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Mortality study of civilian employees exposed to contaminated drinking water at USMC Base Camp Lejeune: A retrospective cohort study
Bove F.J.,Agency for Toxic Substances and Disease Registry ATSDR |
Ruckart P.Z.,Agency for Toxic Substances and Disease Registry ATSDR |
Maslia M.,ATSDR |
Larson T.C.,Agency for Toxic Substances and Disease Registry ATSDR
Environmental Health: A Global Access Science Source | Year: 2014
Background: Two drinking water systems at U.S. Marine Corps Base Camp Lejeune, North Carolina were contaminated with solvents during 1950s-1985. Methods. We conducted a retrospective cohort mortality study of 4,647 civilian, full-time workers employed at Camp Lejeune during 1973-1985 and potentially exposed to contaminated drinking water. We selected a comparison cohort of 4,690 Camp Pendleton workers employed during 1973-1985 and unexposed to contaminated drinking water. Mortality follow-up period was 1979-2008. Cause-specific standardized mortality ratios utilized U.S. age-, sex-, race-, and calendar period-specific mortality rates as reference. We used survival analysis to compare mortality rates between Camp Lejeune and Camp Pendleton workers and assess the effects of estimated cumulative contaminant exposures within the Camp Lejeune cohort. Ground water contaminant fate/transport and distribution system models provided monthly estimated contaminant levels in drinking water serving workplaces at Camp Lejeune. The confidence interval (CI) indicated precision of effect estimates. Results: Compared to Camp Pendleton, Camp Lejeune workers had mortality hazard ratios (HRs) >1.50 for kidney cancer (HR = 1.92, 95% CI: 0.58, 6.34), leukemias (HR = 1.59, 95% CI: 0.66, 3.84), multiple myeloma (HR = 1.84, 95% CI: 0.45, 7.58), rectal cancer (HR = 1.65, 95% CI: 0.36, 7.44), oral cavity cancers (HR = 1.93, 95% CI: 0.34, 10.81), and Parkinson's disease (HR = 3.13, 95% CI: 0.76, 12.81). Within the Camp Lejeune cohort, monotonic exposure-response relationships were observed for leukemia and vinyl chloride and PCE, with mortality HRs at the high exposure category of 1.72 (95% CI: 0.33, 8.83) and 1.82 (95% CI: 0.36, 9.32), respectively. Cumulative exposures were above the median for most deaths from cancers of the kidney, esophagus, rectum, prostate, and Parkinson's disease, but small numbers precluded evaluation of exposure-response relationships. Conclusion: The study found elevated HRs in the Camp Lejeune cohort for several causes of death including cancers of the kidney, rectum, oral cavity, leukemias, multiple myeloma, and Parkinson's disease. Only 14% of the Camp Lejeune cohort died by end of follow-up, producing small numbers of cause-specific deaths and wide CIs. Additional follow-up would be necessary to comprehensively assess drinking water exposure effects at the base. © 2014 Bove et al.; licensee BioMed Central Ltd. Source
Bowler R.M.,San Francisco State University |
Beseler C.L.,Colorado State University |
Gocheva V.V.,San Francisco State University |
Colledge M.,ATSDR |
And 5 more authors.
Science of the Total Environment | Year: 2016
Background: Manganese (Mn) inhalation has been associated with neuropsychological and neurological sequelae in exposed workers. Few environmental epidemiologic studies have examined the potentially neurotoxic effects of Mn exposure in ambient air on motor function and hand tremor in adult community residents. Mn exposed residents were recruited in two Ohio towns: Marietta, a town near a ferro-manganese smelter, and East Liverpool, a town adjacent to a facility processing, crushing, screening, and packaging Mn products. Methods: Chronic (≥. 10 years) exposure to ambient air Mn in adult residents and effects on neuropsychological and neurological outcomes were investigated. Participants from Marietta (n. = 100) and East Liverpool (n. = 86) were combined for analyses. AERMOD dispersion modeling of fixed-site outdoor air monitoring data estimated Mn inhalation over a ten year period. Adult Mn-exposed residents' psychomotor ability was assessed using Finger Tapping, Hand Dynamometer, Grooved Pegboard, and the Computerized Adaptive Testing System (CATSYS) Tremor system. Bayesian structural equation modeling was used to assess associations between air-Mn and motor function and tremor. Results: Air-Mn exposure was significantly correlated in bivariate analyses with the tremor test (CATSYS) for intensity, center frequency and harmonic index. The Bayesian path analysis model showed associations of air-Mn with the CATSYS non-dominant center frequency and harmonic index; while the Bayesian structural equation model revealed associations between air-Mn and lower Finger Tapping scores. Household income was significantly associated with motor dysfunction but not with tremor. Conclusion: Tremor and motor function were associated with higher exposure to airborne Mn. © 2015 Elsevier B.V. Source
Bowler R.M.,San Francisco State University |
Adams S.W.,San Francisco State University |
Wright C.W.,San Francisco State University |
Kim Y.,University of Ulsan |
And 4 more authors.
International Journal of Environmental Health Research | Year: 2016
This report describes the use of medications as a proxy when medical record reviews are unavailable, to study the health effects of residents environmentally exposed to air-manganese (n = 185) compared to unexposed residents (n = 90). Participants' current medication lists and medication questionnaire responses were collected in clinical interviews and categorized into 13 domains. Exposed participants reported fewer hours of sleep than controls (6.6 vs. 7.0). The exposed used significantly more medications than unexposed participants (82.2 % vs. 67.8 %) and, when adjusting for age, education, and personal income, also for pain (aOR = 2.40) and hypothyroidism (aOR = 7.03). Exposed participants with higher air-Mn concentrations, monitored for 10 years by the U.S. Environmental Protection Agency, were 1.5 times more likely to take pain medications. The exposed participants take significantly more medications than unexposed participants in the categories of hypothyroidism, pain, supplements, and total medications. © 2016 Informa UK Limited, trading as Taylor & Francis Group Source
Evaluation of mortality among marines and navy personnel exposed to contaminated drinking water at USMC base Camp Lejeune: A retrospective cohort study
Bove F.J.,Agency for Toxic Substances and Disease Registry ATSDR |
Ruckart P.Z.,Agency for Toxic Substances and Disease Registry ATSDR |
Maslia M.,ATSDR |
Larson T.C.,Agency for Toxic Substances and Disease Registry ATSDR
Environmental Health: A Global Access Science Source | Year: 2014
Background: Two drinking water systems at U.S. Marine Corps Base Camp Lejeune, North Carolina were contaminated with solvents during 1950s-1985. Methods. We conducted a retrospective cohort mortality study of Marine and Naval personnel who began service during 1975-1985 and were stationed at Camp Lejeune or Camp Pendleton, California during this period. Camp Pendleton's drinking water was uncontaminated. Mortality follow-up was 1979-2008. Standardized Mortality Ratios were calculated using U.S. mortality rates as reference. We used survival analysis to compare mortality rates between Camp Lejeune (N = 154,932) and Camp Pendleton (N = 154,969) cohorts and assess effects of cumulative exposures to contaminants within the Camp Lejeune cohort. Models estimated monthly contaminant levels at residences. Confidence intervals (CIs) indicated precision of effect estimates. Results: There were 8,964 and 9,365 deaths respectively, in the Camp Lejeune and Camp Pendleton cohorts. Compared to Camp Pendleton, Camp Lejeune had elevated mortality hazard ratios (HRs) for all cancers (HR = 1.10, 95% CI: 1.00, 1.20), kidney cancer (HR = 1.35, 95% CI: 0.84, 2.16), liver cancer (HR = 1.42, 95% CI: 0.92, 2.20), esophageal cancer (HR = 1.43 95% CI: 0.85, 2.38), cervical cancer (HR = 1.33, 95% CI: 0.24, 7.32), Hodgkin lymphoma (HR = 1.47, 95% CI: 0.71, 3.06), and multiple myeloma (HR = 1.68, 95% CI: 0.76, 3.72). Within the Camp Lejeune cohort, monotonic categorical cumulative exposure trends were observed for kidney cancer and total contaminants (HR, high cumulative exposure = 1.54, 95% CI: 0.63, 3.75; log 10 β = 0.06, 95% CI: -0.05, 0.17), Hodgkin lymphoma and trichloroethylene (HR, high cumulative exposure = 1.97, 95% CI: 0.55, 7.03; β = 0.00005, 95% CI: -0.00003, 0.00013) and benzene (HR, high cumulative exposure = 1.94, 95% CI: 0.54, 6.95; β = 0.00203, 95% CI: -0.00339, 0.00745). Amyotrophic Lateral Sclerosis (ALS) had HR = 2.21 (95% CI: 0.71, 6.86) at high cumulative vinyl chloride exposure but a non-monotonic exposure-response relationship (β = 0.0011, 95% CI: 0.0002, 0.0020). Conclusion: The study found elevated HRs at Camp Lejeune for several causes of death including cancers of the kidney, liver, esophagus, cervix, multiple myeloma, Hodgkin lymphoma and ALS. CIs were wide for most HRs. Because <6% of the cohort had died, long-term follow-up would be necessary to comprehensively assess effects of drinking water exposures at the base. © 2014 Bove et al.; licensee BioMed Central Ltd. Source
Chou S.,ATSDR
Proceedings of the Air and Waste Management Association's Annual Conference and Exhibition, AWMA | Year: 2010
The Agency for Toxic Substances and Disease Registry's (ATSDR) mission is to serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances. A discussion on ATSDR activities on H 2S health effects covers the Priority List of Hazardous Substances; determining levels of exposure that present a significant risk to human health; research areas with data gaps; public health assessment; health consultations; and exposure investigation; and sources of H 2S, e.g., oil fields. This is an abstract of a paper presented at the 103rd AWMA Annual Conference and Exhibition (Calgary, Alberta, Canada 6/22-25/2010). Source


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Dawn Meyerriecks is leaving her post at the Office of the Director of National Intelligence for a tech-related position with the Central Intelligence Agency's Directorate of Science and Technology team.
Wired first reported Meyerriecks' move on April 30, with the current Assistant Director of National Intelligence for Acquisition, Technology & Facilities expected to begin her new position as CIA's deputy director for science and technology shortly.
Meyerriecks has held a variety of tech-related positions over the past decade, including from 2004 to 2006 as AOL's Senior VP for product technology, where she was responsible for developing a slew of consumer-facing products, including the relaunch of AOL Instant Messenger, aol.com and Messenger's open-client platform.
She also spent a decade at Defense Information Systems Agency as chief technology officer of its Joint Interoperability and Engineering Organization and worked at NASA's Jet Propulsion Laboratory as a senior engineer prior to her time at DISA. Meyerriecks was a judge for FCW's most recent Federal 100 awards. She is a past Fed 100 winner herself, and was GCN's Defense Executive of the Year in 2004.
"The CIA is pleased to have Dawn's experience and expertise on the senior leadership team," said CIA spokesman Preston Golson. "Director [John] Brennan is proud that officers of the CIA's DS&T are proven innovators, and is confident Dawn will add to this tradition of excellence."
In a statement, Director of National Intelligence James Clapper said "filling Dawn's shoes will be no easy task."
"Dawn has done truly incredible work at ODNI and leaves a legacy of aligning and integrating the acquisition, S&T research and facilities communities across the entire IC," Clapper said. "She focused the workforces of these very different disciplines on their common mission of integrating technology into operations. I know she will be a terrific addition to the CIA Directorate of Science and Technology team." Clapper added that ODNI has a strong team and personnel ready to continue ongoing projects.
Meyerriecks will be replaced by Kevin Meiners, who previously served the Undersecretary of Defense for Intelligence.
"The continued ascent of acquisition and technology in the IC is due in no small part to Dawn's vision and leadership, and she leaves a strong ODNI team in place to continue her work," Clapper said.
Posted by Frank Konkel on May 01, 2013 at 12:10 PM
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Poipu Beach is a 5.1 mile lightly trafficked out and back trail located near Koloa, Hawaii and is good for all skill levels. The trail is primarily used for hiking and walking and is accessible year-round.
kid friendly
2 months ago
Great trail! Easily accessible, over looking the water most of the time.
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Stunning trail as you overlook the ocean during the hike.


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Nicole's out of X Factor USA too!
Nicole Scherzinger and Paula Abdul join Steve Jones among the departures
Advertisement - Continue Reading Below
Not only have we just heard the news that Steve Jones is leaving The X Factor, but now two judges are leaving too!
Nicole Scherzinger and Paula Abdul have both been booted from the lineup of the show, at Simon Cowell's request.
A source told The Sun:
"Simon wants to take the show in a different direction."
Ouch… No word from either of them yet, but fellow talent-show judge Nigel Lythcoe tweeted:
"Shocked to see Simon has fired Paula Abdul, Nicole and Steve from the X-Factor."
Are you surprised by this move?


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Miami Hurricanes Got Really Excited Over New Uniforms
Sometimes after going through a dark, dramatic period, nothing can do wonders like a brand-new wardrobe. Apparently, that was the Miami Hurricanes and Nike's thinking as they unveiled a new set of uniforms this weekend. Similar to other special-edition uniforms the team has worn in recent years, the full set is perhaps one of the biggest changes in the team's history.
If the players' reactions to the unveiling was any indication, they're a big hit.
Yeah, we'd say they went over well.
The uniforms come in four basic colors: white for home games, orange for road games, and special-edition green and "smoke" uniforms. Mixing and matching of the various colors will be possible.
The designs are somewhat reminiscent of the work Nike has done for the Oregon Ducks, except a bit more subtle. In fact, those Ducks uniforms are famous for the odd feather print featured on some versions. The Hurricanes' new uniforms also feature some avian-inspired elements, but they're far more subdued.
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text:
Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in Northern Ghanaian schoolchildren
Ernest Cudjoe Opoku1,2*, Annette Olsen3, Edmund Browne4, Abraham Hodgson1, John K. Awoonor-Williams5, Lawrence Yelifari5, John Williams1 and Pascal Magnussen3,6
1Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana; 2Copenhagen School of Global Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark; 4Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 5Regional Health Directorate, Ghana Health Service, Bolgatanga, Ghana; 6Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Background: The benefits of integrated control of malaria, schistosomiasis, and soil-transmitted helminth infections have not been fully explored in Ghanaian schoolchildren.
Objective: To assess the impact of co-administered artemether-lumefantrine plus albendazole, and artemether-lumefantrine plus albendazole plus praziquantel compared to albendazole plus praziquantel on anaemia, sustained attention, and recall in schoolchildren.
Design: This three-arm, open-label intervention study was carried out in Ghana among class three schoolchildren. Artemether-lumefantrine and albendazole were co-administered to 131 schoolchildren in Study Arm 1; artemether-lumefantrine, albendazole, and praziquantel to 90 children in Study Arm 2 versus albendazole and praziquantel to 127 children in Control Arm 3. Medicines were administered to all children at least 30 min after a meal. A HemoCue® photometer was used to measure haemoglobin (Hb), while the code transmission test (CTT), adapted from the Test of Everyday Attention for Children (TEA-Ch), was used to measure sustained attention and recall before-and-after interventions in June 2011 and June 2012.
Results: We observed significant malaria parasite prevalence reductions of 62.8 and 59.2% in Study Arm 1 from 24.2 to 9.0%, p<0.01, and 59.2% in Study Arm 2 from 26.7 to 10.9%, p<0.01), respectively, compared to 8.93% in Control Arm 3 (from 34.7 to 31.6%, p>0.05). Meanwhile, anaemia prevalence reduced significantly (p<0.01) in all three study arms after interventions by 38.4% (from 19.8 to 12.2%), 20.7% (from 26.6 to 21.1%), and 36.0% (from 28.3 to 18.1%) in Study Arms 1, 2, and 3, respectively. Although the interventions had no significant effects on Hb levels, anaemia prevalence reduced insignificantly by 38.4 and 20.7% in Study Arms 1 and 2, respectively, compared to 36.0% in Control Arm 3. Among schoolchildren in Study Arms 1 and 2, mean CTT score improved significantly after interventions by 10.4% (from 3.18 to 3.55, p=0.01) and 20.5% (from 2.83 to 3.56, p=0.01) respectively, compared to 5.75% in Control Arm 3 (from 2.95 to 3.13, p=0.09). Likewise, mean recall test score improvements after interventions were 16.9% (from 2.07 to 2.49, p=0.01) and 27.9% (from 1.91 to 2.65, p=0.01) in Study Arms 1 and 2, respectively, compared to 18.3% (from 1.92 to 2.35, p=0.01) in Control Arm 3.
Conclusion: Combined intermittent preventive treatment of malaria and deworming reduced prevalence of anaemia and improved sustained attention and recall in schoolchildren. Best results for sustained attention and recall were seen in Study Arm 2.
Keywords: co-administered intermittent preventive treatment of malaria and deworming; anaemia; sustained attention; recall; schoolchildren
Citation: Glob Health Action 2016, 9: 32197 - http://dx.doi.org/10.3402/gha.v9.32197
Responsible Editor: Peter Byass, Umeå University, Sweden.
Copyright: © 2016 Ernest Cudjoe Opoku et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
Received: 9 May 2016; Revised: 3 August 2016; Accepted: 19 August 2016; Published: 14 September 2016
Competing interests and funding: The authors declare that there were no conflicts of interest in relation to this study. This study was funded by a PhD grant to Ernest Cudjoe Opoku by the Danish International Development Agency (DANIDA) through the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
*Correspondence to: Ernest Cudjoe Opoku, c/o Navrongo Health Research Centre, Ghana Health Service, P.O Box 114, Navrongo, Ghana, Email: email@example.com
A Corrigendum has been published for this paper. Please see http://www.globalhealthaction.net/index.php/gha/article/view/33548
Malaria is a major public health challenge in sub-Saharan Africa, is associated with high morbidity and mortality, and affects economic growth and development (1, 2). However, school-age children, who are most susceptible to schistosomiasis and soil-transmitted helminth (STH) infections, tend to harbour malaria parasites without symptoms in high malaria transmission regions (3–5). Repeated attacks of uncomplicated malaria and chronic asymptomatic malaria parasitaemia in school-age children are common and may result in anaemia, stunting, school absenteeism, and reduced cognitive abilities in schoolchildren in high transmission regions (5, 6). Yet, many malaria control programmes in sub-Saharan Africa lack policy and guidelines on how asymptomatic malaria should be dealt with in the most at-risk group: schoolchildren. Although the targeted population in the World Health Organization's (WHO) strategies and guidelines for the control of schistosomiasis and STHs through chemotherapy is school-age children (3, 4, 7), the global malaria chemoprevention strategy targets pregnant women and children under the age of 5 years (1). Tackling asymptomatic malaria parasitaemia in school-age children is not only right, appropriate, and ethical, but also relevant in the light of global plans to attain malaria elimination and eradication (2, 5, 6, 8).
Intermittent preventive treatment (IPT) of malaria was proposed as one of the strategies schools and health managers in high malaria transmission regions could use to deal with uncomplicated and asymptomatic malaria in schoolchildren (2, 5, 6, 9). IPT is the term used to describe the administration of a full curative dose of an antimalarial to a selected, target population at specified times without determining whether or not the subjects are infected (9). Previous studies have shown that an IPT programme in schools benefits schoolchildren's health and learning capability (9–12), and artemisinin-based combination therapy (ACT) has been used successfully for IPT in malaria endemic countries such as Mali, Uganda, and Ghana (13–15). Moreover, previous studies have shown that when an ACT is used in an IPT programme in an area where malaria and schistosomiasis coexist, the added benefit of schistosomiasis control could be derived (16, 17). However, these findings have not been fully translated into policy to benefit children across sub-Saharan Africa, even though there could be positive results integrating the control of neglected parasitic diseases and malaria (18–21).
In Ghana, most disease control activities implemented by the Ghana Health Service (GHS), including neglected tropical diseases (NTDs), malaria, HIV/AIDS, and tuberculosis, are donor-funded and run as vertical programmes. Even though they are associated with successes, most vertical control programmes are known to incorporate donor interests and dictates and political economics. Apart from addressing some aspects of the specific disease entity, they rarely lead to the strengthening of health systems and have been associated with health system fragmentation and disruption of health services (18, 22–24).
Following attainment of lower middle income status, Ghana has been experiencing dwindling donor support for its health sector, and funding support from the government of Ghana to the GHS has been reduced significantly (24). Recently, the GHS and its health partners have advocated for integrated programming. One successful integrated programme has been NTDs control, with regular distribution of ivermectin, praziquantel, and albendazole/mebendazole against lymphatic filariasis, onchocerciasis, schistosomiasis, and STH based on WHO guidelines (7). However, the control of malaria has not been integrated with the control of the aforementioned NTDs. Little or no knowledge exists regarding how integrated control of malaria, schistosomiasis, and STHs could benefit the most at-risk populations – school-age children, and there is a lack of policy and guidelines regarding how this integrated approach could work in Ghana. Having a policy framework to guide the integrated control of parasitic infections through the use of anti-parasitic drugs is vital. Some of the key ingredients required are 1) an all-encompassing policy to guide implementation, 2) evidence that integrated control benefits the targeted population, 3) evidence of safety and tolerability of the co-administered anti-parasitic drugs, and 4) cost effectiveness (3, 4, 18–21).
With the objective of providing evidence to support the development of an integrated policy for the control of malaria, schistosomiasis, and STHs in schoolchildren using chemotherapy, this study, as a part of a larger investigation, sought to determine whether IPT targeted at the high malaria transmission season (rainy season), combined with deworming, would reduce the prevalence of malaria parasitaemia and anaemia as well as improve sustained attention and recall in schoolchildren. This study therefore attempted to answer the research question: to what extent would co-administered IPT with artemether-lumefantrine and albendazole plus or minus praziquantel reduce anaemia prevalence and improve sustained attention and recall in schoolchildren when compared with albendazole plus praziquantel?
Study area and population
The study was carried out in six primary schools in the Kassena-Nankana Districts (KNDs) of the Upper East Region, Ghana, where poverty, malnutrition, anaemia, and malaria represent major public health challenges (25, 26). The KNDs lie within the Guinea Savannah woodlands between latitudes 10°30'–11°00' N and longitudes 1°00'–1°30' W. The KNDs have a population of about 150,000 inhabitants dispersed in mostly rural settings. The main occupation of the people is subsistence farming (millet, rice, sorghum, and livestock) and petty trading. On average, annual rainfall is about 850–950 mm (almost all in the months of May to September). The average annual temperature ranges from 18 to 45°C. Mosquito-breeding sites are found all year round due to the presence of a major irrigation dam (Tono Irrigation Project) and numerous smaller dams throughout the KNDs.
Malaria is caused predominantly by Plasmodium falciparum and is transmitted by Anopheles gambiae, An. Funestus, and An. arabiensis mosquito vectors in Ghana. Malaria transmission is most intense in the KNDs during the rainy season (May to November), but the entomological inoculation rate varies across Ghana's southern, forest, and northern savannah ecological zones (27–29). Previous studies in the KNDs have described a high incidence of malaria and anaemia in children and large numbers of school days lost due to malarial infection (30–32).
Ghana's National Malaria Control Programme (NMCP) implements a strategic plan and, over the past 10 years, the NMCP has performed creditably, reducing malaria-related mortality and morbidity. Yet in 2013, for instance, malaria was responsible for more than 11 million reported outpatient health facility visits and 2,506 deaths. However, only 48% of the 11 million reported cases were tested either by microscopy or rapid diagnostic tests and, of those tested, 1,639,451 cases were confirmed positive (24). The NMCP's 'test, treat, and track' policy recommends artesunate-amodiaquine as a first-line drug and artemether-lumefantrine as an alternative for uncomplicated malaria treatment. Even though an IPT policy during pregnancy exists, using sulphadoxine-pyrimetamine, Ghana lacks an IPT policy against malaria in infants and schoolchildren (1). The lymphatic filariasis control programme of the GHS has been distributing ivermectin and albendazole annually in all primary schools in the Upper East Region of Ghana, but praziquantel and mebendazole are added occasionally for the control of schistosomiasis and STHs in the KNDs (33).
Ghana has a fee-free primary school education policy. Ghana's educational system has expanded, and more than 90% of eligible children are enrolled in primary schools. Yet, high teacher absenteeism, low teacher-pupil contact time, poor physical infrastructure, and lack of teaching and learning aids, remain challenges and negatively impact educational outcomes (34). The population for this study consisted of class three schoolchildren in the Naaga, Biu, Akurugu Daabo, Kayoro, Katiu, and Nania communities of the KNDs in Ghana.
Study design and interventions
The study was a three-arm, open-label, before-after intervention study including a control arm. The study design, as agreed on with the GHS managers at the regional and district health directorates was to be as close as possible to 'real-life' implementation of the mass drug administration of ivermectin, albendazole, and praziquantel, and was to explore the feasibility of combining IPT of malaria with schistosomiasis and/or STH chemotherapy in school health programmes and assessing the health and cognitive impacts. The four parts of the study were 1) a baseline study to assess the situation in the study area prior to interventions; 2) an evaluation of the impact of the intervention on health and educational capabilities of the schoolchildren; 3) a safety and tolerability study recording adverse drug reactions (ADRs), adverse events (AEs), and serious adverse events (SAEs); and 4) an end-term study to evaluate and document the findings from the various sub-studies. The study sought to answer the following research questions:
- Will IPT with artemether-lumefantrine add to the effect of albendazole and praziquantel in the reduction of the prevalence of the anaemia, malaria, and schistosomiasis burden 1 year after mass treatment?
- Will IPT with artemether-lumefantrine combined with deworming improve sustained attention and recall better than anthelminthic given alone?
- Is IPT with artemether-lumefantrine as effective as praziquantel in reducing the prevalence and intensity of schistosomiasis?
- Is artemether-lumefantrine combined with albendazole and praziquantel safe and tolerated among schoolchildren?
The three arms of the study were:
Arm 1: Artemether-lumefantrine and albendazole (131 children in Naaga and Kayoro primary schools)
Arm 2: Artemether-lumefantrine, albendazole, and praziquantel (90 children in Biu and Katiu primary schools)
Arm 3: Praziquantel and albendazole (127 children in Akurugu Daabo and Nania primary schools)
Study Arms 1 and 2 were the intervention arms, while Control Arm 3 was the control arm.
Inclusion and exclusion
Only primary schoolchildren in class three with no known history of allergy or adverse reactions to any of the study medications were included in this study. We included only class three based on the WHO recommendation for community-based evaluations of schistosomiasis and STH control programs (7). We excluded class three schoolchildren who were grossly sick (including children with severe malaria and those severely anaemic) or those whose parents did not grant informed consent.
Selection of participating schools
The Navrongo Demographic Surveillance System, run by the Navrongo Health Research Centre (NHRC), serves the KNDs and demarcates the districts into five geographic zones (east, west, north, south, and central) relative to the location of the communities to Navrongo, the traditional capital city of the KNDs. We used a purposive sampling technique. We selected the six primary schools because they were at least 10 km from Navrongo, and they had a community clinic or community health and planning services (CHPS) compound. Conveniently, two primary schools in the south (Naaga and Biu), two in the west (Kayoro and Katiu), and one school each from the east (Akurugu Daabo) and north (Nania) were selected for the survey. No primary schools were selected from the central zone due to repeated administration of praziquantel and mebendazole by the District Health Directorate in Navrongo. This ensured a fair representation of the districts based on previous data on Schistosoma haematobium and malaria transmission (30–33). Using a lottery, we randomly selected Kayoro and Naaga for Study Arm 1, Katiu and Biu for Study Arm 2, and Nania and Akurugu Daabo for Control Arm 3.
Determination of malaria parasitaemia, haemoglobin levels, and anaemia
Thick blood films from finger prick blood were prepared, air-dried, Giemsa-stained, and examined for malaria parasites against 200 white blood cells (WBCs) by two experienced microscopists at the regional hospital laboratory in Bolgatanga. One hundred high-power fields were counted before a film was declared negative. A third experienced microscopist in the NHRC conducted a quality assurance reading of 10% of the slides. In the case of a discrepancy, slides were recounted until a consensus was obtained. Haemoglobin (Hb) was measured with a HemoCue® photometer, and anaemia was defined as an Hb concentration <11.0 g/dl.
Sustained attention testing
To determine sustained attention, the code transmission test (CTT) battery of the Test of Everyday Attention for Children was adapted (35). A list of digits were prerecorded on a tape and read one digit per second. Grouping children in 10 per session, the tape was played and children listened out for a 'code', which was the consecutive occurrence of the digit 5, and wrote down the number preceding the code. Two demonstration sessions were undertaken prior to the test. CTT 'A' was administered before interventions in June 2011, and CTT test 'B' at the end of the study in June 2012. Scores were based on the number of correct codes identified (one to five). To complement CTT, we adapted and used the mini-mental state tests in which study participants spelt 'WORLD' backwards (36, 37). We asked each participant, for example, to spell the word 'chalk' backwards. The score was the number of letters in the correct order spanning zero to five (e.g. klahc=5, klkac=3, etc.).
Recall testing
We determined recall by asking study participants to recall the names of three objects (lizard, pencil, and mango) previously mentioned by the investigator after 10 min. A score of one was allotted to each correct answer up to a maximum of three (37, 38).
Drug administration
We administered artemether-lumefantrine (20/120 mg), in a standard 3-day schedule according to body weight, twice per day in June, September, and December 2011. Albendazole (400 mg) was given in June and December 2011, based on the District Health Directorates' STHs control plans. Praziquantel, 40 mg/kg body, was given only in June 2011. Each study participant ate a meal about 30 min prior to interventions, and all medicines were administered with a cup of clean water. All children were observed for about an hour after drug intake. We used both active and passive follow-up to collect information on ADRs, SAEs, and AEs from each study child from the day medicines were administered up to 28 completed days after treatment. Active follow-up involved community health officers and field workers visiting each study participant daily at home to collect information on ill health after interventions. Passive follow-up involved visiting community clinics and/or making telephone calls to parents and gathering information on ill-health events after interventions.
Ethical considerations
Ethical clearance was obtained from the Navrongo Health Research Centre Institutional Review Board (NHRC-IRB), Navrongo, Ghana, in January 2011, reference NHRCIRB098. The study was registered with ClinicalTrials.gov (Identifier: NCT01459146). The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2008.
Prior to data collection, consultations with programme heads for both NMCP and NTDs were held to present and discuss the study design and implementation strategy according to existing guidelines (38–40). Permission was sought from regional and district health and education directors and managers as well as community chiefs and leaders. Community meetings and durbars were held to discuss the study with community members in all six participating communities; clarifications were made and answers to questions raised were given. The NHRC-IRB approved written informed consent and assent forms that were in English and in the three local languages: Kasem, Nankam, and Buli. A community health officer and an NRHC 'field worker' (both trained in the IRB-approved study protocol) visited parents/guardians in their homes, explained the study to them in the local languages, and invited them to visit the community clinic or CHPS compound the next day. In the clinic/CHPS, the study physician presented the informed consent form to each parent/guardian who, upon agreement, either signed or thump-printed the form. Parents/guardians and children were told that participation in the study was voluntary and that they could withdraw from the study at any time.
Data management
Data were entered into Excel files independently by two data entry officers of the NHRC, then merged and harmonized, cleaned, and analysed with STATA® version 11 SE (Stata Corp., College Station, TX, USA). Means and standard deviations were constructed for continuous variables such as Hb level, CTT, and recall test scores. With categorical variables such as sex, presence of malaria, and anaemia, we computed proportions and 95% confidence intervals. Chi-square and Fisher's test were used to compare proportions. All statistical tests were two-sided at a significance of alpha <0.05.
Characteristics of study participants
Overall, 378 class three schoolchildren were registered, but 10 parents (of six boys and four girls; three in Biu, two each in Kayoro and Naaga, and one each in Katiu, Nania and Akurugu Daboo primary schools) declined consent due to the fear of side effects. Eight children who were grossly ill (five with severe anaemia and three with severe malaria) were excluded from the interventions and were referred to the War Memorial Hospital for treatment. A total of 360 parents/guardians gave informed consent, and all children assented to participate. However, 12 children (three in Study Arm 1, four in Study Arm 2, and five in Control Arm 3) dropped out because their parents had relocated to communities outside the KNDs.
The characteristics of the study participants are summarized in Table 1.
Impact of interventions on malaria parasitaemia
Table 2 shows the prevalence of malaria parasitaemia and moderate anaemia at baseline. After intervention, significant changes in malaria parasite prevalence were observed in Study Arms 1 and 2 but not in the Control Arm 3, as shown in Table 3.
Impact of interventions on anaemia prevalence
There were no significant changes in Hb levels within the study arms (Table 3). However, anaemia prevalence reduced from 19.8% (26/131) at baseline in Study Arm 1 to 12.2% (16/131) after intervention (reduction: 38.4%). In Study Arm 2, anaemia prevalence reduced from 26.7% (24/90) before interventions to 21.1% (19/90) after interventions (reduction: 20.7%). In Control Arm 3, anaemia prevalence reduced from 28.3% (36/127) before treatment to 18.1% (23/127) after treatment (reduction: 36.0%). Comparing anaemia prevalence risk reduction in Study Arms 1 and 2 to that of Control Arm 3, the relative risks were 1.07 and 0.58, respectively, but anaemia prevalence risk reduction between Study Arms 1 and 2 was 1.38.
Impact of interventions on sustained attention
The impact of interventions on sustained attention scores, represented by the mean CTT scores, is presented in Table 4. Scores improved by 10.4% after interventions in Study Arm 1 and 20.5% in Study Arm 2. In Control Arm 3, however, mean CTT scores only improved by 5.75% post-intervention. When we compared the mean CTT score improvements in Study Arms 1 and 2 to that of Control Arm 3, the rate ratios are 1.81 and 3.57, respectively.
Impact of interventions on recall test scores
Table 5 presents the impacts of interventions on mean recall test scores among schoolchildren. Mean recall test scores improved by 16.9% in Study Arm 1; but in Study Arm 2, recall test scores improved by 27.9% compared to 18.3% improvement in Control Arm 3. Comparing the improvement in mean recall test score for Study Arms 1 and 2 to that of Control Arm 3, the improvement rate ratios were 1.08 and 1.52, respectively.
Study findings showed that co-administration of IPT for malaria and deworming was associated with a significant reduction in malaria parasite prevalence after interventions in Study Arms 1 and 2 when compared to Control Arm 3, where no antimalarial drug was given. This result is consistent with findings from previous IPT trials involving schoolchildren elsewhere in sub-Saharan Africa in which IPT reduced malaria prevalence remarkably (10, 11, 13–15).
However, the impact of IPT on anaemia varied: some studies observed significant reductions in anaemia prevalence, although others did not (10, 11, 13–15). In our opinion, artemether-lumefantrine could be the medicine exerting this significant antimalarial effect because it is already known that anthelminthic drugs, such as albendazole and praziquantel, have no impact on malaria parasites (41). However, the slight reduction in malaria parasite prevalence observed in Control Arm 3 could be due to the use of insecticide-treated bed nets, self-medication with antimalarial medicines, treatment with antimalarial medicines by community-based agents and chemical sellers, or to the year-to-year variation in transmission level of the study area (29–32, 34). These same factors could be responsible for the variations in malaria parasite prevalence observed between Study Arms 1 and 2 after the interventions.
The study findings showed that the co-administration of IPT and deworming was associated with no significant reductions of anaemia prevalence in schoolchildren in the study area. This finding concurs with the results of previous studies in Ghana, Kenya, and Uganda in which IPT and deworming did not significantly reduce anaemia prevalence – even though some reductions in anaemia prevalence were observed after treatment (10, 12, 14, 15, 42). However, anaemia prevalence reduction was slightly higher in the control arm and in Study Arm 1 than in Study Arm 2. This could have been due to many more parasites (for instance, hookworms and S. mansoni) that were responsible for anaemia in the control group and in Study Arm 1 and that were more sensitive to the interventions in Study Arms 1 and 3 than in Study Arm 2.
Although our results could be used to support advocacy efforts for school-age children in regions of the world where malaria, schistosomiasis, and STH coexist who might benefit from both IPT and deworming interventions, we are also of the opinion that other factors that might not have responded to the deworming and IPT interventions might contribute to anaemia in the study area. Poverty, malnutrition, and genetic predispositions to sickle cell disease and glucose-6-phosphatase dehydrogenase (G6PD) deficiencies, for example, are common in the study area (25, 26, 34, 43).
The results of our study suggests that co-administered IPT and deworming could significantly improve schoolchildren's sustained attention and recall. Although these findings concurred with previous studies in which IPT was associated with improved sustained attention and recall (10, 44), our results suggest that schoolchildren could derive more benefits involving sustained attention and recall when artemether-lumefantrine, praziquantel, and albendazole are co-administered. With respect to the differences in sustained attention and recall test scores between Study Arms 1 and 2, even though we are not certain what was responsible for these differences, we think that the addition of praziquantel could be the reason because it afforded children treatment for schistosomiasis in Study Arm 2, but this was not the case in Study Arm 1 (42).
Strengths and limitations
The high prevalence of parasitic infections (including malaria, schistosomiasis, and STHs) in school-age children and the associated effects on their health (including anaemia and growth stunting) and education is a matter of great concern (7–9, 25, 31). Even though an integrated control approach has been advocated for malaria and NTDs, this study (to the best of our knowledge) was the first attempt in sub-Saharan Africa at integrated control of malaria, schistosomiasis, and STHs using co-administered medicines.
Because of limitations due to funding constraints and expansion to accommodate other thematic areas, our study, which was initially designed as a randomized control trial (RCT), had to be changed to an open-label before-after intervention study with a control arm. One key consideration that influenced our dropping the RCT method was that disease control activities in the study area were planned activities not random events. Other considerations were: 1) the purpose of most RCTs is to determine an intervention's net benefit under ideal circumstances (efficacy) either to satisfy food and drug authorities' marketing approval requirements or to provide insights into a disease's aetiology and underlying mechanisms; 2) RCTs are conducted under tightly controlled clinical conditions that are consequently less likely to reflect the conditions under which interventions are used in common clinical practice for parasitic disease control; 3) the results from RCTs frequently do not reach their potential value for health care decision making, which is a serious waste of resources (45–48). On the other hand, the choice of a before-after study with a control arm was informed by our desire to produce results that would be clinically relevant and timely for policy decisions on integrated parasitic disease control in the study area. Although we concede that our choice was not the best for optimal evidence generation, before-after studies with control groups may be especially useful for rapidly evolving interventions and comparative effectiveness research trials designed for dynamic, unique needs of community medical practices and may be consistent with the concept of a 'learning healthcare system' in that it allowed flexible, adaptive, cumulative learning to be incorporated while the trial is being conducted. It is also useful for studying patient or sub-group characteristics that predict response to alternative management strategies (45–48).
Another weakness of the study as the purposive sampling of primary schools and the choice of class three schoolchildren, which may have affected the generalizability of the results. Purposive sampling was determined by the fact that NTD control programmes in Ghana are almost always targeted at specific eco-epidemiologic settings where a disease is most common and hardly are selected by chance! We, however, chose class three schoolchildren because WHO recommends using this age group for intervention evaluation for the control of STHs and schistosomiasis (3, 4, 7).
Although our findings suggested that treating malaria, schistosomiasis, and STHs could be associated with improved sustained attention and recall, poor performance by children in tests of sustained attention and recall must not necessarily be interpreted as frontal-parietal brain or basal brain impairments. It should be noted that, as children grow, their ability to adapt to and focus on classroom learning and to withstand a test of sustained attention improves; they learn new things and gain new experiences that promote their vigilance and recall. Therefore, children taking a similar test one year later are expected to perform better (33–35). Despite the aforementioned limitations, our findings are important and could contribute vital information supporting efforts toward integrated control of malaria, schistosomiasis, and STHs in schoolchildren.
The results of this study suggest that, in an area where malaria, schistosomiasis, and STHs coexist, co-administration of IPT of malaria and deworming to schoolchildren may significantly reduce malaria prevalence, contribute to a reduction in anaemia prevalence, and significantly improve sustained attention and recall. The best results may be obtained when artemether-lumefantrine, albendazole, and praziquantel are co-administered. Further research is needed to confirm these findings, to assess the effects of the interventions on schistosomiasis and STHs, and to study the safety and tolerability of these co-administered medicines.
Authors' contributions
ECO, AO, EB, and PM conceptualized the study. ECO, AO, EB, AH, JKA, LY, JW, and PM all participated in the study design and implementation. ECO drafted the manuscript, with supervision from AO and PM. All authors contributed to editing the manuscript and have read and approved the final version.
The authors thank the schoolchildren, parents/guardians, and teachers who participated in this study. We would like to thank Alhassan Batong and his team at the Bolgatanga Regional Hospital, Bolgatanga, Ghana, for laboratory services supporting this study. The authors acknowledge the support provided by the management and staff of Navrongo Health Research Centre, Navrongo, Ghana. They also thank Victor Asoala, Isaiah Agorinyah, George Atiah, Callistus Ayelizoya, Aurelia Abapale, Stephen Quaye, and Dr. Patrick Ansah for their practical and scientific support during the study.
Paper context
Even though parasitic diseases such as malaria, STHs, and schistosomiasis commonly infect school-age children in parts of Ghana and sub-Saharan Africa, little is known about the benefits of integrated control of these parasitic diseases on anaemia, sustained attention, and recall in schoolchildren. This paper seeks to share information on some of the health and educational benefits derived from the implementation of integrated control of malaria and helminth infections in Northern Ghanaian schoolchildren to guide public health practitioners, managers, and policy-makers. This study was designed to answer the research question: 'To what extent would co-administered IPT with artemether-lumefantrine and albendazole plus or minus praziquantel reduce anaemia prevalence and improve sustained attention and recall in schoolchildren compared with albendazole plus praziquantel as control?'
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By colonna on 19th Sep, 2016
Mulberry Cottage Gardens95 Feedback reviews, 100% positive
Mulberry Cottage Gardens, Award winning gardeners. Reliable and friendly business with vast experience in garden landscaping and design. From fencing to general garden maintenance, no job is too big or too small.
Latest Fencing feedback review:
By mrshunnyset on 19th Jan, 2017
NAT Builders20 Feedback reviews, 95% positive
We are a company cover most aspects in private properties refurbishments. We are reliable with great feedbacks. In every task of our work we are paying attention with professional approach. Seeking customer's satisfaction is the only way to gain higher level skills. It is...
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By hamish9 on 17th Dec, 2016
Dreamscape Gardens & Designs20 Feedback reviews, 95% positive
Tim & Max have many years experience landscape gardening and do this work because they love it. They are innovative, creative, friendly and accommodating, and work to exacting standards - with a tidy on-site approach and a full clean up afterwards. Work is completed on...
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By cardhanw_71 on 16th May, 2016
Nico5 Feedback reviews, 100% positive
Repair and install new fence.
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By user_1rhl on 1st Nov, 2016
Build New Construction8 Feedback reviews, 100% positive
i completed nvq level2 in bricklaying in 2009, Since then I have worked on multiple sites and for various companies whilst self employed, learning many different trades, I then works as a project manager for a small business for 2 years before starting my own company in...
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By crystalp_32 on 29th Jan, 2017
Rosenberrys Ltd19 Feedback reviews, 95% positive
Rosenberrys LTD is here to help, we thrive off happy customer, No job to large or small, let us turn your frown upside down
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By zoltanpinter on 24th Feb, 2016
KK Gardends26 Feedback reviews, 100% positive
I have run a gardening maintain acne and landscaping company for over 25 years. We offer maintainance services from small gardens to large commercial properties. We also install a large variety of fences and design and landscape gardens.
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By charlotte_joy on 22nd Oct, 2016
M&C Paving and General Landscaping166 Feedback reviews, 100% positive
M & C Paving and General Landscaping is a family run business. We are hard-working people with an acute attention to detail and use initiative to complete tasks on time and to a high standard.
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By michael_435 on 5th Nov, 2016
VC Landscapes London Limited104 Feedback reviews, 97% positive
VCLandscapes Ltd is a family run business with over 15 years .We specialise in full Garden Makeover.Patios,Driveways,Decking,Lawn,Artificial Grass,Fencing,Children's Play Area .Our attention to detail is second to none.
Latest Fencing feedback review:
By jam220 on 17th Oct, 2016
Scapes Landscapes7 Feedback reviews, 100% positive
Scapes Landscapes are a reputable landscape construction company with many years experience in both commercial and domestic markets. Customer satisfaction and delivering a quality job is our priority We pride ourselves on being able to deliver a quality job completed on...
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By mdv_63 on 17th Jan, 2017
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text:
Perret in France and Algeria Trailer (2012)
29 November 2012 110 mins
Lauded artist-filmmaker Heinz Emigholz (Schindler's Houses) offers an exquisite excursus on the work of pioneering French architect Auguste Perret, including privileged views of his innovative concrete structures in Algeria and such magnificent landmarks as Paris' Art Deco Théâtre des Champs Elysées. (TIFF)
Watch the official Perret in France and Algeria 2012 trailer in HD below or find more Perret in France and Algeria videos on Vidimovie.com.
Watch Perret in France and Algeria Free on Popcorn Time Online


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Digital Publishing Magazine For Ipad
Digital Publishing Magazine For IPad for publishers
Between 2010 (introduction of Apple iPad) and today Digital Publishing Magazine For IPad become a necessary element of Publishers toolkit. They sit in the same compartment as Adobe InDesign now.
Digital Publishing Magazine For IPad help small and medium publishers compete with big rivalsWhen Apple introduced the iPad in 2010 very few small publishers thought they can compete with big titles. What has happened since then surprised experts and media all around the World: rise of Digital Publishing Magazine For IPad helped mostly small publishers, while big media corporations fall behind or got stuck with custom build solutions that aged fairly quickly.
Magazines and newspapers around the World use Digital Publishing Magazine For IPad alreadyIntroduction of iPad in 2010, closely followed by Android tablets few months later really changed the way people consume content nowadays. New opportunities opened for many publishers and significant percentage of them already uses Digital Publishing Magazine For IPad to get to the readers.
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Hi! My Son (21) & Daughter-In-Law (24) will be married on the eastcoast and coming home in Mid Feb 08...We are looking for a fun dining experience-brunch, buffet style or dinner in Seattle/Tacoma area to celebrate with a few friends and family (15-20). We thought of a dinner cruise but that time of year weather is unpredictable...the other places we are considering are the Space Needle and Dinner Train, however the dinner train has closed. There will be 3 children, also nobody drinks so bar access isnt important. We are looking to keep under $1000. Another idea might be to rent a small intimate space and have it catered? THANK YOU! P.S., There has to be items available besides seafood, his wife is extremely picky! :(
Also an experience doing something fun with food as part of the activity could also be an option...
Updated 2 years ago | 7
Updated 1 year ago | 9
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Updated 5 hours ago | 48


text:
Venezuelan President Nicolas Maduro has enacted a slew of new laws as his emergency powers expire.
Maduro used decree powers Tuesday to put in place 28 new measures, including a luxury tax, increased protection for young workers, and the establishment of new economic development zones.
Also read: President Trump, The Rule Of Law, And The Separation Of Powers
Read more


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Last Date : 29 Oct 2016
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text:
Wily Peralta (0-3, 8.35 ERA) and the Milwaukee Brewers (7-11) go up against Jerad Eickhoff (1-2, 1.89 ERA) and the Philadelphia Phillies (9-9) in the last of a three-game series at Miller Park. The Phillies won the last game 10-6, and Philadelphia leads the series 2-0. The game starts at 2:10 p.m. ET on Sunday, Apr. 24 and will air on CSPh and FSWI.
In his last start, Peralta pitched 5.0 innings, allowing two runs, striking out two and walking four in a 6-5 victory over the Twins. Chris Carter (.281, 9 Rs, 5 HRs, 15 RBIs) continued his strong season yesterday, going 2 for 3 with one run, one home run, and one RBI. The Phillies were unsuccessful the last time Eickhoff pitched. He had a good outing, pitching 7.0 innings, giving up two runs, striking out nine and walking three in a 5-2 loss to the Mets. Maikel Franco (.299, 6 Rs, 5 HRs, 12 RBIs) has been hitting the ball well for the Phillies, going 3 for 5 yesterday with one run, one home run, and four RBIs.
The odds are Milwaukee -110 for this game and the Over/Under (O/U) is 8.5 at the moment.
The previous two games have all gone Philadelphia's way.
Predictions: SU Winner - MIL
Philadelphia has won 43% (3-4) of its games when leading after seven innings. However, Milwaukee has won 50% (3-3) of its games when taking a late lead.
The Phillies are coming into this meeting after a high-scoring game where they scored an impressive 10 runs. The Brewers have a 0-3 record when opponents score that many runs or more.
When they are outhit, the Brewers are 1-11. The Phillies have a 3-7 record when opponents outhit them.
Both Milwaukee and Philadelphia are tied at 16th in home runs, hitting 17 this season.
Milwaukee and Philadelphia both rank near the bottom of the league in hits. Milwaukee sits at 29th with 7.17 hits per game and Philadelphia ranks 26th with 7.39.
Philadelphia ranks near the bottom at 26th with an OPS of .658.
When the Phillies allow at least one home run, they are 4-7. When the Brewers allow one or more homers, they have a 7-10 record.


text:
Audio Samples
- Supersonic Sounds $1.29 on iTunes
- Clap Your Hands $1.29 on iTunes
- Blast Off! (feat. Lady Bunny) $1.29 on iTunes
- Tropical Intention $1.29 on iTunes
- Balearix (feat. Federico Aubele) $1.29 on iTunes
- I Got What You Need (feat. The Lovers Key) $1.29 on iTunes
- Faded Denim Wash $1.29 on iTunes
- Dancing Underground (feat. Mocean Worker and Qdup) $1.29 on iTunes
- The Shadow of Your Smile (feat. Puddles Pity Party) $1.29 on iTunes
Track List
Album Notes
Photographer: Marissa Gimeno.
Being silly and funky at the same time isn't easy, but producer Alex Gimeno's project Ursula 1000 often sounds like the Art of Noise went kitsch, and maybe never more so than on the fantastic Voyeur. This ridiculous mix of quirky samples and dancey beats comes off as an after-hours party at Pee-Wee's Playhouse, where campy guests like Puddles Pity Party (a "sad, sad clown" and Perry Como sound-alike) stop by with a full-bodied cover of Tony Bennett's hit "The Shadow of Your Smile." Ursula supplies the funky electro beat underneath, but when drag queen and Wigstock founder Lady Bunny applies her diva style to "Blast Off!," it's as if Deee-Lite reunited for one night of space disco dancing. Yello comes to mind as the hot and spicy "Tropical Intention" rapidly chugs along, but there's nothing cheeky about the indie house "Faded Denim Wash" or the deep house "Dancing Underground," although both cuts are lighthearted. As much as Ursula has been known to raise the roof, Voyeur is an even-keeled release with midtempo exotica (the shuffling calypso of "Supersonic Sounds" is somewhere between Steinski and Señor Coconut) and Moby-like numbers ("I Got What You Need" features lush strings, twangy guitars, and gospel-sized vocals) breaking up the pace. Too bad it doesn't come with a representative and swanky title like All Systems Are Go Go or Mondo Beyondo, but otherwise is this is a near perfect Ursula 1000 album and an asset to any swinging pad. ~ David Jeffries


text: Kamtexsolar is a solar energy products & service provider and distributor in Singapore. Solar energy is the most promising renewable energy source worldwide. Solar power systems are becoming more affordable and practical for both industrial and commercial uses. If you would like to benefit from this phenomenon, feel free to explore our products & services, We are a solar stockist, wholesaler, distributor and integrator of solar energy systems in Singapore. Solar products that we stock include solar panels, solar charge controllers, solar batteries, inverters and solar balance-of-system accessories. We welcome both local and international enquires. Do not hesitate to contact us to discuss your solar requirements!


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|Separate WC's
|Property type
The apartment is an open space with 2 bathrooms and 2 small balconies on the river with views of the castle
'Casa Archi' is located in the district of San Zeno, one of the oldest and most typical of the historic center of Verona. The arena is at a distance of 10 minutes walk and all the other monuments of the city are easily accessible without a car. The apartment, located in an old building of merit (former barracks in the nineteenth century Habsburg), enjoys a picturesque view over the Adige and is very quiet.
There are two bicycles, included in the price and a parking space in private courtyard of the house at a cost of € 10.00 per day.
Animali domestici €10,00
Posto auto privato nel cortile della casa € 10,00 al giorno.
We were met by the owner who was very helpful. The apartment has been tastefully renovated and well appointed. The kitchen had a generous provision for breakfast. The location is near the city centre. Overall an exceptional experience.
We stayed in Casa Archi 1. Perfect for a couple or a couple with one child like us who stayed on the large sofa bed.
It is equipped with evything you need and Paola is so welcoming and helpful at any time. There is secure parking in a gated courtyard downstairs which is really hard to find and so good for just a little extra cost. Well worth it if you have a car. It is about 10 minutes lovely walk to the old town and then the beauty of old Verona is all there to enjoy.
There is a supermarket just 150metres away up the street and round the corner. A very comformfortable stay and perfect for what we needed.
We stayed at this apartment for three nights and fell in love with the premise. The owner Paola was so warm and friendly, we felt immediately at home. The amenities in the apartment are top notch and the location of the apartment cannot be beat for ease and access to all that Verona offers. We are definitely planning a return visit!
An amazing place to stay with an amazing owner. Half of the pleasure of Verona was living in this apartment and having the river sing me to sleep.
I wish I had stayed in Verona longer! This is a lovely apartment located in the perfect area of Verona for sightseeing, dining and shopping. I did not cook, but the kitchen appeared to be very well-stocked with appliances and dining needs. Fabulous restaurants are within walking distance in Piazza Bra, and the views are breathtaking along the way! Grazie to Paolo for a comfortable visit!
Stayed at Casa Archi in Sept 16. Very nice clean apartment with all the facilities you need, much better than any hotel room. Short walk into the centre of Verona with all the restaurants, shops, and amphitheater etc. Would highly recommend Paola's apartment :D


text:
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Free Elliott Wave Tutorial from Elliott Wave International
Elliott Wave Courses | by ForexCycle.com | Friday, 04 January 2008 00:49 UTC
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Angela merkel
Showing of 0 - 10 from 374 results
Angela merkel - Total results - 374
Feb 16, 2017
Germany's Angela Merkel testifies on alleged US eavesdroppingChancellor Angela Merkel testified Thursday to a parliamentary committee examining alleged US surveillance in Germany and the activities of German intelligence, defending her insistence that "spying among friends" is unacceptable.
Feb 16, 2017
Canadian Prime Minister Justin Trudeau: EU-Canada relations based on shared valuesParis: Canadian Prime Minister Justin Trudeau told the European lawmakers on Thursday that the relationship between his country and the EU went beyond trade deals and was rooted in their shared values.
Feb 14, 2017
Angela Merkel pushes Tunisia PM to speed up migrant returnsOn Tuesday, German Chancellor Angela Merkel pushed Tunisia's prime minister to speed up the returns of rejected asylum seekers, as Tunis rebuffed criticism that it was blocking repatriations.
Feb 12, 2017
Germany to elect 'anti-Trump' Frank-Walter Steinmeier as new presidentBilled as Germany's "anti-Trump", centre-left former foreign minister Frank-Walter Steinmeier is set to be elected on Sunday as the new ceremonial head of state.
Feb 12, 2017
Donald Trump and Brexit may have globalisation on the backfoot, but don't expect it to go quietlyWith the rise of the right-wing in America and the Europe, free trade and globalisation that marked the post World War II decades is on the backfoot. The surprise victory of Donald Trump in the American elections, his constant rant against free trade, immigration and linking refuges from seven Muslim countries to terror, has been a major morale booster for these forces.
Feb 09, 2017
Angela Merkel hopes to step up Germany's migrant deportations to bolster re-election bidChancellor Angela Merkel hopes for progress on deporting more rejected asylum-seekers as she meets with governors of Germany's 16 states on Thursday.
Feb 06, 2017
Angela Merkel says she will seek common ground with Trump wherever possibleGerman Chancellor Angela Merkel says she will seek common ground "wherever possible" with US President Donald Trump's administration, despite differences over Trump's entry ban for citizens of seven Muslim-majority countries.
Feb 04, 2017
German magazine's controversial cover depicts Donald Trump beheading Statue of LibertyGerman magazine Der Spiegel sparked controversy on Saturday with a front cover illustration of US President Donald Trump beheading the Statue of Liberty.
Jan 31, 2017
Ukraine conflict: Russia-backed rebels as Kiev urges Berlin for stronger sanctions against MoscowA sudden surge in clashes between Ukrainian forces and Russian-backed rebels killed at least seven people on Monday despite a tattered truce in Ukraine's war-scarred east.
Jan 30, 2017
Donald Trump's immigration ban: How the world reacted to US president's decreeDonald Trump faced mass protests and global outrage Sunday over his controversial ban on travellers from seven Muslim countries, facing the first real test of his nine-day administration.


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Dog Walkers in Fowlstown, GA
Book a dog walker to give your dog a 30-minute walk around your neighborhood.
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We know you can't always be there, and it's our goal is to connect you with sitters in your neighborhood who can help take care of your pet. With Rover, it's easy to find and book Fowlstown dog walkers who will give your dog the exercise they need. Book a 30-minute walk one day, once a week, or even every day. That way, you can take care of what you need to do and know your dog is getting the love they deserve. No matter how often you need a sitter or dog walker, we're here for you. We're proud to offer complimentary premium insurance with dog walking services booked through Rover. The next time you're looking for a dog walker in Fowlstown, GA, visit Rover to search for the perfect dog walker, set up a Meet & Greet, and book a walk anytime you need it. All you have to do after that is sit back and relax: your dog's in good hands.
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New 2016 / 2017 Cadillac CTS-V For Sale Near Denver, CO
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New Cadillac CTS-V at McCaddon Cadillac Buick GMC
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