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Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour.
Methods and Findings
We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ2 = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours.
Author Summary
Dengue fever is one of the most rapidly increasing vector-borne diseases of humans in the tropics. There is currently no treatment and no vaccine, so control of the disease depends on controlling the mosquito vector. Unfortunately health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites have not always been 100% effective. Self-efficacy is an area of increasing research interest and can be thought of as people's confidence in their ability to engage in health behaviours. We report a study of the impact of self-efficacy on dengue preventive behaviour. We conducted face to face interviews in villages in the state of Terengganu, Malaysia that had been affected by dengue outbreaks. A structural equation model was tested and fitted the data well. Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. However, self-efficacy fully mediated the relationship between knowledge of dengue and engagement in dengue preventive behaviours. We conclude that educational components of community dengue control programmes should focus on interventions.
Citation: Isa A, Loke YK, Smith JR, Papageorgiou A, Hunter PR (2013) Mediational Effects of Self-Efficacy Dimensions in the Relationship between Knowledge of Dengue and Dengue Preventive Behaviour with Respect to Control of Dengue Outbreaks: A Structural Equation Model of a Cross-Sectional Survey. PLoS Negl Trop Dis 7(9): e2401. doi:10.1371/journal.pntd.0002401
Editor: Marilia Sá Carvalho, Oswaldo Cruz Foundation, Brazil
Received: May 3, 2013; Accepted: July 22, 2013; Published: September 26, 2013
Copyright: © 2013 Isa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: Funding for this study came from the Malaysian Ministry of Health through support for AI PhD studentship. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Dengue fever is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. Although most infections are self-limiting a proportion of cases develop severe complications such as dengue haemorrhagic fever which can carry a significant risk of death. The incidence of dengue has risen dramatically around the world in recent decades. Since no vaccine is currently available, primary prevention is regarded as the most effective measure in controlling dengue. Each time an outbreak occurs, the local health authority will plan and carry out various types of promotional and educational activities that aim to increase knowledge of dengue and change dengue preventive behaviour among communities at the centre of the outbreak. These promotional activities can be carried out through various methods such as individual home visits, or at the population level through the mass media. Health promotion and educational intervention like, 'search and destroy' activities, advice on the need to seek immediate medical attention in patients with fever, and proper disposal of rubbish are usually the focus of behavioural-change promotion activities. The promotional and educational messages are usually delivered using small group discussion, public lecture, live public announcement, demonstration, distributing printed materials, putting up posters, bunting and billboards, community source reduction and community dengue-cleanliness program (in Malay: Gotong-Royong) and health exhibition [1].
There have been a number of systematic reviews of public health interventions aimed at reducing the risk of dengue fever in recent years [2]–[6]. However, as pointed out by Bouzid et. al. authors have often reached different conclusions regarding the effectiveness of interventions, even when reviewing the same primary studies [7]. Health promotion campaigns that appear to have some benefit are those aimed at encouraging local people to engage in activities that reduce the number of mosquitoe breeding sites close to home [2]. However, such campaigns are not totally effective and the impact on vector presence may only be short-live. Achieving sustainable change in dengue preventive behaviours remains difficult [8], and may not necessarily lead to dengue prevention [9], [10], [11].
Dengue fever is endemic in Malaysia with frequent major outbreaks in the urban areas. Since dengue was first documented in Malaysia in 1902 and was made notifiable in 1973, the disease pattern has changed from major outbreaks every four years to one of increasing trend yearly. The largest outbreak was seen in 1996 with 14,255 dengue cases reported and 32 deaths. The fever is the number one disease in the top 10 listed communicable diseases in Malaysia as compared to other diseases like Tuberculosis, Malaria and HIV/AIDS in 2010 and 2011 [12]. The number of dengue cases reported also increased from 27,381 cases in 1998 to 46,171 cases in 2010. Estimate of an economic burden of dengue in Malaysia is USD102.25 (95%CI: 77.94–310.66) million per year which is approximately USD3.72 (95%CI: 2.83–11.30) per capita [12]. There is evidence that despite the fact that Malaysians generally have good knowledge of dengue fever and its prevention [13], dengue incidence rate has substantially increased from 31.6/100,000 population in year 2000 to 163/100,000 in year 2010 [12].
There is a growing body of literature concerning the concept of self-efficacy, which is considered to be people's belief or confidence in their capabilities to achieve different levels of performance attainment [14]. Self-efficacy perceptions are viewed as important determinants of behaviour and affect, and the potency of these perceptions in predicting behaviours in many domains has been shown [15]. The concept of self-efficacy is commonly used in studies of health behaviours [16], [17]. including area such as smoking cessation [18], [19], weight loss and body weight control [20]–[25], exercise [26], [27], [28], nutrition intake [29], [30], alcohol use [31]–[34], and AIDS prevention [35], [36], [37]. Self-efficacy may also function as a mediator between cognitions, feelings and behaviours and the adoption of lifestyle behaviours such as healthy diet [38]–[41]. Although the effects of health promotion and educational interventions to control dengue fever have been investigated in previous studies, none of the studies have investigated the impact of self-efficacy dimensions (level and strength of self-efficacy) as mediators between level of dengue knowledge and effective behavioural actions to control dengue outbreak and transmission. Strength of self-efficacy refers to a person's perceived assurance that they 'can do' or 'cannot do' something reflected in their affirmative answers to questions about whether they can perform particular dengue preventive behaviours. Level of self-efficacy is a person's judgement about whether or not they can accomplish a given performance which reflects their perceived capability as measured against task demands (dengue preventive behaviour) at various levels of challenge (scenarios) to successful control of dengue fever during outbreaks [42].
We argue that understanding the relationship between knowledge, self-efficacy and behavioural change may be a route towards improved and sustainable dengue control. This paper reports on work that was conducted to study the impact of self-efficacy on dengue preventive behaviours. We conducted a survey in villages that was subsequently examined with analyses based on predictions from Bandura's Social Cognitive Theory and Maibach's path model [42], [43]. We specifically examined the potential mediating effects that level and strength of self-efficacy may have on the relationship between knowledge of dengue and dengue preventive behaviour after being exposed to health promotion and educational interventions during the outbreaks.
We recruited heads of families or their spouses aged above 18 years old from 27 villages that had recently experienced an outbreak of dengue fever. These villages were located in the state of Terengganu, on the east coast of peninsular Malaysia. Using the method by Woodward, we calculated that we needed a sample size of about 280 respondents [44]. This was based on a requirement to detect a Pearson correlation coefficient of 0.4 with a power of 80% and alpha 5% (200 samples). This sample size was then inflated by 20% to account for possible non-parametric tests and 20% for potential impact of clustering within village.
The population of the study included all the villages of the outbreak localities from July to December 2010 in the state of Terengganu. The list of outbreak sites was obtained from Terengganu Vector Borne Disease Division and the Terengganu Crisis Preparedness Resource Centre (CPRC) database. In total there were 32 outbreak locations for that 6-months period, but only 27 locations were included in the study as five others were not actually villages but higher education institutions and schools. Figure 1 shows a simplified illustration of sampling procedures used in this study. The households that were interviewed in those selected villages or sites were randomly selected based on the current outbreak list obtained from the Terengganu Crisis Preparedness Resource Centre (CPRC) database. The households were selected randomly from 9,959 houses or premises included in the study using SPSS. A total of 149 premises were excluded because they were non-owner premises or abandoned houses. The selected households were not changed or replaced with other households even if the first and second visits resulted in failure to meet some the participants for interview.
Ethics statement
Research ethics approval for this study was granted by the National Medical Research Register, Ministry of Health Malaysia (NMRR-10-206-5412) and the Faculty of Health Research Ethics Committee of the University of East Anglia (2010/2011–13), the author's institution, prior to data collection. Written informed consent was obtained from all participants prior to completion of the survey.
Data collection
The data collection was carried out from January to March 2011. The recruitment and training of the 32 interviewers from the local State Health Department staff was undertaken in December 2010. The interviewers were dedicated staff from the State Health Department whose usual tasks involved running health promotion and education activities during the outbreak. The training was conducted by the lead researcher assisted by the Head of the Health Promotion Unit, Terengganu Health State Department. All respondents were recruited after they had given informed consent. The interviewers read the questionnaires and the respondents gave their answers to those questions. The interviewers then ticked the answers in the column provided and recorded any subjective answers not listed in the answer scripts. A copy of the questionnaire is given in supplementary Text file S1. The questionnaire used in the field was in Malay. Correct translation was checked through a parallel back-translation by members of Malaysia Institute of Translation. The questionnaire was also tested in a pilot study in both languages.
Measures of variables
1. Health promotion and educational intervention exposure.
Exposure to health promotion and educational interventions was assessed using sets of questions adapted from Kriska's Modifiable Activity Questionnaire (MAQ) [45], and the campaign exposure index developed by Maibach et. al. [42]. Even though the original concept of evaluation of the 'intensity' of the particular behaviour was unchanged, our questions were modified accordingly to suit the evaluation of the 'intensity' for the health promotion and education exposure. There were 3 main components assessed in this section, consisting of involvement in the health promotion and education activities, sources of information during the outbreak and recent behaviour compliance as promoted in the previous outbreak. For the details of respondents' involvement in the health promotion and educational activities, 1 mark was given for 'Yes' and no mark was given to a 'No'. Respondents also were asked to list the types of activities in which they were involved and they were given marks ranging from 1 to 5 accordingly, with the highest possible mark being 15 if they were involved in all the activities. The respondents were then asked about the number of days of their involvement in the activities. The answer ranged from 0 (minimum) to 14 (maximum) in line with the need for an outbreak to be controlled within 14 days. These answers were later converted to a categorical scale according to Health Promotion Intervention Guidelines during Dengue Outbreaks, Ministry of Health Malaysia [1] as shown in table S1 in Text S2.
For respondents' scores on the sources of information on dengue prevention during the outbreaks, 1 mark was given for 'Yes' and 0 mark for 'No'. The types of information sources the respondents received were scored between 1 to 6 marks, the maximum score being 20 if they received the information from all the sources listed. Respondents also were asked about types of health promotion and education activities they were involved in and the duration of their involvement. The marks for sources of information and types of activities involved were given based on its priority as indicated in the guidelines [1]. Assessment of respondents' recent behaviour compliance was determined by the number of days they performed 'search and destroy' activities by themselves and the duration of their engagement. The number of days recorded ranged from 0 and 2 days only because they were taught to perform the activity once a week for a minimum of 20 minutes per session. The overall health promotion and educational intervention exposures weighted score was measured as in table S2 in . The total mark determined the exposure level of the respondents to the health promotion and education during the dengue outbreak based on Maibach's index of health campaign exposures [42].
2. Health promotion and educational intervention activities and sources of information.
When constructing the model, there were 11 health promotion activities or sources of information that could affect knowledge of dengue. Several of these activities or sources of information were highly correlated and so we used factors instead of the original variables. Factor analysis was done in SPSS using principal component extraction with Equamax rotation. Factor scores, derived by regression, were then saved for use in the Structural Equation Model.
3. Dengue preventive behaviour.
The indication for behavioural compliance and maintenance was measured through systematic calculation of recent behaviour of the respondents. This calculation was based on the number of days that the respondents performed 'search and destroy' activity within the last 14 days, and the duration of the activity for each session. These types of behaviour were taken into consideration in the analysis since they were the main aspects that should have been modified and maintained as promoted during the dengue outbreak interventions. The measurement of such dengue preventive behaviours during outbreak was adopted based an additive index measuring behavioural occurrences per week by Maibach et. al. [42]. The measurement was in weighted scores in which the maximum total scores were 20.
4. Knowledge of dengue.
The level of knowledge was assessed using a set of questionnaires adopted from the Malaysia Health Morbidity Survey [46]. The respondents were asked to choose the correct answers based on their knowledge of dengue fever, its signs and symptoms, indoor and outdoor breeding sites and specific dengue preventive behaviour measures to control dengue fever transmission. The questions were arranged according to Bloom's Taxonomy of Educational Objectives [47]. One mark was given for each correct answer. The maximum total mark was 25 and this was transformed into a percentage, as in table S3 in Text S2, to indicate the level of knowledge on dengue from poor to excellent based on 3 educational goals of Bloom's Taxonomy of Educational Objectives [47].
5. Self-efficacy dimensions.
Level and strength of self-efficacy were measured using Likert Scales from 1 (Not at all confident) to 10 (Extremely confident) adopted from Maibach et. al. [42]. Level of self-efficacy was measured through several specific scenarios related to behavioural confidence to prevent dengue transmission, while strength of self-efficacy was determined by three graded questions that ranged from simple to more complex. The behavioural scenarios themselves were graded to assess self-efficacy in increasingly difficult situations. The level and strength of the self-efficacy measures were derived from the mean scales of all answers and subsequently categorized into 5 groups based on 5-point mean measurement of Likert Scales, as in table S4 in Text S2, [48]. Results from Confirmatory Factor Analysis (CFA) on each of pooled items for level and strength of self-efficacy yielded factor loadings ranged from 0.72 to 0.99. Therefore, because of pooled factor loadings >0.5 we retained all of the items for further analysis as suggested by Hair et. al. [49].
Statistical analyses
Pearson or Spearman correlation coefficients used in analyses between the three main outcome measures: exposure to health promotion and education, knowledge of dengue and self-efficacy dimensions. Regression modeling was carried out using Generalized Estimating Equations of SPSS 18 to account for cluster sampling at the village level. Based on consideration of Bandura's theory, the research model by Maibach et al. [42], and previous empirical findings on related public health issues and significant correlations from the investigation, an initial proposed model was constructed [38]–[41]. A structural equation model (SEM) was developed using AMOS version 18 [50]. The model reflects the relationships between variables obtained in the study in order to predict the dengue preventive behaviour change resulting from an increased dengue knowledge level and self-efficacy dimensions after being exposed to health promotion and educational intervention during the outbreak. SEM was used to test the proposed model against the observed dataset. SEM is a combination of factor analysis and path analysis and it is a confirmatory rather than an exploratory technique, because it compares a hypothesized model's covariance matrix with that of the observed data. Since the proposed model of this study involved observed variables, SEM allows us to determine significant paths between those variables in deriving a better explanation of their significant relationship findings based on the research hypotheses and proposed model.
There are several steps in analysing SEM using AMOS: 1) to develop a model based on research theory; 2) identify unique values that can be used for the parameters to be estimated in the proposed model; 3) apply various estimation techniques, for example in this study, maximum likelihood; and 4) test the fit of the model against the data. According to the results, the researcher might 5) modify the measurement model based on theoretical justifications; revise the model by adding, deleting, or modifying relationships between variables; or use measures indicating lack of fit for specific parts of the model when theoretically justified in the Modification Indices table [51]. Goodness of fit indices were used as indicators of model fit. Chi-square tests were used as an index of the significance of the discrepancy between the original (sample) correlation matrix and the (population) correlation matrix estimated from the model. Because the significance of chi-square tests is dependent on the number of subjects, the comparative fit index (CFI) and the root mean square error approximation (RMSEA) were further considered. CFI values are derived from the comparison of the hypothesized model with the independence model. RMSEA values help to answer the question of how well the model with unknown but optimally chosen parameter values would fit the population covariance matrix if it were available [52]. The lower the discrepancy measured by the RMSEA the better, with an RMSEA of 0.0 indicating a perfect fit. Acceptable values are CFI>.90 and RMSEA<.08.
Once the model fitted the data well, the next step was to test the mediation effect of self-efficacy dimensions on the relationship between knowledge of dengue and dengue preventive behaviour by comparing a Full Mediation Model, Direct Model and Indirect Model as recommended by Baron and Kenny [53], and Hayes [54]. The post-hoc probing test for mediation effect significance was performed to determine if the drop in the total effect (i.e. level of dengue knowledge to dengue preventive behaviour) was significant upon inclusion of mediator (level or strength of self-efficacy) in the model [55].
Descriptive analysis
We recruited 280 participants as per the sample size calculation. More than half of the respondents were female (58.9%). Their mean age was 42.7 years, and the majority (57.5%) were aged between 36 to 55 years old, and were married (96.1%). The ethnic background of the respondents was 98.6% Malay with the remainder being Chinese. Nearly half of the respondents were housewives (45%).
Table 1 presents the means, standard deviations, percentiles and ranges for all the principle scores. The level of health promotion and educational intervention exposure was low, with only 20% of the respondents receiving a moderate to high level of exposure. The respondents seemed to have moderate (40.7%) to good (38.6%) knowledge of dengue. In general, the self-efficacy of the respondents was at the moderate level. Although it was also found that 62.2% of respondents perceived they were relatively confident in performing dengue preventive behaviours, only 1.1% of them reported having excellent strength of self-efficacy. About half of respondents (45.4%) showed moderate levels of self-efficacy, while 36.4% had little confidence and felt uncertain how to perform these kinds of dengue preventive behaviours. 2.5% of them reported below the average confidence (mean = 2.99).
Most of respondents said they had received health information on dengue fever from Public Announcements (57.5%), Television (57.9%) and the Newspaper (44.6%). In term of respondents' participation in the health promotion and educational interventions, most of them tended to be involved in the Community Source Reduction Program or Gotong-Royong (60%) as compared to the Public Lecture (24.3%). Only 4.6% were involved in Demonstration activities. Regarding respondents' recent behaviour to control dengue outbreak and transmission, 73.2% of them failed to perform a 10-minute search and destroy exercise to eradicate Aedes mosquitoes breeding sites within the last 14 days.
With regards to dengue preventive behaviour, about half (45.5%) of the respondents did not comply with correct behaviours to control dengue fever transmission. Moreover, 30.4% of them had carried out only 5 minutes of cleanliness activity within the past 14 days. Only 23.9% of the respondents were found to comply with the correct behaviours to prevent dengue fever transmission as promoted in the educational interventions during the outbreaks.
Bivariate analysis
Four factors were extracted from the data on information sources and together these four factors represented 60.1% of the variance in the original variables. Table 2 shows the rotated component. Factor 1 was associated with obtaining information through Television, Radio and Newspaper (regression score >0.5). We named this factor Mass Media. Factor 2 was associated with participation in Gotong-royong and obtaining information from public announcements and outdoor media. This factor was named Local Contact. Factor 3 was named Small Group Contact (Small Group Discussion and Demonstration) and Factor 4 was named Direct Information-Giving Session (Public Lecture and Individual Advice).
A correlation matrix was generated that included each of the variables in the study (see Table 3). Overall, the bivariate relationships between the majority of independent and dependent variables were weak. The relationship between Factor 1 from the health promotion and educational intervention (Mass Media) and mean dengue knowledge scores was the strongest (r = 0.326, p<0.01) as compared to other factors. Significant bivariate relationships were evident between dengue knowledge and level (r = 0.262) and strength of self-efficacy (r = 0.363) at p<0.01. Level of self-efficacy was significantly correlated with strength of self-efficacy (r = 0.383) at p<0.01 and dengue preventive behaviour (r = 0.212) at p<0.05. There was a significant correlation between dengue knowledge and dengue preventive behaviour. There was no significant difference in level of dengue knowledge between those respondents who were exposed to different levels of health promotion and educational intervention. However, there were different degrees of strength in self-efficacy among those who were exposed to different levels of health promotion and educational interventions (p = 0.022). The level of self-efficacy however was no different among them. Although not included in the SEM, we found a significant correlation between proportions of villages who didn't undertake at least 10-minutes-cleanliness behaviour per week with the duration of the outbreak in the village (p = 0.044).
Path analysis
Examination of our proposed model using SEM of AMOS 18 indicated that adjustment could be made to improve the match between the data and model (χ2 = 75.622, df = 41, p = 0.189, CFI = 0.870, TLI = 0.895, RMSEA = 0.098). To identify the sources of error in the proposed model as indicated in Modification Indices, we eliminated paths that were not significant one at a time in order to find the most parsimonious model. First we eliminated the path between Factor 3 from the health promotion and educational intervention (small group contact) and knowledge of dengue. Second, we dropped the path between knowledge of dengue and dengue preventive behaviours. Table 4 contains the models' goodness of fit indices.
Our final model fitted the data well (χ2 = 71.659, df = 40, p = 0.002, CFI = 0.973, TLI = 0.963, RMSEA = 0.053). Bentler [56], and Chou [57] both recommend CFI and TLI scores of greater than 0.90 as indicators of good fitting models. Browne & Cudeck [58], (1993) and Byrne [52] recommend that models with an RMSEA of 0.08 or less and preferably 0.05 or less are good fitting models. Figure 2 shows the entire final model with accompanying path coefficients. Overall, the structural model contains relatively weak influences on the dengue preventive behaviours, with path coefficients ranging from 0.092 to 0.271.
** Significant at the .01 level. * Significant at the .05 level. (NS) Not significant. SE = Self-Efficacy, Factor 1 = Mass Media (TV, Radio, Newspaper), Factor 2 = Local Contact (Gotong-royong, Public Announcement, Outdoor Media), Factor 3 = Small Group Contact (Small Group Discussion, Demonstration), Factor 4 = Direct Information-Giving Session (Public Lecture, Individual Advice), L1 = Pooled Level of Self-efficacy (Scene 1), L2 = Pooled Level of Self-efficacy (Scene 2), L3 = Pooled Level of Self-efficacy (Scene 3), S1 = Pooled Strength of Self-efficacy (Personal Domain), S2 = Pooled Strength of Self-efficacy (Family Domain), S3 = Pooled Strength of Self-efficacy (Community Domain).
Mediation effect analysis
Our main objective was to investigate the self-efficacy dimensions as mediators of the relationship between dengue knowledge and dengue preventive behaviours in relation to control of dengue outbreaks. Assessment of the mediation effects was done by comparing the full mediation model (which includes a direct model) and indirect model from the final structural model that we created earlier. Table 5 shows the mediation effect findings of this models comparison.
From the initial analysis, knowledge of dengue did not have a direct effect on dengue preventive behaviour (standardized β weight = 0.092, p = 0.082). However, knowledge significantly predicted the level of self-efficacy as expected (standardized β weight = 0.172, p<0.001), and this level of self-efficacy also significantly predicted dengue preventive behaviour (standardized β weight = 0.179, p = 0.036). Knowledge had a direct effect on strength of self-efficacy (standardized β weight = 0.291, p<0.001) and this strength of self-efficacy also significantly predicted dengue preventive behaviours (standardized β weight = 0.149, p<0.001). Analysis for model comparison as recommended by Baron and Kenny [53], and Hayes [54] found that the Beta for the Indirect Model was reduced from 0.092 to 0.090 in the Full Mediation Model (in both for level of self-efficacy and strength of self-efficacy as mediators). Therefore, knowledge on dengue was found to have significant indirect effect on dengue preventive behaviour with a mediation effect of level of self-efficacy or strength of self-efficacy on the relationship.
Post-hoc probing of significant mediation effects was performed using the Sobel Equation of computing to determine if the drop in the total effect (i.e., knowledge on dengue) is significantly dependent upon inclusion of the mediator (level of self-efficacy and strength of self-efficacy) in the model [53], [55], [59]–[60]. This strategy indicated that level of self-efficacy (z = 4.77, p<0.05) and strength of self-efficacy (z = 2.38, p<0.05) did function as mediators. According to Holmbeck [55], p<0.05 is the absolute value of z>1.96. In addition since the Beta for the total effect of the relationship between knowledge on dengue and dengue preventive behaviours was 0.37, thus roughly 65% of the path was accounted for by level of self-efficacy as a mediator (Beta for indirect effect was 0.2405). Likewise, the path between knowledge of dengue and dengue preventive behaviours was 97% accounted for by strength of self-efficacy as a mediator in the relationship (Beta for indirect effect was 0.3575) [61]. Therefore, since the direct path between knowledge on dengue and dengue preventive behaviours was not significant, level and strength of self-efficacy did function as full mediators of that relationship. This result showed that self-efficacy has a complete mediation effect on the relationship between knowledge on dengue and dengue preventive behaviour.
As we hypothesized, strength of self-efficacy and level of self-efficacy significantly predicted dengue preventive behaviours (p<0.001). In addition, strength of self-efficacy significantly predicted level of self-efficacy (standardized β weight = 0.282, p<0.001). Later analysis for models comparison found that, the Beta for the Indirect Model was reduced from 0.179 to 0.168 in the Full Mediation Model. Therefore, strength of self-efficacy was also found to have a significant indirect effect on dengue preventive behaviour with a mediation effect of level of self-efficacy on the relationship.
Once again, post-hoc probing of significant mediation effects was performed using the Sobel equation of computing as a follow-up to the findings for the structural equation model. The post-hoc strategy was conducted to determine if the drop in the total effect (i.e., strength of self-efficacy) is still significant upon inclusion of the mediator (level of self-efficacy) in the model. This strategy indicated that level of self-efficacy did function as mediator (z = 2.020, p<0.05). (Note that p<0.05 if the absolute value of z>1.96). In addition since the Beta for the total effect of the relationship between strength of self-efficacy and dengue preventive behaviours was 0.3695, thus roughly 43% of the path was accounted for by level of self-efficacy as a mediator (Beta for indirect effect was 0.1596) [61]. In this case, level of self-efficacy partially mediated the association between strength of self-efficacy and dengue preventive behaviours. This result showed that level of self-efficacy has a partial mediation effect on the relationship between strength of self-efficacy and dengue preventive behaviour.
This investigation is one of the first within the public health and health psychology research literature to concentrate on health promotion and educational interventions designed to reduce the risk of dengue fever. With regards to our first primary hypothesis, knowledge was found not to be independently associated with dengue preventive behaviour other than through the impact of knowledge on self-efficacy. For the second hypothesis, both level and strength of self-efficacy were predictive of dengue preventive behaviours. Our hypothesis regarding the mediational effect of self-efficacy on the relationship between knowledge on dengue and dengue preventive behaviours was supported through post-hoc probing, as recommended by Holmbeck [55]. Thus, our work would suggest that increasing the public's knowledge about dengue fever is an essential first step towards encouraging people to engage in dengue preventive behaviours. However, increasing knowledge alone would not be sufficient unless it results in increasing the level and/or strength of people's confidence in performing these behaviours. These findings are consistent with previous work on self-efficacy and healthy lifestyle behaviours [15], [38]–[41]. Our findings hold a number of important implications for health promotion authorities and planners. This is because, since both self-efficacy level and strength are modifiable and reliable mediators of health behaviours [62], health promoters should design dengue educational interventions and campaigns that promote self-efficacy as well as knowledge.
With regards to knowledge generation, we have shown that mass media campaigns such as TV, radio and newspapers and local contact (Gotong-royong, public announcements, and outdoor media) and direct face-to-face communication session (public lecture and individual advice) are the most effective. For self-efficacy, various authors have suggested that one of the most effective means of promoting self-efficacy is through modelling socially relevant enactments of the behaviours in the mass media [15], [42], [62]–[65]. For example, in order to empower people to perform dengue preventive behaviours, the health authorities could produce video-taped material with trained role-players/actors performing the desired behaviours. The specially made videos could be shown to people who do not feel confident performing the specific preventive behaviours. People could then be asked to perform the desired behaviours until a level of competence and confidence was achieved. These activities could be promoted in groups or at individual level.
We would also add that since the self-efficacy dimensions are a cognitive response to direct and vicarious experiences with the behaviours, health promotion and educational interventions should use persuasive messages on dengue prevention. This is to enable the community to translate the messages into the anticipated or actual dengue prevention behaviour (example of a persuasive message: "If it breeds, we bleed, take action! Only 10 minutes to destroy Aedes breeding sites"). This accords with Bandura's idea on health campaign messages that successfully encourage the target audience to engage in simply enacted interim behaviour which will serve to enhance self-efficacy through direct experience. In relation to dengue prevention, such interim behaviour might include both trial performances of the behaviour such as not purchasing flower pots that accumulate water, as well as low-level versions of the target dengue preventive behaviour such as putting garbage in a closed bin instead of accumulating it in a group for incineration. Tailored messages tend to be more personally relevant and thus attract more attention [66]. When recipients received messages tailored to their personal information processing style, they were later more likely to engage in the desired behaviour advocated in the message [67]–[69].
Therefore, in health promotion and educational interventions during dengue outbreaks, guidelines and protocols should outline vividly the specific persuasive messages to be conveyed to specific target audiences during the outbreaks in order to increase self-efficacy dimensions. The health promotion and educational interventions should advocate dengue preventive behaviour that takes account of the psychological characteristics of the desired behaviour and of the information-processing style of the target population. This simple strategy may lead to better crafting of persuasive messages, which in turn, increase adoption of dengue preventive behaviour so that outbreaks and transmission are reduced.
In considering the generalizability of our study it should be noted that our respondents were predominantly based in rural villages that had recently experienced a dengue outbreak. Our findings may not be applicable in areas where there had been no prior experience of dengue fever. However, given the fact that the vast majority of the world's currently at risk population will have had prior experience, our findings ought to remain applicable. Clearly our study was conducted in a rural Malaysian population and so there are issues about whether the results can be generalised to urban populations or to rural populations in other countries with different cultures. It should also be noted that because the structural equation model was based on cross-sectional data, there should be some degree of caution on the interpretation of causal inferences. Nevertheless, it should be noted that these causal paths were hypothesized based on available research concerning predictors of dengue preventive behaviours during the outbreaks [12], [70], [71]. There remains an issue regarding possible reporting bias in the data collection, especially as the interviewers were also involved in the health promotion activities. The importance of not leading the respondents in any questions was stressed during the interviewers training sessions in order to minimise this source of bias. Although we cannot say definitively that there was no bias in our data collection, we would argue that the complexity of the model and the relationships between self-efficacy and knowledge independent of any particular health promotion activity would suggest that interviewer bias would have been unlikely to have played a major role in the main findings of this study.
Our findings address the important need for studies that generate empirically sound and theoretically relevant data to identify variables likely to be effective for designing interventions. Further research should aim to describe other aspects of psychological variables related to behaviour changes and maintenance in relation to control of dengue fever, such as the complex role of motivation as well as perceived barriers and perceived benefits to engaging in the target behaviours [72]–[76]. Furthermore, we should also consider future intervention studies that evaluate different mediation effects of level and strength of self-efficacy as separate psychological components in predicting other health behaviours to control or prevent public health diseases.
In conclusion, our research indicates that the impact of public health campaigns designed to increase the adoption of behaviours by the public to control dengue fever by increasing knowledge is mediated by the impact on self-efficacy. We argue that to be most effective public health campaigns should be designed to maximise the impact on self-efficacy. There is a strong need for further research on how to design public health campaigns for the control of vector-borne disease that maximise self-efficacy and not just knowledge.
Supporting Information
Text S1.
Text S2.
Additional tables.
Author Contributions
Conceived and designed the experiments: AI YKL AP PRH. Performed the experiments: AI. Analyzed the data: AI PRH YKL JRS. Wrote the paper: AI PRH YKL JRS AP.
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This review is from: Mee audio RX12 3.5mm Connector In-Ear Headphone (Blue)
Pros: Like the flat cable design; it really does help avoid tangles. Initial sound quality was good.
Cons: After about a week or so, the audio in the right earbud has gotten noticeably weaker than the left one. The buds also dig into your ears alittle bit.
Other Thoughts: They were only $5 bucks but considering the generally good feedback that meelectronics headphones get, I kind of expected a higher quality product.READ FULL REVIEW
This review is from: Sennheiser HD201 Over-Ear Headphones
Pros: Sound quality overall is very good. Lots of bass for those who want that. Comfortable and the cord is really long so you can plug these in to your desktop and still be able to move around.
Cons: Fragile. I left them on the floor (my mistake, I know) and just nudging them with my foot resulted in the headphones breaking. They don't need to be indestructable, but they should be able to hold up to being thrown around here and there.
Other Thoughts: If you plan on using them with a desktop or are willing to make sure that they're stored out of harm's way, then you really can't beat the price for the audio quality you get. If you need something a bit more robust however, I suggest you consider something else.READ FULL REVIEW

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Roma were pegged back yet again by Sassuolo at the death, Milan and Lazio were held, while Atalanta and Cagliari also left it late.
Click here for all the individual match reports from Serie A Week 12. [12]
Keep up to date with the latest news and action from Spain's Primera Division with Football Espana - from the team behind Football Italia. [13]


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Sometimes, it's a good thing to get fired. It all depends on why you got the boot in the first place.
Getting fired isn't difficult in these "at-will employment" times, but some folks get downright creative about it. You could find some perverse thing to do with the prosthetics made by your employer, like one factory worker. Or you could use the security x-ray machine to give an impromptu MRI—the courtroom guard in Springfield, MO who did that was unaware that it was all caught on video.
You could utilize "found objects" as makeshift swords, like the furniture mover who was fired after indulging in a "dildo duel" with a co-worker, jousting with the adult sex toys found in the client's bedroom. If your found object was a dead buzzard, putting the carcas on the automated chicken-packaging line, as two young men did, would certainly get you fired.
Perhaps a disability brought you down, like the shipping clerk who misheard instructions to send some sensitive data to microfilm, eMailing it to "Michael Finn" instead. Or you could misdirect a "NetSend" message, shooting the word about an itch on a rather unmentionable part of your anatomy to the boss instead of the co-worker you intended.
Or you could write down your prize-winning tale of firing and wind up on a free Caribbean cruise with the fired contestants of The Apprentice instead.
That's what happened to Jim Garrison, a computer engineer from Colorado, who was fired because he ate some pepperoni pizza left over from a company meeting. Garrison, who declined to identify the company that fired him, described the incident as a simple mistake. He saw the six slices of pizza, left after a meeting in another department, and ate two of them, thinking they would go to waste otherwise. Other employees had planned to take home the leftovers, and they reported Garrison. Ultimately—one month after the incident—he was let go. "I know I made an impression," Garrison said, "to this day my former coworkers refer to unattended pizza as 'programmer bait'."
The contest generated a lot of traffic for the Silicon Valley company who conceived it, Simply Hired, Inc. So enticing was the contest site, in fact, that one woman's entry said she got fired for spending too much company time scrolling through all the postings to the Simply Fired contest site.Powered by Sidelines


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Went to the farmer's market today. Today was its opening day for the
season. Spinach, asparagus, strawberries, scallions, snap peas. Not much
else. Lots of nursery people, however, and mostly organic, selling
everything from pea pyramids to yellow oyster mushroom starter kits to
various native plants. We ate lunch there: Peruvian tamales, which were
quite tasty.
When we left the market, we went to an odd little nursery that seems to
specialize in stuff other nurseries may avoid. They had peonies in bloom,
for example, and all manner of columbine. There were two huge [I'm not
making this up] lupines in full bloom in 3-gallon pots by the front door.
They had fig trees and, growing in a planter next to the building, what I
took to be a Chinese fan palm [Livistona chinensis], one of my favorites;
next time I'm there, I'll have to ask.
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INTEGRITY [Authenticity, Honesty]: Speaking the truth but more broadly presenting oneself in a genuine way and acting in a sincere way; being without pretense; taking responsibility for one's feelings and actions SCRIPTURE Psalm 78:72 And David shepherded them with integrity of heart; with skillful hands he led them. Proverbs 10:9 Whoever walks in integrity walks securely, but whoever … [Read More...]
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BOSTON -- When Boston Red Sox second baseman Dustin Pedroia credits a teammate, or any baseball player, for playing the game the right way, that player must be something special.
Enter Pedro Ciriaco.
The Red Sox utilityman has been a spark plug since he was added to the big league roster from Triple-A Pawtucket on July 6. Time and again, especially against the New York Yankees, the 26-year-old has produced both offensively and defensively.
In the opener of a three-game series against the Yankees on Tuesday night at Fenway Park, Ciriaco went 2-for-3 with a double and two runs scored. He scored the winning run in the bottom of the ninth when he came home from second base on Jacoby Ellsbury's base hit to right field.
"He's been playing great for us," Ellsbury said of Ciriaco. "He's been huge all season for us. He was again in the ninth inning, getting on and once he got on second I knew any ball hit to the outfield, he was scoring with his speed."
Even with the arm of Yankees right fielder Ichiro Suzuki?
"Yeah, I'll take Ciri's speed, a deep right field at Fenway, I'll take Ciri any day," Ellsbury said.
Ciriaco is 17-for-35 (.486) with 7 RBIs, 11 runs scored and 4 stolen bases in nine games against the Yankees this season. In fact, five of his 13 multihit games this year have come against New York.
"I don't know," Ciriaco said when asked what his secret was to playing so well against the Yankees. "I just try to play hard every time I come to play, but I think I got a little bit lucky tonight. I just tried to hit the ball and the ball found the holes. I'm happy that we got a win tonight."
On July 7 and Aug. 18, Ciriaco collected a pair of four-hit games against the Yankees to become the first Red Sox player since Wade Boggs (1989) to accomplish that feat in one season.
"He's a good player, man. He's a good player," Ortiz said. "He showed his skills in spring training and I know Bobby wanted him on the team, but he wasn't on the roster, so he had to take some other guys. Now that he finally got him, the kid is showing what he can do. This is what he showed during spring training. The guy's hungry and he's trying to put some thoughts in peoples' head and go from there."
Red Sox rookie catcher Ryan Lavarnway spent the majority of the season as Ciriaco's teammate in Pawtucket. During his time with the PawSox, Ciriaco mostly played second base since prospect Jose Iglesias was at shortstop. Once Iglesias landed on the disabled list with a back strain, Ciriaco was moved to the left side of the infield.
When he got called up to Boston, he mostly played shortstop until rookie third baseman Will Middlebrooks suffered a broken wrist on Aug. 11. In total, Ciriaco has played 21 games at third, 11 at shortstop, nine at second base, six as the DH and one game in left field.
"Ciriaco has done a phenomenal job," Lavarnway said. "I don't think we can ask any more of him, especially [against the Yankees]. I've had the pleasure of watching him all year in Triple-A and I don't think I ever saw him go two days in a row without getting a hit. And if he didn't get a hit one day, he's going to get three the next two. He's amazing."
Ciriaco's defense has been solid and his speed has been a difference-maker for the Red Sox. He made three Gold Glove caliber plays at third Tuesday night -- a diving grab and throw, a bare-handed play and a catch on what appeared to be a routine pop-up that was made difficult since a baserunner got in his way.
"The play he made on the ball down the line, I didn't think there was any way he could make that play, and then the backhanded play James [Loney] made by picking it on the other end was the highlight of the play," Valentine said. "Ciriaco has played well at third base for a guy who never played there before. We didn't know if he could." Valentine then knocked on the table twice as he said, "He's played well."
With the way he's played this season, Ciriaco has given himself a serious chance at becoming the club's everyday shortstop next season.


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Moity, Laurianne and Molinier, Valérie and Benazzouz, Adrien and Joossen, Benjamin and Gerbaud, Vincent and Aubry, Jean-Marie A "top-down" in silico approach for designing ad hoc bio-based solvents: application to glycerol-derived solvents of nitrocellulose. (2016) Green Chemistry, vol. 18 (n° 11). pp. 3239-3249. ISSN 1463-9262
Moity, Laurianne and Benazzouz, Adrien and Molinier, Valérie and Nardello-Rataj, Véronique and Elmkaddem, Mohammed Kamal and De Caro, Pascale and Thiebaud-Roux, Sophie and Gerbaud, Vincent and Marion, Philippe and Aubry, Jean-Marie Glycerol Acetals and Ketals as Bio-based Solvents: Positioning in Hansen and COSMO-RS spaces, Volatility and Stability towards Hydrolysis and Autoxidation. (2015) Green Chemistry, vol. 17 (n° 3). pp. 1779-1792. ISSN 1463-9262
Pizzino, Aldo and Rodriguez, Maria-Patricia and Xuereb, Catherine and Catté, Marianne and Van Hecke, Elisabeth and Aubry, Jean-Marie and Salager, Jean-Louis Light Backscattering as an Indirect Method for Detecting Emulsion Inversion. (2007) Langmuir, Vol.23 (n°10). pp 5286-5288. ISSN 0743-7463


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Whitetail Deer Hunting Photos & Stories
Every hunter likes to share stories about their experiences afield and many hunters like to hear these stories. The Photos & Stories section of BigGameHunt.net (BGH) allows hunters to share their hunting adventures in the form of stories and photos. Please feel free to browse, read, and contribute to this section of BGH.
16 Point Washington Whitetail
George Webster
I was hunting with my brother-in-law in unit #101 (Sherman unit, Washington) the late archery whitetail deer season. We had left my truck about half way from the top of the mountain. I was hunting back to my truck and using a grunt call and working down very slow.
Deer Hunting Success in Pike County Illinois
Josh Pawson
I have been hunting for 8 years and have taken some nice deer, for instance in 2008 I shot a 145 in. 10 pointer with my bow but this one really made my 2009 season. I had made up mind that I was going sit all day in my stand for the first time. Usually I come out of the woods about 10:30 am but I had a hunch that if I remained patient something big would come out especially since anything can happen during the rut.
Jonah's First Deer
Jeremy Swisher
Two very long days in stands. We moved three times the 1st day hunting as guests on a lease in Millividge GA. Always walking into the tree stands 1 hr prior to sunrise and walked out at dark. Let me just say for a father and son (from Northern Maine used to tracking in snow and still hunting) in a two man tree stand sitting for 3 to 4 hours at a time being silent and watching will task your willpower.
Jordan's Nine Point Deer
Jordan Wilson
One day on a cold afternon in November I saw this buck walk out at 200 yards from my stand. I shot this 9 point buck with my Remington 243. He scored around 145 inches.
Oklahoma Bowhunting Grand Slam
Mac Moad
The first week of October was finally here. The first three days were spent in my favorite stand watching 3 raccoons in which I had named Larry, Curly, and Moe. The mother raccoon was slightly bigger than the two younger ones, and seemed curious to every movement surrounding them. The days here in eastern Oklahoma in October were still in the 80's with mosquitoes buzzing everywhere. I was wondering if it was still too hot to hunt and questioned myself again over and over.
Indiana Deer Hunting Success
Chris James
It was a nice November 5th 2009 evening in Indiana. I had just gotten off work and I was off to the woods to get in my stand. I got my gear on, sprayed down and to my stand I went. I put out a couple of scent pads on the way in. I arrived at my stand at about 4:00 pm, I set down and was getting comfortable for the night's hunt. After getting comfortable I hit my grunt and within 2 minutes I saw my buck standing in the partially picked cornfield about 80 yards from my stand.
Ohio Piebald Deer
Bryant Hatem
I hunt in Franklin County Ohio, and I took my piebald deer on Novemember 7th, 2009.
The Early Bird Gets the Worm
Lance Stephens
For big bow hunters all around, the beginning of the season is a time we anticipate with great enthusiasm. Everyone has their bows tuned in, tree stands set, and you just can't wait to try out that new decoy. But, is every bow hunter really prepared to see more big bucks in that first evening than they ever had before? Well, I wasn't.
Virginia Piebald Whitetail Buck
Chris Blankenship
Photos of my piebald buck that I was able to take on opening day of general firearms season in Bedford County, Virginia. He is an 8 pointer, 22" wide outside, 20" inside and weighed about 180 pounds.
80 Year Old Tags 10 Point Buck
David Berry
My 80 year old dad tagged a 10 point 184 pound buck on 11/19/2009. Dad and I have hunted the Pawtuckaway Park area in Nottingham, New Hampshire for many, many years. Although he has helped me bag a few deer over the years and times past he tagged a doe or two, it has been quite some time since he has had the right opportunity to get a deer for himself.


text:
Potts Point, New South Wales, Australia 1920 – Sydney, Australia 2001
not titled [Two abstract human forms]. not titled [loose sheet from a sketchbook].
Place made:
London, Greater London, United Kingdom, England
Materials & Technique: drawings, graphite; ink; paper drawing in black pencil and ink Support: paper
Cat Raisonné: Gleeson (1983)
Acknowledgement: Purchased 1976
Accession No: NGA 76.1255.179


text:
"We only move into the 21st century on the foundation of things that have been established long, long ago."
"I don't really believe in history. And I think that at some level that's one subject of some of my work- the fact that history is mutable, which is essentially denying history. So either you can believe there is this thing called history which is a linear narrative or in some general sense a linear narrative with a definable kind of thrust to it, or you could say that there's just a lot of different stories. And if you believe that, which I would argue I believe, then you can't really break with them. You could only reassemble them, possibly in some other way. Or you could add your own. I am interested in the past because for me it seems like a very rich thing to try to understand, especially because art is essentially a physical remnant of a moment."
- Josiah McElhrny


text:
Swix Techlite Pro Ski Poles
The Swix Techlite Pro Ski Poles are durable aluminum sticks featuring the new DD6 handle and Swix Add Tab. Comes with the Swix Saturn basket system, comfort strap, and are recommended for recreational and freeride skiing.
- Brand
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- Female Male
- Age
- Adult
- Features
- Performance aluminum The new DD6 handle with ADD Tab Comfort strap Saturn basket system
- Tech Specs
- Diameters: Handle 18 mm, ferrule 10mm. Lengths: 110 cm - 135 cm. 5 cm interval.
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Evolution of Physical Oceanography
Evolution of Physical Oceanography was created to mark the career of Henry M. Stommel, the leading physical oceanographer of the 20th Century and a longtime MIT faculty member. The authors of the different chapters were asked to describe the evolution of their subject over the history of physical oceanography, and to provide a survey of the state-of-the-art of their subject as of 1980. Many of the chapters in this textbook are still up-to-date descriptions of active scientific fields, and all of... More
Material Type: Online Course
Date Added to MERLOT: June 09, 2011
Date Modified in MERLOT: October 16, 2013
Submitter: Phil Moss
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Re: EXPAT ASSGMT MEDELLIN: TO GO OR NOT TO GO?
HI, I think you´re the same guy who posted these same questions at the poorbuthappy site, aren´t you? Well, if you are then you got lots of answers to your questions, including mine, but you didn´t include one very important question there that I´d like to answer here: quality of medical services. Medellin has some of the most respected and advanced medical facilities in south america. Many foreigners go to Medellin to have their medical procedures done there because of the quality and the lower prices than in the U.S. There are several top level hospitals with excellent medical teams and technology. It´s better if you study spanish before you get there, probably your colleagues are fluent or somewhat fluent in english but besides that you won´t find many people on the street who could have a conversation with you. Shopping? there are five large malls, many supermarkets and shopping areas. I hope this helps.
Be the first to rate this answer!
Re: EXPAT ASSGMT MEDELLIN: TO GO OR NOT TO GO?
Medellin is great!!! Poblado area is really nice. Didnt find to many english speaking people, but generally doctors etc do, cause many train in the states.
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Well, Medellin is the second biggest city in Colombia, the only one with Metro system, with to Bus Terminals and Two Airports. It is the Medicine, Confection, Sports and Industry capital of Colombia.
Medellín is world leader in Organ and tissue transplants, we have the best water quality in South America as well as the more advanced technology and communications plataform in the Country.
There is violence as in other city of the western world, we have the international festivals of: Flowers, Jazz, Poetry, Fashion and Christmas.
About English, you can easily found place where they speak it, as well as doctors.
Medellin is in fact a really good place to life.
Be the first to rate this answer!
Ok,firstly- the last reply was written by a "paisa", i.e. a person from Medellin. I think you should do listen to what "natives" have to say about their city and the general sitaution. BUT..do consider the fact that like all of us they also tend to turn a blind eye to situations and events that we from Europe or the US would NOT consider as part of our day to day normal lives. I have lived outside my native Western European country for more than ten years now and the normal reponse you get from people from the "southern" hemisphere is that "just like all major cities we have crime" or "like all countries we have poverty". I do not like this response and it is due to local and national pride and the fact that the vast majority of people have not been outside their own country and seen something vastly different. Visit Scandinavia and then tell me if "all countries" have problems with crime and poverty!?
Ok, depending on where you are from in the states but Medellin have their fair share of problems. Poverty and crime rates are high, eventhough the sitaution have improved a lot (this depends a lot where you live also. In some areas you are never faced with poverty). With a white non-colombian face you will be treated differently. When visiting a market for example, you will pay a different and higher price than locals, that´s a given. Taxi drivers will often screw you over due to this as well. Doctors etc. do speak english will but the general person won´t, so yes do learn spanish. People will also appreciate the effort if you try to speak to them in their native tongue. If you live in the south-east or south-west of the city, you will be living in great comfort and be safe I would say. There are a bunch of malls where you could spend time with your family. There are also some get-aways putside of the city. Small cute villages that are nice to visit for a weekend. Note however that some parts are not that great to visit and don´t drive at night outside of Medellin. Some roads are also closed off at night.
I am sure you would like Medellin. It is so much nicer than Bogota. The climate, the people, the city is prettier and more green. What you always have to conside here though is that you need to be aware of situations that might arise. Secuirty is an issue, but if you just know what to do to you should be alright. Listen to what the locals do. If they don´t go out walking in some areas at night, neither do you. Just remember my point of local pride and that you with a foreign appearance always will be in the spotlight as there are few foreigners here.
If you are hesitant, go there and visit first! The bad rep the city has gained is unfair nowadays. It is not a war zone! You just need to know the what-to and the what-not to do´s. Good luck!
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This is for the owner to the last replay. I´m a "paisa" woman and I don´t know What the hesitant man did, anyway I´m agree what everything you wrote him, your's is a good picture about our city and situation, and i think he must go to Medellin to discover by him self what the city is.
Thank you to be honest, i´m sure he´ll appreciate.
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Growing Farmers Collective
Growing Farmers Collective
Meeting Information
|Place: Roos Rhode House
|Time: Mondays 5pm
Contact Information
|Email: email@example.com
Signer Information
|Signer 1: Sarah Chichetti (sac13)
|Signer 2: April Nugent (ann15)
|Signer 3: Owen Aptekar-Cassels (lfa14)
Advisor Information
|Advisor name: Nancy Hanson
Signer Resources
|Group Account Number: 560
|Submit a Funding Request
|Funding Request Decisions
|Student Group Signer Manual
Mission Statement
We seek to bring together the interests of students who find a common thread in agriculture yet bring other vastly different interests with them, creating a unique space for students to share. While many students work on farms, it is very rare for young people to be able to lead their own work, choose what crops to plant, methods, philosophies, plan for yield, etc. We hope to create a space that fosters excitement around agriculture and sustainability with like-minded students who are eager to learn!
****check out our Market Garden blog for photos and updates at: hampshiremarketgarden.tumblr.com
Use this google doc link to access template sheets for record work in the Market Garden. ====
Spring 2016
We will be hosting a Garden Work Day, Art Build and Cob Oven Cookout and Potluck in the community garden behind Roos-Rhode House Saturday April 23rd from noon to six. Join us in collaborating with other student groups like New Leaf, Guerrilla Arts Brigade and the Community Garden Stewards to come together and revitalize our community garden space, make art and eat yummy food.
We will also be hosting a tree planting event in the Greenwich Greenhouse (date to be announced). Come plant a fig tree with us and learn about our plans for this cool space!


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Hotels in Challes-les-Eaux
Hotel reservation
Hotel rooms in Challes-les-Eaux
There are not so many hotel rooms in Challes-les-Eaux, just 6, still everyone can find an offer to suit his choice. The most common offers in this city are 3 и 4 stars, they count 1 out of 6, and their prevalent location is central district. According to our practice, it is the most profitable to book a hotel in the south of Challes-les-Eaux, as it is the location of the hotels with optimal cost and quality offers along with the cheap hotels. Taking into account the small size of the city, there is no need to dwell hotel reservation on the location: the road to the city center would take less then half an hour, so one can book a hotel in any district of Challes-les-Eaux. The most populated with hotels district of Challes-les-Eaux is the north, 50% of cheap hotel rooms are concentrated here. However, even those who want to live in the south can choose from 1 variants of hotel rooms. Challes-les-Eaux is an ideal place for family and couple, such travellers rate hotels there 7.4 out of 10 on average. Apart from all these, hotels in Challes-les-Eaux offer their customers business centre, pets allowed, bar and restaurant/cafe. The most appreciated amenities in Challes-les-Eaux hotels are location and amenities. According to the visitors reviews, hotels in Challes-les-Eaux has great amenities, fantastic service and tasty breakfast. Take a look at our selection of the cheap hotel rooms in Challes-les-Eaux to make a well-informed choice for your reservation!
Challes-les-Eaux cheap hotels
All cheap hotels in Challes-les-Eaux
hotel collections
Top-3 hotels in the center of Challes-les-Eaux
average rating
It is not a surprise that many guests arriving to Challes-les-Eaux pay great attention to the location of their hotel. In order to save your time, we have prepared a collection of the hotels in the center of this city.
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Hotels in Challes-les-Eaux are spread around the city within the distance of 4.1 kilometers, while 2 hotels are located directly in the city center. Those who are keen on antique should definitely fall in love with
Chateau des Comtes de Challes
, the oldest hotel of Challes-les-Eaux, constructed in 1400. This hotel is located 0.6 km away from the city center. The most popular accommodations in Challes-les-Eaux is
Chateau des Comtes de Challes
, 3 stars hotel located in a 0.6 kilometers from the city center.
The best hotels are here and now. Try them!
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Gmail App "Intercepting" Emails?
Ever since my gmail app synced with my main gmail account i have stopped receiving mail to that account in the HTC mail app.
I have enabled IMAP so im thinking for some reason the phone recognizes the emails going to my gmail app and does not download them also to the HTC app.
Anyone have a similar problem or advice?
EDIT: I'll add that i can still send emails from the gmail account in the HTC app, just not seeing them come in.
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You are here: Shop Wildflower Seeds Sandy Soils Wildflower Seeds
Dry, Sandy Loam Soil - 100% Wildflower Seeds
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The Public Administration as a Developing Discipline
Perspectives on Past and Present Part 1
By (author) Robert T. Golembiewski
Format: Hardback
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Public Administration as a Developing Discipline by Robert T. Golembiewski
Book Description
The title of this book is Public Administration as a Developing Discipline and is written by author Robert T. Golembiewski. The book Public Administration as a Developing Discipline is published by Taylor & Francis Inc. The ISBN of this book is 9780824765651 and the format is Hardback. The publisher has not provided a book description for Public Administration as a Developing Discipline by Robert T. Golembiewski.
Book DetailsISBN: 9780824765651
(279mm x 216mm x 15mm)
Pages: 264
Imprint: Marcel Dekker Inc
Publisher: Taylor & Francis Inc
Publish Date: 1-Aug-1977
Country of Publication: United States
Other Editions...
Books By Author Robert T. Golembiewski
Handbook of Organizational Behavior, Hardback (October 2000)
Analyzes OB from a business marketing perspective - offering a treatment of central, soon-to-be central, contiguous, and topics of OB to facilitate greater viability and demand of OB practice. This book covers strategic and critical issues of the OB field with descriptive analyses and documentation.
Current Topics in Management, Hardback (June 1999)View all books by Robert T. Golembiewski
Part of the "Current Topics" series, this work contains seventeen chapters divided into six sections. They are labelled: Organization Theory, Organizational Behavior, Trust, Morality, and Ethics, Organizational Development and Innovation, International Management, and Concluding Comments.
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Biography, pictures and video galleries
|Christina Rene Hendricks portrayed the parts and roles in 'Grease' and 'Joseph and the Amazing Technicolor Dreamcoat'. Hendricks birth date is May 3, 1975 (Knoxville, Tennessee). Hendricks is a celebrity actress. Hendricks started her acting career when Hendricks joined the "Junior Musical Playhouse Company". Christina appeared regularly in, "Beggars and Choosers" (TV series) which aired from June 1999 to December 2000. Hendricks appeared in several shows such as "Kevin Hill", "The Big Time" and "The Court". Hendricks is popularly known for her character as Joan Holloway in the series "Mad Men" (AMC cable television). Hendricks became popular because of her Red hair, Busty figure and for playing intelligent dominating Women. Hendricks is married to Geoffrey Arend in 2009. Hendricks grabbed the award for Best Special Guest/Television for the Firefly episode Trash at 2006 SyFy Genre Awards. Hendricks also won the Best Actress award for, Mad Men (TV show) in 2009.
Christina Hendricks Galleries
Visit Banned Sex Tapes for more Christina Hendricks photos and movies. The most complete celebrity nudity archive on the net.


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Good evening, all:
I have two questions for the group: 1. I have several hosta clumps that have
drastically been reduced in size this year, e.g., 'Jack of Diamonds' ~6 yrs
old ['Jack of Diamonds' was never a good grower for me. However, it the size of
a TC liner this year.], 'Chesterland Gold' ~6yrs old, tokudama Aureonebulsoa
~8 yrs old, & 'Love Pat' ~8yrs old. No vermin damage. 2. What factors hinder a
hosta from sending up new divisions?
Thank you in advance for your assistance.
Rich Horowitz
Stoughton MA
To sign-off this list, send email to email@example.com with the
message text UNSUBSCRIBE HOSTA-OPEN


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Wall-Street is the most read online business publication in Romania. News, analisys and interviews are brought to the user daily, free of charge, by the web site's own editorial team. By accesing the Latest News section, the user learns about the latest information before it gets printed.
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Makes 2 cups
Dare to be different. That's Jim Budros's motto, and his culinary open-mindedness has won the financial advisor turned pit bull boss a championship at the Kansas City Royal International Barbecue Contest. What's different about his barbecue sauce is its main flavoring, an ingredient most people are more likely to drink than cook with: Coke! This isn't quite as strange as it sounds, because Coke is sweet, tart, and spicy the flavor profile of most great barbecue sauces. Incidentally, pot roast braised in Coca-Cola is a favorite in Venezuela.
1 cup Coca Cola
1 cup ketchup
1/4 cup Worcestershire sauce
1 teaspoon liquid smoke
1/2 cup A-l Steak Sauce
1/2 teaspoon onion powder
1/2 teaspoon garlic powder
1/2 teaspoon freshly ground black pepper
Combine all the ingredients in a heavy, non-reactive saucepan and gradually bring to a boil over medium heat. Reduce the heat slightly to obtain a gentle simmer. Simmer the sauce until reduced by a quarter, 6 to 8 minutes. Use right away or transfer to a large jar, cover, cool to room temperature, and refrigerate. The sauce will keep for several months.
Barbecue! Bible
Sauces, Rubs, and Marinades,
Bastes, Butters & Glazes
By Steven Raichlen
Workman, 2000
Paper: $12.95 (ISBN: 0-7611-1979-5)
Hardcover: $22.95 (ISBN: 0-7611-2013-0)
Illustrations throughout; two color; 320 pages
Recipe reprinted by permission.
This page created August 2000
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