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To determine whether general dietary supplement use is associated with cancer risk in UK women and to estimate risks related to use at one and two recording points.
Cox's proportional hazard regression models were used to estimate cancer risks for 32 665 middle-aged women in the UK Women's Cohort Study relating to any current supplement use recorded in a baseline questionnaire. During a median follow-up of 15 years, there were 3936 registered cancer incidences, including 1344 breast, 429 smoking-related and 362 colorectal cancers. Cancer risks for 12 948 of these women, who also completed questionnaires on average 4.4 years later, were estimated in relation to any supplement use at both time points (1527 cancers, including 561 breast, 131 smoking-related and 141 colorectal cancers). Adjustments were made for baseline confounders.
Total smoking-related cancers were associated with baseline supplement use (hazard ratio (HR)=1.41, 95% confidence interval (CI): 1.10, 1.81) compared with non-use, but not associated with use at both recording points (HR=1.29; 95% CI: 0.78, 2.13) compared with use at neither. There was no evidence of the associations between total, colorectal or breast cancers and baseline supplement use, or use at both recording points. In sub-analyses, no significant associations with breast cancer were found for premenopausal or postmenopausal baseline users, or similarly for use at both points (HR=1.35, 95% CI: 0.91, 2.01; and HR=0.93, 95% CI: 0.68, 1.26, respectively).
There was evidence that general supplement use was associated with increased smoking-related cancer risk, but there was no evidence of associations with total, colorectal and breast cancers.
A large proportion of UK women take supplements; 41% of women in the 2008/9 National Diet and Nutrition Survey reported using supplements in the previous year.1 Some women may take supplements to reduce their risk for chronic diseases.2 However, the 2007 World Cancer Research Fund review clearly states that supplements are not recommended for cancer prevention, and reports no convincing evidence from their systematic reviews that specific micronutrients in supplement form protect against the risk of developing cancers that affect women.3 Furthermore, increased lung cancer risks were found for smokers who used high-dose β-carotene supplements.4,5
Supplementation with a variety of micronutrients may not be protective either; a meta-analysis of Randomised Control Trials (RCTs) showed no association between multivitamin supplement use and cancer mortality.6 Nevertheless, multivitamin use has recently been reported to reduce total cancer risk in men in a large US RCT;7 men, though, tend to have lower baseline antioxidant status than women indicative of a poorer diet.8 Two large US cohort studies reported no association between multivitamin supplement use in women and total cancer incidence, or cancer at the major sites such as breast, colorectal and lung.9,10 Ten-year, long-term use of multivitamins, which contain low-dose micronutrients, was also not associated with lung cancer in the Vitamins and Lifestyle (VITAL) cohort study.11 High-dose users tend to take a number of supplement types,12 and therefore are likely to supplement with a range of micronutrients. However, the majority of previous research has analysed risks relating to single supplements rather than multiple or general supplement use.
Although RCTs are less prone to bias than observational studies, supplementation over the intervention period may be insufficient to affect long-term risks, and these periods are usually substantially shorter than follow-up periods in most prospective observational studies. In addition, unlike drug trials, members of control groups can easily obtain supplements. On the other hand, it is possible that the sporadic nature of supplement use in free-living populations, as highlighted in European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg,13 might explain the lack of associations or inconsistencies in results in cohort studies. However, only the analyses of the EPIC-Heidelberg cohort and a Japanese cohort study have assessed whether general supplement use at more than one recording point was associated with cancer incidence,14 or with cancer mortality,15 and no associations were found for users who took supplements at more than one recording point. However, there was evidence from these cohorts that users at more than one recording point had a healthier diet compared with past and new users as well as non-users.13,14
This study prospectively analyses the relationship between current use of any supplement type and total cancer, smoking-related cancer,16,17 colorectal cancer and breast cancer risk in UK women. In secondary analyses, the cancer risks for women using supplements at two recording points, and the risks for use at only one of these points, are compared with the risks for women not taking supplements at either point. In addition, the characteristics of UK women in these different supplement user groups are compared.
Materials and methods
Study population
UK Women's Cohort Study (UKWCS) recruitment data were gathered between 1995 and 1998 from 35 367 women aged between 33 and 74 years who completed a 217-item validated food frequency questionnaire.18, 19, 20 This national cohort of mainly Caucasian, well-educated, middle-class, middle-aged, married women was designed to compare disease incidence in vegetarians, fish eaters and meat eaters.18 At recruitment, 34 958 (99%) provided information about whether or not they took supplements.
Women with any prevalent malignant cancers recorded in UK cancer registries before baseline cohort entry were excluded. This provided 32 665 women for the risk analysis, which compared women who took supplements at baseline with those who did not. Over the median follow-up period of 15 years, there were 3936 malignant cancer incidences (including non-melanoma skin cancers) ascertained from UK cancer registries via the UK Office of National statistics. These included 1344 breast and 362 colorectal cancers diagnosed by the censor date 1 October 2011. There were also 429 smoking-related cancers16,17 (lung (172), cervical (27), bladder (53), kidney (48), oesophageal (47), stomach (24) and pancreas (66)).
To explore the stability of general supplement use between two survey points, further secondary analyses were undertaken for 12 948 of the above women who also completed supplement questions on the UKWCS follow-up survey between 2 and 5 years after baseline (4.4 years on average). These women were split into three categories. 'Users at both' were defined in these analyses as women who were taking any type of supplement at both the baseline and the second survey. 'New/past users' reported taking supplements at only one of the two survey time points and 'never-users' reported no supplement use at either. Over a median follow-up period of 15 years from baseline, there were 1527 incident cancers in total and 561 incident breast, 131 smoking-related and 141 colorectal cancers registered to the censor date 1 October 2011 in these 12 948 women. One hundred and forty eight (26%) of the 561 breast cancer cases and 308 (20%) of the 1527 total cancer cases occurred between baseline and the second survey in the UKWCS.
Data collection
General supplement use at baseline was determined by means of a questionnaire using self-reported yes/no answers to:
Do you take any vitamins, minerals, fish oils or other food supplements?
General supplement use at the second survey was determined by means of a questionnaire using self-reported yes/no answers to:
Do you presently use any dietary supplements?
Supplements were defined on this second survey questionnaire as vitamins, minerals, fibre, fish oils or other food supplements. In addition, if participants did not answer yes to the above questions but provided details of any type of supplements taken, regardless of amount taken, these women were designated as being general supplement users. The most popular supplement types taken daily were determined at this second survey where women were asked to indicate the frequency of types they took from a list of 16 types provided on the questionnaire.
Covariates were derived from the health and lifestyle part of the baseline questionnaire, except for total alcohol intake and total energy intake which were derived from the baseline food frequency questionnaire.
Statistical analyses
Characteristics of women in the different supplement use categories were described using means and percentages. Significant differences between means of baseline users and non-users were established using t-tests and significant differences between categories were established using χ2 test. Any significant trends across groups from 'never-users' to 'new/past users' to 'users at both' were determined using linear regression followed by tests for linear hypotheses for means, or using χ2 test for trend for dichotomous variable percentages.
Cox proportional hazard regression was used to provide hazard ratios (HRs) to estimate cancer risks in relation to supplement use for women in the UKWCS. The reference groups in the main analyses were 'non-users' at baseline, whereas in the secondary analyses cancer risks for 'users at both' and 'new/past users' categories were compared with 'never-users'. Probability weighting was used to produce estimated average risks representative of the UK population of women, needed because of the recruitment of substantially higher proportions of vegetarians and fish eaters into the cohort compared with the UK population. Vegetarians and fish eaters were weighted by 0.27 and 0.43, respectively. Adjustments were made in the total cancer, smoking-related cancer and colorectal cancer analyses for age, body mass index (underweight, normal, overweight, obese), education (none, up to degree level, degree), smoking status (never, past, current occasionally, current every day), minutes of sweating exercise per week, alcohol intake (g/day), total energy intake (kcal/d) and dietary type (mainly meat, oily fish, other fish eater, vegetarian as described elsewhere18). In addition to the above, the breast cancer analyses were adjusted for contraceptive pill use (never, past, current), hormone replacement therapy (HRT) (never, past, current), age at menarche, and parity, but not smoking status. Although there was no interaction between supplement use at baseline and menopausal status in relation to breast cancer risks in likelihood ratio tests for interactions, HRs were examined by menopausal status, as commonly practised in breast cancer risk analyses. Menopausal status at baseline was determined from responses to a number of questions relating to last natural period, HRT and contraceptive pill use, hysterectomy and ovary removal.21 Sensitivity analyses were undertaken to make additional adjustments for family history of cancer in first-degree relatives (missing data was >5%) and in the breast cancer analysis for estimated weeks of breastfeeding. Other sensitivity analyses excluded incident cancers within 2 years of baseline. Further sensitivity analysis, with a median follow-up time of 10.6 years, was undertaken relating to use at two time points where the time-to-event calculation was started from the second survey date instead of from baseline, thereby excluding incident cases diagnosed between the surveys. Analyses were carried out using Stata version 12 (Timberlake Consultants UK, London, UK) and results were based on a significance level of P<0.05.
Of the 32 665 eligible women, 62% were supplement users at baseline and 54% of the 12 948 women at the second survey had taken supplements at both recording points, and were classed as users at both. At the second survey, 25% were new/past users (had taken supplements at either recording point but not at both) and 21% were never-users. Of the 8915 (69%) women who were currently taking supplements at the second survey, 7010 (79%) had also taken supplements at baseline and were classed as users at both. On the second survey questionnaire, 27% of all women reported taking fish oils, 25% reported taking multivitamins/minerals, 19% were taking primrose/starflower oil, 18% reported taking vitamin C and 14% were taking calcium supplements on a daily basis. These were the most popularly named supplement types, and for each of these there were statistically significant differences in intake between menopausal statuses: multivitamins and primrose/starflower oil were more likely to be used by premenopausal women, whereas cod liver oil and the others were more likely to be taken by women of postmenopausal age.
There were statistically significant differences between general supplement users and non-users at baseline for the majority of characteristics listed in Table 1. In particular, users reported a higher fruit and vegetable intake, a lower meat intake, lower alcohol intake and reported doing more vigorous exercise compared with non-users. Users were also more likely to have a family history of any cancer. However, there were no significant differences in level of education.
Similarly as observed in Table 2, there were increasingly healthier behaviours relating to exercise, alcohol use, fruit and vegetable intake and meat intake from never-users (at baseline and second survey), through new/past users, to users at both recording points. There was a decreasing trend for HRT use, number of children and estimated cumulative breastfeeding, but an increase in trend for supplement use for ex-smokers. However, there were no significant differences between user frequency in relation to family history of cancer.
As observed in Table 3 in the analysis of supplement use assessed at baseline for all women, there was no statistically significant difference in total cancer, colorectal cancer or breast cancer risk between all supplement users and non-users either in the unadjusted or adjusted analyses (adjusted HR=1.06, 95% confidence interval (CI): 0.98, 1.14; HR=1.13, 95% CI: 0.87, 1.46; and HR=1.01, 95% CI: 0.89, 1.15, respectively). There was no evidence of interactions between supplement use and menopausal status (P=0.13) or HRT use on breast cancer risk. Furthermore, in the sub-analysis by menopausal status, HRs were not statistically significant (adjusted HR=0.96, 95% CI: 0.81, 1.13; and HR=1.07, 95% CI: 0.88, 1.30 for postmenopausal women and premenopausal, respectively, as shown in Table 3). However, an association was found for smoking-related cancers (HR=1.41, 95% CI: 1.10, 1.81; P=0.007), which remained after excluding cancers occurring within 2 years of baseline (HR=1.36, 95% CI: 1.05, 1.76; P=0.02).
Similarly in the secondary analysis exploring consistency of supplement-taking between baseline and the second survey, compared with never-users there was no significant difference in the risk for total cancer, colorectal cancer and breast cancer in the adjusted analyses for new/past users (HR=0.96, 95% CI: 0.81, 1.14; HR=0.71, 95% CI: 0.40, 1.26; and HR=0.98, 95% CI: 0.73, 1.30, respectively) and users at both recording points (HR=1.01; 95% CI: 0.88, 1.17; HR=1.00, 95% CI: 0.63, 1.57; and HR=1.08; 95% CI: 0.85, 1.38, respectively) as observed in Table 4. Although the point estimates were raised in the premenopausal sub-analysis they were not statistically significant (HR=1.17, 95% CI: 0.74, 1.84; and HR=1.35, 95% CI: 0.91, 2.01, respectively, for past/new users and users at both recording points). In addition, no evidence of association was found for smoking-related cancers for past/new users (HR=0.97 95% CI: 0.53, 1.79) or for users at both recording points (HR=1.29; 95% CI: 0.78, 2.13). Additional adjustment for estimated cumulative breastfeeding duration in the breast cancer analyses and for family history of cancer had little effect on HRs and confidence intervals in the above analyses.
The results of the sensitivity analysis, which excluded cases diagnosed within 2 years of baseline or diagnosed between supplement-taking surveys, did not affect the overall conclusion of this research (data not shown).
There was little evidence of associations between general supplement use and total cancer, colorectal cancer and breast cancer risk in this UK cohort, whether comparing risks for supplement users at one recording point with non-users or comparing risk for users at two recording points with never-users or comparing past/new users with never-users. There was evidence that general supplement use was associated with increased smoking-related cancer risk in the full-sample baseline analysis. However, this was not significant for the users at both recording points, but this secondary analysis was limited by lower numbers and therefore lower power. There was evidence, however, that users at both recording points had different characteristics from women who had not used supplements at one or both points.
Descriptive results from these UKWCS analyses support the inverse supplement hypothesis that supplement users lead a healthier lifestyle than non-users, as found in the UK22, 23, 24 and elsewhere.25, 26, 27, 28, 29, 30 In particular, supplement users in the UKWCS had on average a higher intake of fruit and vegetables and a lower intake of meat and alcohol, and also spent more time exercising vigorously, and had lower body mass indices. Moreover, the results show a trend toward these healthier behaviours from never-users, to new/past users to users at both recording points. Similarly, women taking supplements at all three recording points in the EPIC-Heidelberg cohort in Germany, classed as 'consistent users', had the highest intake of dairy products, fish, fruit and vegetables and wine, and the highest physical activity, but the lowest intake of meat compared with the other categories, producing trends for all but physical activity.13 In the cohort of Japanese women, 'consistent users' had lower body mass indices and consumed significantly larger amounts of fruit, folate and vitamin C than the other categories, but were more likely to be regular alcohol drinkers and exercised less; in addition, there were no significant trends for green vegetables, meat and fish intake.14 In these previous studies, unlike the current study, ex-smokers were more likely to be inconsistent users. Trends in HRT or contraceptive pill use were found in the current study, but were not examined in the previous studies.
The increased risk in smoking-related cancers in the baseline analysis, found after adjustment for confounders, may relate to evidence that high-dose β-carotene is associated with increased lung4,5 and other smoking-related cancer risks in smokers.31 Conversely, β-carotene has also been inversely associated with smoking-related cancer risks in non-smokers.31 Potentially, β-carotene may act as a pro-oxidant or antioxidant depending upon the biological environment.32 Unfortunately, the amount of β-carotene taken in supplements by the UKWCS users in the current analyses was not reported by the questionnaire and is unknown, although it is usually present in low doses in popular multivitamin supplements.33 Furthermore, as only 11% of the women smoked, the numbers were considered too low to power sub-analyses by smoking status in relation to general supplement use. Alternatively, the increased risks found in the main analysis may be due to other micronutrients in supplements, or due to confounding or multiple testing. The lack of association for smoking-related cancers for users at the two recording points in the UKWCS does not support the main analysis finding; however, this may be due to fewer cases and shorter follow-up time from use at the second survey in this secondary analysis.
There was no evidence of significant associations between general supplement use at baseline and later incidences of total cancers, colorectal cancer or breast cancer for all women, or when explored by menopausal status in the breast cancer analysis. This is in line with results from a breast cancer meta-analysis,34 and also results from two large cohort studies that reported no associations between multivitamin use in women and total cancers, colorectal or breast cancer, and lung cancer incidence.9,10 There is some prior evidence, however, that folic acid in multivitamins is associated with reduced risk of early stages of colorectal cancer.35 The breast cancer results support those from two Danish and US case–control studies on general supplement use;36,37 however, they are in contrast to a Taiwanese case–control study in which general supplement use was associated with a reduced risk for breast cancer (odds ratio=0.40, 95% CI: 0.3, 0.7).38 Selection and recall bias, which can occur in case–control studies, possible lower dietary intakes of micronutrients in the Taiwanese women or the nature of the supplements taken could account for discrepancies in results.
In addition, there were no associations between reporting supplement use at two recording points (both baseline and second survey) and total cancer, colorectal cancer or breast cancer risk for all women, and by menopausal status in the breast cancer analysis. The current study is the first to analyse cancer risks for UK women reporting supplement use at more than one time point in comparison with never-users. Previously, only two studies had analysed general supplement use at more than one recording point in relation to cancer, reporting no associations for 'consistent users' in relation to total cancer and major site-specific cancers in a Japanese cohort incidence, and total mortality in the EPIC-Heidelberg cohort in Germany.14,15
Major strengths of the UKWCS study are the prospective design and the large number of cancer cases, particularly in the baseline analysis. However, the power to detect associations was substantially reduced in the analysis of users at two recording points, although numbers in this category were larger (7010 (54%)) compared with previous studies (German men and women: 3559 (18%); Japanese women: 1962 (5.8%)).14,15 Another limitation of this secondary analysis in the UKWCS is that within the category of 'users at both' it was not possible to distinguish between regular users who took any supplements for several days each week and sporadic users. Misclassification of sporadic users in the UKWCS into this 'users at both' category for premenopausal women, for instance, would have attenuated risks in this category, if cancer risk were lower for sporadic users. However, the questions relating to regular intake, used to define consistent use in the two previous studies,14,15 indicate that the women in this group in these studies were more likely to be stable longer-term users. The average period between baseline and final supplement use recordings was also shorter in the UKWCS. A limitation in the current and previous studies is that it was unknown whether the same types of supplements were taken at baseline as those at second survey: it was unknown for how long, how frequently, how many and at what doses supplements were taken.
Although supplement use in nutrient-deficient populations may be required to reduce the development of cancer,39 any protective effects of general supplement use per se on cancer risk in well-nourished populations such as the UKWCS would be more difficult to explain biologically. As previously reported, many in the UKWCS took a variety of supplement types.12 In line with findings from a small 2008 UK national survey,40 at the UKWCS second survey cod liver oil was more likely to be taken by women of postmenopausal age, whereas multivitamins were more likely to be used by younger women. Whether or not these supplement types have different associations with breast cancer risk, differences in estimates between menopausal statuses in the current analyses were not significant, nor were the increased risk estimates across use categories for premenopausal women significant. Further research is needed into premenopausal users, particularly with larger sample sizes, as research is lacking in this area.
Although observational data such as these are only able to highlight links between diet and disease incidence rather than provide causal evidence, the apparent lack of benefit associated with general supplement use on cancer risks shown in this UK cohort lends support to the guidelines produced by the World Cancer Research Fund that supplement-taking is not advised for reducing cancer risk.
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The UK Women's Cohort Study was conceived and designed by JEC and the creation was funded by the World Cancer Research Fund. JH conducted the analysis for this manuscript, wrote the first version and contributed to all other versions. DCG provided statistical advice. All authors contributed to the design of the analysis and to the write-up.
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The authors declare no conflict of interest.
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Hutchinson, J., Burley, V., Greenwood, D. et al. General supplement use, subsequent use and cancer risk in the UK Women's Cohort Study. Eur J Clin Nutr 68, 1095–1100 (2014). https://doi.org/10.1038/ejcn.2014.85
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Further reading
Cohort Profile: The UK Women?s Cohort Study (UKWCS)
International Journal of Epidemiology (2017)
Trends in vitamin, mineral and dietary supplement use in Switzerland. The CoLaus study
European Journal of Clinical Nutrition (2017)
Total dietary antioxidant capacity, individual antioxidant intake and breast cancer risk: The Rotterdam study
International Journal of Cancer (2015)


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digiKam Software Collection 2.0.0 beta4 is out…
Dear all digiKam fans and users!
digiKam team is proud to announce the 4th digiKam Software Collection 2.0.0 beta release!
With this release, digiKam include Group of items feature and MediaWiki export tool.
digiKam include since 2.0.0 beta3 Color Labels and Pick Labels feature to simplify image cataloging operations in your photograph workflow.
Also, digiKam include since 2.0.0 beta2 the Tags Keyboard Shorcuts feature to simplify tagging operations in your photograph workflow.
digiKam software collection 2.0.0 include all Google Summer of Code 2010 projects, as XMP sidecar support, Face Recognition, Image Versioning, and Reverse Geocoding. All this works have been processed during Coding Sprint 2010. You can find a resume of this event at this page.
This beta release is not yet stable. Do not use yet in production. Please report all bugs to KDE bugzilla following indications from this page. The release plan can be seen at this url.
See also the list of file closed with this release into KDE bugzilla.
digiKam software collection tarball can be downloaded from SourceForge Repository
Happy digiKam testing…
Great job!
This new release is coming along nicely, thank you very much to all the involved ;)
Face detection works nicely,
Face detection works nicely, but I don't see any face recognition happening anywhere, even after manually associating lots of "Unknown" faces with people tags. Or am I just looking in the wrong place in the UI?
Btw, I found it very confusing that the list of detected but unknown faces is tied to a pre-created "People/Unknown" tag. Not only is it confusing (because, logically, a detected face doesn't really have anything to do with tags, until it is actually tagged by the user). And not only is it confusing, but also:
1) being a tag like any other. it also shows up in the normal tag view, but it's always empty there, so it's just additional UI clutter…
2) when you accidentally delete it, there doesn't seem to be a way to get it back (manually re-creating a tag with the same name doesn't seem to work)…
I think it would be much more logical to have a dedicated hard-coded "unknown faces" list in the People view, without "abusing" a tag for this.
Otherwise: Nice work!
please report on Bugzilla…
So does this mean that face
So does this mean that face recognition is actually supposed to work in this beta, and I'm merely encountering some kind of bug?
How exactly is it supposed to work?
Is it supposed to just tag faces it thinks it recognizes, as if the user himself had tagged them?
Or is it supposed to propose suggestions for individual faces so that you can accept/deny them with a single click (like in Picasa)? If so, where (in which view)?
I couldn't observe either, so far.
That's why I didn't go straight to the bug tracker, because I don't even know what the expected behavior should be… ;-)
face tagging with example pictures
It would be nice, to show each person-tag with an (choosable) example face-picture. see how it is done in picasa. that would be in the 4th screenshot on the left a foto-icon instead of the icon, and also in the context menu on the bottom right. perhaps the icons could then be a little larger.
Version for Windows?
Thanks again for this wonderful application !!!
I saw that one screenshot was made on a windows machine. Is there any hope to get an installer for digiKam on windows? The KDE Windows installer is not yet updated and I would really like to test the new features on windows to give some feedback.
Windows and Mac?? PLEASE!
I know digikam on Linux, and it's a killer application.
But if you had that on Windows (Win XP and Win 7 64 bit) and Mac OSX (without the awful X environemnt that Gimp for Mac needs) it will be a real killer for several commercial products and the majority of shareware/opensource/freeware products. I know most applications in this business, believe me, this wonderful program would become number one within months.
Grouping, Versioning and XMP Sidecars
The grouping, versioning and XMP sidecar support are features that I am really looking forward to. I have a quick question about how they would fit into my typical workflow and I hope one of the developers could help me understand how those features will work for me.
Most cameras that support a raw format also support RAW+JPEG shooting, where two files are created for each shot. I often shoot RAW+JPEG when conditions are difficult. Most of the time, the JPEG is good enough, but it is handy to have the RAW file available for some adjustments in post processing. Shooting the two together saves conversion time and gives me two files with the same name and different file extensions. To all intents and purposes, these are the same image, so tags that apply to one will apply equally to the other.
What will happen with the XMP sidecar support in this case? As the images are tagged individually, if I add tags A, B and C to the RAW file and the XMP sidecar is updated, will these tags appear for the JPEG file, or do I need to apply them again to that file to have them reflected in the database? What if I apply tags A and B to the JPEG file and forget to add tag C, will the sidecar be overwritten and the C tag (added for the RAW image) be removed?
Will the grouping feature automatically group my RAW and JPEG images into one, or do I have to do that manually? The files have the same name, but different extensions.
Say I modify a RAW file and a new version is created in JPEG format. Now I make a modification to the original companion JPEG image. Will the version of the JPEG image overwrite the version of the RAW image (saved in JPEG format), as the files will probably have the same name (Xv1.jpg, or something like that)?
It is little details like this that will make or break these features for me. I haven't been able to find any information about these use cases anywhere.
Looking forward to 2.0,
No need to reply
I see from some of the more active bug reports that the developers never properly considered any of these possibilities. Never mind, I'll wait for some sort of usable implementation in 3.0.
this paper is accurate to be useful. Thanks to the author.
Great Product
Thank you for spending so much time creating this 'must-have' for all web designers and even budding photographers. I was pointed in your direction by someone who just 'happened' upon your site.
Since I am a full-time web designer and often need tools to help me cut down on the time that I spend manipulating photos, I was absolutely delighted to try your comprehensive software.
I was very pleasantly surprised, firstly that it was so very flexible and interactive. Secondly, that you have not attached a HUGE price tag to such a great product.
To make a long story short, I so impressed today that I dedicated my blog to your efforts at
I am very proud to give all bragging rights to digiKam today! Thank you.
Joanna (Joanna's Blog)

subset: commoncrawl


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Tour Guide at Florida Southern College
Class of 2021
Hometown: Lakeland, FL
Major: Biology
Secondary Major: Psychology
Minor: Chemistry and Neuroscience
On campus I am involved in campus ministries, academic honor societies (such as Beta, Beta, Beta and the National Society of Leadership and Success), the Alpha Chi Omega Fraternity, intramurals, and am a Resident Advisor in for freshman in Wesley. One of my favorite organizations that I am involved in is the Pre-dental society, which involves some fun events throughout the semester such as dinner with dentists and learning to suture on fruits.
Growing up in Lakeland, I regularly attended sporting events and Florida Southern's annual homecoming activities. Other colleges I've toured nationwide did not feel like home to me, as FSC has always felt. Also, both my parents attended FSC, so I do feel a sense of belonging here as a legacy. Through my involvement on campus, I know I made the right decision, as there's nowhere else I'd rather be than at FSC.
One of my favorite things to do in Lakeland is to go to the Saturday morning farmers market and hang out and study in our many coffee shops. It is a great time to experience some of the best features Lakeland has to offer.
So far, one of my favorite classes at FSC has been Sensation and Perception. Being a double major in biology and psychology, I found that this course was the perfect combination of both anatomy and physiology. It also touched on the vital act of receiving and interpreting information. This course was engaging as well as thought provoking, and one of my favorite memories was when we held class in a local breakfast diner. I love how the small class sizes at FSC make it extremely feasible to be involved and have a one-on-one relationship with professors.


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Private Dining at LouRonzo's
Located in the heart of downtown Stuart,LouRonzo's is pleased to offer our Private Dining Room for your next function. Decorated with a modern Tuscan flair, The Private Room will make your next event unforgettable. Completely separated from the main dining room, The Private Room offers a quiet and peaceful setting to conduct a business meeting or a celebratory social party. The Private Room comes fully equipped with flat screen TV's, WiFi, and more. Whether it is for a holiday party, rehearsal dinner or a corporate working dinner, LouRonzo's Private Room will work with you to create the event of your dreams.
Maximum Capacity
Seated – 50
Cocktail Party – 60
With several menus to choose from LouRonzo's will be sure to please even the most discriminating palette. For assistance in planning your next celebratory event or company business meeting, please contact our Private Dining Manager Giuseppe at (772) 287-3334.


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Welcome on board!
Together we can make the difference
Because #theseastartsfromhere
Discover how
The Sea Starts From Here is a file rouge of change-making actions dedicated to the safeguard of the Oceans, developed and carried out with likeminded businesses.
Change starts from our daily actions, which can have a positive or negative impact on the future of our Blue Planet. Together we strive to (re)connect people, companies and businesses to the Ocean.
When it comes to our daily actions, it is up to us to choose where we stand.
The sea has no boundaries, and so should we to protect it. That's why we are creating a network of realities united to bring the sea closer to our everyday life. Because the sea starts also from your offices! Together, we can shape start the blue journey that is most fitting to your scenario.
A step-by-step journey to turn your company plastic-free and make your employers and their families fall in love with the Ocean, its wonders, but also its vulnerabilities. Because our daily actions can have a positive or negative impact on the Ocean, it is up to us to choose!
Let's get to know each other!
Tell us how is your business like to start our sustainable journey on the right wave.
Action plan
Consultancy, support and contacts to make your company more sustainable and bring the sea closer.
No More Plastic
Our expert communicators are ready chat about the beauty and fragility of the sea to motivate your actions.
The Sea starts from Us
An active and continuative journey where small actions can make a big change.


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Laura moved to Wales to live with her partner on a beautiful farm near Usk. She graduated from Bristol University in 2009, and during her degree had some fantastic placements including working at an elephant sanctuary in Thailand. Laura initially worked in a busy mixed practice in Kent, and then a small animal hospital in Windsor, where she gained a lot of emergency and out-of-hours experience. She left reluctantly in 2014 but was pleased to join such a dedicated team at Sanders, and loves living in Wales.
Outside of work, Laura is surrounded by animals: a black Labrador called Murray and a mad ginger cat called Angus.
She loves being outdoors, and tries to go horse riding as often as possible. Laura also enjoys drawing and painting when she can find the time. She is also a keen blues/soul singer and can often be found at open mic nights locally. Laura became Head Vet in December 2014, and feels lucky to work with such a lovely team.
Practice information
Sanders Veterinary Surgery
Opening Hours
Find Us
Find us here:


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Those contracts that are part of our daily lives!
Contracts are everywhere and come in different forms, from buying a package of gum to renting a house, to a handshake between two neighbours for an exchange of services. The vast majority of contracts do not involve a lawyer. Lawyers are generally involved when it comes to a fait accompli, and often only intervene when the parties have agreed to and executed a contract, and a dispute arises. It is therefore important to know some basic rules of contract law, if only to make the right decisions until you consult a lawyer.
Contracts don't have to be in writing: it is made with the consent of the contracting parties
This is one of the most fundamental principles of contract law: respect for the promises made, which in our jargon is called the principle of "consensualism". Two people agree on something that provides for reciprocal obligations and there are all the ingredients to form a contract. The oral contract is therefore valid in the eyes of the law and has the same legal effects as a written contract. However, it is less practical and carries greater risk in the event of a dispute, since both the proof of its existence and the terms of the contract will have to be proven by testimony. This may complicate the court's efforts, especially if there are contradictory testimonies! Words are fleeting, while a written contract is permanent. Thus, for greater peace of mind, important contracts should be recorded in writing, whether by an exchange of e-mails or text messages, or in a duly signed written deed.
The contract is the law that binds the parties
Contract law is called "private" in that it governs relations between two private persons, as opposed to public law, which governs relations between the State and individuals. The government has little interest in relationships or contracts between individuals or private companies, subject to public policy.
What exactly is public policy? It is a concept that evolves according to the habits, customs and values of a given era. Public policy is something that is fundamental, sacred and mandatory for all citizens. Breaking it is unacceptable in society, often immoral, contrary to public peace or fundamental rights. For example, the crimes contained in the Criminal Code are all contrary to public policy, as are contracts designed to circumvent tax rules. Family law generally concerns public policy, especially when children are involved.
Thus, as long as a contract does not conflict with public policy, it binds the parties and prevails over the other provisions of the law, which apply only if the parties have made provision otherwise. Thus, in the case of a sale, the price is payable in principle as soon as the good sold is handed over. If the parties agree that the purchase price will be payable in monthly instalments, the contract will apply and not the law.
The contract binds the parties
It is the nature of a duly formed contract that in the event of non-compliance, remedies and sanctions are provided. Civil law recognizes the principle of full reparation: the party aggrieved by a contract that has not been respected must be reinstated in the same situation as if the contract had been faithfully performed. This objective can be achieved in two ways: through specific performance (for example, if a fence was to be installed, the court may order that it be done) or through performance by equivalence (by ordering that a sum of money be paid to compensate for the damage suffered).
Once a contract has been made, it binds the parties not only to the provisions of the contract, but also to everything that stems from the law, equity and practice. It is only normal that the parties may not have been able to foresee everything, so any contract has implicit content. The law provides rules to mitigate the silence of the parties and, failing that, the court can still render a decision in accordance with both equity and practice.
Faced with the impossible, no one is bound
This maxim is included in civil law in the concept of force majeure. Unless a person has committed to a contract even beyond force majeure, it is always possible to exonerate oneself from a contract by demonstrating that a circumstance beyond one's control, unforeseeable and irresistible, has made it impossible to fulfil the contract. But beware! Any force majeure is interpretable restrictively and it must be a real impossibility.
The contract may be cancelled under certain circumstances
Let's be clear, this is the exception and not the rule. Cancelling a contract is contrary to another major principle, namely the stability of contracts. But the fact remains that our legal system recognizes certain causes of nullity of contracts, the most significant of which is undoubtedly the defect of consent. We mentioned earlier that the contract is an agreement of intent and that it is formed by the simple exchange of consent among the contracting parties. However, this consent must have been free and informed, and the parties must have had the authority to enter into a contract! Thus, a person who is not competent cannot give valid consent. Consent will not be free and informed if it is flawed by error, fear or injury.
The so-called "simple" error generally does not vitiate consent and allows the contract to be cancelled only when it concerns:
a) The nature of the contract (e.g., you believe that your brother-in-law is lending you his trailer, when in fact he is renting it to you)
b) The purpose of the service (e.g., you believe you are buying a real car, when it is actually a model version of a car)
c) Any essential element that determined the consent, provided it has been communicated (e.g., you want to rent a fully soundproofed room)
In contrast to a simple error, there is the error resulting from fraud on the part of the other party. Fraud is defined as any word, gesture or omission made with the intention of misleading the other party. In such a case, the contract may be cancelled if the person misled proves that they would not have accepted the terms of the contract if they had been aware, or that they would have entered into the contract under different conditions. For example, the seller of a house who claims that they have never had water infiltration when this is not true may be exposed to the buyer requesting cancellation of the contract when the unpleasant surprise is discovered.
We also mentioned that consent can be vitiated by fear: the well-known "arm twisting" or "gun to the head" technique. Anyone who signs a contract under such conditions can certainly request cancellation of the contract.
Finally, injury, which is less frequent, is another ground for voiding contracts. Injury is when a party accepts a contract that is unfavourable to them and causes them harm. In principle, injury will only make it possible to cancel a contract in the case of minors or protected adults (guardianship, trusteeship or others), or where the law provides for specific remedies, as in the case of a consumer contract, for example.
Based on the foregoing, one might be inclined to think that there is a wide range of ways to get out of a contract but, in reality, these are exceptional remedies and the person who invokes grounds for the cancellation of a contract must prove it, as the validity of the contract is always assumed.
Good faith is at the heart of any contractual relationship
Good faith is central to our civil law and this holds true in contractual matters. Good faith is a concept that is sometimes difficult to define, sometimes even subjective: it is good intentions, honesty, sincere and just belief. It is to be a little lenient and flexible when something unexpected arises, rather than to hide behind a clause in the contract that provides for draconian consequences. It means not using a cause of invalidity as a pretext when in fact we have simply contracted under economically disadvantageous conditions. It is also to always give the other party a chance to make amends when, a priori, said party is in default under the terms of the contract. Even without a good understanding of the law, any human being with a reasonable mind is capable of acting in good faith at all times. For a lawyer, it is often easier to defend a person who is acting in good faith and who is wrong than a person who is acting in bad faith and who is right.
Each of us enters into contracts every day, several times a day. Obviously, it is not necessary to consult a lawyer every time, however, in the case of certain major contracts, it is a good idea to consult us beforehand. If not, we are also here to help you find the best solution to your contractual dispute.


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Ohio's starting five took one last look to the crowd as the standing ovation from the Ohio faithful roared throughout The Convo.
Jason Preston, Jordan Dartis, Lunden McDay, Ben Vander Plas and Sylvester Ogbonda all took to the bench with nearly two minutes left in the second half and for good reason.
In the midst of a blowout, they watched as their teammates and backups made the most of the time that was left. Michael Brown Jr. scored on a flashy layup, and John Tenerowicz hit his first career 3-pointer in the final points of the Bobcats' 77-46 win over Miami in the 206th meeting between the two schools.
Saturday's win was more needed than the team could say. Ohio was on a four-game losing streak that started back on Jan. 21 in a nine-point home loss to Toledo.
Since then, it lost by two points to Akron and Northern Illinois, and then suffered an 11-point loss to Ball State.
It had a Tuesday bye before it played Miami, and coach Jeff Boals planned accordingly by telling his team to not come to the gym.
"It's a long season. It's a grind, especially when you've lost four in a row the way we've lost them," Boals said. "Mentally you can either check out or check in. They never wavered."
It would've been easy for Ohio to check out. The excuses are there: a young team, first-year coach, inexperienced. Instead, it put together its best game.
A sluggish first few minutes were erased when Dartis knocked down his 291st career 3-pointer, which now gives him the most in Ohio program history.
Moments later, the Bobcats generated a 16-0 run with 3-pointers from McDay and Ben Roderick. It wasn't just the offense, however, that gave the Bobcats the edge.
Miami missed 24 consecutive shots in the first half, and Ohio took advantage as it rattled off shot after shot. The points were coming as frequently as the RedHawks' missed shots were.
"Good defense, man," Dartis said. "I think we just kept throwing punches tonight."
Dartis was quick to credit Preston for the idea to come out and start the game pressing Miami, not because anything on film showed a clear-cut advantage, but because the Bobcats wanted to be aggressive from the start and force Miami to play the Bobcats' game.
Preston, who finished the game with his first career triple-double and the second-known triple-double in program history on 15 points, 10 rebounds and 10 assists, forced the turnovers that caused the RedHawks' offensive blunders.
In turn, it gave the Bobcats the success they have long been searching for over the course of two weeks.
"We just had a really fun and aggressive warmup, and everybody had lots of energy, and I wanted to keep that going by pressing," Preston said. "When we have a lot of energy and play with a lot of fun, we're tough to beat."
Credit the two days off at the beginning of the week for Ohio to maintain that energy. Boals noticed on their first day back at practice that the guys were laughing and smiling, not what you'd necessarily expect for a team that until Saturday had just two conference wins in nine games.
"I had to ask if that was our guys," Boals joked in reference to the looseness that Ohio showed before tipoff. "They were locked in on this game."
It certainly showed. For the first time in conference play, Ohio (11-12, 3-7 Mid-American Conference) simply dominated from start to finish.
It's been close several times this MAC season in springing out a win, but a series of plays made the differences.
Not on Saturday, though. Ohio made all the plays, and it never looked back, and with eight more games left in conference play, it can make the end half better than the start so long as it plays the way it did Saturday.


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supporting mental health
We know that sometimes it can be hard to know how to help yourself or a loved one struggling with their mental health. We also know a lot of people don't know how to ask for help. So we have asked for you! Here is a list of all different peoples experiences with what they find helpful AND unhelpful when it comes to support for their mental health. We hope that you find something on here that you've not tried before!
If you want to help contribute to pages like this you might want to become a contributor


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Book Review: A guide for male tweens about puberty and growing up.
Guy Talk by Lizzie Cox is a simple book that provides boys with everything that they need to know about puberty and being a teenager.
This book talks about all the changes that happen during puberty, including important things like managing social media, keeping fit, eating healthy food, depression and much more. It also talks about sexual intercourse (very simply) and liking girls (or boys). It also talks about what changes happen to girls.
Sexual intercourse is talked about in this book.
Guy Talk by Lizzie Cox is ideal for children between the ages of 12 years of age and older.
You can buy a copy of Guy Talk by Lizzie Cox from Amazon or Book Depository.
You can find more books like this in my extensive list of Sex Education Books for Children.
Today we're looking at a 2017 book called Guy Talk by Lizzie Cox. There are two versions; girl and boy puberty, and obviously, this is the boy's one. There is lots of easy to understand information and only 60 pages. There are larger words in it like foreskin that your kids might not know. To help that, it's got word definitions at the back, making it easy for you and your kids to read.
It is one of those books that talks about puberty and sex as they're very closely linked. Once people begin to ovulate or produce sperm, your kids need to understand they could start making babies and having sex. What I also like about this book is that it talks about what relationships are. This is important because once you go through puberty, your brain is wired to think of others in a different way. A way that is different from friendship.
There is a massive list of what this book talks about. What makes puberty happen, changes to your brain, and lots of information about penises. How they grow, how stuff can come out of them, and how to care for your penis. That last one is especially important as your child's penis will be changing. Eventually, they'll also want to make decisions on their pubic hair and circumcision based on cultural expectations. The book talks about how erections happen, wet dreams, and what to do about them. On top of that, the book talks about the changes to other parts of their body like odour, their feet, eyes, and teeth. That, because their body is changing, they might need to get glasses or braces. Female puberty is also explained as it's important for boys to understand it.
There is also a section that talks about love and relationships. As it says, 'Puberty turns you from a boy to a man. You might start to feel attracted to someone and think about them being your girlfriend or boyfriend.' What I like about this book is that it doesn't assume all boys like girls. One in ten boys are homosexual, so this book begins to normalize it.
Then, it talks about hormones, how they change your emotions, and what a relationship is. The book explains it as a friendship where your child shouldn't feel pressured to do anything. Sex and how babies are made is another great chapter. The descriptions aren't detailed and keep it simple for your children to read.
This is a line from the book, 'When a man and a woman are attracted to each other, they might decide to have sexual intercourse, or sex for short. When this happens, a man's erect penis is inserted into a woman's vagina. It's much more than that though. It's about giving one pleasure and engagement.' As you can see, it's very simplified.
That chapter also talks about orgasms, body image, and social media. Social media is what a lot of new books are now talking about, and I really like it. Using social media and the internet, kids are now being bullied through it more often than face-to-face. With the latter form of violence, kids could just escape it by going home and hiding. Cyberbullying is different. Even when they come home, they're still getting notifications and harassment from people down the street or even across the city.
This is a great book. I really like it because it's simple, casual, and fun. They also have a simple description of sex and talk about relationships. This makes it a great book that's easy to read for both you and your kids.
Okay, I hope that helps.
My mission is to create resources that will help you to naturally talk to your kids about sex, all while respecting your personal values.
Which means that inside this website, you'll find lots of resources to help you with talking to your child about love, sex, relationships and growing up.
My Sex Education 101 page includes all of the information on sex education. You'll find lots of different blogposts to help with getting started, on a wide range of different topics.
My Puberty 101 page includes all of the information on puberty. You'll find lots of different blogposts to help with talking to your child about growing up.
You'll find videos about sex ed in my Sex Education Videos resource page that you can watch with your child or to learn more about sex education yourself.
You'll also find an extensive range of sex education books for children, for kids of all ages. There's even some books in there for parents!
If you're looking for some ideas on how to talk to your child about bodies, How to Talk to Kids About Bodies, will help you to start naming the private body parts and to have shame-free conversations with them about bodies. It is filled with lots of different ideas on how to have natural converasations with your child about their body.
You'll also find some child friendly anatomically-correct cartoon illustrations of the genitals and internal reproductive organs that are appropriate for children from the age of 3 and up. Let's Look at Different Body Parts is a printable that will help take the awkward out of talking to your child about their body, so they grow up feeling educated, confident, and comfortable in their own skin.
If you're worried that talking to your child about bodies might lead to questions about sex, then you can relax. How to Talk to Kids About Sex, will help you to explain sexual intercourse to your child in a way they will understand. It breaks sex down into simple steps that take the stress out of explaining!
If you want a printed book to hold in your hands, then the The Sex Education Answer Book will give you age-specific answers to the most common questions kid's ask parents about sex. Which means you don't need to worry about finding a child-friendly explanation that your child understands.
If you want the answers to questions about a lot more than just sex, then Sex Ed Quickies is your best option. It has answers to 300+ questions that kids commonly ask parents, including how babies are made, sexual intercourse, body parts, puberty, relationships, pregnancy, birth, masturbation, sexual diversity, gender, pornography, STIs, contraception and much more.
I'm Cath, a sex educator living in Australia with my husband and 2 kids. I help parents to talk about sex (with less cringe and more confidence) and empower their child to make smart sexual decisions. To find a better way to talk about sex, you can join my community of parents and visit my shop for helpful resources.


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An acclaimed collection of stories from the internationally bestselling author of The Crimson Petal and the White
Deft and lyrical, this paperback edition of Michel Faber's collection of stories is his first since his auspicious debut, Some Rain Must Fall. It has sealed his reputation as one of Britain's most daring and original authors.
Acclaimed for his pitch-perfect prose and brilliant characterisation, Faber is also celebrated for his mastery of contrasting styles. From achingly sad lost lives, through moments of exquisitely distilled happiness, to biblical innocence and savagery, Faber's characters are redeemed, abandoned, beloved and laid bare.
"No only can he scare the bejesus out of you, he can make your heart swell … Mr Faber, you have officially got under our skin."
the Times
See more reviews
"I dread to think where Faber gets his inspiration from, but there's certainly no shortage of it in sight."
independent On Sunday
"Michel Faber at his uncanny best."
times Literary Supplement
"Here is a writer who can compare with Conrad in his ability to write the perfect sentence."
Michel Faber has written nine books. In addition to the Whitbread-shortlisted Under the Skin, he is the author of the highly acclaimed The Crimson Petal and the White, The Book of Strange New Things, which was shortlisted for the Arthur C, Clarke Award and won the 2015 Saltire Book of the Year, and most recently Undying, his first poetry collection. Born in Holland, brought up in Australia, he now lives in the UK.


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Even before the forsythia's bright yellow early blooms have arrived in Stony Run park, joggers, dog walkers and cyclists were out enjoying the seemingly secluded nature path in North Baltimore Saturday morning.
Several children played along the stream's edge, picking up rocks or dipping their hand into the cool water. It's something Doug Frost remembers doing with his own children when they were growing up.
"That's exactly what happens," he said, watching the young kids running along the water's edge. "They would play in the stream."
Frost, whose home backs up to the park's edge and now has 15 grandchildren, was one of about two dozen residents who walked its path Saturday to make recommendations for future improvements. The Roland Park Community Foundation is spearheading a study to find ways to preserve and improve the trail and stream, which runs roughly from Northern Parkway to Remington before spilling into the Jones Falls. The stream is ultimately a tributary of the Patapsco River and the Chesapeake Bay.
During the tour, Tom McGilloway, a board member with Friends of Stony Run, a volunteer stewardship organization for the stream valley, took notes on a map of the path he carried on a clipboard, as he and others combed along a section just south of Wyndhurst Avenue.
The recommendations made Saturday would be considered for a strategic plan being developed for the park by the Roland Park Community Foundation.
In some areas, the group pointed out erosion issues; in other, they noted places for new infrastructure.
The tour allowed for a "more hands-on" opportunity for residents to look at and talk about the trail, he said, rather then just submitting input at a community meeting or through email.
Overall, proposals are intended "to preserve the natural character," McGilloway said. "It's a wonderful gem."
Once the plan is developed, it will be shared with the city. Some of the less intensive work would be taken on by volunteers, he said, while more involved projects likely would left to the city, which owns the land.
Robert Friedman, who has called Evergreen community home for 17 years, said he came out because "I care about the neighborhood."
He occasionally walks through the park but said he came more often when his kids were younger.
In past years, he volunteered to take water quality samples of the water, looking for any sewage overflow or other issues.
One improvement he said he would like to see is a small boardwalk added along a section of the path that travels over some natural springs, where the trail can get swampy, he said.
He'd also like to see some wood chips added on the walking path to improve its surface texture.
"I want it to be preserved and protected, made nicer but not fancy," he said, saying the park's natural scenery should not be overshadowed by any improvements.
While most plants have yet to bloom along the path, Friedman said the park is an attraction throughout the whole year.
"It's a nice resource to get away from the cares of the city," he said.
While the path's attraction has been for its natural setting in the middle of the city, it has seen changes over the years, said Frost, who pointed along the path where the Maryland and Pennsylvania Railroad once ran.
Along the stream, he said the water has cut its own path over the years but stones have been added in some sections of the embankment.
"It's always changing," he said of the area. But kids, he said, always will be drawn to "the beach."