover of the English song "Waterloo Road"), Lenôtre will always be known as the chef that radically changed the art of pastry making. A tradition that Dominque, Lenôtre's former student, continues on Rio's Champs-Elysées, Avendia Nossa Senhora.
Boulangerie Guerin has only been operational for five months. However, the Guerin namesake has been aligned with pastry arts for almost a century, Dominique Guerin's grandfather opened his bakery in the suburbs of Paris in 1921.
It was here, during WWII, that Gaston Lenôtre began his training, laying the foundation for the culinary revolution the chef would later lead. A few decades later the Lenôtre-Guerin relationship would take another turn, when in the early seventies a young Dominique Guerin would begin his own training with Lenôtre.
Guerin's work with the master ultimately brought the young chef to Rio, for the opening of the Rio Palace (now Sofitel) in 1979. Thirty years have passed and in between Guerin worked in some of the finest restaurants around the world before returning to Copacabana – first as the pastry chef for Sofitel, now as the owner/operator of Boulangerie Guerin.
"Our way of working is that of Lenôtre, keeping the Lenôtre spirit alive" says a smiling Guerin. "Our focus is on quality ingredients, all-natural ingredients. We try to go back to the roots of quality, the roots of taste. The approach is simply complex. We create products that are new, exciting, but that remain true to classic recipes. Revolutionized classics, just like Lenôtre."
The bakery is small with a spirited decor and is usually crowded – as word spreads Cariocas are traveling from far and wide to satisfy their craving for a proper French baguette and Guerin's famous deserts (the tartelette aux fruits rouges, éclair au chocolat and millefeuille recently were awarded the best desert in Rio during Rio Gastronomia).
When asked about the decision to locate, what may at first seem like a delicacy reserved for Rio's more well-to-do, in Copacabana, Guerin quickly cited price as the main deterrent from originally establishing in the city's more sought after areas (e.g., Leblon, Ipanema).
"It is very expensive to be in Leblon right now," said Guerin. "But Copacabana is a place where we saw a lot of potential. The culinary scene in Rio is changing because you have an emerging middle-class that is opening to new ideas, new flavors. A lot of those people are here in Copa."
Boulangerie Guerin is a bit of an anomaly in Rio's evolving culinary scene, offering visitors the chance to try true French delicacies without a significant investment. "There are many great, and many expensive restaurants in Rio now. For most, the good ones, it is a necessity, the cost of getting the proper ingredients is not cheap," said Guerin.
Fortunately for other neighborhoods, this taste of Paris that for the moment can only found in Copacabana, may soon be available in other parts of the city. The success of Guerin at the current Nossa Senhora location (what Guerin calls the Champs-Elysées of Copacabana) has lead to plans for expansion elsewhere in the city.
For now, those craving something different and delicious must make the trip to Nossa Senhora. Best to put some Joe Dassin on the iPod and find your way to the little piece of Paris in Copacabana.
Boulangerie Guerin
Avenida Nossa Senhora de Copacabana nº920
Copacabana, Rio de Janeiro
Open Hours: 8AM – 8PM
Phone: +55 (21) 2523-4140


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okay, here are the official rules of the user gyms.
1.) must be a mod or have 4 badges.
2.) gyms go from 1-10, pokemon increasing in strength as we get more people.
3.) cannot pick ubers and no legends. only normal, regular based pokemon.. THAT INCLUDES YOU INFERNAPE
4.) 1st gym: 2 pokemon
2nd gym: 2 pokemon
3rd: 3 pokemon
4th: 3 pokemon
5th: 4 pokemon
6th: 5 pokemon
7th: 5 pokemon
8-10: 6 pokemon
5.) no cheating, a moderator/Admin will control the fight.
Last edited by Choco Chip (2011-06-07 03:04:36)


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Leased at 205-215 Sherway Gardens
Units: 2311,1702,2505,1806,2505, 711,904,2710,2301
With all the action at these condos its starting to feel like a second home to me. In the last 2 1/2-3 Months
I've written 19 leases alone between 205-215 Sherway Gardens. I've made some great contacts
and friends working at these condos.
Imagine Living In A Condo Steps To One Of Toronto's Luxurious Shopping Mall Sherway Gardens. With Mississauga Transit, TTC, QEW, And Highway 427 Right At Your Door Step Getting Around The City Has Never Been Easier.
This Is The Last Phase Of One Sherway. With 2 Phases Already Built In This Modern Community Is One Of The Most Desired Area In Etobicoke. Menkes Who Brought Us Lumiere On Bay And The Luxe In North York Has Teamed Up With Great Gulf Who Brought Us Charlie (Spadina/King) And They Will Be Bringing 1 Bloor; Has Teamed Up To Bring Us One Sherway.
Club One Sherway provides excellent facilities to their residents. 17,000 sq.ft. state of the art fitness and recreation centre that includes an indoor swimming pool, whirlpool, his and her saunas, fitness and weight rooms, virtual golf and putting green, billiard room, theatre, media lounge, lounge bar, party room and private dining room.
Sherway Gardens Offers Luxury Shopping Stores: Holt Renfrew, William Sonoma, Lacoste, Abercrombie & Fitch, Aritzia, Lululemon, etc. TrilliumHealthCentreHospital, TOYS R US, Chapters and restaurants are only minutes away.
For a private viewing please call me direct 647-408-5226
Looking to sell?? E-mail me at firstname.lastname@example.com for an up to date Market Evaluation


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Rhubarb has the reputation of being an old fashioned vegetable, after reaching the peak of it's popularity around WWII. It's distinctive tartness is popular with some, but not everyone!
Season : Mid May to the end of June
Recipes: Simple Rhubarb Sauce (pictured to the right)
Rinse rhubarb in cool water and then wrap the bottom in damp paper towels. It should be kept in the refrigerator in a plastic bag.
- Rhubarb is most popular when made into a pie with strawberries.
- Delicious in cakes, breads, and muffins, rhubarb also makes a superb crisp.
- For the brave, rhubarb can be eaten raw... we recommend dipping it in sugar!
- It makes an excellent sauce to accompany meats, desserts, or served on ice cream.
- Jar up some rhubarb jam to enjoy this refreshingly tart vegetable all year.
About Rhubarb…
The origins of rhubarb can be traced back to China at least 2700 years ago, where it was highly regarded for it's medicinal properties. While it was used medicinally in medieval Europe, the first recorded planting outside of China didn't occur until 1608. If early Europeans wanted rhubarb, they had to trade with China for it.
It took another 100 years for this tart vegetable to land on anyone's plate - rhubarb wasn't considered food until the early 1700's! But that's not too surprising, considering that the leaves are poisonous and parts of the plant can be used as a laxative. There is also an understandable connection between the decrease in cost of sugar and the new classification of rhubarb as food - have you ever bitten into a raw rhubarb stem? Rhubarb made it's first appearance stateside in the early 1800's, in Maine, where it has since gained the alias of "Pieplant".
- The part of the plant that we eat is the 'petiole', or stem.
- Rhubarb was so highly regarded it was given to Emperors as tribute and used as leverage for trade negotiations.
- A rhubarb flower is a large, beautiful, cluster of tiny, cream-colored blossoms on a thick, round stem.
Nutritional Facts
Rhubarb contains some potassium and is low in sodium. It's a good source of vitamin C and dietary fiber.


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Del Coronado Hotel and Coronado Community Center
If you're planning on having your wedding in Coronado and don't care for complications and hassle, then we suggest the Community center in Coronado located simply across the street from the Hotel Del Coronado. The vast vistas are of the Glorieta Bay marina and the Coronado golf course and there are plenty of gardens for the wedding photography. If you're looking for more variety in your wedding photography then we can also head over to Coronado beach for more photos at sunset in front of the historic hotel Del Coronado. Overall it's a great facility at a great price!


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Black Canyon Inn
- 800 McGregor Ave
- Estes Park, CO 80517
- Ph: (970) 586-8113 | TF: (800) 897-3730
Black Canyon Inn Weddings is nestled on a secluded hillside, north of downtown Estes Park and overlooking the historic MacGregor Ranch. We provide our couples with three breathtaking outdoor ceremony sites, the lawn, pond and pavilion. We have contract options to suit elopements up to groups of 175. Our onsite event team will be available to you throughout the planning process, and of course the day of, to ensure your wedding is what you dreamt of! The vacation rentals around the property are the perfect central location for family and friends to get away and celebrate your mountain wedding. Please contact us today for specific pricing and availability!
- Outdoor Pool:
- Kitchen/Kitchenette:
- Fireplace:
- Handicapped Accessible:
- Cable/Satellite TV:
- BBQ/Grill:
- Laundry Facilities:
- Restaurant On Site:
- Open Year-Round:
- Balcony/Porch/Deck:


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Imagine cardiac cells, beating in a petri dish, being used to form human tissue that might be used to replace damaged heart muscle. Think about those same cells acting as a surrogate for the human heart to determine whether experimental drugs would be toxic.
It is not science fiction, but a real project that scientists are working on, using human embryonic stem cells.
Scientists from across the country discussed that and other research projects yesterday at the third annual Stem Cell Meeting on the Mesa at the Salk Institute.
The meeting brought together more than 200 scientists from academia and biotechnology, including the leaders in various areas of stem cell research, including cardiac disease, diabetes, neurodegenerative disease and cancer. Presented by the coalition of San Diego's four largest research institutes – known officially as the Sanford Consortium for Regenerative Medicine – the gathering was meant to stoke creative juices and foster collaborations.
"Another reason for the meeting is to reignite the rallying cry of scientists in the field," said Evan Snyder, who heads the stem cell program at the Burnham Institute in Torrey Pines.
It is a field that is thought to hold the potential for curing some of society's most devastating diseases, but it also has been extremely controversial. California taxpayers supported a $3 billion initiative to fund research that the federal government wouldn't.
The meeting gave some local scientists a chance to highlight their work. And it gave San Diego's biotechnology executives a peek at research in the pipeline, because their companies, among others, will be expected to turn that research into products.
Many people hoped those products would be therapies, essentially stem cells grown into replacement cells that could be transplanted to replace cells or tissue destroyed by disease.
While that hope has not died, scientists are learning it remains distant. Science must overcome several issues, such as immune-system rejection of transplanted cells or the risk of the cells creating tumors, said Joseph Wu, of Stanford University's School of Medicine.
Meanwhile, scientists are excited about how the cells are being used now – as human models to test drugs and get a better understanding of disease development.
Mark Mercola showed how scientists at the Burnham have been working to perfect the process of coaxing human embryonic stem cells into cardiomyocytes, the cells that make up heart muscle.
His lab, in collaboration with the San Diego company Vala Sciences, is developing tests and instruments that help measure the toxicity that experimental drugs would have on the cells.
Currently the drug toxicity isn't determined until clinical trials, after years of research and millions of dollars have been invested.
Human models help scientists weed out the problem drugs early, saving them time and money to invest in more promising molecules, Mercola said.
Harvard Stem Cell Institute's Kenneth Chien talked about his lab's approach to growing heart cells and using them to construct beating pieces of replacement tissue. One day Chien's team hopes the tissue can be transplanted to replace damaged heart muscle.
Using an old photograph of California Gov. Arnold Schwarzenegger in his acting days as Conan the Barbarian, University of California San Diego professor Larry Goldstein explained the complex and lengthy road over which the body's neurons must transmit signals to synapses in the feet and hands, and all that could go wrong in between.
Using human embryonic stem cells, scientists in Goldstein's lab are creating human models of Alzheimer's disease to determine the role of environmental and genetic damage.
It's one disease that requires a human model, Goldstein said, because mice and other animals don't get it.
"Who can tell if a mouse is demented anyway?" Goldstein said.
Through its work, Goldstein's team learned that the best models are created by coaxing skin cells from people with Alzheimer's to go backward down the development chain until they are pluripotent, meaning they are like embryonic cells in having the capacity to evolve into many cell types. These so-called induced pluripotent cells are then coaxed to develop forward again, into diseased neurons.
The meeting gave young Scripps researchers Inbar Friedrich Ben-Nun and Suzanne Peterson leads on teams and projects with which they might want to collaborate.
Even more seasoned scientists, such as Scripps neuroscientist Floyd Bloom, were jazzed about what they were seeing.
"There's a joy in watching young scientists come up with solutions to problems we didn't even recognize as a problem," said Bloom, who is on the board of the state stem cell institute. "Seeing new ideas emerge is the most reinforcing part of being a scientist."
Terri Somers: (619) 293-2028; email@example.com


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Improving access to contraception and care
Our research aims to address unintended pregnancy in the US through improved access to contraception. We investigate financial, educational and medical barriers that prevent and hinder access, especially among underserved populations, including adolescents and young women. Our studies evaluate approaches to expand access to contraception, including evidence-based counseling, provision of care in varied practice settings and elimination of unnecessary medical exams.
Featured Research: Public funding improves women's access to birth control
According to a new study published in the American Journal of Public Health, public funding reduces the high upfront costs of some methods, which is critical to increase access to birth control, especially for low-income and uninsured women who wish to use these methods.
As part of the effort to expand access, we have evaluated the provision of contraception in a range of practice settings, including family planning clinics, pharmacies, primary care and post-abortion. We have conducted studies on over-the-counter and direct pharmacy access to emergency contraception, advance provision of emergency contraception, same day provision of long-acting reversible contraception and post-abortion access to contraception.
We have studied health care providers' contraceptive education and counseling practices to assess the extent to which they are evidence-based and to identify the need for training on contraceptive eligibility and indications.
Our research has also focused on streamlining access to reproductive health care and reducing unnecessary medical tests, including removing the pelvic exam requirement for hormonal contraception. The pelvic examination can present an obstacle for women seeking to prevent pregnancy, especially for adolescents. While the dissemination of new clinical practices can be a lengthy process, our research has helped to move women's reproductive health care in the direction of greater efficiency and improved health outcomes.
Selected Publications
- Over-the-counter, direct pharmacy, advance and same day access to contraception
- Post-abortion access to contraception
- Health education & counseling
- Streamlining testing and exam requirements in reproductive health care
Over-the-counter, direct pharmacy, advance and same day access to contraception
- Rafie S, Kelly S, Gray EK, Wong M, Gibbs S, Harper CC. Provider opinions regarding expanding access to hormonal contraception in pharmacies. Contraception 26(2):153-160, 2016.
- Biggs A, Harper CC, Brindis C. California Family Planning Health Care Providers' Challenges to Same-Day Long-Acting Reversible Contraception Provision. Obstetrics & Gynecology 126(2):338-45, 2015.
- Thompson KMJ, Raine TR, Foster DG, Speidel JJ, Darney PD, Brindis CD, Harper CC. Access to levonorgestrel emergency contraception: Science v. federal politics. Women's Health 9:139-43, 2013.
- Rafie S, Haycock M, Rafie S, Yen S, Harper CC. Direct pharmacy access to hormonal contraception: California physician and advanced practice clinician views. Contraception 86:687-93, 2012.
- Harper CC, Weiss DC, Speidel JJ, Raine-Bennett T. Over the counter access to emergency contraception for teens. Contraception 77:230-233, 2008.
- Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC, Grimes DA. Advance provision of emergency contraception for pregnancy prevention: a meta analysis. Obstetrics & Gynecology 110:1379-88, 2007.
- Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC, Grimes DA. Advance provision of emergency contraception for pregnancy prevention (full review). Cochrane Database of Systematic Reviews, 2007.
- El-Ibiary SY, Raine T, McIntosh J, Darney PD, Harper CC. Pharmacy access to emergency contraception: the perspective of pharmacists at a chain pharmacy in San Francisco, California. Journal of the American Pharmacists Association 47:702-710, 2007.
- Raine TR, Harper CC, Rocca CH, Fisher R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: A randomized, controlled trial. JAMA 293:54-62, 2005.
Post-abortion access to contraception
- Rocca CH, Goodman S, Grossman DJ, Cadwallader K, Thompson KM, Talmont E, Speidel JJ, Harper CC. Contraception after medication abortion in the United States: results from a cluster randomized trial. American Journal of Obstetrics and Gynecology 218(1):107e.1-8, 2018.
- Rocca CH, Thompson KM, Goodman S, Westhoff CL, Harper CC. Funding policies and postabortion long-acting reversible contraception: results from a cluster randomized trial. American Journal of Obstetrics and Gynecology 214(6):716.e1-8, 2016.
- Morse J, Freedman L, Speidel JJ, Thompson KMJ, Stratton L, Harper CC. Post-abortion contraception: Qualitative interviews on counseling and provision of long-acting reversible contraceptive methods. Perspectives on Sexual and Reproductive Health 44:100-106, 2012.
- Thompson KMJ, Speidel JJ, Saporta V, Waxman NJ, Harper CC. Contraceptive policies affect post-abortion provision of long-acting reversible contraception. Contraception 83:41-47, 2011.
- Goodman S, Hendlish SK, Benedict C, Reeves MF, Pera-Floyd M, Foster-Rosales A. Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion. Contraception 78(2):136-42, 2008.
- Goodman S, Hednlish SK, Reeves, MF, Foster-Rosales, A. Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion. Contraception 78(2):143-8, 2008.
Health education & counseling
- Gibbs SE, Rocca CH, Bednarek P, Thompson KM, Darney PD, Harper CC. Long-acting reversible contraception counseling and use for older adolescents and nulliparous women. Journal of Adolescent Health 59(6):703-709, 2016.
- Thompson KMJ, Stern L, Gelt M, Speidel JJ, Harper CC. Counseling for IUDs & implants: Are health educators & clinicians on the same page? Perspectives on Sexual and Reproductive Health 45:191-195, 2013.
- Harper CC, Stratton L, Raine TR, Thompson K, Henderson JT, Blum M, Postlethwaite D, Speidel JJ. Counseling and provision of long-acting reversible contraception in the US: National survey of nurse practitioners. Preventive Medicine 57:883-8, 2013.
- Harper CC, Henderson JT, Schalet A, Becker D, Stratton L, Raine TR. Abstinence and teens: Prevention counseling practices of health care providers serving high-risk patients in the United States. Perspectives on Sexual and Reproductive Health 42:125-132, 2010.
- Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B. Preventing excessive weight gain in pregnancy: How do prenatal care providers approach counseling? Journal of Women's Health 19:807-814, 2010.
- Raine T, Marcel AV, Rocca CH, Harper CC. The other half of the equation: Serving young males within a young women's reproductive health clinic. Perspectives on Sexual and Reproductive Health 35(5):208-214, 2003.
Streamlining testing and exam requirements in reproductive health care
- Hsu A, Henderson JT, Harper CC, Sawaya GF. Obstetrician–gynecologist practices and beliefs regarding external genitalia inspection and speculum examinations in healthy older asymptomatic women. Journal of the American Geriatrics Society 64(2): 293-8, 2016.
- Schneider A, Henderson JT, Harper CC, Hsu A, Saraiya M, Sawaya GF. Obstetrician-gynecologists' beliefs about performing less cervical cancer screening: the pendulum swings. American Journal of Obstetrics & Gynecology pii: S0002-9378(15)00719-X, 2015.
- Henderson, JT, Yu JM, Harper CC, Sawaya GF. U.S. clinicians' perspectives on less frequent routine gynecologic examinations. Preventive Medicine 62;49-53, 2014.
- Yu JM, Henderson JT, Harper CC, Sawaya GF. Obstetrician-gynecologists' beliefs on the importance of pelvic examinations in assessing hormonal contraception eligibility. Contraception 90(6):612-4, 2014.
- Henderson JT, Saraiya M, Martinez G, Harper CC, Sawaya G. Changes to cervical cancer prevention guidelines: Effects on screening among U.S. women ages 15-29. Preventive Medicine 56:25-9, 2013.
- Henderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya G. Routine bimanual pelvic examinations: Practices and beliefs of US obstetrician-gynecologists. American Journal of Obstetrics & Gynecology 208:709e1-7, 2013.
- Henderson JT, Sawaya GF, Blum M, Stratton L, Harper CC. Pelvic examinations and access to oral hormonal contraception: Results from a national survey. Obstetrics & Gynecology 116:1257-64, 2010.
- Stewart FH, Harper CC, Ellertson CE, Grimes DA, Sawaya GF, Trussell J. Clinical Breast and Pelvic Examination Requirements for Hormonal Contraception: Current Practice vs Evidence . JAMA 285(17):2232-2239, 2001.
- Harper C, Balistreri E, Boggess J, Leon K, Darney P. Provision of hormonal contraception without a mandatory pelvic exam: "First Stop," a California demonstration project. Family Planning Perspectives 33(1):13-18, 2001.
- Sawaya GF, Harper C, Balistreri E, Boggess J, Darney P. Cervical neoplasia risk in women provided hormonal contraception without a Pap smear. Contraception 63(2):57-60, 2001.