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Courtyard West Orange
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TripAdvisor Reviews Courtyard West Orange
Travel Blogs from West Orange
Right through the very heart of it...
... Horses of Helios' statue and the proximity of Carnaby Street. Then it occurred to me that having such a mental process about Times Square probably made me a bit of a '*****y Brit does America' type. Which I guess is okay, so long as I remember to temper my opinions with good grace in conversation and/or otherwise keep them to myself. But even those very few minutes in Times Square seemed to drain me and I decided to head back to the hostel ...
Getting my Broadway on.
Well it has been an interesting, fun and eventful day today. Started in the early hours of the morning when I got up to go to the loo and somehow managed to walk into the bathroom door with my head. That was a surprise and I still can't work out how it happened. I think having my eyes shut may have had something to do with it. As my forehead above my eye began to swell, I had to resort to an ice pack, and of course a ...
Day Two
An eventful day today with lovely clear skies but it was rather chilly! Kids now contributing to the photograph submissions! Luke going for quantity (over 100 pics in a day!), whereas Mia focused on quality (definitely got her Mom's genes). Richard's HD app still rendering some of the day's best!!
Kids not keen to ...
Great day
... ferocity and scale, it is an amazing tribute - so many stories, photos, artefacts, documents, transmissions and testimonials that bring many of its visitors to tears. To see the huge beams literally bent into a horseshoe shape by the force of the impact was unbelievable. It is put together so respectfully and serves to reiterate the horror and senselessness of the events that occurred right where you are standing in the museum. Sam even left ...
I want to be a part of it New York New York
... 8211; the oil on the lane, the holes in the ball, how to bowl. Hinesh and I are social players so we just throw our balls. The first lane is not to Dan or Jem's liking. Its dry so the way they bowl is not working with the lane. I manage to get a groove and bowl five spares in a row and I go out and win the first game. Dan gets us a new lane for game two. Hinesh opens up game 2 with a strike and everyone else but me ups their games. My bowling style doesn't work for this lane and I ...


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Bandai Harumika
Dressing up dolls is a lot more inspiring with Bandai's Harumika. Each set includes fabrics and trims for styling runway-ready ensembles. And there's no cutting or sewing: A flat plastic tool helps insert the material into a groove in the back of each form.
Ages: 6+
Reviewed: December 2010
Price When Reviewed: $10.00 –$40
What do you think?
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subset: commoncrawl


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Okay if you've seen the first Scary Movie and laughed, you'll find this funny. I like silly/dumb funny so I was cracking up at many parts. Some folks are looking for witty, award winning comedy, full of heartfelt all-around good jokes. If this is you, skip out on this one. Overall, I'd give it a 6.5/7. Some parts were simply dumb, but that's to be expected. If you have 10 bucks, an hour and a half, and you wouldn't mind a laugh or two, I say go for it. If you're looking for wit, class, and style, keep it moving. Still unsure? Okay I'll tell you the movie, without spoiling it. Basically a guy has his girlfriend move into his house. He's skeptical, because his friends have warned him about the dangers of having a girlfriend move in, ya know, no more dream-girlfriend. Anyways, she moves in and stuff starts getting weird. With the increasing weirdness, more characters are introduce to help stop the weirdness. It's a movie with a simple plot, simple characters, and a silly flow. If this sounds good to you, you'll love it!
A Haunted House
Comedy / Horror
A Haunted House
Comedy / Horror
In October 2012 a video footage is found at the home of Malcolm Johnson and the recordings are still unexplained. Past this prologue a story in flashback form unfolds. During the summer of 2012, Malcolm and Kisha move in together and start a happy life. One night Kisha notices a few unexplained phenomena that convince her their house is haunted by ghosts. To allay her fears Malcom hires a camera crew to film inside the house day and night. A few nights later Malcom and Keisha have sex on camera, despite Keisha's protests at being filmed. Upon reviewing the sex tape the next day, Malcom and Keisha notice a few paranormal phenomena caught on tape. Malcom wants to sell the house but the housing market is slow. Therefore, Malcom decides to hire a psychic to come to the house and investigate. After Kisha confesses to making a deal with the devil for a pair of shoes things start to make sense but it doesn't solve the problems caused by the paranormal phenomena.
Uploaded By: Gaz
Downloaded 102,954 times
April 16, 2013 at 6:44 am
Tech specs720p 1080p
Movie Reviews
It's a Good Laugh, Not Oscar Winning, But Decent
Under-rated film worth seeing
Whether or not this movie was stereotypical should be set aside for reviews. Focus on the main parts of this movie which were to utterly make fun of paranormal activity and the devil inside. I felt like this movie is under-rated. I thought they got straight into funny and absolutely making fun of paranormal activity 1 very quickly. The first scene was based on making fun of the camera work of paranormal activity in the bed room. Although these sorts of comedies are always a stupid sort of funny, I laughed throughout this movie, especially at the character of Chip the psychic; whose main goal is to bring out the gay demons in Malcolm the main character. I had a good laugh and if you can score some tickets for cheap its not a bad, make you laugh at stupid comedy, type of movie.
Great Comedy
I am giving this movie a "9". I loved this movie, every scene was hilarious. I don't understand why the movie critics are so critical of this movie, to me a "spoof" is just like "a roast" it is meant to be funny and sometimes delivered in a risque manner. Bravo Marlon... You did a fantastic job with this. I can not wait to go see it again plus buy the movie when it comes out. Everyone in my party was laughing and still laughing today and we send it two days ago. I thought my boyfriend was going to pee his pants he was laughing so hard. The whole theater was cracking up. Go see it people, we need to laugh after all the craziness that has been going on this world we live in.


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Garage Car
Transparent Pontiac in 1939 at auction in July
Why would someone pay from $ 275,000 to $ 475,000 to get a car? Just because it is a collector and wants to have the collection of every strange car in the world. The RM Auctions will turn out to tender a 1939 Pontiac in which the body is made of Plexiglas. The Pontiac Plexiglas Deluxe Six of 1939, known as the "Ghost Car", built in New York in 1939-1940 and was presented at Futurama, as part of the thought that the GM cars in 1960, before the outbreak of the Second World War.
Taedium Vitae
Sunday, June 12, 2011
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November 14, 2011 at 3:54 PM
I owned a 1940 Pontiac sedan, but mine was opaque...
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- 18 & over
- Two drink minimum
- Special Event
Purchase Tickets
Stand Up For Pits
Wednesday, April 23, 2014 7:30 PM
Gotham Comedy Club, New York, NY
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Show Details
- Ticket Price: $0.00
- Door Time: 4:00 PM
- Show Type: Stand Up
18 & over
Two drink minimum
Special Event
Rebecca Corry's two biggest passions in life are comedy and Pit Bull Terriers (Pibbles) especially her own rescue, Angel, who is the inspiration for it all. The Stand Up For Pits Foundation is thrilled to bring Stand Up For Pits to New York City! You don't have to own a Pibble or own a dog at all to enjoy and support this event. This event is for anyone who supports putting an end to discrimination and abuse and wants to see safer and more humane communities for humans and pets all while having a blast. Come Stand Up For Pits and save lives through laughter. These events sell out, so be sure to get tix in advance!
4-7pm Pit -bull aka pibble adoption (downstairs in our lounge)
5pm 9:30p -silent auction
6pm pibble -kissing booth with angel
7:30pm -showtime
4-7pm Pit -bull aka pibble adoption (downstairs in our lounge)
5pm 9:30p -silent auction
6pm pibble -kissing booth with angel
7:30pm -showtime
Tweet Feed
- RT @Rosie: see u there this weekend !! gothamcomedyclub.com/event.cfm?id=4… 12 h
- RT @ComedyJuiceNY: NYC! Tomorrow @GothamComedy 930: Americas Got Talent Finalist @GaryVider! Plus: @andrewschulz, @ahmedcomedy & More! http… Oct 12
- RT @bcgoldthwait: Hey NYC I'm @GothamComedy Friday and Sat night! Come say 'hi'. Thanks! Pic by the genius @vonswank pic.twitter.com/3VYThoEjca Oct 09
- RT @FlexAforeal: Chillin with my good friend @angiemartinez @Power1051 come out to @GothamComedy @AXSTV 10pm 208 w 23rd street ny ny Oct 08
- RT @TheOrlandoJones: I'll be on stage at @GothamComedy this Sunday Oct 11th at 8pm #DoesThatCount? twitter.com/alwaysadrienne… Oct 08


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Tuesday, October 13, 2015
Global TV News Bytes
+ International children's channel KidsCo has acquired CG animated series Sendokai Champions from media agent Nottingham Forest. Co-produced by Kotoc and Spain's TVE, the ... Continue Reading →
ILM's John Knoll to Keynote View Conference
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The Oneida Indian Nation's Four Directions Productions has released My Home: An Oneida Legend, the second in a series of animated short film Blu-ray/DVD combo packs with an illustrated ... Continue Reading →
Next Media Launches New Animated News Venture
Next Media Animation, the Taiwan-based studio famous for its hilarious animated takes on breaking news items has launched the beta version of TomoNews, its English-language website ... Continue Reading →
'Geronimo Stilton' Debuts on DVD Next Month
U.S. fans of Scholastic's popular mouse journalist Geronimo Stilton will finally be able to enjoy the popular animated series based on the character on DVD in September. Entertainment ... Continue Reading →
Studio Heads Comment on 'Animation Saturation' in Theaters
Disney/Pixar chief creative officer John Lasseter, DreamWorks topper Jeffrey Katzenberg and Illumination Entertainment's founder/CEO Chris Meledandri are among the top studio ... Continue Reading →
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Animated 'Outlands' Makes a Splash on YouTube
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Home Viewing Gets 'Epic' This Week
Home audiences have the chance this week to enjoy the richly animated CG magic of Fox/Blue Sky's Epic on DVD ($29.98) and Blu-ray sets. Directed by Blue Sky Studios co-founder ... Continue Reading →


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Commercial flour sifters help remove lumps by turning your flour into a fine powder that evenly mixes in your batter. Good bakers know that equal distribution of ingredients is key when it comes to baking in bulk—the hundredth cupcake should taste the same as the first. Keep a few flour sifters accessible in your kitchen.
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YIELD: Makes 2 2/3 cups
- 1 tablespoon black pepper
- 2 teaspoons salt
- 1/4 cup (1/2 stick) butter
- 3/4 cup (packed) golden brown sugar
- 4 teaspoons water
- 2 2/3 cups blanched whole almonds
Preheat oven to 350°F. Line large baking sheet with foil. Lightly butter foil. Mix pepper and salt in small bowl. Melt butter in large nonstick skillet over medium-low heat. Add sugar and 4 teaspoons water; stir until sugar dissolves. Add almonds; toss to coat. Cook over medium heat until syrup thickens and almonds are well coated, stirring occasionally, about 5 minutes. Sprinkle half of pepper mixture over.
Transfer almonds to baking sheet. Using spatula and working quickly, separate almonds. Sprinkle remaining pepper mixture over. Bake until deep golden brown, about 10 minutes. Transfer sheet to rack; cool. (Can be made 4 days ahead. Store airtight at room temperature.)
my notes
Nutritional Info
- Calories247
- Carbohydrates22 g (7%)
- Fat17 g (26%)
- Protein5 g (11%)
- Saturated Fat4 g (19%)
- Sodium259 mg (11%)
- Polyunsaturated Fat3 g
- Fiber3 g (13%)
- Monounsaturated Fat9 g
- Cholesterol12 mg (4%)


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Nosler Partition Bullets 338 Caliber (338 Diameter) 210 Grain Spitzer Box of 50
Product #: 406097 Nosler #: 16337 UPC #: 054041163378
- Information
- Videos
The bullet that started the company, Nosler Partition Bullets feature a fully tapered jacket that ruptures instantly at the thin jacket mouth, yet the gradual thickening along the bullet's axis controls expansion and curls the jacket uniformly outward at high or low velocities.
Nosler's integral Partition supports the expanded mushroom and retains the rear lead alloy core. The enclosed rear core retains more than half the original bullet weight for deep penetration. The special crimp locks in the rear core section, adding strength to resist deformation under the pressure of heavy magnums. This is not loaded ammunition.
Technical Information
Caliber: 338
Bullet Diameter: 0.338
Bullet Weight: 210 Grains
Bullet Length: 1.200"
Bullet Style: Spitzer
Bullet Coating: Non-Coated
Ballistics Information:
Sectional Density: 0.263
Ballistic Coefficient: 0.400
Nosler's integral Partition supports the expanded mushroom and retains the rear lead alloy core. The enclosed rear core retains more than half the original bullet weight for deep penetration. The special crimp locks in the rear core section, adding strength to resist deformation under the pressure of heavy magnums. This is not loaded ammunition.
Technical Information
Ballistics Information:
Delivery Information
The total weight of the product, including the product's packaging as it sits on our shelf. Since some products ship directly from the Manufacturer, their weight may be unavailable. Because of variations in the manufacturing process, similar products may have differing weights. Unless the product is designated as "Ships Alone", Shipping Weight does not include the shipping box or packing materials associated with your order.
Product ships from MidwayUSA, separate from any other products on your order due to its size. Products that are Shipped Alone incur separate "Per Order" and "Per Pound" shipping charges.
Product is regulated by the US Department of Transportation (DOT) and cannot be shipped via USPS or air shipping methods. DOT-Regulated products must ship UPS Ground.
Product is restricted by shipping carriers and cannot be shipped to certain locations or via certain shipping methods.
Additional shipping charge for HazMat products. Carriers charge extra to ship packages with products they consider hazardous, such as reloading powder and primers.
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Get started
Bring yourself up to speed with our introductory content.
Get started
Bring yourself up to speed with our introductory content.
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SpringHill Suites Shreveport-Bossier City/Louisiana Downs
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
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TravelPod Member ReviewsSpringHill Suites Shreveport-Bossier City/Louisiana Downs
Ok, nothing special. Good view of racetrack. Window coverings sucked. Did not block out daylight.
This review is the subjective opinion of a TravelPod member and not of TravelPod.com.
TripAdvisor Reviews SpringHill Suites Shreveport-Bossier City/Louisiana Downs
Travel Blogs from Bossier City
Highway 61 Visited
Today we drove the Blues Highway from Tunica, to Vicksburg. Then west to Monroe, La., finally ending up at Harrah's Louisiana Downs. It is a horse race track and casino. It was 32 degrees when we left. 50 when we arrived.
On the way we drove into Clarksdale, Ms. For one photo. The Crossroads. This is where blues guitarist Robert Johnson …
Drove over to the Riverfront in Shreveport and checked it out. Really nice area. Four or five casinos. Went and ate lunch at Bodacious Bar-B-Q in Bossier City. It was awesome. We had pulled pork sandwiches and peach cobble!
Went back to Louisiana Downs to catch some horse races, but they were already over. They have quarter horse racing in …
The good stuff is getting closer!
Well, I-10 and I-12 are in no better shape than last trips. It's like riding a roller coaster for 2 hours. Luckily I-49 was much better. We took I-49 North to line up with Hwy 380 in Texas. This is a small 2 lane highway to nowhere. Roswell, The Very Large Array, Valley of the Fires and the Painted Desert are accessible from this road.
Now It Begins
... the time I hit the outskirts of Shreveport... nothing. There is always something, but nothing has yet come to mind. Oh, well. The goal is Meridian, MS by suppertime, which should be an easy drive, since we left at 1:30 PM. The truck is running fine, the Jeep pulling smoothly, Lacey curled up and happy and we are "On the Road Again". ...
Rose Garden
... garden. Many of the beds were completely empty of rose plants. Others were almost overrun with weeds. In others the rose bushes were overgrown and leggy. Grass clippings were on the sidewalks which were often cracked and chipped. There were gardens identified as test gardens that had no plants.
Interesting note: Winston-Salem Rose Society has ...


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COOL SIDE OF THE PILLOW by Gregory G. Allen to be Released 2/8
ASD Publishing has announced the launch of the latest novel by award-winning author, Gregory G. Allen that sends a man tumbling down the rabbit hole instead of Alice. COOL SIDE OF THE PILLOW is a story of a stay-at-home dad whose life becomes intertwined with an eccentric older actress specializing in children's theater.
Zachery Kleinmann lives in the elite world of New Canaan, Connecticut and has left his accounting job four years earlier to be a modern stay-at-home father. But as his son is starting preschool, his wife is passionately involved in her own career, and Zach is knocking on forty years old, he begins to wonder how he will find his own serenity and define himself moving forward. Enter Ginger Charman, an older, eccentric, free living children's theater actress who has dedicated her life to bringing joy to children and keeping all those around her young at heart. As Zach is pulled into her world and discovers secrets about his new friend, he is not sure he'll ever be able to leave that rabbit hole once he has fallen through - or if he'll even want to venture outside of it again.
Allen started his career as an actor in theater and worked for years touring the country as a Teenage Mutant Ninja Turtle, received his equity card performing Theater for Young Audiences in the early 90s, and has played libraries, malls, and schools. He found that wild world a fitting place to plunge his main character into for the setting of his new novel. He loves to write about people making life-altering decisions and creating unusual characters to fill the pages of his books. While Zachary and Ginger become bonded despite their differences, the author ponders the question as to whether men and women can be 'just friends', as well as stay friends once secrets emerge. It is that element of mystery and intrigue in his stories that adds another layer to his writing.
"I wanted to pay homage to my early roots of theater without telling a standard theater story," Allen said. "Having Zach enter the world in which a woman runs an entire company out of her house with all of its oddities and quirks is one of the reasons a reader called this book a cross between Grey Gardens and Mr. Mom."
Allen has been in the entertainment industry for over twenty years as an actor, director, producer and writer. He is an award-winning composer, has been featured in national magazines, NY/NJ Public Broadcast Stations, and several radio shows; and is a contributor to BroadwayWorld.com and HuffingtonPost.com. He currently manages an arts center on a college campus in New Jersey.
COOL SIDE OF THE PILLOW will be available February 8, 2013 exclusively on the Amazon Kindle before a wider release. For more information visit www.gregory-g-allen.com or www.asdpublishing.com Book Trailer
About Author
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The plan to burn copies of the Koran has attracted criticism from global political and religious leaders, but this does not seem likely to stop pastor Terry Jones from going ahead with the project on the ninth anniversary of the 9/11 terrorist attacks.
Month: September 2010
Free Exercise Of Industry And Its Fruits
Barring legislative action before the end of the year the Federal estate tax — also known as the death tax — will return on Jan. 1, 2011. That means the Feds will steal 55 percent of the estates valued at more than $1 million of people who die after Jan. 1.
Elected elites and their media lapdogs have successfully sold the argument that only the rich pay estate taxes and therefore those taxes are justified. But add the value of a home, a retirement account (such as a 401k) and a little bit of savings and other real property and it doesn't take long to pass the $1 million threshold.
Thomas Jefferson expressed his own views of the "death tax."
Representative Steve King (R-Iowa) Talks With Robert Ringer
Representative Steve King (R-Iowa) is a Constitutional conservative and advocate of the Tea Party. Robert Ringer recently interviewed King as part of his Liberty Education Series. In the interview King talks about President Barack Obama's economic philosophy and his (Obama's) lack of respect for entrepreneurs and small business owners, and King's efforts on the small business committee to try and reign in the over-regulation of the government…
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Town Square
Slocum, Masur face off in November
Original post made on Jun 12, 2012
Read the full story here Web Link posted Tuesday, June 12, 2012, 9:13 PM
Comments (1)
a resident of another community
on Jun 12, 2012 at 11:40 pm
Although Masur has the most endorsements listed, some of those endorsed her for the 2011 school board race, and we're rolled over without confirmation. Many others abandoned her for other candidates when they entered the race. If you remove all the council members that later endorsed other candidates, her list is quite small. Out of 20 cities in San Mateo County, she was endorsed by only one current mayor.
We won't know if Masur has the only campaign that survived without self funding until the final 460s are submitted.
Big endorsements help with fundraising, and those funds can buy mailers. The more mailers you send, the more name recognition you can buy. In the end, name recognition alone wins elections, and everybody knows Warren Slocum.
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Originally posted on HoopStuff | Last updated 2/20/13
Kings Trade: Thomas Robinson, Tyler Honeycutt and Francisco Garcia Kings Receive (From Houston): Patrick Patterson, Cole Aldrich and Toney Douglas Analysis: What are the Kings thinking? They just gave up Thomas Robinson, the fifth pick in last June's draft, who has enormous upside as a post scorer and rebounder and could easily become a double-double machine and all they really got was Patrick Patterson. Yes Patterson can shoot and is an average rebounder, but his upside is extremely limited and he may never be better than he is now. They did part with Garcia's contract and got expiring contracts in Aldrich and Douglas, but they gave up one of their best trade chips and a possible All-Star big man, for a mediocre starter and two bench players, wow. Grade: F
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Fine art print on bright white, fine poly-cotton blend, matte canvas using latest generation Epson archival inks. Individually trimmed and hand stretched museum wrap over 1-1/2" deep wood stretcher bars. Includes wall hanging hardware.
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Probably my worst experiencie in my life. Arrived 20.15 pm first dish 21.10 (1 salad)..second 22.25. Late and thounsand times late. Quality poor. Veal steak no good. I complained 4 times about the service but no one did nothing. At least they gave me a refund...but the damage has been done before
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Site Information
Field Notes
These updates from our field biologists discuss the movements and activities of individual Florida panthers. Biologists use prefixes and numbers to identify each cat.
Panther Identification
When a kitten is handled at the den a transponder is inserted under the skin which permanently identifies that individual and it receives a "K" number. When a panther is captured and wears a radio collar it gets an "FP" number. FP just stands for Florida panther; they are numbered sequentially as they're captured. A panther that has never been handled at the den or captured for placement of a radio collar is identified as an uncollared Florida panther and has the designation "UCFP."
Mortality CausesIA = intraspecific aggression (panthers killing panthers)
RK = road kill
LocationBCNP = Big Cypress National Preserve (specific units within BCNP include Add Lands, Bear Island)
FPNWR = Florida Panther National Wildlife Refuge
OSSF = Okaloacoochee Slough State Forest
SIR = Seminole Indian Reservation
ENP = Everglades National Park
FSSP = Fakahatchee Strand State Preserve
CREW = Corkscrew Regional Ecosystem Watershed
PSSF = Picayune Strand State Forest
CSS = Corkscrew Swamp Sanctuary
Panther Position Statement FAQ's
The FWC approved a panther position paper at its September Commission meeting to provide strategic direction to staff moving forward with panther management and conservation efforts. Florida panther conservation has reached major milestones and is an impressive success story. This position paper reaffirms the FWC's commitment to work with partners to conserve and protect panthers. Read More
Panther Position Statement
Panther Position Statement approved by Commission, September 3, 2015. Read More
Friends of Florida Panther Refuge Panther Update Newsletter July 2015
Curious what constitutes panther habitat? Find out in this edition of the Panther Update. Read More
Friends of Florida Panther Refuge Panther Update Newsletter March 2015
Read the fascinating stories of a panther that found himself in the posh Port Royal neighborhood in Naples and about a pair of 16-year-old sisters that were recollared this past capture season. Read More
Florida panther returned to the wild after recovering from vehicle strike
Florida panther #232 returns home to central Florida after recovering from broken leg suffered in car accident. Read More
USFWS Florida Panther Update Newsletter December 2014
This edition of the Panther Update by the Friends of the Florida Panther National Wildlife Refuge summarizes a recent study of calf mortality factors. Read More
USFWS Florida Panther Update Newsletter Sept 2014
Read about "Yuma", the young panther kitten that was rescued from certain death, in this edition of the Florida Panther Update published by the US Fish and Wildlife Service. Read More
Commissioners receive Florida panther update
Florida Fish and Wildlife Conservation Commission (FWC) biologists provided an update at the agency's June Commission meeting in Fort Myers regarding Florida panther research and conservation programs. Read More
FWC captures panther near the beach; relocates it to more suitable area
Where do panthers go for spring break? To the beach, of course. Read about the recent capture and relocation of one that was spotted by beach goers in the mangroves at Clam Pass park in Naples. Read More
Rehabilitated Florida panther returned to the wild
FP224 was successfully released on March 10th, 2014 after being rehabilitated for a broken leg. Read More


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Page 1
PLoS Medicine | www.plosmedicine.org0561
Open access, freely available online
June 2005 | Volume 2 | Issue 6 | e129
Medical Decision Making:
The Family–Doctor–Patient Triad
Fawad Aslam, Omar Aftab, Naveed Z. Janjua
The importance of a person-centred approach and the
intricacies of risk communication have recently been well
described in PLoS Medicine [1,2]. The applicability of the
patient-centred approach to Eastern countries, however, has
cultural, religious, and practical impediments that demand
careful consideration. The bulk of the world population
lives outside the United States and western Europe. Unlike
in the West where the patient takes centre stage by both
tradition and law, the family–doctor–patient triad is the
norm in Eastern states, in general, and Pakistan in particular
Pakistan is a predominantly Muslim country of 150 million
people. About half the population is uneducated, and
more than a third lives below the poverty line. There is one
doctor for every 1,432 patients, compared to one doctor for
every 390 patients in the US. The health-insurance system
is virtually nonexistent, and there is no concept of assisted-
care living, with the care of the elderly largely taking place
at homes by their families. Strongly held religious beliefs
and cultural views govern everyday life and dictate the roles
of every member of the society. Families consist of well-knit,
supportive, and collectively earning interdependent members
who take mutual decisions on all matters pertaining to life
and death [3,4]. The elder members of the family command
the greatest respect and authority. The family unit is the
functional unit of the society, the dynamics of which need
attention and respect.
Strong family systems and the authoritative position of the
doctor are the governing forces of medical decision making
in these countries. Illiteracy, poverty, poor awareness of
patient's rights, and a lack of accountability for physicians are
factors conducive to such a practice. With this background,
the role of the patient is limited. Health expenditure is borne
by the family, giving it a central role in decision making.
The concept of the fi nancial survival of the family is a harsh
reality [3,4]. The health-care costs of one seriously ill member
may jeopardize the survival of others by draining the limited
resources. Due to familial, moral, and monetary support, the
patient relinquishes the responsibility of decision making and
gives the primary role to the family or the doctor. Women,
for example, may not give consent unless they get approval
from their spouses [5]. In the case of women, who may have
a lesser say in the patriarchal family system, the doctor should
strive for active participation. Sometimes the family aims to
protect the patient from stress by withholding information,
and in terminal illnesses, the doctor and family act in concert
to conceal complete information from the patient. They, for
example, may not mention the word cancer to patients who
have malignancies [9].
In contrast to Western practice, the role of the doctor is
authoritative. Doctors are regarded as instruments of God
and given the fi nal authority in decision making [3,4,10].
In such circumstances, doctors are likely to take decisions
unilaterally. When they do involve patients in decision
making, physicians accept the centrality of families, with
some considering patients and families as one [5]. One
worry regarding communication of harm is of losing patients
to other physicians with a more reassuring "nothing will
go wrong" attitude [5]. It is also said that more time and
patience are required to explain things to the illiterate. It
is perhaps impractical, therefore, to expect overworked
and underpaid physicians to practice risk communication
according to the book.
Thus, the concept of individual centrality that is so
elementary in the West stands challenged in the East.
Research is needed to formulate appropriate strategies of
risk communication. Areas needing research include the
patient's concept of autonomy, the role of the family as
perceived by patients and doctors, the existing practices
of medical decision making, and the training of doctors in
communicating risk.
An economically sound and literate population, properly
trained doctors, and institutional checks and balances are
essential prerequisites for establishing decision making with
parity of partners. The need is to fi nd a middle ground where
not only the family unit is respected, but the patient also plays
a proactive role. A dynamic balance between cultural values
of caring and the possibility of a more individualistic role
in health care is needed and is, indeed, attainable. Doctors,
being the most infl uential component of the family–doctor–
patient triad, can play a signifi cant role in bringing about this
change. ?
Fawad Aslam
Omar Aftab
Aga Khan University Medical College
Karachi, Pakistan
Naveed Z. Janjua (email@example.com )
Aga Khan University
Karachi, Pakistan
1. Alaszewski A (2005) A person-centred approach to communicating risk.
PLoS Med 2: e41. DOI: 10.1371/journal.pmed.0020041
2. Herxheimer A (2005) Communicating with patients about harms and risks.
PLoS Med 2: e42. DOI: 10.1371/journal.pmed.0020042
3. Moazam F (2000) Families, patients, and physicians in medical decision
making: A Pakistani perspective. Hastings Cent Rep 30: 28–37.
4. Moazam F (2001) Reconciling patients' rights and God's wisdom: Medical
decision making in Pakistan. Responsive Community 11: 43–51.
5. Jafarey AM, Farooqui A (2005) Informed consent in the Pakistani milieu:
The physician's perspective. J Med Ethics 31: 93–96.
6. Cong Y (2004) Doctor-family-patient relationship: The Chinese paradigm of
informed consent. J Med Philos 29: 149–178.
7. Fetters MD (1998) The family in medical decision making: Japanese
perspectives. J Clin Ethics 9: 132–146.
8. Younge D, Moreau P, Ezzat A, Gray A (1997) Communicating with cancer
patients in Saudi Arabia. Ann N Y Acad Sci 809: 309–316.
9. Holland JC, Geary N, Marchini A, Tross S (1987) An international survey
of physician attitudes and practice in regard to revealing the diagnosis of
cancer. Cancer Invest 5: 151–154.
10. Kanabar P (2002) Doctor-patient partnership. J Indian Med Assoc 100: 718.
Citation: Aslam F, Aftab O, Janjua NZ (2005) Medical decision making: The family–
doctor–patient triad. PLoS Med 2(6): e129.
Copyright: © 2005 Aslam et al. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Competing Interests: The authors have declared that no competing interests exist.
DOI: 10.1371/journal.pmed.0020129
Page 2
PLoS Medicine | www.plosmedicine.org 0562
Malaria Diagnosis and Treatment:
One Size Does Not Fit All
Chris Drakeley, Roly Gosling, Hugh Reyburn
Icke and colleagues highlight an online and CD-ROM source
available for the teaching of malaria diagnosis [1]. While this
is a commendable initiative that provides open access to badly
needed training materials, we feel that it is overambitious to
propose this Web site (which gives equal weight to diagnosis,
treatment, and chemoprophylaxis) as a resource that can
be equally relevant to the issues of travel-related malaria, to
which the Web site primarily applies, and the problems of
malaria diagnosis and treatment in sub-Saharan Africa, which
are described as the primary focus in the PLoS Medicine article
The microscopic diagnosis of malaria is indeed an
important resource in Africa to which the large majority of
health facilities do not have access. Even where microscopy
is available, there is evidence of substantial overdiagnosis of
malaria and that better access to malaria microscopy may
not result in better targeting of antimalarials [2,3]. What
data there is on the accuracy of slide results suggest that
microscope quality, preparation of blood fi lms, and quality of
reagents are at least as important in constraining the quality
of results as the ability of slide readers to identify Plasmodium
parasites from high-quality thin blood fi lms [4–6]. In fact,
thick blood fi lms are the norm in Africa, thin fi lms being
almost exclusively confi ned to research, yet these are in the
small minority on the Web site.
P. falciparum is overwhelmingly the dominant Plasmodium
species seen in Africa, and training guides that try to give
a "global overview" run the risk of giving a misleading
impression of the relative importance of the four species in
any given setting where malaria is endemic. The only actual
setting where all species of malaria might be seen relatively
frequently would be in travel clinics in developed countries.
This point might seem obvious, but for many junior
laboratory technicians in Africa hungry for scarce training
opportunities it is potentially distracting and confusing.
The problems of simultaneously addressing the issues
of malaria in endemic areas of Africa and in travellers
from resource-rich countries are particularly applicable
to malaria treatment. On the Web site, among the drugs
recommended for the treatment of non-severe malaria are
quinine, atovaquone/proguanil hydrochloride, mefl oquine,
and two tetracyclines. In Africa quinine is reserved for severe
malaria and is associated with a high rate of failure due
to poor adherence in outpatients; atovaquone/proguanil
hydrochloride and mefl oquine are not widely used because
of their high cost; and tetracyclines are contraindicated in
children and pregnant women, who bear the overwhelming
burden of malaria.
The Web site describes criteria for severe malaria that are
not appropriate for Africa. Thus, cerebral malaria, jaundice,
renal failure, and lactic acidosis (impossible to detect in
most African hospitals where "respiratory distress" is the
equivalent criterion) are all listed ahead of severe anaemia,
the most common manifestation of severe malaria in Africa.
Repeated convulsions are not mentioned, presumably
because they are rare among travellers with malaria, but they
are common among children in Africa and are associated
with a poor outcome. Renal failure as a manifestation of
severe malaria is mentioned second but is very uncommon
in Africa [7,8].
The apparently large numbers of African health-care
workers who have accessed this site might legitimately feel
confused by some of these descriptions, and there is no
indication of which, if any, sections apply to Africa and which
to travellers. While many will interpret the information
critically, others may not, especially when English is not
their fi rst language and where there is a tendency to accept
didactic sources in preference to what is obvious from
personal or local experience.
The diagnostic component of the Web site has important
potential as a training tool, but we feel that signifi cant
modifi cation and more explicit indication of information that
is country-specifi c are needed before its use is likely to result
in improved standards of care in African hospitals and clinics.
It is true that Internet technologies can "revolutionise
information technology…for healthcare professionals in
developing countries". The World Health Organization
and others already have very extensive Web sites that are
contributing to this. Searching the Internet on "malaria
diagnosis" reveals a number of sites, many with excellent
sections, but one is struck by the lack of clarity defi ning
the target audience and context of the problem. For much
information available on the Web this may not matter, but for
malaria we feel it does. ?
Chris Drakeley (email@example.com)
Roly Gosling
Hugh Reyburn
London School of Hygiene and Tropical Medicine
London, United Kingdom
Joint Malaria Programme
Moshi, Tanzania
1. Icke G, Davis R, McConnel W (2005) Teaching health workers malaria
diagnosis. PLoS Med 2: e11. DOI: 10.1371/journal.pmed.0020011
2. Barat L, Chipipa J, Kolczak M, Sukwa T (1999) Does the availability of blood
slide microscopy for malaria at health centers improve the management of
persons with fever in Zambia? Am J Trop Med Hyg 60: 1024–1030.
3. Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, et al.
(2004) Overdiagnosis of malaria in patients with severe febrile illness in
Tanzania: A prospective study. BMJ 329: 1212.
4. Amexo M, Tolhurst R, Barnish G, Bates I (2004) Malaria misdiagnosis:
Effects on the poor and vulnerable. Lancet 364: 1896–1898.
5. Bates I, Bekoe V, Asamoa-Adu A (2004) Improving the accuracy of malaria-
related laboratory tests in Ghana. Malar J 3: 38.
6. Opoku-Okrah C, Rumble R, Bedu-Addo G, Bates I (2000) Improving
microscope quality is a good investment for under-resourced laboratories.
Trans R Soc Trop Med Hyg 94: 582.
7. Schellenberg D, Menendez C, Kahigwa E, Font F, Galindo C, et al. (1999)
African children with malaria in an area of intense Plasmodium falciparum
transmission: Features on admission to the hospital and risk factors for
death. Am J Trop Med Hyg 61: 431–438.
8. Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, et al. (1995)
Indicators of life-threatening malaria in African children. N Engl J Med 332:
Citation: Drakeley C, Gosling R, Reyburn H (2005) Malaria diagnosis and treatment:
One size does not fi t all. PLoS Med 2(6): e156.
Copyright: © 2005 Drakeley et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Competing Interests: The authors have declared that no competing interests exist.
DOI: 10.1371/journal.pmed.0020156
June 2005 | Volume 2 | Issue 6 | e156
Page 3
PLoS Medicine | www.plosmedicine.org0563
Authors' Reply: Teaching Health Workers
Malaria Diagnosis
With reference to the letter commenting on our paper
[1] from Drakeley and colleagues [2], they have some
justifi cation in stating that one size does not fi t all. However
our Web site, which is the basis for their comment, was
originally designed on a wholly voluntary basis for Australia.
We have been overwhelmed by the interest and acceptance
of this site worldwide. Not only have we had more than
750,000 visitors to the site but have issued free CD-ROMs to
institutions in 149 countries.
The fact that it was warmly embraced by so many others
from around the world bears testimony to its usefulness
as, indeed, do the tens of thousands of letters and E-
mails thanking us for our efforts. We have made some
modifi cations on our annual update in response to
suggestions and changes in approach. The main section
of interest has been the section on diagnosis, testing, and
teaching, and perhaps the reason for this is the high quality
of the illustrations. One only has to look at the site to
recognize that we have not given equal weight to all sections,
as Drakeley and colleagues point out. The emphasis is on
diagnosis, testing, and teaching. Many large organizations
have requested a substantial number of copies of the CD-
ROM, and in Germany one organization has been printing
its own (with permission). We are aware of some superb CD-
ROMs on malaria put out from other sources, but they are
expensive for organizations with a very small budget.
We accept that diagnosis by thick fi lm is the norm in Africa
and a number of other countries and, in fact, have spent
many years ourselves diagnosing malaria from thick fi lms in
India and Southeast Asia. We have described how to make
thick fi lms and have provided a picture. We have mentioned
the staining of fi lms, but we have not described how to
prepare the stains because we considered that outside our
brief. It is important with Web sites to be concise, otherwise
they won't be read. The actual diagnosis of malaria is the
same for Africa, India, South America, and Southeast Asia,
and it is the proper diagnosis that we believe is paramount.
We know that language can be a serious problem. We have
provided a version in French and Spanish. The French
version we are told is useful for certain parts of Africa. When
other languages have been requested, we have suggested that
a small booklet should be written in the local language by
those with local knowledge.
In regards to the comments on treatment, this section was
written by T. M. E. Davis, who holds the Chair of Medicine
at the University of Western Australia and is a consultant on
malaria to Thailand and Cambodia. If we sought an expert on
treatment for every endemic region, we would never get the
material into print. One is not always able to use the drugs of
choice in Southeast Asia because up to 50% of antimalarials
sold in some areas are fake. It has been stated that children
should not be given tetracyclines, but that has already been
made very clear on the site.
We are aware that the site needs to take into account
various interests and situations, which is why we have included
our E-mail addresses on the site. We presume that as experts
in the fi eld Drakeley and colleagues would have been aware
of the site either in Tanzania or the London School of
Tropical Medicine, where a number of CD-ROMs have been
requested and sent. We hope and expect that eventually
a group with the enthusiasm of these correspondents will
accept the challenge and produce a site that will overcome
the problems that are the cause of their concern. We fully
understand the diffi culty of doing this on a voluntary basis. In
the meantime, we will continue to service the site and hope
that the very large number of users will continue to fi nd it
helpful. Finally, we state once again that if concise suggestions
for improvements are sent to us by E-mail we will give them
serious consideration. Our E-mail contact is now sandy.
firstname.lastname@example.com. ?
Graham Icke
Richard E. Davis
Royal Perth Hospital
Perth, Western Australia, Australia
1. Icke G, Davis R, McConnel W (2005) Teaching health workers malaria
diagnosis. PLoS Med 2: e11. DOI: 10.1371/journal.pmed.0020011
2. Drakeley C, Gosling R, Reyburn H (2005) Malaria diagnosis and treatment:
One size does not fi t all. PLoS Med 2: e156. DOI: 10.1371/journal.
Citation: Icke G, Davis RE (2005) Teaching health workers malaria diagnosis. PLoS
Med 2(6): e165.
Copyright: © 2005 Icke and Davis. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Competing Interests: To produce and distribute the CD-ROMs discussed in this
article, the authors received sponsorship from Becton Dickinson (Franklin Lakes,
New Jersey, United States of America) and Abbott Diagnostics (Abbott Park, Illinois,
United States of America).
DOI: 10.1371/journal.pmed.0020165
Allocating Antiretrovirals in South
Africa: Using Modeling to Determine
Treatment Equity
David P. Wilson, Sally M. Blower
Recently PLoS Medicine published our paper entitled
"Designing Equitable Antiretroviral Allocation Strategies in
Resource-Constrained Countries" [1]. We were disappointed
to fi nd that the editorial perspective written by the World
Health Organization (WHO) ethicists regarding our paper
[2] was based upon a substantial misunderstanding of our
novel quantitative analyses and our important results. Hence,
they misunderstood the signifi cance of the health-policy
implications of our results. Thus, we wish to correct the
Firstly, Capron and Reis [2] misunderstood our
quantitative analyses. They stated that "Wilson and Blower
developed a mathematical model that could inform policy-
makers' decisions regarding the optimal distribution of
treatment sites to ensure equal access by all individuals
infected with HIV." However, our model does not determine
the optimal distribution of treatment sites. As we clearly
state in our paper [1] (and is also stated in the synopsis [3]),
we developed a model that policy makers can use to make
decisions regarding how to achieve the optimal allocation of
scarce antiretrovirals among the available health-care facilities
(HCFs) if the objective is to ensure treatment equity. We also
calculated how the optimal allocation of antiretrovirals would
vary if the number of HCFs utilized increased and/or the size
June 2005 | Volume 2 | Issue 6 | e165 | e155
Page 4
PLoS Medicine | www.plosmedicine.org 0564
of the catchment area that each HCF services increased [1].
Thus, we took the treatment sites (i.e., HCFs) as given, and we
used their specifi c spatial location in South Africa as inputs
to our model in order to determine optimal antiretroviral
allocation strategies under a variety of conditions.
Secondly, Capron and Reis [2] misunderstood our
important results. They stated that "applying this tool to
the South-African province of KwaZulu–Natal, Wilson and
Blower were able to confi rm mathematically the intuitive
assumption that using a maximum number of centers, at the
least possible distance from most affected populations, would
lead to the greatest fairness in the geographical distribution
of ART [antiretroviral therapy]." We agree that if these had
been our results, they would have been trivial and obvious.
However, Capron and Reis [2] did not discuss our actual
results: we determined how to decide how many drugs to
allocate to each of the available HCFs in order to achieve
an optimal allocation if the objective is to ensure treatment
equity. This is a very complex problem and the antiretroviral
allocation strategies that we calculated (by using our model)
to be optimal are very complex (see Figure 3 in our paper,
which graphically shows the proportion of drugs that should
be allocated to each of the available HCFs). Furthermore,
we also determined what catchment area each HCF should
service; specifi cally, we calculated that each HCF should serve
(if the objective is to achieve treatment equity) a catchment
area of 40–60 km. Thus, our results demonstrate (to our
knowledge for the fi rst time) that patients infected with
HIV will have to travel extremely large distances (i.e., 40 –60
km) in order to receive antiretrovirals, if the objective is
to achieve treatment equity in South Africa. We stress that
currently it is unknown what the actual size of the catchment
area is around HCFs in South Africa. Catchment areas may
in fact be very small. Thus, we suggested [1] that a primary
goal should be to obtain empirical data of the distances that
patients in South Africa are willing (or able) to travel in order
to receive antiretrovirals. We have been the fi rst to provide a
quantitative assessment of the necessary size of the catchment
area, and our results have identifi ed that there is an urgent
need to collect these critical data for quantifying the size of
the catchment areas around HCFs. We have determined that
the size of the catchment area will be a critical component
in the ability to achieve treatment equity in South Africa.
We also compared the optimal antiretroviral allocation
strategies that we calculated with the current plan of the
South African government for allocating antiretrovirals [4],
and we determined that the current antiretroviral allocation
strategies in South Africa will not achieve treatment equity.
Taken together, our quantitative results are novel and
controversial, providing important quantitative insights into
a complex public-health problem.
We applaud the ambitious "3 by 5" WHO target for
the antiretroviral rollout. However, the WHO has not yet
devised a quantitative policy for determining how to allocate
antiretrovirals in situations where the demand for drugs
greatly exceeds the supply [5]. Health-policy offi cials in
each country will have to make these important and diffi cult
decisions, and they will all make different decisions based
upon what objectives they wish to optimize and prioritize.
There are a multitude of factors to consider (these factors
are well described in the recent Institute of Medicine report
[6]). We stress that the alternative to a quantitative rational
approach for allocating scarce resources is an ad hoc
approach, which is how the scarce supply of antiretrovirals
is currently being distributed in many resource-constrained
countries. Our operations research modeling approach is
based upon spatial heterogeneity in the distribution of HCFs
in South Africa and the spatial heterogeneity of the HIV-
infected population. The most important "real world" result
is that we show that what the South African government is
currently doing is inequitable. We show them how to achieve
equity, if they wish to do so. We hope that our novel approach
for deciding how to allocate antiretrovirals will be of use to
the WHO and also to the relevant authorities in the many
resource-constrained countries who will soon have to make
very diffi cult decisions as to who lives and who dies. Our
analysis is to our knowledge the fi rst analysis to show how a
rational and scientifi c solution can be reached for deciding
how to allocate a limited amount of antiretrovirals, if the goal
is to achieve treatment equity. Clearly, other goals must be
taken into consideration (and our model can be modifi ed to
include these other goals); however, we hope that treatment
equity will be a very high priority during the antiretroviral
rollout that is just beginning. ?
David P. Wilson
Sally M. Blower (email@example.com)
University of California
Los Angeles, California, United States of America
1. Wilson DP, Blower SM (2005) Designing equitable antiretroviral allocation
strategies in resource-constrained countries. PLoS Med 2: e50. DOI:
2. Capron AM, Reis A (2005) Designing an equitable strategy for allocating
antiretroviral treatments. PLoS Med 2: e69. DOI: 10.1371/journal.
3. (2005) Equitable allocation of antiretrovirals in resource-constrained
countries. PLoS Med 2: e57. DOI: 10.1371/journal.pmed.0020057
4. Tshabalala-Msimang M (2003) Statement of cabinet on a plan for
comprehensive treatment and care for HIV and AIDS in South Africa.
South Africa: Cabinet. Available at http:⁄⁄www.capegateway.gov.za/eng/
pubs/news/2004/feb/29782. Accessed 12 May 2005.
5. Blower SM, Bodine EN, Kahn JO, McFarland W (2005) The antiretroviral
rollout and drug- resistant HIV in Africa: Insights from empirical data and
theoretical models. AIDS 19: 1–14.
6. Curran JW (2004) Scaling up treatment for the global AIDS pandemic:
Challenges and opportunities. Washington (DC): Institute of Medicine of
the National Academies. Available at http:⁄⁄www7.nationalacademies.org/
ocga/briefi ngs/Scaling_Up_Treatment_for_the_Global_AIDS_Pandemic.
asp. Accessed 12 May 2005.
Citation: Wilson DP, Blower S (2005) Allocating antiretrovirals in South Africa: Using
modeling to determine treatment equity. PLoS Med 2(6): e155.
Copyright: © 2005 Wilson and Blower. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Competing Interests: The authors have declared that no competing interests exist.
DOI: 10.1371/journal.pmed.0020155
Authors' Reply
In response to our commentary [1] on their paper,
"Designing Equitable Antiretroviral Allocation Strategies in
Resource-Constrained Countries" [2], Wilson and Blower
assert that we misunderstood both their analysis and the
importance of their results [3]. Rather than "setting the
record straight," what may be needed is more effort to bridge
the differences in disciplinary approach that create a greater
appearance of disagreement than is actually the case.
June 2005 | Volume 2 | Issue 6 | e155 | e186
Page 5
PLoS Medicine | www.plosmedicine.org0565
On a factual level, we believe Wilson and Blower's
results were appropriately described for the purposes of
our commentary. As their letter points out, they applied
the operations research methods to model the allocation
of antiretrovirals (ARVs) among 17 health-care centers in
KwaZulu–Natal, based on a hypothetical distribution of
HIV/AIDS among the communities in that province. Their
article characterizes this as "an elegant and simple theoretical
framework," but they object to our concluding that it could
"inform policy-makers' decisions regarding the location of
HIV services," since they took the treatment sites as given. Yet
their article compared the alternatives of using all 54 centers
in the province, at one extreme, and of using only a single
treatment site (in Durban), at the other extreme; in each
case, the possibility of allocating to a larger number of centers
is equivalent to the creation of additional centers closer to
remote groups of patients.
Wilson and Blower write that geographic accessibility is
improved if the number of health-care facilities is increased,
and they calculated that it would be optimal if all 54 facilities
in the province of KwaZulu–Natal distributed the medicines,
instead of just 17. We took this result to confi rm the need to
reach out and build capacity. We are sorry if we were mistaken
in assuming that Wilson and Blower would want to see their
stated objective of ensuring fair distribution applied in the real-
world context of many poor countries with a high HIV burden
and where fairness in ARV care cannot be achieved solely by
allocating resources among the existing sites.
A wider gap in perception can be seen in Wilson and
Blower's repeated confl ation of "optimal," "equal," and
"equitable," combined with their suggestion that decision
makers who fail to apply their model must be following an
"ad hoc approach." The central point of our commentary
was that various ethical theories reach very different
conclusions about what result would be optimal, and that
even among those aiming to achieve the greatest equity
(rather than some other optimum), many would not take
equality as the measure of equity. Wilson and Blower
themselves recognize that apparent equality of access (in
terms of distance to treatment) needs further study to
determine whether patients can in fact access treatment.
We need to know whether some distances are simply too far
for patients to travel for chronic care, and when distances
of equal length affect access very differently because
of the characteristics of particular patient populations,
transportation systems, and so forth.
Wilson and Blower seem unwilling to accept the notion
that, in the furtherance of a rational strategy to achieve
equity, some health authorities might decide, for example,
to allocate a disproportionate share of ARVs to traditionally
disadvantaged populations. Wilson and Blower's model
could still be useful in allocating resources among the
centers chosen (or established) to reach the target
population, but the calculation would have to take account
of more information about the centers and the population,
lest assumptions about catchment areas produce a formal
equality that does not translate into actual equality in
access, much less into equitable access in light of all relevant
Plainly, we share Wilson and Blower's aim of optimizing
countries' responses to the tragedy of treatable, but
untreated, HIV/AIDS. Any tools that are useful to that
end are welcome. But besides using models to distribute
ARVs in a way that optimizes spatial equality, governments
that want to achieve equity will need also to overcome
nongeographic barriers to accessing treatment. These
include ignorance, stigma, discrimination, and outright
criminalization of vulnerable groups, as well as fees at point
of service that are prohibitive for the poor. All of these are
given attention within the context of the "3 by 5" program
of the World Health Organization and the United Nations
Joint Programme on HIV/AIDS, including in the guidance
document on equitable access to ARV treatment cited in our
commentary [4]. ?
Alexander M. Capron (firstname.lastname@example.com)
Andreas Reis
World Health Organization
Geneva, Switzerland
1. Capron AM, Reis A (2005) Designing an equitable strategy for allocating
antiretroviral treatments. PLoS Med 2: e69. DOI: DOI: 10.1371/journal.
2. Wilson DP, Blower SM (2005) Designing equitable antiretroviral allocation
strategies in resource-constrained countries. PLoS Med 2: e50. DOI: DOI:
3. Wilson DP, Blower S (2005) Allocating antiretrovirals in South Africa: Using
modeling to determine treatment equity. PLoS Med 2: e155. DOI: 10.1371/
4. World Health Organization/UNAIDS (2004) Guidance on ethics and
equitable access to HIV treatment and care. Geneva: WHO/UNAIDS.
Available at http:⁄⁄www.who.int/ethics/en/ethics_equity_HIV_e.pdf.
Accessed 12 May 2005.
Citation: Capron AM, Reis A (2005) Authors' reply. PLoS Med 2(6): e186.
Copyright: © 2005 Capron and Reis. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Competing Interests: The authors have declared that no competing interests exist.
DOI: 10.1371/journal.pmed.0020186
The Debate over Placebo-Controlled
Frankllin Miller
Turner and Tramèr provide a cogent argument in favor of
the ethical use of placebo controls despite "proven effective
treatment" [1]. However, they are wide of the mark citing the
APPROVe trial in support of their position. Because there
is no established treatment to prevent adenomatous polyps,
few commentators would have any objections to the use of
placebo controls in this study. Nevertheless, they are right to
suggest that it would have been desirable to have included
a placebo control in the VIGOR study to provide a more
rigorous assessment of safety. Whether, all things considered,
a placebo control would have been ethical in this study of
treatment for rheumatoid arthritis is debatable.
Another issue not discussed in this PLoS Medicine Debate
is the value of placebo controls in early "proof of concept"
effi cacy trials, despite the existence of established treatment.
The effi ciency of seeking a rigorous effi cacy signal before
moving on to larger-scale trials (and exposing as few subjects
as possible to drugs that might not work or turn out to be
toxic) is a valid ethical reason for using placebo controls,
provided subjects are not exposed to undue risks of harm
from withholding established treatment [2]. ?
June 2005 | Volume 2 | Issue 6 | e186 | e157


text:
Retail Design Institute and Chain Store Age announce collaboration
The Retail Design Institute, the oldest and largest association for design professionals, and Chain Store Age, the leading authority on retail operations and producer of the annual SPECS conference, are partnering on the Institute's 45th Annual International Store Design Competition.
Dollar Tree takes Deals in new direction
The Deals stores Dollar Tree acquired nearly a decade ago never turned into a meaningful growth vehicle for the company and soon the banner will disappear.
Nominate the Most Influential Women in Retail Tech
Chain Store Age is accepting nominations for its annual feature recognizing female retail executives who are helping to transform the industry through technology.
J.C. Penney CEO Ellison makes $1 billion promise
J.C. Penney CEO Marvin Ellison contends the retailer's turnaround plan is working and by executing three key strategies it will achieve a financial milestone that was unthinkable a few years ago.
HRC Study: Retail industry divided on growth strategies, capital spend
Dominos turns quality focus on store network
Featured media
PwC: Ten Trends Expected to Drive the Holiday Shopping Season
Consumers are cautiously optimistic this holiday season with 53% indicating they will likely spend about the same as last year and 32% indicating they will likely spend more than last year.
Another retailer takes a stand on turkey day
Real Estate
Creative anchor joins Union Market District
Featured media
Free Returns: An Obstacle for e-Commerce
Studies indicate that online shoppers abandon websites that do not offer free returns shipping.


text:
Walmart offers the Honeywell QuietSet Whole Room Tower Fan in White, model no. HY254BWMD1, for $49.64. Pad your order over $50 to bag free shipping. Excluding padding, that's tied with last month's mention and is the lowest total price we could find by $10, outside of the mention below. It features five control speeds and oscillation, electronic controls, remote control, and auto shut-off timer.
A close price: Target has it for a buck more.


text:
Search Results
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Senior UX Designer — mavis — London - London - United Kingdom
An independent creatively led agency that create products, campaigns and content across the physical and digital space are looking to hire a senior level, top drawer UX designer. Working with a host of great brands, they need a specialist in this field who can create beautiful experiences. You must be a confident, dynamic and talented designer with lots of creative flair, delivering exquisite digital thinking and design execution.
Posted September 23, 2015
Senior UX Designer — Reevoo — London - London - United Kingdom
We are looking for a talented UX designer with a passion for combining seamless interaction with beautiful visual design. Your work needs to be easy to navigate and comprehend, logically organized, accessible, and in-tune with the latest web technologies. Your focus will be delivering the highest standard of usability and simplicity to the software's end users.
Posted August 17, 2015


text:
AT&T will allow out-of-contract customers to unlock their iPhoneStarting this Sunday, AT&T will begin offering out-of-contract customers the ability to unlock their iPhone and use it on another carrier.
AT&T announced the change in policy in a statement issued on Friday. It takes effect in just two days, on April 8.
"Beginning Sunday, April 8, we will offer qualifying customers the ability to unlock their AT&T iPhones," the statement reads. "The only requirements are that a customer's account must be in good standing, their device cannot be associated with a current and active term commitment on an AT&T customer account, and they need to have fulfilled their contract term, upgraded under one of our upgrade policies or paid an early termination fee."
Previously, customers who finished the terms of their two-year contract with AT&T had an iPhone that could not be unlocked through official avenues. That meant even though they were free to leave for another carrier, they could not bring their iPhone with them.
Apple's latest handset, the iPhone 4S, is a "world phone" capable of connecting to both GSM networks like AT&T, as well as CDMA carriers like Verizon. If unlocked, it can also be used to roam worldwide on GSM networks. That means customers who unlock their iPhone from AT&T will not be able to use it with Verizon, even if it is the iPhone 4S.
The iPhone 4S can also be purchased unlocked and contract-free direct from Apple. It is available priced at $649 for the 16-gigabyte model, $749 for 32 gigabytes, and $849 for 64 gigabytes.
Apple's website alerts people that the unlocked iPhone only works with supported GSM networks, like AT&T in the U.S. The iPhone can also be used with T-Mobile in the U.S. for voice and EDGE data connections, but it is not compatible with T-Mobile's faster 3G network.
"When you travel internationally, you can also use a micro-SIM card from a local GSM carrier," Apple's site reads. "The unlocked iPhone will not work with CDMA carriers such as Verizon Wireless or Sprint."
On Topic: iPhone
- Apple's iPhone 6s 4K camera shoots better video than $3,000+ Nikon DSLR, test finds
- Adobe makes Lightroom iOS apps completely free, drops license & Creative Cloud requirements
- Verizon plans to share 'supercookie' tracking data with AOL ad network
- Apple Pay not coming to UK's Barclays until 2016, CEO says
- AT&T granted FCC waiver to activate Wi-Fi calling amid tiff with T-Mobile, Sprint


text:
Riverside CA Real Estate & Homes For Sale
262 Properties Found
The median home value in Riverside, CA is $263,600.
This is
lower than
the county median home value of $267,100.
The national median home value is $170,100.
The average price of homes sold in Riverside, CA is $263,600.
Approximately 52.36% of Riverside homes are owned,
compared to 38.87% rented, while
8.77% are vacant.
Riverside real estate listings include condos, townhomes, and single family homes for sale.
Commercial properties are also available.
If you see a property you're interested in, contact a Riverside real estate agent to arrange a tour today!
1 - 10 of 262 Properties Displayed
Courtesy: COLDWELL BANKER ARMSTRONG PROP Andrew Villalobos
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Courtesy: VINCENT PROPERTIES CLARENCE VINCENT
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Courtesy: BRADFORD HILT, BROKER Brad Hilt
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Courtesy: MAXIM PROPERTIES POLLY WATTS
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Open House:
Saturday, 10/10 1:00-4:00PM
Courtesy: Coldwell Banker Res. Brokerage Janet Moon
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An absolutely beautiful home located in a highly desire neighborhood in Riverside City. 4318 SF, Completed remodeled kitchen with brand NEW counter top, Brand NEW cabinets, NEW floor, NEW paint, Crown moldings, lots of build in cabinets. formal office, A Bounds room down stairs with bath room could be 6th bed room. Large size entertaining room up stairs. It's just like a NEW BUILD HOME. Yes, it was a MODEL HOME
8525 Yarrow Lane Riverside, CA 92508
Courtesy: CENTURY 21 BRIGHT HORIZONS Aneese Bishara
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Cozy home in Orangecrest, Riverside that has been upgraded for your convenience. Beautiful living room with a combination of tile and hardwood floor. bright breakfast nook area with granite countertops Well Maintained Pool with a heating system Plenty of Fruit trees in the back yard. 1 bedroom downstairs next to a full bathroom, new carpeting on the stairways leads to 3 bedrooms upstairs with mirrored closet doors, every room has a ceiling fan. 3 car garage.
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text:
Jamie Lee Curtis 'Absolutely Fine' After Car Accident
The actress was taken to the hospital after an SUV in which she was riding collided with a BMW; moments later, Jodie Foster arrived to help.
Jamie Lee Curtis is "absolutely fine" after being involved in a car accident in Venice, Calif., on Thursday, the actress' rep tells The Hollywood Reporter.
Curtis, now back home, was taken to the hospital with minor injuries on Thursday morning after an SUV she was riding in collided with a BMW, TMZ earlier reported. The driver of the SUV was also hospitalized. After the crash, Jodie Foster -- a friend of Curtis' -- arrived on the scene, responding to a phone call from the Freaky Friday star, according to the website.
E-mail: firstname.lastname@example.com
Twitter: @ErinLCarlson
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