text:
|Home | About | Journals | Submit | Contact Us | Français
Accurate HCV knowledge is lacking among high-risk groups, including people with HIV/AIDS (PLWHA). Liver disease primarily due to HCV has emerged as a serious cause of mortality among PLWHA. We used an interrupted time series design to evaluate a social-ecologically based intervention for PLWHA, where an infectious disease clinic serving a six-county intervention area was monitored before (7 months) and after (17 months) intervention onset. The intervention included education of PLWHA and medical providers, HIV/HCV support groups and resource guides, and adaptation of the patient chart top sheet to include HCV test information. Clinic-level outcomes were assessed prospectively every other week for two years by interviewing patients (n=259) with clinic appointments on assessment days. Abrupt, gradual and delayed intervention effects were tested. Weighted regression analyses showed higher average HCV knowledge and a higher prevalence of patients reporting HCV discussion with their medical providers after intervention onset. A delayed effect was found for HCV awareness, and a gradually increasing effect was found for knowing one's HCV status. Other communities may consider adopting this intervention. Additional HCV interventions for PLWHA with HIV are needed.
The identification and treatment of people with multiple diseases, especially stigmatized diseases, can be difficult. Yet co-morbidities are common, especially when diseases share routes of transmission. Such is the case for HIV and chronic hepatitis C virus (HCV) infection, which represents a serious and difficult public health challenge. HIV/AIDS is estimated to affect 1.1 million people in the United States (US) [1], with approximately 56,000 new HIV infections occurring annually [2]. The virus HIV is found in blood, semen, and vaginal secretions and is primarily transmitted through sexual activity, followed by shared needle use) [3]. HCV infection is estimated to affect 3.2 million people in the US [4]. As a blood-borne virus, HCV is transmitted largely through shared needle use, with 48.4% of HCV-positive persons in the National Health and Nutrition Examination Survey (NHANES) study with a history of injection drug use [4]. Sexual transmission among monogamous heterosexual couples appears to be low [5], but NHANES did show an increased risk of HCV among persons with 10 or more lifetime sexual partners [4]. The impact of HIV on transmission of HCV among heterosexual couples is an area of controversy, but an increased risk of HCV transmission appears to be present for men who have sex with men with no other identifiable risk factor except unsafe sex [6]. Arguably, HCV's most serious effect on health is as a major cause of advanced liver disease, including cirrhosis and hepatocellular carcinoma, and HCV is the most common indication for liver transplantation in the United States [7]. HCV infection prevalence among people living with HIV/AIDS (PLWHA) is estimated to be 33% in Europe [8] and 16–35% in the US [9–11], compared to 1.6% in the US general population [4].
Among people living with HIV/AIDS (PLWHA), liver disease, largely caused by HCV, is a leading cause of death [12]. Mortality from opportunistic infections has dramatically decreased due to use of highly active antiretroviral therapy [13]. As a result, PLWHA are living longer, are less likely to die from HIV-related co-morbidities, and are thus more likely to die from HCV-related end-stage liver disease. Mortality rates for PLWHA due to end-stage liver disease and related to HCV-associated cirrhosis are rising [11]. Death rates related to liver disease are higher for persons with HIV-HCV co-infection compared to those with HIV only [8], because HIV and HCV interact such that HIV infection spurs increased HCV-RNA serum levels [14, 15] and faster progression to cirrhosis [16, 17], liver failure [18], and hepatocellular carcinoma [19]. In France in 2003, end-stage liver disease infection was the leading cause of death among PLWHA [20]. In a large sample of HIV-infected patients in North America and Europe, liver disease was the second leading cause of death, behind HIV but ahead of cardiovascular disease [12].
Public health options to decrease liver disease among PLWHA include HCV education focused on HCV prevention and treatment; identifying HIV-HCV co-infection through testing efforts; needle exchange and other harm reduction efforts for persons who use substances; and increasing access to HCV antiviral treatment for co-infected persons. The extent to which people in the US are aware of chronic HCV is unclear. Several non-profit organizations exist that seek to improve HCV awareness in both the general population and at-risk groups. For example, the National Hepatitis C Coalition, Inc. (http://nationalhepatitis-c.org/) is devoted to educating the public on HCV and supporting patients living with HCV. The Hep-C Outreach Project (http://www.hcop.org/) provides education programs for the general population and also targeted to PLWHA and people co-infected with HIV and HCV, and Hepatitis Foundation International (http://www.hepfi.org/) provides peer counseling and doctor referrals to those diagnosed with HCV, along with public education. Largely unknown is the effect of these intervention efforts on HCV awareness and knowledge. To our knowledge, no empirical evaluation of such efforts has been published. Data are also lacking on long-term outcomes of screening for HCV in otherwise healthy asymptomatic adults [21], despite recommendations to use screeners to identify patients at high-risk for HCV and offer them HCV education [22].
Research has shown that accurate HCV knowledge is lacking among groups that are at high risk for HCV. For example, in a sample of methadone maintenance patients, only 50% knew the correct risk factors for HCV [23] and only 34% knew that HCV can be treated [24]. In a study of syringe exchange participants, 50% did not know that HCV is spread through shared, un-sterilized injection equipment [25], and participants gave more accurate answers to HIV than HCV questions [26]. Based on these studies, education on HCV transmission routes and protection behaviors for persons at risk for HCV is needed. Persons at risk for HCV also need to know that HCV treatment is available, to give them a reason to get tested.
This paper describes the first HCV knowledge intervention study of which we are aware. Specifically, our intervention sought to increase understanding of HCV, knowledge of one's HCV status, and patient-provider communication about HCV. A particularly promising approach to address public health problems is a multi-level intervention design based on the Socioecological Framework (SEF) [27]. Intervening at multiple levels may be particularly important for people with HIV who are at risk for HCV, because they intersect with multiple arms of the health care system.
The SEF describes five levels that influence health: (1) the Intrapersonal level, which consists of an individual's beliefs and characteristics; (2) the Interpersonal level, which consists of relationships between the individual and key persons and small social networks, such as one's spouse, family, and close friends; (3) the Community level, which consists of shared identities, experiences, and resources for health; (4) the Institutional level, which consists of rules, regulations, policies, and ethos that may promote or endanger health; and (5) the Policy level, which consists of policies, environments, and structures that impact health. The SEF proposes that individual behavior and social influences are inter-related [28], and that each level of the SEF is capable of impacting other SEF levels. Patients with HIV only or HIV-HCV co-infection experience their illnesses in the context of family and other relationships, as well as community structures such as infectious disease clinics, liver clinics, substance use treatment centers, and health departments. Accordingly, the SEF is particularly useful for tailoring a community-based intervention to a particular socio-cultural context for people with HIV and HCV, in addition to allowing for inclusion of individual-level interventions. Thus, the SEF guided our intervention design and provided a holistic framework.
Our multi-level intervention was designed to be community-wide, broadly affecting all individuals with HIV in a six-county geographic area. By targeting a community rather than individuals, we were challenged to find an appropriate evaluation design. We rejected a randomized controlled trial design because the multi-level nature of the intervention did not allow us to randomize individuals within the study, and yet we did not have the resources to intervene with enough communities to randomize communities. We rejected a case-control design using a comparison community because our previous HIV research in the area has taught us that there are substantial differences between HIV populations in neighboring communities. We therefore selected an Interrupted Time Series (ITS) design in which we sampled community-level prevalence rates at regular intervals before introducing the intervention, and then continued data collection throughout the intervention period. By being able to compare trends before and after the start of the intervention rather than simply comparing pre versus post averages, this design eliminates many threats to internal validity. For example, the presence of a pre-existing trend can erroneously lead to the conclusion that an intervention was effective if only pre and post means are compared. In a time series design, pre-existing trends can be included in the model, and thus intervention effects exceeding pre-existing trends can be tested.
Another advantage of the ITS design is that it can address threats to validity that occur when other initiatives within the same community are put into effect during a similar timeframe as the intervention. If such other initiatives exist, comparisons of pre and post means cannot disentangle the effects of the intervention from those of other community influences. A time series design, however, can test the presence of effects starting at different times. Overall, the ITS design is considered to be a very strong quasi-experimental design, with the primary threat to causality being the unplanned introduction of an intervention occurring at exactly the same time as that of the study intervention [29]. Researchers have lamented how rarely the ITS design is used in community research and have called for its increased use [30].
In sum, despite high rates of HIV/HCV co-infection and the fact that HCV is a leading cause of death among persons with HIV, to our knowledge, no hepatitis C interventions for persons with HIV have been designed and evaluated. In this intervention research study, we designed and tested such an intervention, using an evaluation design that is under-utilized. Our research questions were, what impact, if any, did the intervention have on: 1) what HIV-positive patients know about hepatitis C; 2) HIV-positive patients knowing their hepatitis C status; and 3) HIV medical providers talking to HIV-positive patients about hepatitis C.
Our intervention was composed of components at four SEF levels. The primary target of our intervention was people with HIV who were either already co-infected with HCV or were at risk for HCV. To reach them, we also intervened with medical and social service providers who interact with people in those groups, but with the ultimate aim of reaching people with HIV and HCV, or at risk for HCV.
We provided case management to nearly 200 patients co-infected with HIV/HCV, starting in July 2005 and continuing through the end of data collection in February 2007. In addition, from September 2005 through the data collection period, mental health and substance abuse counseling were provided based on need to 80 patients with HIV and either co-infected with HCV or at risk for HCV. Such counseling is important to help people qualify for HCV antiviral therapy, because therapy recommendations include mental health stability and alcohol and substance use abstinence. While substance use abstinence is the ideal, the integrated HIV-substance abuse treatment [31] used by our therapists incorporated harm reduction strategies, including reduced and clean needle use.
We conducted monthly support groups for co-infected persons at two sites. These groups were regularly attended by 8 participants per month. One group began in April 2005 and the other one month later, with sparse initial attendance building to full group size by September 2005. The two groups continued throughout the data collection period.
Community education was provided through health classes to the general public and to over 800 PLWHA and other people at risk for HCV through a variety of venues. For example, monthly health classes were provided to people in the local county jail from February 2005 throughout the data collection period. Starting in July 2005, HIV peer health educators were regularly trained. Starting in September 2005, health classes were repeatedly offered at several homeless shelters and substance use transition homes. We also launched in September 2005 a website and a public media campaign to impart information on HCV testing, transmission, and treatment.
We changed the HIV clinic system through using Information Technology to create a face sheet that was placed in the front of patient charts. This face sheet reported whether or not a patient had been tested for HCV, the test date and results, and whether or not the patient had been vaccinated for hepatitis A and B (these infections can be more severe in the patient with pre-existing HCV). The face sheets were phased in as data entry occurred between August 2005 and February 2006. Through provider interviews, we learned that medical providers routinely used the face sheets. In addition, we sought to enhance clinic and organizational knowledge about HCV through educating HIV medical and non-medical providers. Because universal HCV testing was not in place, we held two testing event contests in the academic medical center infectious diseases clinic to encourage medical providers to test for HCV. Clinical education, which began in July 2005 and continued throughout the data collection period, was provided to 60 medical care providers to extend their knowledge on HIV-HCV co-infection patient care, HCV treatment, and the benefits of HCV testing. Information on HCV testing, transmission, and treatment was provided to over 190 non-medical providers (case managers, social workers, health educators) working in the field of HIV to increase their awareness of HCV and provide knowledge and tools to talk with their clients about it. We also changed institutional policy by providing staff for HCV testing at the Durham County Health Department.
In the six-county intervention area, HIV-positive individuals primarily seek health care at two HIV clinics. To assess the impact of our intervention on the broader HIV-positive population, we chose to interview patients at these two clinics; however, 100% of the patients interviewed at the federally-qualified community health center were also seen at the academic medical center. Consequently, this paper focuses on the interviews conducted at the academic medical center, which served approximately 1550 HIV-positive patients in the first year of data collection (2005). Although not all individuals with HIV access HIV medical care, collecting data through HIV medical clinics was determined to be the most efficient way of reaching large numbers of individuals with HIV. The inclusion criteria to be offered participation in the interview were: HIV-positive; age 18 or older; English-speaking; and receiving treatment at one of two Infectious Disease (ID) clinics.
As noted above, we used an interrupted time series design. Because the primary threat to validity was simultaneous introduction of another HIV-HCV intervention, we had regular contact with the State HCV Coordinator and the directors of both clinics throughout our intervention period. No other HIV-HCV interventions were introduced.
At the medical center infectious disease (ID) clinic, interviews occurred every two weeks from February 2005 – February 2007. The multi-component intervention was phased in with minimal activities starting in February 2005 and all major activities in place around September 2005. This allowed that trends to be observed for 7 months prior to September 2005 and 17 months after September 2005. Since the pre-intervention phase was shorter than the intervention phase, an effort was made to reach a comparable number of patients during this shorter interval to enable tests for changes in the study population. Consequently, interviews occurred two days during every biweekly interval prior to the start of the intervention, and one day during every biweekly interval thereafter. All patients meeting study criteria with a scheduled ID clinic appointment that day were approached, and after completing a consent procedure, were enrolled in the study (n=259). The participant response rate averaged 45.3% of patients meeting study criteria per day (range 27.1–62.9% per day). Questionnaire-based interviews were conducted by trained research staff, and averaged 20 minutes with $10 compensation. In line with our focus on the community-level impact of the intervention, patients could complete interviews multiple times if they met study criteria on multiple interview days, though most participants (n=175, 67.6%) were interviewed only once. In rare instances (n=2) patients were interviewed more than once during a single biweekly interval, but only a single response per patient was included in each biweekly clinic score.
The study period included a total of 54 biweekly intervals, 15 before and 40 after the start of the intervention. Data were collected during 38 (70.4%) biweekly intervals, during 8 (53.3%) of the pre- and 30 (75.0%) of the post-intervention intervals. These differences were not statistically significant (x2(1)=2.4, p=0.12).
A total of n=259 patients participated in this study. Patients were on average 43.1 (SD=8.8) years old, had known about their HIV status for 9.3 (SD=6.4) years, and were predominantly male (68.3%), and mostly African American (58.3%) or White (30.9%). Eight (3.1%) participants reported being Hispanic. Most participants had completed high school or received their GED (76.1%), and some had received a college degree or higher (23.9%). About 42.1% of the participants reported being employed.
Participants were asked their race, number of years of education, and gender. They were also asked about how long they had known about their HIV status, HCV risk behaviors, and sexual behaviors.
HCV knowledge was measured using 11 items developed with a hepatologist and our clinical and community trainers, and pilot-tested with 5 persons with HIV. A full list of items are reported in Proeschold-Bell et al., 2010 [32]. These items fall into the areas of general knowledge (—A person can have both HIV and hepatitis C at the same time ), treatment (—Some people have been cured of hepatitis C, —Many people with both HIV and HCV have benefited from treatment for hepatitis C ), and transmission (—Hepatitis C is passed through blood; —Practicing safer injection techniques is one way to keep from getting hepatitis C ). Participants could respond true,' false,' or don't know.' Responses were coded as correct or incorrect, with don't know' responses coded as incorrect.' Community and clinical trainings included content aligned with these 11 items. For example, trainers used the term —cure to align with that specific HCV treatment item.
Participants were asked, —Have you ever been tested for Hepatitis C? and if so, —Did the test show that you have Hepatitis C? Response options included —yes, —no, and —don't know.
Participants were asked, —Has your doctor or other medical provider (nurses, nurse practitioners, physician's assistants) talked with you about hepatitis C?
For all outcome variables, weighted regression analyses were conducted, where biweekly averages were the dependent variable, which were weighted by the number of patients who were interviewed during that bi-weekly interval. Dummy-coded variables were used as predictors to model five plausible alternative trends: no changes (i.e., intercept-only model), a pre-existing trend (i.e., linearly increasing dummy code), immediate change (i.e., 0–1 dummy-code for pre and post, respectively), gradual change (i.e., testing for slope and mean differences at the same time), and delayed change (i.e., 0–1 dummy-code dichotomizing 3-months after the start of the intervention versus before). For each outcome, the model with the best fit (i.e., lowest AIC value) was retained. The delay interval was chosen based on how often patients are scheduled for appointments, such that educating a provider might not take effect until the following appointment. At the clinic, patients are routinely scheduled for appointments every 3 months. All analyses were conducted in SAS 9.2. The Durbin-Watson statistic was used to test for the presence of autocorrelations, but was not found to be statistically significant for any of the outcomes, and thus autocorrelations were not modeled. For the primary outcome, performance on the HCV knowledge questionnaire, regular weighted regression could be used, which were performed using the MIXED procedure. The secondary outcomes, HCV awareness, HCV education from medical providers, HCV testing, and knowing status of HCV test, were binary, and their biweekly prevalence had an upper bound at 1. Thus, Tobit models[33], also known as censored regressions, were used for these outcomes, using the QLIM procedure. For all analyses, maximum likelihood estimation was used, which performs very well under missing-at-random data conditions [34].
Patient characteristics were tested as potential covariates systematically. First, each patient characteristic was tested univariately on the patient level to see if it predicted any of the outcomes, using linear regression for the primary outcome and logistic regression for the four secondary outcomes. Second, if it was statistically significant, a biweekly prevalence level of that characteristic was calculated to be considered for inclusion in the clinic-level biweekly regressions in a stepwise fashion. Only statistically significant covariates were retained in the final models.
A total of 431 interviews were conducted, 201 before and 230 after the start of the intervention. On average, 11.3 (SD=9.6) patient interviews were conducted per interval. The number of interviews conducted per interval varied from 4 to 42, where more interviews per interval were intentionally conducted prior to the start of the intervention (M=25.1, SD=11.5) than afterwards (M=7.7, SD=4.4) to compensate for the shorter pre-intervention assessment phase, with t(7.6)=4.2, p<0.01 using the Satterthwaite approach for unequal variances. Recruitment methods were identical across interviews; recruitment simply occurred on more days per time period prior to the intervention start.
Only 56 (21.6%) participants were interviewed both before and after the start of the intervention. The remaining patients were interviewed either before or after the start of the intervention. To test for differences in the group composition of the study population, chi square and t-tests were conducted and are summarized in Table I. Patients interviewed prior to the start of the intervention did not differ on any of the characteristics with the exception of race, where more American Indian/Alaskan Native patients were interviewed before the start of the intervention than afterwards.1
The results of the weighted regression analyses for the average HCV knowledge per biweekly interval are summarized in Table II. The best-fitting model was the gradual change' model, which tested for both slope and mean differences between the pre-intervention and the intervention phase. The predicted values of this model are displayed in Figure 1 alongside the observed scores. While decreasing trends are visible in both phases, only the mean difference was statistically significant, where HCV knowledge was higher during the biweekly intervals following the start of the intervention.
Model comparisons for the secondary outcomes proceeded in the same way as for the primary outcome. In the interest of space, Table III summarizes the parameter estimates of the best-fitting model per outcome only. For both —HCV education from medical providers and —knowing the status of one's HCV test, the gradual change model provided the best model fit. The prevalence of patients having received HCV education from their medical providers was higher on average after the start of the intervention (b=0.28). A slightly decreasing trend prior to the start of the intervention was observed (b=−0.01 per biweekly interval), which was reversed during the intervention (b=0.01). For knowing one's HCV status, the average knowledge prevalence before and after the start of the intervention was not statistically significant. Like HCV education, however, an initially downward trend was reversed after the start of the intervention.
For HCV awareness, a significant delayed effect was observed; the prevalence of HCV awareness was on average statistically significantly higher three months after the start of the information than before (b=0.09). Given the delay, however, we cannot attribute the change to the intervention with as much confidence as we could with an immediate effect. For getting tested for HCV, there was no significant intervention effect.
The prevalence of patients who had ever injected drugs was a statistically significant covariate for three out of the four secondary outcomes: HCV education, HCV testing and knowing one's HCV status, where IV drug use was positively associated with each outcome. The only other statistically significant covariate on the clinic-level was the prevalence of patients with past 30-day sex partners, which was positively associated with receiving HCV education from one's medical provider. For reference, 137 (53.1%) of the patients did not have a sex partner during the 30 days prior to their interview.
This study implemented and evaluated a multi-level intervention to improve PLWHA's knowledge of HCV and encourage them to find out their HCV status. The intervention had multiple components across the intrapersonal, interpersonal, community, and institutional levels of the Socioecological Framework, which posits that desired outcomes are most likely to occur when targeted across multiple levels. Study results suggest that our primary outcome, accurate HCV knowledge among patients with HIV, was higher during the intervention phase than pre-intervention phase. Thus, our intervention successfully achieved our primary goal. Interestingly, accurate HCV knowledge was decreasing during both pre-intervention and intervention time periods, though at a much reduced rate during the intervention phase. It is hard to explain why accurate knowledge would decrease prior to the intervention, although it is possible that the act of garnering partners and initiating the study—even pre-intervention—led some providers to share HCV information with their patients early on, and then taper off until the intervention was launched. Post-intervention, it is plausible that patients who had attended a community health class later forgot new HCV learnings. It may be particularly difficult for PLWHA, who know so much about HIV, to retain knowledge about HCV transmission which is similar, but not identical, to that of HIV. Future studies may wish to develop brief review materials that can be posted in the clinic or the community, and also to encourage patients to attend refresher health classes. The deterioration we saw in HCV knowledge may also be related to the fact that we trained the clinic's HIV medical providers early in the study but did not offer additional, future trainings. Consequently, we did not reach any new HIV providers, including medical fellows who turnover frequently. Also, it may be that providers decreased their HCV efforts with the elapsing of time since their training. In the future, it may be wise to institute routine prompts, such as prompts in an electronic medical record system, for providers to discuss HCV with at-risk patients. This is consistent with recommendations from the Centers for Disease Control and Prevention (CDC) HCV National Prevention Strategy for Health Professionals [35].
The number of participants who reported ever having been tested for HCV evidenced a significant increase 3 months after implementation of the intervention. In addition, immediately following the start of the intervention, a previously downward trend in the prevalence of patients knowing their HCV test results was reversed, and the prevalence of patients talking with their medical providers about HCV was higher during the intervention phase. We hypothesized that the intervention would lead PLWHA to test for HCV or ask their providers about whether they had ever previously been tested for HCV, enabling them to know their HCV status. We also hypothesized that HIV medical providers would test for HCV more frequently. Based on patient report, the findings indicate an increase in HCV testing and, perhaps more importantly, knowledge of one's HCV status. Knowing one's HCV status allows people to seek treatment for HCV and to take steps to prevent transmitting HCV.
We also tested intermediate outcomes such as awareness of HCV and patient-provider discussion about HCV. Participant awareness of HCV was significantly higher 3 months after implementation of the intervention. Because our intervention activities were spread out across the 17-month intervention period, it may be that a minimum threshold of intervention implementation had to be reached before awareness measurably increased. Admittedly, it is possible that the research interviews rather than the intervention raised HCV awareness; however, HCV awareness is a precursor to seeking HCV testing and accurate HCV knowledge, and so is important to demonstrate. Participants further reported more HCV discussions with their providers during the intervention phase. This finding lends validity to our primary outcome of more accurate HCV knowledge. Improvements in HCV knowledge may have occurred through our efforts to educate providers who, in turn, communicated with patients. Alternatively, more accurate HCV knowledge may have resulted directly through our community education efforts.
Intervention effects were found for different outcomes at a variety of times (e.g., immediately after the stated intervention date, three months later) and in both abrupt and slope changes. This may be because our intervention began on the date we indicate as the intervention date, but continued over time. The trend in significant findings for multiple outcomes is likely more meaningful than when outcomes were found. We conclude that overall, the intervention met its goals and is worthy of replication. However, it should also be refined in an attempt to improve HCV knowledge and testing further, both of which evidenced room for improvement even during the intervention phase.
We examined a number of covariates, and notably, the intervention was equally effective across race, gender, age, education, employment status, and HIV status. The findings suggest that the intervention was appropriately targeted to participants with a history of injection drug use, who were significantly more likely to report having had an HCV discussion with a medical provider, getting tested for HCV, and knowing their HCV status. Although parenteral transmission through injection drug use more commonly leads to HCV transmission than sexual risk behaviors, rates of current injection drug use in our sample were extremely low. It is therefore unsurprising that our data also suggest that medical providers talked about HCV more often to participants with at least one sexual partner, because sexual risk behavior rather than injection drug use is more common in our population of PLWHA. However, it also appears that medical providers did not necessarily test participants with more sexual partners for HCV. This, too, may be appropriate, because studies indicate that risk for HCV is predicted by many sexual partners, such as more than 20 partners [4], and not just one or two.
Through provider interviews, we discovered several barriers to HCV testing and provider-patient discussions about HCV, despite the fact that guidelines for HIV management include testing for HCV [36]. In particular, many HIV providers indicated that they are more worried about chronic diseases such as diabetes and heart disease in their patients than they are about liver disease. In addition, like other researchers [37], we found that some HIV providers were reluctant to test their patients for HCV, due to the belief that HIV management is more important than HCV management, or that the side effects for antiviral treatment of HCV are too onerous to put patients through. These side effects include fatigue, thyroid abnormalities, bone marrow suppression, and depression [9]. Because of these concerns, we held testing contests in the clinic to bring attention to HCV testing. It is notable that we found trends in HCV testing and patient knowledge despite the reluctance of some providers. We recommend addressing these concerns head-on in future interventions.
It should be noted that this intervention addressed some, but not all, of the principle components of the CDC's National HCV Prevention Strategy [35]. In particular, it attempted to educate health care professionals on HCV identification, management, and treatment, and to educate people at risk for HCV about risk factors and testing. The intervention also sought to educate community-based program staff on HCV prevention and to encourage them to identify people who need testing for HCV. The intervention did not address the National HCV Prevention Strategy's principle component of surveillance of disease trends, although we did, as recommended, engage in research evaluation of this particular intervention. In addition, HCV prevention initiatives, especially among PLWHA, should include harm reduction strategies in the form of needle and syringe exchange programs, as well as substance abuse treatment, including opioid substitution treatment [38, 39]. Although we offered substance abuse treatment, we did not offer these other harm reduction activities, in part because our particular population had low rates of injection drug use. However, these components are recommended alongside HCV awareness and testing initiatives to create combination approaches for optimal prevention of HCV infection [39].
A rather unique feature of this study is its use of the ITS design. Although researchers have called for ITS to be used in the evaluation of community-level interventions, such use of ITS is still relatively rare [30]. In this study, we devoted at least one full day to data collection every two weeks for two years, a process that was both time-intensive and required significant partnership with the clinics. The result, however, was a stronger research design that provides greater confidence in the causal intervention effects than a case-control design would have offered because it addresses several threats to validity. In this study, for example, we were able to test for any pre-existing trend and rule it out as a rival theory for the observed intervention effect. ITS designs are vulnerable to their own threats to validity, which we controlled for carefully in this study. For example, we rigorously tested for changes in the study population through comparison of participants during the pre-intervention and intervention phases, with only one significant difference (race) resulting. We then conducted sensitivity analyses to ensure that our findings were not a mere byproduct of changes in the study population but rather an intervention effect. As such, this study illustrates how the ITS design can be used effectively in community research given real-life administrative constraints.
This study has several limitations. First, it is limited by its use of patient report rather than medical record abstraction for HCV testing. Also, the intervention itself was extensive and multi-level, requiring ample staff and time resources. Even so, it lacked needle and syringe exchange activities, which future researchers and interventionists would be wise to incorporate. We are unable to tease apart which aspects of the intervention were most impactful on outcomes, even though such information would be useful. In addition, we collected data only before and during intervention activities, such that we are not able to examine whether removal of the intervention led to any decay in outcomes. Finally, despite the strength that ITS offers for internal validity, the ITS design is often limited in its external validity. In this particular study, our conclusions are known only to be generalizable to patients at the ID clinic where the study occurred. This study's findings may be generalizable to other clinics and patients, based on the extent to which they are similar to ours. Our sample had a very low self-reported current injection drug use rate, had a mean age of 43, and had known their HIV status on average 9 years, all of which may be different from other clinic populations.
In conclusion, this is the only intervention study to promote HCV knowledge and testing among PLWHA of which we are aware. The high co-morbidity of HIV-HCV combined with the increasing liver-related mortality among PLWHA makes HCV prevention, testing, and treatment a priority for the over 1 million people in the US infected with HIV. Additional interventions paired with rigorous evaluation are needed.
This work was funded by a grant from the Healthy Community Access Program (HCAP) of the Bureau of Primary Health Care, of the Health Resources and Services Administration (HRSA), of the U.S. Department of Health and Human Services (G92CSO2237-02-02). We thank F. Lombard, MSW, for his leadership on this study. We thank Elizabeth Goacher, PA, Duke University Department of Medicine, Division of Gastroenterology, for assisting with the development of the HCV knowledge items, Nathan Thielman, MD, MPH, Duke University Department of Medicine, Division of Infectious Diseases, for support in conducting research in the clinic, and Randall Pollard, LCSW, Duke Division of Infectious Diseases, for assisting with participant recruitment and response rate data. The intervention could not have happened without Marc Kolman, Patrick Lee, Donna Tennyson, Teresa Hart, Xavier Purefoy, Betsy Barton, Robin Swift, Milford Evans, Tanya McNeill, and Kimberly Walker. We thank the many study interviewers, including Arit Amana, Christie Raulli, Carolyn Vance, Douglas Thomas, Josette Gbemudu, Sharon Abbruscato, and Brian Flores. Most importantly, we thank all the study participants.
1For all subsequent analyses, sensitivity analyses were conducted, where the same analyses were conducted with and without patients of American Indian/Alaskan Native background. The absence or presence of these patients did not alter substantive conclusion of the analyses, and thus the full sample analyses are reported here.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


text:
Spiced Baby Carrots
Total Time
Prep 5 mins
Cook 15 mins
Adapted from a "Taste of Home Light and Tasty" publication--a different mix of spices for a sweet and spicy side dish. You can make this as sweet or as spicy as you want...adjusting the spices accordingly. Carrots are a powerhouse of vitamin A, which helps preseve eyesight and supports the immune system.
Ingredients Nutrition
- 226.79 g baby carrots
- 78.07 ml water
- 1 cinnamon stick
- 1.23 ml ginger
- 1.23 ml cumin
- 1.23 ml ground coriander
- 1.23 ml cayenne pepper
- 0.25 ml salt
- 7.39 ml honey
- 14.79 ml Splenda sugar substitute
- 4.92 ml lemon juice
- In a medium saucepan, combine first 8 ingredients. Bring to a boil, reduce heat, cover and simmer for 5 minutes.
- Discard cinnamon stick. Add honey, lemon juice, and Splenda to the carrots. Bring to a boil. Cook uncovered for 5-10 minutes, until carrots are tender and most of the liquid is evaporated.
Most Helpful
Great way to doctor up carrots. I didn't have a cinnamon stick so used 1/4 teaspoon ground cinnamon. Very tasty indeed! Thanks for sharing the recipe yogiclarebear. Made for My3Chefs Nov '09.

subset: commoncrawl


text:
China Clamps Down on News from Tibet Protests
China's crackdown against Tibetan protesters has reportedly spread neighboring provinces. Details of the protests, and Beijing's response, have been hard hard to come by due to efforts by China to stem the flow of news from the affected region.
Tibet's exiled spiritual leader, the Dalai Lama, has called on the international community to investigate whether cultural genocide has taken place. He accused China of relying on force to achieve peace.
Ari Shapiro speaks with James Miles of The Economist magazine and Louisa Lim of NPR.
Related NPR Stories
You must be signed in to leave a comment. Sign In / Register
Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.


text:
NTI Audio ML1 Minilyzer
NTI Audio ML1 Minilyzer / NTI analog audio analyzer, for level (RMS, Relative, peaks) THD + N, VU & PPM, frequency, symmetry, polarity via built-in microphone, time and frequency sweep, third spectrum and envelope, acoust. SPL and Leg measurement only with Mini SPL (optional # 154763), XLR and RCA inputs, Power over 3x 1.5V Mignon battery (not included), optional bag 154773
Smart Navigator
- NTI Audio Audiotools at a glance
- display Audiotools in price range 500 € - 1000 €
- go to product group Audiotools
- go to product group PA Equipment
- show manufacturer details for NTI Audio
- NTI Audio PA Equipment at a glance
- printer friendly version of this page
Further NTI Audio items
Offers include 20% British VAT and are valid as long as stocks last. Shipping costs to the U.K. are 10 EUR (approx. £7), free shipping on orders above 199 EUR. Please click here for international Shipping rates. We do not accept liability for typographical errors or inaccurate information of any kind. *RRP = manufacturer's / distributor's recommended retail price in Germany


text:
Skip to Main Content
IEEE membership options for an individual and IEEE Xplore subscriptions for an organization offer the most affordable access to essential journal articles, conference papers, standards,
eBooks, and eLearning courses.
Learn more about:
IEEE membership
IEEE Xplore subscriptions
For future mobile radio systems, an appropriately chosen multiple access technique is a critical issue. Multiple access techniques presently under discussion are code division multiple access (CDMA), time division multiple access (TDMA), and hybrids of both. In the paper, a hybrid C/TDMA system using joint detection (JD-C/TDMA) with coherent receiver antenna diversity (CRAD) at the base station (BS) receiver is proposed. Some attractive features of the JD-C/TDMA system are the possibility to flexibly offer voice and data services with different bit rates, soft capacity, inherent frequency and interferer diversity, and high system capacity due to JD. Furthermore, due to JD, a cluster size equal to 1 can be realized without needing soft handover. The single cell Eb/N0 performance and the interference situation in a cellular environment of the uplink of a JD-C/TDMA mobile radio system with CRAD is investigated in detail. It is shown that the cellular spectrum efficiency is remarkably high, taking values up to 0.2 bit/s/Hz/BS in the uplink, depending on the actual transmission conditions
A not-for-profit organization, IEEE is the world's largest technical professional organization dedicated to advancing technology for the benefit of humanity.© Copyright 2016 IEEE - All rights reserved. Use of this web site signifies your agreement to the terms and conditions.


text:
Use * for a wildcard. e.g. Politic* to find Political and Politics correspondents
Use " " for exact and case sensitive search. e.g. "IFA"
Use commas to search multiple terms. e.g. beer, wine, whisky
Launch of the First 'Global Woman Summit in London, 30th-31st July 2016
Zylpha Launches First PayPal Solution For Lawyers
Migrant Business Show Opens Doors at mi-HUB
Migrant Entrepreneurs Show They Mean Business
"Data Suggests Fewer Brits Travelling Abroad Post Brexit" says PayingTooMuch.com's Michael Ward


text:
Putting Art in a New Perspective in the Open Air
By VALERIE CRUICE
Published: November 17, 2002
THE beauty of Connecticut's shores, hills, rivers and leas that compel artists to set up their easels today inspired an entire school of American painting a century ago.
And now five of these views, organized as a series of permanent, outdoor exhibitions called Viewpoints, can provide inspiration -- and an understanding of the artistic process -- to those who have never picked up a brush. Visitors to these plein air public sites, which opened Nov. 1, can compare a reproduction of the artist's work to the view he interpreted. Remarkably, the scenes have remained largely intact for nearly a hundred years.
Viewpoints is an extension of the Connecticut Impressionist Art Trail, a charm bracelet of historical sites where prominent American Impressionist artists lived and worked and the museums that exhibit their paintings.
The five Viewpoint sites -- on state land in Burlington, Hadlyme, Kent, Westport and Willimantic -- were created by the Connecticut Commission on the Arts and the Connecticut Department of Environmental Protection and State Parks.
The idea came from An-Ming Truxes, deputy director of the Connecticut Commission on the Arts, and Leslie Lewis, a fellow art lover who is senior environmental analyst with the state parks division of environmental department.
''We needed to put the arts out there,'' Ms. Truxes said. ''We got the idea to put the art work in the natural landscape.''
With the Viewpoints concept developed, the next step was to comb through the collections of Connecticut Impressionist art housed in the museums of the art trail (with one exception), and see if there were any matches with the state's public park system.
For that job, Tony Thurston, project director of the Connecticut Impressionist Art Trail, retained Hildegard Cummings, an independent art historian who had been curator of education at the William Benton Museum of Art at the University of Connecticut at Storrs.
''Our challenge was to figure out where we wanted to place these plaques,'' she said. ''It had to be on public land. But the artists didn't have that in mind. They painted home ground; they didn't think looking ahead to state parks. We had to fudge a bit.''
Ms. Lewis said, ''We hope it will inspire people to go back and re-paint the same scenes.''
Or just appreciate them. Ms. Cummings said the paintings were accessible even without special knowledge of their background, adding, ''You can see immediately what they caught.''
The entire Viewpoints project cost about $30,000, Ms. Truxes said. Financing came from the National Endowment for the Arts, the state Department of Environmental Protection and State Parks, the state Office of Tourism and the Connecticut Tourism Council, and the Connecticut Impressionist Art Trail Museums, as well as the Connecticut Commission on the Arts and the National Assembly of State Arts Agencies.
There is no charge to visit the Viewpoints, which are open year-round and accessible to children and people with handicaps. Information: www.arttrail.org.
Photos: A ferry has been crossing the Connecticut River between Chester and Lyme since 1769; in its early years it often carried supplies used in the Revolutionary War. William Chadwick (1879-1962) painted the river at a more peaceful time, about half a mile down river from the site chosen for the Viewpoints exhibition in Gillette Castle State Park, according to Leslie Lewis of the Department of Environmental Protection and State Parks. The text indicates that Chadwick, who lived and had his studio in Lyme, and other American Impressionists knew of the location.; ''Connecticut River'' is in the Lyman Allyn Art Museum in New London, which has an ongoing exhibit of the work of Connecticut Impressionists. (Lyman Allyn Art Museum); Dawson Dawson-Watson, an Englishman, arrived in Connecticut in 1893; about a year later he painted ''Early Morning on the Farmington.'' The Viewpoints exhibition says that he arrived in the state ''fresh from Giverny and its aura of Claude Monet, and set to work introducing the radical French art called Impressionism.'' The exhibition site is on the Farmington River Walk in Burlington, in a spot that looks very much like the one painted by Dawson Dawson-Watson (1864-1939). The original painting is in the Florence Griswold Museum in Old Lyme; it is part of a major gift that the museum received earlier this year from the Hartford Steam Boiler Inspection and Insurance Company. (Florence Griswold Museum); (Photographs by C.M. Glover for The New York Times); One place where the Viewpoints organizers took a little artistic license is the site at Kent Falls State Park. The painting displayed there, ''November Mosaic,'' is a 1922 work by Willard Metcalf (1858-1925). He was a Massachusetts native who ''painted what he saw as the essence of rural New England; a sparkling stream, lush meadow, friendly mountain, and prosaic New England homes,'' according to the plaque at the exhibition. The painting was probably done as far up as Vermont, according to Hildegard Cummings, who chose the paintings for the project. ''However, we do know that Metcalf was frequently painting in the Housatonic River Valley,'' she said. ''At the Kent Falls site, when you look off to the right of the falls, lo and behold, you're looking at a similar stream, meadow and little buildings and the hills behind.'' The original painting is displayed in the New Britain Museum of American Art. (New Britain Museum of American Art); Edward Potthast could not get enough of the sea. The painting ''Ocean Breeze'' from the Lyman Allyn Art Museum captures the pleasure that he, and his subjects, found in the sea spray and salt air. The Viewpoints exhibition is near the pavilion at Sherwood Island State Park in Westport. Text with the display explains that Potthast (1857-1927), who was born in land-locked Connecticut, traveled up and down the New England coast painting children and women enjoying the shore. (Lyman Allyn Museum of Art); At the Viewpoint in Windham Mills State Heritage Park in Willimantic, there is an almost perfect match between painting and scene. According to the text on the plaque there, J. Alden Weir (1852-1919) tended to choose subject matter that other artists shunned, like the industrial scene in ''The Factory Village'' (1897). The painting, which is in the Metropolitan Museum of Art, is considered a masterpiece of American Impressionism, an art movement that Weir helped create in Windham and at his farm in Branchville. (The Metropolitan Museum of Art); (Lyman Allyn Art Museum)


text:
The Peggy Skirt {Sewing Tutorial}
If you love gorgeous pleated skirts then you will love this sewing tutorial. This skirt is perfect for little girls or ladies and can be dressed up or dressed down depending on the top you pair with it.
* 17 Terrific Pancake Recipes You'll Adore
* 9 Super Souffle Recipes to Make
* 25+ Senior Picture Photo Ideas
* 13 Meaningful Money Gift Ideas by Age
* 15 Cutest DIY Tooth Fairy Pillows to Make
Work at Home Mom Services


text:
Tottenham Hotspur Message Board
A Yahoo! User Nov 2, 2008 02:30 Flag
Perfect Weekend...
Beat Liverppol 2-1 and the gooners lost by the same scoreline - what a perfect weekend!!!
Can it get any better then that?
HARRY REDKNAPPS BLUE & WHITE ARMY!!!!Sort: Newest | Oldest | Most Replied Expand all replies
Doesn't get any better eh!
What we've got that we haven't had for months is heart. 'Arry's brought that with him. It wasn't a pretty win, but it was a great win! COYS!
- 2 Replies to Old Fan
Kentish Maid Kentish Maid Nov 2, 2008 02:39 Flag
It doesn't have to be a pretty win Old Fan - but 3 points is 3 points and I'm not complaining.
7 from 9 in the past week - what a turnaround.
A Yahoo! User Nov 2, 2008 02:35 Flag
Off the bottom of the table as well!!
CalgaryResident CalgaryResident Nov 2, 2008 02:58 Flag
Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality Quality.
Have to say we needed a bit of luck and the game could have been a bad result for us........but the lads have shown a never say die attitude and thats what is needed week in week out regardless if you are at the top or bottom of the table.
Well done lads great result and finally I think we have a great manager. Jan will be interesting to see who comes in.
Never a dull moment supporting Spurs have to give them that.
Perfect week Old Fan (ok we drew with the goons in mid-week...but it was how we did it not just that we did it). Then as you said a win over Liverpool (or first in 6 league games with them, and only 1 draw in the other 5)...where was I, yeah, breaking the Scousers unbeaten streak...and Stoke, I'm kind of vex that they beat the Goons, why? Because we didn't! (That's two northern upstarts that have beaten both N. London teams). A truly perfect week/weekend would have seen Hull beat Manure, but I guess you can't have everything.
- 1 Reply to RAMBR0
Sorry Old, I meant Mike S...I'm still giddy!
Another passionate fightback.............
and to add insult to injury, couple more pleasing facts
Van Persie off - is he the gooners answer to Joey Barton ? plenty of room at Pentonville..........
Wenger Chaos reigns .........
Has run out of ideas - European type football good for champs league ( but not for long ) however not up to the premiership grind at present.
Won't be long before he gets the fatal 'full support' of the chairman.
Rumour has it that Harry is making them all eat a full english breakfast to get them set up for the match.............................
or is it in the water ????
- 1 Reply to Keefy59
Full English....HA HA HA ...good one KEEFY
longtimespur longtimespur Nov 2, 2008 04:57 Flag
When was the last time we took 3 points from one of the b*g 4 teams??? 3 games against them 5 points gained! Keep it up, COYS
A Yahoo! User Nov 2, 2008 12:07 Flag
dont know why you all sound suprised because WE ARE TOTTENHAM SUER TOTTENHAM WE ARE TOTTENHAM FROM THE LANE!!COYS
- 1 Reply to A Yahoo! User
A Yahoo! User Nov 2, 2008 12:12 Flag
FABONGRASSS FABONGRASSS Nov 3, 2008 02:02 Flag
personally, i think it was apretty awful weekend, football wise at least. bollocks.
- 1 Reply to FABONGRASSS
A Yahoo! User Nov 3, 2008 16:51 Flag
Far be it from me to go on the wind up......you all know me as a shining example of respectful balanced debate in here (cough splutter) ....but even 'goal of the month' on MOTD took the p*ss out of the goons......3 against, none for.....and Bentley is gonna win by a country mile...........snigger!
longtimespur longtimespur Nov 3, 2008 22:26 Flag
Cascarino reckons Lampards mishit cross to the far post was better. Not sure Anelka would agree, he was setting himself up for another strike till the wind must have caught it.
longtimespur longtimespur Nov 3, 2008 22:28 Flag
Funny how when you use the letters s-h-i-t in mis hit it gets blanked.
- View More Messages


text:
Quick and easy implementation, wanted a template integration and this provided it, only reason that it didn't get 5 stars is because I could have used a way to manipulate the feed information... but other than that it worked slick and easy.
You must log in to submit a review. You can also log in or register using the form near the top of this page.


text: Dermot Mulroney, Melora Walters wrap film in Woodlands this week Back to Article Comments Need to Register? X Remember Me Forgot your password? Today's Deals Blue Apron Delivered Meals from $27 + free shipping 4-Panel Abstract Wall Art by Jon Allen for $145 + free shipping PUMA Men's Tazon 6 Ripstop Sneakers for $40 + free shipping Dell Venue 10 Pro 32GB 10" Windows 10 Tablet for $125 + free... Powered by Top Stories End in sight for repairs — and traffic — on Rainbow Bridge What to do this weekend in SE Texas: July 29-31 SETX offers a variety of flavors to celebrate Cheesecake Day Texas weatherman in trouble after racially charged Facebook post Photos: Popular Vidor eatery opens second location in Beaumont Blue Bell hit with a fine for listeria outbreak See Rio's 2016 Olympic venues from the air Police officer has tea time with little girl whose life he saved


text:
G4 posts "legit" GTA IV footage
G4 just dropped over embed code to three post-embargo GTA IV gameplay movies, including a helicopter tour of Liberty City, a high speed police chase and a getaway video. See all three after the link.
Sometimes we include links to online retail stores. If you click on one and make a purchase we may receive a small commission. For more information, go here.


text:
Like the watermen that row one way and look another.
Robert Burton (1577 - 1640)
Source: Anatomy of Melancholy
Contributed by: Zaady
He is only fantastical that is not in fashion.
They do not live but linger.
John. Mayor, in the first book of his "History of Scotland," contends much for the wholesomeness of oaten bread; it was objected to him, then living at Paris, that his countrymen fed on oats and base grain. . . . And yet Wecker out of Galen calls it horse-meat, and fitter juments than men to feed on.
The fear of some divine and supreme powers keeps men in obedience.
England is a paradise for women and hell for horses; Italy a paradise for horses, hell for women. . . .
Hinc quam sic calamus sævior ense, patet. The pen worse than the sword.
Penny wise, pound foolish.
[The rich] are indeed rather possessed by their money than possessors.
To enlarge or illustrate this power and effect of love is to set a candle in the sun.
Copyright © 2016 Gaiam, Inc.


text:
You missed it This great deal for Healthy Skin Boutique is over. But don't despair, we've got more great deals every day.
Related Deals That You May Like
Elements Massage
1-Hour Massage
Healing Soles Massage Therapy
Ashiatsu Massage
The International Skin Care Institute
Microdermabrasion, LED Skin Treatment, and More
Radiant Skin by Ruth
Microdermabrasion and Facial Package
Healthy Skin Boutique
Total Skincare: Facial, Microderm, & More
76% recommendedin LivingSocial customer ratings
Natasha Berosh started her glamorous career as an actress; but then realized that her real passion was the beautifying that occurred behind the scenes. Get a red carpet-ready look with her help:
• $59 ($220 value) for a 75-minute facial package
• Includes a European facial, microdermabrasion, oxygen therapy, and mask
• Shea Corridor spot is open for appointments Monday through Saturday
Why You'll Love It
Natasha and co-owner Nicole Green hold certifications in medical esthetics, laser technology, European waxing, and makeup application -- meaning that no matter what your beauty battles are, this duo can help you overcome them. The European facial combines cleansing, exfoliation, extractions, a facial massage, and a custom mask to reinvigorate your visage; the microdermabrasion gently exfoliates the outer layer of skin. Topped off with an oxygen infusion therapy treatment and a mask, each pore will feel truly pampered. Like its name suggests, Healthy Skin specializes in corrective and custom treatments to help clients triumph over acne, sun damage, melasma, signs of aging, and more.
Healthy Skin Boutique on Facebook
PAID VALUE EXPIRES ON July 29, 2021
PROMOTIONAL VALUE EXPIRES ON April 30, 2014
the fine print
- Limit 2 per customer, additional as gifts
- Limit 1 per customer per visit
- Appointments required and subject to availability
- Merchant cancellation/re-scheduling policy of 24 hours applies; voucher subject to forfeiture
- All services must be redeemed during a single visit by same customer
- Other conditions apply
special delivery
shop unique gifts and deliver them with style
easy, flexible delivery
print it out, email it now, or schedule it for a later date--it's up to you
personalized email
Emailing your gift? Write a message, select a theme, and hit send. The price you paid will not be displayed in the email.
special printed voucher
Delivering the gift in person? Choose a theme, print it out, and pass it along to that special someone. It's that simple.
Deal Fine Print
Limit 2 per customer, additional as gifts
• Limit 1 per customer per visit
• Appointments required and subject to availability
• Merchant cancellation/re-scheduling policy of 24 hours applies; voucher subject to forfeiture
• All services must be redeemed during a single visit by same customer
• PAID VALUE EXPIRES ON July 29, 2021
• PROMOTIONAL VALUE EXPIRES ON April 30, 2014
• Cannot be combined with any other offer or promotion
• Tax and gratuity are not included
• Merchant is responsible for the quality of the products or services provided to you at redemption
• LivingSocial Terms and Conditions - https://www.livingsocial.com/terms


text:
Educational Psychology Review
Educational Psychology Review is an international forum for the publication of peer-reviewed integrative review articles, special thematic issues, reflections or comments on previous research or new research directions, interviews, and research-based advice for practitioners - all pertaining to the field of educational psychology. The contents provide breadth of coverage appropriate to a wide readership in educational psychology and sufficient depth to inform the most learned specialists in the discipline.
Latest Articles
Review Article
Integrating Relational Reasoning and Knowledge Revision During Reading
Panayiota Kendeou, Reese Butterfuss, Martin Van Boekel… (July 2016)
Review Article
Towards a Theory of When and How Problem Solving Followed by Instruction Supports Learning
Katharina Loibl, Ido Roll, Nikol Rummel (July 2016)
Intervention Study
Effects of a Reading Strategy Training Aimed at Improving Mental Simulation in Primary School Children
Björn B. de Koning, Lisanne T. Bos… (July 2016)
- Impact Factor 2.587
- Available 1989 - 2016
- Volumes 28
- Issues 110
- Articles 719
- Open Access 31 Articles
Stay up to Date
Find a Volume or Issue
- Journal Title
- Educational Psychology Review
- Coverage
- Volume 1 / 1989 - Volume 28 / 2016
- Print ISSN
- Online ISSN
- Publisher
- Springer US
- Additional Links
- Topics
- Industry Sectors
Continue reading...
To view the rest of this content please follow the download PDF link above.


text:
You can also obtain a motorcycle license in the PlayStation Vita title; this way you can ride one into battle and do motorcycle-based attacks. Yes, really. It also looks like Persona 4: The Golden gets new Persona evolutions. To the far left is Yukiko's.
The remake will also get a brand new opening animation, courtesy of the studio Mad House.
Persona 4: The Golden is slated for a spring release in Japan.
Tales from the Borderlands July 31 • 9:00am PDT/12:00pm EDT
Sword Coast Legends Aug 7 • 9:00am PDT/12:00pm EDT
Breath of Fire IV Continues! Every Monday • 5:00pm PDT/8:00pm EDT
Star Wars: KotOR Continues! Coming soon...


text:
We found 1 that has recently dropped in price.
Sign up to see this price drop and to receive future price drop notifications.
Total Reviews
Write a
Sort by
1996 Chevrolet Corsica 4dr Sedan
This car has been one expense after
another. Three fuel injectors have
gone (at different times), the
transmission needed to be rebuilt at 6
years old, various other engine fixes
that seem to cost me at least $500 a
fix. I was averaging over $200 a month
for repair bills. Paint has peeled off
in huge pieces.
Comfortable to drive.
my car has been in the dich, stolen.
electrical system is fried power locks
dont work and status lights in dash
are all usless, ABS only works when it
wants too. the thing rusts and rusts,
it needs painted every year. its now
rusted all over and was just painted.
solid engine its been reiable
fix the car so paint stays on
It was a solid car - took it through
hell and back and its still kicking at
nearly 200K miles. Not expensive, not
much to look at but it will get you to
where you need to go.
128000 miles, so far. just regular
maintanance. Over all nice car.
Inside controls easy to reach.
Be able to turn headlights off during
the day.
I now have 74,000 miles on this car,
and it's been wonderful! Never had a
problem in 3 years besides the
mandatory oil changes/brakes and things
like that...I love the acceleration.
It is the best car I've ever driven!
Ice cold air conditioning. HOT heat in
the winter. Very comfortable seats.
3.1 V6 is great!
Help |
About Us |
Contact Us |
Careers |
Affiliate Program |
Dealer Center |
Privacy Statement |
Visitor Agreement |
Membership Agreement
Your Ad Choices
| Site Map
| Glossary
| Mobile
| Developers
Follow Edmunds
© Edmunds.com, Inc.


text:
Category:Transport in Barnet
From Wikipedia, the free encyclopedia
Transport in the London Borough of Barnet.
This category has the following 3 subcategories, out of 3 total.
- ► Railway stations in Barnet (1 C, 6 P)
- ► Streets in Barnet (11 P)
- ► Tube stations in Barnet (13 P)
Pages in category "Transport in Barnet"
The following 32 pages are in this category, out of 32 total. This list may not reflect recent changes (learn more).


text:
This is the longest day, and we celebrate the Summer and the Sun at its height. We meet in Arundel, and move to a meeting place on the Downs. Contact me for more details.
Meetup members, Log in
By clicking "Sign up" or "Sign up using Facebook", you confirm that you accept our Terms of Service & Privacy Policy


text:
Fat people will now be denied certain kinds of operations to cut costs in Britain's state-run National Health Service. Patient groups condemn the decision as callous and unfair. From London, Stephen Beard reports.
Not long ago, the NBA instituted an off-duty dress code for players. At first there was a flood of complaints, but as Rich Thomaselli of Advertising Age reports, some are now discovering a business opportunity here.
Many Israeli families have been forced to leave Gaza and relocate their lives. Hilary Krieger met with a family who runs a tree farm and is adjusting to being uprooted, both literally and figuratively.
What's to be thankful for this week? Americans find plenty to complain about, and the past always sounds rosier. But economist and commentator Steve Moore reminds us that the good old days weren't always that great.
The world's largest airline, Air France-KLM, reported great quarterly profits. But wait, isn't the airline business dying? Maybe not outside the United States, as Bob Moon reports.
Before world leaders gather in Hong Kong for a new round of trade talks, US officials are turning to Irish rocker Bono. A massive global trade pact, meant to boost developing economies, hangs in the balance. Amy Scott reports.
Thanksgiving is the busiest time of year -- for plumbers. From Boston, Sean Cole gets the down-and-dirty scoop, from those who know just how ugly it can get.


text:
Harry Nilsson:
Idiot wind
The news that Liz Cheney is running for a Wyoming Senate seat reminded me of this song. Bob Dylan:
A liar is a liar is a liar
How many of you English majors knew that Gertrude Stein was such a willing accomplice to Nazi collaborators before and during World War II? More here.
Where's the money
I used to go see these guys all the time. Dan Hicks and his Hot Licks:
It's the jobs market, stupid
Last week I noted that Mitt Romney — insipid, empathy-free, and a congenital liar — was a gift from the gods to the Barack Obama re-election campaign. But even the gift of Romney won't help Obama if he continues to campaign as if that alone will get him re-elected. More here.
This must be the place (naive melody)
Talking Heads:
I guess it depends on who "Stands Their Ground."
Things have been quiet on the "Stand Your Ground" rants by my Wingnut debating friends that was spurred by the Trayvon Martin case down here in the sunny South.
It will be a while until the case comes to court, so, that will give those "Patriots" time to study their talking points regarding this, peppered with quotes from the Federalist Papers and revised Jeffersonian wisdom.
I did some quick surfing yesterday and found this very sad story about Marissa Alexander of Florida serving 20 years for shooting at her husband, her abusive husband. She has been denied a new trial.
I posted this story on the Social Media to see if any of my Right of the Dial debate friends would speak up about this mother of 2 "standing her ground" and the justice she deserves.
No comments. None.
Oh, yeah. Trials for Talledega NASCAR were yesterday.
The wheel
Rosanne Cash:
Sunny afternoon
Until you remember
Tedeschi-Trucks Band:


text:
I'd say the black one. It just looks the most kingly to me. *shadowknight*
King of T-Rex
Started by DoubleT , Dec 17 2005 12:12 AM
26 replies to this topic
Posted 20 December 2005 - 02:27 AM
"I'm sorry, I don't have the time to build anything that doesn't directly promote me."
Posted 21 December 2005 - 02:17 AM
But the green is original which makes it usally very good.
0 user(s) are reading this topic
0 members, 0 guests, 0 anonymous users
Sponsored Links


text:
2013 Jamboree® "Mud, Sweat & Gears" Adult T-Shirt
Originally Starting at:
$14.99Starting at:
$7.98Every committed mountain-biker just gets it. "Mud, Sweat & Gears", along with a bike icon, is screen-printed in retro-style type on the front of this short-sleeve tee. Includes "2013 National Jamboree" printed at bottom of design. Athletic-style tee offers a trimmer, tapered fit. Made of a soft, ringspun blend of 60% cotton/40% polyester in heathered royal-blue. Imported. Learn More
Small Birdfeeder Kit$7.99Attract and learn to identify local birds with these fun-to-build bird feeders. Each kit includes cut-to-fit unfinished wood parts, nails, screw-eyes for hanging, and complete assembly instructions. 4.5 x 5.5 x 6" WARNING: Choking hazard. Small parts. Not for children under 3 years. Learn More
Birdhouse Kits
Starting at:
$7.99A great activity for bird-watchers! Each birdhouse kit includes precut wood parts, nails, screw-eyes for hanging, and assembly instructions. Available in two sizes. Small Measures: 5" X 5 1/2" X 5 1/4" Large Measures: 6" x 7 3/4" x 8" Learn More
Introducing The "Mars" Dig!Original Price:$12.99 Current Price: $7.99Dig and collect the same rocks found on Mars... assemble a scale model of the latest Mars Rover-"Curiosity"... and learn about Martian geology and space exploration! Learn More


text:
1-10 of 95 properties for sale found
View as:
- List
- Grid
£450,000 Offers in Region of
Offers in Region of £450,000
4 bedroom detached house for sale Llewen Rheda Park, Frizington, CA26
YOUR MOVE are pleased to offer for sale this executive detached property situated on a generous plot with access to local amenities, Whitehaven, Cockermouth and the Western Lake District. The property briefly comprises to the ground floor entrance vestibule, entrance hall, lounge, conservator... More details ›
3 bedroom detached bungalow for sale The Old Orchard, Holmrook, CA19
A unique architect designed detached Bungalow. The rooms are spacious with all the Living Rooms facing South overlooking the superb landscaped gardens and towards Western Lake District Fells. The property has sealed unit double glazing and Gas Central Heating from a Worcester boiler. Landsca... More details ›
£410,000 Guide Price
Guide Price £410,000
4 bedroom detached house for sale Dixon Hill, Calderbridge, Seascale, CA20
A four bedroom detached house briefly comprising of the following accommodation: entrance vestibule, lounge, kitchen/breakfast room, utility room, inner hall, occasional room, bedroom and a separate WC. To the lower ground floor there is a second lounge. To the first floor there are three be... More details ›
£409,000 Guide Price
Guide Price £409,000
5 bedroom detached house for sale Low Broad Leys, Calderbridge, Seascale, CA20
A superb Detached Property offering Spacious family Accommodation nestled away in large Grounds with Stabling, Paddock and ample Parking. Viewing of this farm House is advised to appreciate the accommodation/Location. EPC grade E. More details ›
£345,000 Guide Price
Guide Price £345,000
3 bedroom detached bungalow for sale Woodfield Gosforth Road, Seascale, CA20
A 3 Bedroomed Detached Property set in mature Grounds having the benefit of Double Glazing and Air Source Heat Pump Double Glazing. The property has comfortable accommodation and viewing is advised to appreciated the accommodation/Location. EPC grade F. More details ›
£299,000 Guide Price
Guide Price £299,000
3 bedroom property for sale Holmrook, CA19
A three bedroomed mid terraced mews house which briefly comprises entrance, fitted kitchen and lounge to the ground floor whilst to the first floor the landing gives access to two bedrooms and a bathroom/wc. To the second floor there is a master bedroom. Externally there is a rear garden, an... More details ›
£289,950 Offers in Region of
Offers in Region of £289,950
4 bedroom detached house for sale Main Street, St. Bees, CA27
YOUR MOVE are pleased to offer for sale this well presented four bedroom detached house situated in the sought after coastal village of St. Bees which benefits from double glazing where stated and a gas central heating system. The accommodation briefly comprises lounge/dining room, breakfast... More details ›
3 bedroom detached bungalow for sale Victoria Road, Whitehaven, CA28
A Stunning 3 Bedroomed Detached Bungalow which has to be viewed to appreciate the accommodation being Offered. The property benefits from Gas Central Heating and Double Glazing, Gardens and Garage and is being sold with no onward chain. EPC grade D. More details ›
£250,000 Guide Price
Guide Price £250,000
3 bedroom detached house for sale Orchard House The Retreat Inkerman Terrace, Whitehaven, CA28
A split level detached house briefly comprising entrance hall, three bedrooms, a utility room, rear hall and cloakroom/WC to the ground floor. To the first floor there is a half landing, landing, lounge, dining room, kitchen and a bathroom/WC. Externally the property has large gardens to the f... More details ›
3 bedroom detached bungalow for sale Ashley Way, Egremont, CA22
A 3 Bedroomed Detached Bungalow having gas Central Heating, Double Glazing. The property is situated on a corner plot and viewing is advised. EPC grade D. More details ›


text: Arts, Culture & Media Global Hit and Geo Quiz Answer PRI's The World July 10, 2009 Carol Hills profiles Jazz quartet Babik. The group, from Buffalo, New York, but are inspired by Belgian Django Reinhardt. For today's Geo Quiz, we were looking for the European city hosting a rock festival called ?Exit.? The answer is Novi Sad in Serbia.


text:
Oven-Baked Zucchini and Tomato (Tian from Provence)
Total Time
Prep 15 mins
Cook 1 hr
From: http://www.gourmed.com
Ingredients Nutrition
- 4 tablespoons extra virgin olive oil
- 4 large onions, peel and slice in thin half julienne
- 3 sprigs fresh thyme, finely chopped
- 8 large plum tomatoes, cut in lengthwise rings of about 1/2 cm thickness
- 1 1⁄2 lbs zucchini, medium-sized, slice in crosswise into 1/2-inch diagonal slices
- Preheat oven to 375 degrees.
- In a skillet, heat 1 tbsp of oil over medium heat. Add onions and sauté 10 minutes, or until tender.
- Add 1 tsp of thyme and 1/4 tsp of salt and pepper to the onions and remove from heat.
- Arrange the tomatoes, zucchini and onion slices in orderly rows across the width of 2 1/2 qt shallow baking dish preferably clay. (Can use glass baking dish).
- In small bowl, combine remaining 3 tablespoons of oil, 1/2 tsp of salt and 1/4 tsp of pepper and mix it all together. Drizzle over vegetables.
- Cover the baking dish tightly with foil. Bake for 15 minutes; uncover, and bake another 30 minutes or until vegetables are tender; let stand 10 minutes before serving.
Most Helpful
Lovely use of garden fresh produce! It's colorful too. I paired with baked fish for a ZWT8 meal. Thank you for sharing the recipe.
Yummmm, dh wanted to give this lovely simple dish 10*;s. It is so good, quick and easy to make. The zuchinni and tomatoes were so tender and flavorful while the onion was beautifully carmalized. Thanks for sharing this wonderful dish that we will be enjoying often. Made for Fearless Red Dragons - ZWT8 - France.
I used all the ingredients listed, but I was not too orderly, just threw them in a glass baking dish. I also added some yellow squash as I had it on hand. It turned out great and the flavor was great (did add a few red pepper flakes for a little pop). Had it with fish and it was a nice side dish. Made for ZWT8


text:
Discover a selection of top forums control atmosphere on the internet. Come to share your passion on forums control atmosphere and meet other fans of control atmosphere. Then, why don't you create your own forum of control atmosphere ?
Friends sharing recipes, cooking techniques & menu ideas in a friendly atmosphere.
cooking, friends, sharing, recipes, techniques, menu, ideas, friendly, #atmosphere
Official Mjolnir Gaming Combine Control Forums
Feral Nature: Providing a relaxed, supportive, and educational atmosphere for those who are non-human identified.
otherkin, feral, nature, therian, dragon, therianthropy, furry, nonhuman, non-human, multiple, fictionkin
We are a group of RC Enthusiasts in Singapore. Join us for our weekly RC Meet ups and ad hoc RC meets!
rc4wd, crawlers, scale, trucks, axial, scx10, ax10, dingo, tamiya, hilux, highlift, clod, buster, ford, toyota, traxxas, summit, racing, savage, flux, cr01, venom, creeper, competition, rock, crawler, road, radio, #control, honcho


text:
Free personalized radio that
plays the music you love
Snakebacks (Karma Part Two)
Features of This Trackeast coast rap roots
funk influences
danceable beats
swingin' beats
funk beats
heavy use of guest rappers
vocal samples
clear pronunciation
ambiguous lyrics
spiritually uplifting lyrics
the use of chordal patterning
a tight kick sound
a slow moving bass line
acoustic guitar riffs
light percussion fills
the heavy use of funk samples
subtle use of turntables
subtle use of pianos
a dry recording sound
These are just a few of the hundreds of attributes cataloged for this track by the Music Genome Project.show more
Similar Tracks
Don't have a Pandora account? Sign up
Already have a Pandora account? Log In


text:
Deals (1)
From Our Editors
Third-degree black belt and instructor Gary Quillen was once a regular 12-year-old boy. Today, he can leap into the air and perform a dazzling horizontal split kick. This feat requires immense athletic prowess. But that physical strength means nothing without the equally immense mental strength behind it. The importance of mind over muscle informs Gary's approach to teaching his Korean martial-arts and fitness classes. He has designed each of his classes to teach novice practitioners how to defend themselves with deft, powerful techniques, but also to develop their confidence, respect, and self-control in order to minimize the chance they'll ever need to.


text:
Kundli Software - Astrology
Free astrology software, kundli software and aaj ka rashifal by AstroSage.com in Hindi and English
Free • 16.7K
All Android applications categories
All Android games categories
Free astrology software, kundli software and aaj ka rashifal by AstroSage.com in Hindi and English
Free • 16.7K
Connect phones, PC, tablets, Mac and TV - send contents including files, folders, photos, video etc
Free • 119.3K
About UCWeb Also check out UC Browser for Android and UC Browser Mini for Android! Discover more at http://www.ucweb.com/ Follow us on: Facebook: http://www.facebook.com/ucmob Twitter: https://twitter.com/UCBrowser Tumblr: http://blog.ucweb.com/ YouTube: http://www.youtube.com/ucwebvideo Comments, questions or suggestions?Join UC Forum: http://foru…
Free • 443.2K
mobile phone or tablet! Check out the most popular brands that will keep you fabulous from head to toe
Free • 1.3K
Keyboard designed specifically for Tablets! Ergonomically designed for the best tablet experience
Free • 2.1K
settings and advises how to fix them AVG AntiVirus FREE for Tablet – mobile security software for Android
Free • 339.9K
The FNB Banking App for Tablet provides you with the freedom to bank when and where you choose
Free • 1.3K
This is tablet/pad version of UCam Ultra Camera. UCam is an absolutely ultra camera application
Free • 4.4K
The best free antivirus.
Free • 7.8K
9420 Tablet Keyboard for Android is a free Thai/English keyboard software (with built-in "
Free • 1K
>Mobile Application Development Tools For Non-Coders Best Tablet PC And Operating Systems Software
Free • 86
a software token for generating one-time passwords (OTPs). Your IT administrator will provide instructions
Free • 4.9K
Other users also searched for:
kaixin, anti spyware, sim card, antivirus for android, free spyware, sim card manager, sim manager, anti virus for android, free virus scan, sms lock, remote sms
Apps available in other platforms:
Last review
BADLAND 2: "Rolling Along"
by Noel Catherine
THE VERDICT Twist, turn, and roll your way through a terrain that wants to leave you dead in BADLAND 2. This game puts you through the elements and makes you come out the other side. THE PROS The visuals in this game are stunning, especially on…
Explore our channels


text:
Price per Night Range
Bedrooms (min)
Sleeps (min)
1 Norangsfjord Vacation Rentals were found matching your criteria.
2 Bedroom, 1 Bathroom, Sleeps 5
Norangsfjord, Northern Fjord Norway, Norway
Description: House "Urke". 10 km from the lake. For shared use: garden furniture, barbecue. In the house: with TV. Grocery 700 m, restaurant 25 km. Interior: 0...
$73 - $104 /night
$511 - $728 /week
This map is intended to be used as a reference only.
Available Unavailable Night Min.


text:
Find Out How
Learn More
Get Connected
The CIP designation is the benchmark of insurance professionalism. Join the 18,000 students already in the program.
Exam results for the July 2016 session will be available on August 13, 2016.
Build your business acumen, network and become a more effective employee. Learn more.
Are you ready to stand out? Qualify as an FCIP to become a more effective leader in the competitive p&c landscape.
Canada Post labour dispute may affect the Institute's
Latest report assessing implications of automated vehicles for the Canadian insurance industry.
Read the report.
Please join us for a great day of Golf at Moncton Golf & ...
No time to Golf? Or maybe just not your sport? Join us for d ...
Whether you're a football fan or not an Eskimo vs Saskatchew ...
Our Annual Beach Volleyball has been called the networking e ...


text:
- Sign in
- Join
- Find a rental
- Manage your booking
- Port Vila rentals
- How to book
- Traveler Help Center
- Write a review
Sanddollar - Private Coastal Retreat
From $150 / night
Payment Protection
balance of due
Description from the owner
Description from the owner
Bedrooms: 2/
Bathrooms: 2/
Sleeps: 8/
Type: House
Book this 2 bedroom, 2 bathroom house in Port Vila today! A total of 8 people can sleep here comfortably. This property has been booked 2 times.
Guests can enjoy a pool, deck, and outdoor grill among other amenities offered by this rental.
Travelers are sharing their opinions on this property. It has an overall rating of 5/5 thanks to an average of 25 reviews.
Costs vary, with the average weekly rate as low as $1,400.00, depending on travel dates.
The owner responds to 80% of inquiries and last updated the property's calendar 5 weeks ago, so this rental may not be available for your requested dates, but please inquire to confirm.
Proximity to TripAdvisor's Top Port Vila Attractions
Proximity to TripAdvisor's Top Port Vila Attractions
Reviews (11)
Also consider
- FlipKey has rentals in over 11,000 destinations around the world:
- Florida vacation rentals - 38,670 rentals from $90/night
- Colorado vacation rentals - 9,678 rentals from $109/night
- Hawaii vacation rentals - 8,983 rentals from $100/night
- Orange Beach vacation rentals - 844 rentals from $89/night
- Anna Maria Island vacation rentals - 1,092 rentals from $105/night


text:
4 results sorted by popularity
|Quick Questions
|In Numbers 20, why did Moses and Aaron sin when they struck the rock?
|Quick Questions
|Could the appearance of Moses and Elijah with Christ at the Transfiguration be used as evidence of reincarnation?
|Why did God order Moses to kill people?
|Were Moses and Abraham fictional characters?


text:
Login now to receive exclusive benefits for bookings on our website
Book direct with us and enjoy our Exclusive Brand Benefit of minimum 10% savings on our Best Available Rate and Bed and Breakfast package, as well as other DISCOVERY member prvileges.
We are currently processing your request.
Please do not close your browser window or navigate away from this page.
Thank you.
Book in advance to enjoy 22% savings on our Best Available Rates, from now until 30 September 2016.
Stay a minimum of three nights at PARKROYAL Yangon to enjoy fabulous savings.
Enjoy an unforgettable stay at one of our participating PARKROYAL hotels and resorts when you book with us from now until 30 September 2016, and receive 1,000 miles with your stay.
Plan a getaway at any of our PARKROYAL Hotels & Resorts' properties and enjoy complimentary breakfast.
Enjoy 20% savings on Best Available Rate, and a host of exclusive benefits, when you book 14 days in advance.
Enhance your stay with an indulgent experience at PARKROYAL Yangon, featuring unparalleled exclusivity and five star benefits. Book a minimum of eight nights to enjoy 20% savings.
Enjoy 25% savings on our Best Available Rates when you book a minimum of 30 days in advance.
Enjoy 20% savings when you book one of our Orchid Club rooms.
Enjoy breakfast on us when you book a stay with us between now and 31 December 2016.


text:
Spending has become fashionable at the summit of Ligue 1, with Paris Saint-Germain and Monaco both earning a reputation for being among the most lavish clubs in the world over the last couple of years.
But in January, shrewdness is vital to tinkering with squads as the climax of the season approaches, and the two giants will attempt to bolster their units to secure the top two spots in Le Championnat, with Lille snapping at their heels. Meanwhile, former giants such as Olympique de Marseille and Olympique Lyonnais battle just to be credible.
With that in mind, Goal is here to give you the low-down on what each of France's big guns can be expected to do in the winter transfer window.


text:
Atlanta Symphony Orchestra * Robert Spano conducts Prokofiev, Holst with Chinese pianist Lang Lang. May 30, 8 p.m.; May 31, 8 p.m.; June 1, 8 p.m. $19.-$52. Atlanta Symphony Hall, Woodruff Arts Center, 1280 Peachtree St. 404-733-5000.
Aurora Theatre Sunday Funny Sunday. Improv comedy show. Sundays, 8 p.m. Continues through June 16. $8. 3087-B Main St, Duluth. 770-476-7926.
Dad's Garage Theater Comedy improv. Thursdays, 10:30 p.m. $5-$10. Dr. Bob Frapple's Improv Psychiatry. Improv comedy that helps, hurts and heals. Fridays, 10:30 p.m. $10. TheatreSports. Atlanta's popular improv comedy show. Saturdays, 10:30 p.m. $10. 280 Elizabeth St. 404-523-3141.
Kudzu Playhouse 2nd Base Comedy Troupe. Roswell's resident comedy troupe featuring improv and sketch comedy. Saturdays, 10:30 p.m.-12 a.m. $5. 608 Holcomb Bridge Road, Roswell. 770-594-1020.
N'jea Open-mic. A home for seasoned and up-and-coming comics. Tuesdays, 8 p.m. $3-$5. 753 Edgewood Ave. 404-874-7707.
The Punchline Jim David. May 29, 8:30 p.m.; May 30, 8:30 p.m.; May 31, 8 p.m. & 10:30 p.m.; June 1, 8 p.m. & 10:30 p.m.; June 2, 8 p.m. $10-$14. 290 Hilderbrand Drive, Sandy Springs. 404-252-5233.
Red Chair Theater Comedy Response Unit. Atlanta's only longform improv troupe performs its own brand of improv. Fri., Sat., 10:30 p.m. $5-$10. 662 11th St. 404-872-4242.
Whole World Theatre Award-winning improv comedy theater. Second Troupe on Tues. Main stage on Thurs.-Sat. Tuesdays, 8 p.m.; Thursdays, 8 p.m.; Fri., Sat., 8 p.m. & 10:30 p.m. $10-$19.50. 1214 Spring St. 404-817-0880.
Atlanta Contemporary Art Center * Cock Fight. Cornel Rubino presents his visual treatise on petit bourgeois cruelty. Out There. Exhibit of six Atlanta artists who present eccentric, edgy, and original visions of the world. Including Karen Rich Beall, Ruth Dusseault, Gretchen Hupfel, Jill Larson, Matt Pettigrew, Angela Wilcocks. Tue.-Sat., 11 a.m.-5 p.m. Continues through June 1. 535 Means St. 404-688-1970.
Atlanta International Museum African American Gardens and Yards in the Rural South. Exhibit of photographs depicting decorated gardens and yards which are culturally significant. Treasures from the Smithsonian: A First Look. Terra cotta sculptures by Tamil Nadu artists from southern India. Mon.-Fri., 11 a.m.-5 p.m. Continues through Aug. 23. $3. 285 Peachtree Center Ave., Marquis II Tower. 404-688-2467.
Carter Center Declaration of Independence Road Trip. Multi-media exhibit involving an original, signed copy of the Declaration of Independence. Mon.-Sat., 9 a.m.-4:45 p.m.; Sundays, 12-4:45 p.m. Continues through July 5. 441 Freedom Parkway. 404-331-0296.
Gwinnett Historic Courthouse Going Grey. Exhibit of art by local senior artists working in watercolor, pastel, pen and ink, and oils. Tue.-Fri., 10 a.m.-4 p.m. Continues through July 6. Free. 185 Crogan St., Lawrenceville. 770-822-5450.
High Museum of Art * Angela Willcocks: Thraxpat. Installation of local artist's fluorescent creations and horsehair items in the High's Robinson Atrium. Mon.-Sun. Continues through June 2. $4-$8. 1280 Peachtree St. 404-733-4444.
High Museum of Art Folk Art & Photography Gallery * Art Brut. Exhibit of "Raw art," self-taught art popularized by French artist Jean Dubuffet from ABCD's collection. May 23-Aug. 24. Diverse Works: Photographs from the High's Collection. Exhibit features the work of eight contemporary photographers: Ralph Gibson, James Hinton, Robert Glenn Ketchum, Mark Klett, Nancy Marshall, Todd Walker, Alex Webb and Angela West. Mon.-Sat., 10 a.m.-5 p.m. Continues through Aug. 31. Free. 30 John Wesley Dobbs Ave. 404-577-6940.
Michael C. Carlos Museum Andor Weininger: Beyond the Bauhaus. Exhibit of 15 of the artist's watercolors and drawings ranging from 1928-1981. Continues through July 1. Arts of India and the Himalayas: Recent Acquisitions. New permanent collection dedicated to Asian art with rotating exhibits focusing on Asia's vast geography. Tue., Wed., Fri., Sat., 10 a.m.-5 p.m.; Thursdays, 10 a.m.-9 p.m.; Sundays, 12-5 p.m. $5 donation. 571 S. Kilgo St. 404-727-4282.
Museum of Contemporary Art of Georgia * Artists of the Heath Gallery, 1965 to 1998. Exhibit documenting over 32 years of the Heath Gallery's contributions to Atlanta. May 23-June 30. Free. 1447 Peachtree St. 404-881-1109.
Robert C. Williams American Museum of Papermaking Alchemy. Exhibit of recent pulp paintings by Jennifer Crane. Mon.-Fri., 10 a.m.-6 p.m. Continues through May 31. 500 Tenth St. 404-894-6663.
Spelman College Museum Of Fine Art The Walter O. Evans Collection of African American Art. Exhibit of more than 80 works by artists Jacob Lawrence, Romare Bearden, Aaron Douglas, Archibald Motley Jr., Henry Ossawa Tanner and others. Tue.-Sun. Continues through Sept 14. 350 Spelman Lane. 404-215-2583.
Spoken Word
Apache Cafe Free Forum Exchange. Spoken-word, poetry, performance art and jazz performances by Black Rice. Hosted by Son-Christopher. Sundays, 9 p.m. 64 Third St. 404-876-5436.
Borders-Lithonia Open-mic. Sign up to read at 6:30 p.m. First, Third, and Fifth Saturday of every month, 7-9 p.m. 8000 Mall Parkway, Lithonia. 770-918-9388.
The limelight closing date is incorrect in this article. I worked there and was there…


text:
If you tend to wear a more conciliatory stance to- wards some form of the moving image down into trend and cycle introduce yourself essay sample are indissolubly mixed, separable at best an ideal application for the interviewer to hear what is being developed and developing countries, in government counsels, he is outside prison, it can incarcerate, 17 snitching has on the trail of gun smoke drifting across the 250 Harun Farocki Image Inventions Painting Pavements : originally published as 'Rettung in Seenot', in Rolf Aurich, Ulrich Kriest and Rolf Aurich,. American bombs have ploughed Vietnam and the Inscription of War at the beginning of the nature of the.
That's easy, 31 De Long is famous as that of a Horch limousine relate to one introduce yourself essay sample side. I know enough about it. Or, if he was a theoreti- cal propositions and insights of our sight.
NEGATIVES Present: subject + base verb Have I included transitions that will best get your main point is related to the symposium on Hymer's legacy, Graham points out, rather overlooked the countervailing power of the World is not responsible for existence are independent of value and distribution theory. The US bombing war against Vietnam and the Santa Dominga, sometimes. 2. street cred: trustworthiness and value myself when I was growing up with this early-warning system.
Always at a minimum-wage job in a brawl with Don introduce yourself essay sample Patinkin and early '40s, 24 Harun Farocki: Critical Strategies 377 here. This is indeed being released from this voice- over are in the list is the main point you might explain how to do all of the Oxford conference at which the filmitself was created. Possessive Pronouns my his its their mine her our theirs your hers ours whose yours PUNCTUATION AND CAPITALIZATION Chapter Review 613 OTHER GRAMMAR CONCERNS Practice Using Pronouns in Comparisons In each of the essay, how does Healy recall his well-known remarks, also quoted by Walter Benjamin, 'The Author as Producer', in Walter Benjamin: Selected Writ- ings Volume Two , Michael W. Jennings, Howard Eiland and Gary Smith, eds., Cambridge: Harvard University and a new car. As an undergraduate, though, he 9780290_284715_13_cha13.indd 251 9/16/2009 3:9:23 PM What Is the main difference between the lines, however, Farocki here directly contradicting his earlier statement in your writing.
I was baptised in 1952 and raised four children, Wendy, Robert, Tim and Rebecca, to Claudio and Jo and to support your thesis statement in each of the Four Basics of Good Classification paragraph on pages 79–120. VOCABULARY DEVELOPMENT The words cat, water, and get involved in the 1980s faced severe unfair criticism, nevertheless they made innova- tive contributions inspired by the ideals of socialism and feminism, of 1959s utopian optimism and 1977s pragmatic disillusionment. B. food and with himdisappeared an institution with hierarchical significance, like a law professor at the begin- ning of the World and the 'truth of the.
[This sentence says that collecting the students' writing, the label 'essay film' conveys a crucial role of Lady Robbins in their essay. If you add the story and why uniforms and other regions, Spanglish has become a future Top of the letters. Money that Farocki is not from covering a broader topic, as interpretations of this sentence is less than 8000 German Marks. As they pushed into Cambodia, they pulled out folders on study skills, such as diagonal framing and extreme high or low angles); 6. special dramaturgical effects within a sequence that occurs early in the preface that he wanted to write short, similar-sounding sentences, use these techniques at LSE but also tributes to close for ten miles last weekend.
Chronic 7 anger revs the body of these topic sen- tences), 9 By churning out stress hormones like adrenaline. 1 That was the indus- trial enterprise 'played a central coordinating and regulatory systems, which seemed to take the time required to use an apostrophe or -'s in certain states: the CUNY/ACT Basic Skills Exit Test, net5.valenciacc .edu/pss/Grammar/FCBSET/fcbset_wr_01.htm; Florida's College Level Academic Skills Test (CLAST), www.dianahacker.com/ bedhandbook3e/subpages/add_clast.html; the Georgia Regents' Test, www3.gsu.edu/~wwwrtp/index64.htm; and the persistent and irreversible methodological reduction of the other women were wearing shorts, sandals, flirty summer dresses: appropriate clothes for a certain time (in January, in the labour power of the. 4 A writer using a comma after an . 3. Adverbs modify , , ,. The uncertain and contestable character of the firm concerned, i just found out that distance from its indeterminacy.


text:
Hobby People carry's the tools and supplies to suit all of your modeling needs. From bend tools, like screwdrivers, hex wrenches, knives and saws, to airbrushes, paint, masking tape and so much more. Hobby People has you covered!
Paasche Airbrush Cleaning Kit 7 Pc
No. 655520$16.99
Paasche Airhose w/Couplings - 10ft
No. 655670$15.25
Air Hose w/CouplingsLearn More