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We sought to perform a patient-level meta-analysis using the individual patient data of the trials identified in our previous study-level meta-analysis investigating the effect of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP).
Patient-level meta-analysis.
968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials.
Therapeutic PAP versus non-therapeutic control conditions (sham-PAP, pill placebo or standard care) over at least one week.
The mean reductions in BP between PAP and non-therapeutic control arms were -2.27 mm Hg (95% CI -4.01 to -0.54) for systolic BP and -1.78 mm Hg (95% CI -2.99 to -0.58) for diastolic BP. The presence of uncontrolled hypertension at baseline was significantly associated with a reduction in systolic BP of 7.1 mm Hg and diastolic BP of 4.3 mm Hg after controlling for OSA severity (apnea-hypopnea index, Epworth Sleepiness Scale score, PAP level), patient demographics (age, gender, body mass index, use of antihypertensive medication/s), and measures of PAP efficacy (PAP adherence and treatment duration).
OSA patients with uncontrolled hypertension are likely to gain the largest benefit from PAP in terms of a substantial reduction in BP, even after controlling for disease severity.
Bakker JP; Edwards BA; Gautam SP; Montesi SB; Durán-Cantolla J; Aizpuru F; Barbé F; Sánchezde-la-Torre M; Malhotra A. Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity. J Clin Sleep Med 2014;10(4):365-369.
Evidence to date has established that the gold-standard treatment for obstructive sleep apnea (OSA), positive airway pressure (PAP), has beneficial effects on the cardiovascular sequelae of OSA; however, the extent to which PAP can reduce blood pressure (BP) has been difficult to discern based on individual randomized controlled trials (RCTs). More importantly, which patient subgroups likely to experience a substantial reduction in BP with PAP is unclear.
We recently published the largest systematic review and meta-analysis to date comparing the effect of PAP treatment versus a non-therapeutic control condition on BP, including 28 RCTs (representing n = 1,948 patients).1 We reported that compared to control conditions, PAP significantly reduced both systolic BP (SBP) and diastolic BP (DBP) when assessed either during the day (SBP -2.58 mm Hg and DBP -2.01 mm Hg) or night (SBP -4.09 mm Hg and DBP -1.85 mm Hg). Using meta-regression, we found that the reduction in DBP with PAP was predicted by high mean baseline DBP and hypersomnolence as measured by the Epworth Sleepiness Scale (ESS).
Current Knowledge/Study Rationale: The extent to which positive airway pressure therapy can reduce blood pressure has been difficult to discern based on individual randomized controlled trials. This investigation was performed in order to identify which patient subgroups are more likely to experience a substantial reduction in blood pressure with treatment.
Study Impact: Our findings suggest that patients with uncontrolled hypertension are likely to experience the largest reduction in blood pressure with positive airway pressure therapy, after controlling for disease severity and daytime sleepiness. This finding has direct clinical relevance, in that it suggests that even patients with mild/moderate disease who do not report hypersomnolence are likely to benefit from treatment.
Our original hypothesis that OSA severity as measured by the apnea-hypopnea index (AHI) would be a significant predictor of the change in BP with PAP was not supported; similarly, age, treatment duration, and PAP adherence were not significant predictors in meta-regression analyses. Meta-regression is conceptually similar to simple regression except that in this setting, the independent (predictor) variables are at the study level. Hence, a degree of between-study variability of the independent variable/s in question is required in order for these data to be useful predictors of the dependent variable (outcome). For example in our meta-analysis, the mean age of patients in the 28 included trials fell into the narrow range of 43-63 years, and 85% of included trials had a mean age in the range of 45-55 years, despite the fact that the age range of each individual trial was wide. The low variability in study-level independent variables therefore limited our ability to identify significant predictors of BP using meta-regression.
Rather than performing further costly clinical trials targeting narrowly defined subgroups, we aimed to address this limitation by performing a patient-level meta-analysis using the individual patient data of the trials we identified in our previous study-level meta-analysis. Our primary hypothesis was that baseline AHI would be significantly associated with a reduction in both SBP and DBP with PAP treatment. We also sought to measure a range of other potential predictors encompassing OSA severity, patient demographics, and PAP efficacy.
Our published study-level meta-analysis1 contains details of the literature search and inclusion/exclusion criteria, which we adopted following PRISMA guidelines.2 In brief, we analyzed 28 RCTs published between 1980 and 2012 comparing PAP treatment to a non-therapeutic control condition (sham-PAP, pill placebo, or standard care) over at least one week in adult OSA patients without major comorbidity, reporting office BP and/or ambulatory BP measurements at ≥ 2 time points. For the current study, we emailed the first, second, last, and/or corresponding author of each RCT, allowing at least 8 weeks response time.
We requested that the authors provide de-identified individual data including: descriptive information (age, gender, body mass index [BMI] at baseline, use of antihypertensive medication/s), measures associated with OSA severity (AHI at baseline, ESS at baseline, therapeutic PAP level), and measures associated with PAP efficacy (residual AHI, PAP adherence, treatment duration). A binary independent variable of "uncontrolled hypertension at baseline" was created by identifying all patients with daytime SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg regardless of medication usage. We chose to exclude patients whose BP was well controlled with antihypertensives from this group, as a substantial reduction in BP would not be expected. AHI and ESS data were categorized according to commonly accepted cutoffs (AHI ≥ 30 events/h indicating severe OSA and ESS ≥ 11/24 indicating daytime hypersomnolence).
We requested all BP data available, recognizing the differing methods by which these data were collected. Our 2 dependent variables, daytime SBP and DBP, were created by using either office or daytime ambulatory measurements, with preference given to ambulatory measurements for studies that measured both. The change in SBP and DBP for each patient was calculated by subtracting the baseline value from the end-trial value, such that a negative value represented a reduction in BP. Our intention for crossover trials was to combine the data as above only when we were able to ascertain which intervention each patient received first, thereby treating these as parallel trials by ignoring the second arm of the study (in fact, no crossover studies were included in the final analyses).
In order to determine whether the data that we received for the current analyses were representative of our previous study-level meta-analysis, we performed a standard random-effects study-level meta-analysis for daytime SBP and DBP using Review Manager (RevMan) Version 5.1 (Nordic Cochrane Center, Copenhagen, Denmark), using only trials for which individual data were obtained.3
Using individual patient data, we then evaluated associations of our 2 dependent variables using mixed linear modeling with the study as the random factor. No within-studies clustering effect was evident, so standard between-group tests and linear regression were used for all patient-level statistical analyses, using SPSS (Version 20, IBM, NY USA). The differences between the changes in SBP and DBP with PAP versus non-therapeutic controls were assessed using independent t-tests. Univariate linear regression was used to assess the association between our 10 independent variables (age, gender, BMI, antihypertensive medication/s, AHI, ESS, PAP level, PAP adherence, treatment duration, uncontrolled hypertension at baseline) and each of the 2 dependent variables (SBP, DBP) in patients randomized to PAP treatment. Three multivariate linear regression models were then constructed for each of the 2 dependent variables; all multivariate models included uncontrolled hypertension at baseline, as substantial reductions in BP would not be expected in normotensive patients. Model 1 included measures of OSA severity (AHI, ESS, PAP level); Model 2 additionally controlled for patient descriptive information (age, gender, BMI, use of antihypertensives); Model 3 additionally controlled for measures of PAP efficacy (PAP adherence and treatment duration).
Data were received from the authors of 11 original trials; however, for the 3 crossover trials we were unable to determine which intervention each patient received first,4–6 leaving us with 8 analyzable trials (all parallel designs).7–14 The authors of 12 papers were not able to send their data,15–26 and the authors of the remaining papers did not respond.27–34 Study quality was assessed by analyzing various risks of bias by 2 independent investigators (JPB and BAE); see Table 1. On the whole, study quality was high, given that we included only randomized controlled trials; the most noteworthy source of potential bias comes from the fact that 4 of the trials were not placebo-controlled and were therefore not blinded completely.
Authors' judgments as to risk of bias in each randomized controlled trial
(more ...)
Our total sample size was n = 968; 486 patients were randomized to PAP, with the remaining 482 randomized to a non-therapeutic control condition. Six trials representing n = 564 patients8–13 used 24-h ABPM monitoring divided into diurnal/nocturnal data either by patient report or by a pre-determined clock time. The remaining 2 trials representing n = 404 patients7,14 used office BP measurements. Few studies had records pertaining to the follow-up time for individual patients; therefore, the average follow-up duration for each study as reported in the primary papers was used. Residual AHI was not available in the majority of studies due to the absence of follow-up sleep studies; this independent variable was therefore not used in any analyses.
Study-level meta-analyses of the aforementioned 8 trials7–14 found weighted mean differences between PAP and non-therapeutic control arms of -2.12 mm Hg (95% CI -3.89 to -0.36) for SBP and -1.60 mm Hg (95% CI -3.33 to 0.13) for DBP, both favoring PAP (statistical significance for SBP only). Pooling individual patient data from the same 8 trials, the mean differences between groups were -2.27 mm Hg (95% CI -4.01 to -0.54) for SBP and -1.78 mm Hg (95% CI -2.99 to -0.58) for DBP (significantly favoring PAP for both SBP and DBP).
Univariate predictors of the change in SBP and DBP with PAP are shown in Table 2. Increased treatment duration and the presence of uncontrolled hypertension at baseline were both significant univariate predictors of SBP and DBP reduction; PAP level was a significant univariate predictor of the change in DBP only. Results pertaining to the 3 multivariate models are also shown in Table 2. Uncontrolled hypertension at baseline remained an independent predictor of the reduction in both SBP and DBP, after controlling for (1) measures of OSA severity, (2) patient descriptive information, and (3) measures associated with PAP efficacy. The unstandardized β-value for uncontrolled hypertension at baseline remained at ≥ 7.0 (SBP) and ≥ 4.0 (DBP) in all models (all p-values ≤ 0.01).
Predictors of the change in daytime systolic and diastolic blood pressure with positive airway pressure treatment
The current study extends previous work1,35 by demonstrating that the sole predictor of a reduction in both SBP and DBP with PAP was the presence of uncontrolled hypertension at baseline. Although PAP level was also a significant independent predictor of the reduction in DBP, the magnitude of this trend was not strong (β values indicated that each 1 cm H2O increase in PAP was associated with a reduction in DBP of < 1 mm Hg). The presence of hypertension, however, was associated with a reduction in SBP of 7.1 mm Hg and DBP of 4.3 mm Hg after controlling for OSA severity, daytime sleepiness, patient demographics, and measures of PAP efficacy.
Our primary hypothesis, that baseline AHI would be significantly associated with a reduction in both SBP and DBP with PAP treatment, was not supported. Further, daytime sleepiness as measured by the ESS was not a significant predictor of the PAP-induced reduction in BP, in contrast with our previous study-level meta-analysis.1 Our previous work published in 2012 contained data that have subsequently been retracted. A major strength of the current analysis, however, is that we assembled the largest database of PAP patients measuring BP to date, and thus we were adequately powered to detect even small effect sizes, if they existed.36,37
Although the data pooled from eight trials represents only one-third of the studies included in our study-level meta-analysis, the fact that we were able to obtain data from several of the larger studies means that our sample size of n = 968 represents just over half of the available population. Given that the original trials were published over a period of 17 years, we believe that this response rate is substantial. The missing data may have led to some bias; however we believe this limitation to be minor, as (1) the point estimates for the reductions in SBP and DBP from the study-level meta-analyses performed here are in close agreement with our previously reported results,1 and (2) t-tests using individual patient data demonstrated almost identical mean differences in SBP and DBP. We are therefore confident that our data are representative of the total study population, and thus generalizable. Another limitation is that based on the type of studies included, we were limited to only assessing the effect of PAP on BP as this is the most widely reported cardiovascular measure. Similarly, very few studies reported the residual AHI and we were therefore unable to assess PAP efficacy. Approximately half the patients in our analyses had BP recorded using ABPM while the rest had BP recorded in the office setting; these methods are not necessarily comparable but we chose to combine these data. In all cases, the BP data was collected during a single 24-hour period or a single office visit, which limits reproducibility.38 Finally, we collected data from RCTs even though our regression models included only the patients randomized to PAP. We chose to do this for comparability to our previous meta-analysis, and also to limit potential publication bias resulting from the fact that non-randomized negative trials may remain unpublished whereas all RCTs should in theory be locatable.
Our findings suggest that obstructive sleep apnea patients with uncontrolled hypertension are likely to gain the largest benefit from positive airway pressure in terms of a substantial reduction in blood pressure, even after controlling for disease severity and daytime sleepiness. Whether the greater reduction in blood pressure in this group is independently associated with reductions in other cardiovascular sequelae associated with obstructive sleep apnea should be the focus of future studies.
This was not an industry supported study. Dr. Malhotra has consulted for Philips Respironics, Sleep HealthCenters, Sleep Group Solutions, Apnicure, Apnex, and Pfizer, but has relinquished all outside personal income since May 2012. The other authors have indicated no financial conflicts of interest. Work was performed at Brigham & Women's Hospital and Harvard Medical School, Boston, MA.
We thank the authors of original trials who provided individual patient data for these analyses. This work was conducted with support from Harvard Catalyst, the Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health. Dr. Bakker is supported by NIH R01HL110350. Dr. Edwards is supported by the National Health and Medical Research Council of Australia's CJ Martin Overseas Biomedical Fellowship (1035115). Dr. Malhotra is supported by NIH (R01HL110350, R01HL085188, R01HL090897, K24HL093218, P01HL095491) and AHA (0840159N) grants. Dr. Barbé is supported by Instituto de Salud Carlos III (PI 04/0165 and PI10/02763) (Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo, Spain) grant. No financial support was obtained for this investigation.
Montesi SB, Edwards BA, Malhotra A, Bakker JP, authors. The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med. 2012;8:587–96. [PubMed Central][PubMed]
Liberati A, Altman DG, Tetzlaff J, et al., authors. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65–94. [PubMed]
DerSimonian R, Laird N, authors. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88. [PubMed]
Comondore VR, Cheema R, Fox J, et al., authors. The impact of CPAP on cardiovascular biomarkers in minimally symptomatic patients with obstructive sleep apnea: a pilot feasibility randomized crossover trial. Lung. 2009;187:17–22. [PubMed]
Barnes M, McEvoy RD, Banks S, et al., authors. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med. 2004;170:656–64. [PubMed]
Barnes M, Houston D, Worsnop CJ, et al., authors. A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165:773–80. [PubMed]
Oliveira W, Campos O, Cintra F, et al., authors. Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real-time three-dimensional echocardiography. Heart. 2009;95:1872–8. [PubMed Central][PubMed]
Lozano L, Tovar JL, Sampol G, et al., authors. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens. 2010;28:2161–8. [PubMed]
Drager LF, Pedrosa RP, Diniz PM, et al., authors. The effects of continuous positive airway pressure on prehypertension and masked hypertension in men with severe obstructive sleep apnea. Hypertension. 2011;57:549–55. [PubMed]
Drager LF, Bortolotto LA, Figueiredo AC, Krieger EM, Lorenzi GF, authors. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2007;176:706–12. [PubMed]
Hui DS, To KW, Ko FW, et al., authors. Nasal CPAP reduces systemic blood pressure in patients with obstructive sleep apnoea and mild sleepiness. Thorax. 2006;61:1083–90. [PubMed Central][PubMed]
Duran-Cantolla J, Aizpuru F, Montserrat JM, et al., authors. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ. 2010;341:c5991. [PubMed]
Barbe F, Mayoralas LR, Duran J, et al., authors. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med. 2001;134:1015–23. [PubMed]
Barbe F, Duran-Cantolla J, Capote F, et al., authors. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010;181:718–26. [PubMed]
Kohler M, Stoewhas AC, Ayers L, et al., authors. Effects of CPAP therapy withdrawal in patients with obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2011;184:1192–9. [PubMed]
Kohler M, Pepperell JC, Casadei B, et al., authors. CPAP and measures of cardiovascular risk in males with OSAS. Eur Respir J. 2008;32:1488–96. [PubMed]
Norman D, Loredo JS, Nelesen RA, et al., authors. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension. 2006;47:840–5. [PubMed]
Mills PJ, Kennedy BP, Loredo JS, Dimsdale JE, Ziegler MG, authors. Effects of nasal continuous positive airway pressure and oxygen supplementation on norepinephrine kinetics and cardiovascular responses in obstructive sleep apnea. J Appl Physiol. 2006;100:343–8. [PubMed]
Dimsdale JE, Loredo JS, Profant J, authors. Effect of continuous positive airway pressure on blood pressure: a placebo trial. Hypertension. 2000;35:144–7. [PubMed]
Alonso-Fernandez A, Garcia-Rio F, Arias MA, et al., authors. Effects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomised trial. Thorax. 2009;64:581–6. [PubMed]
Cross MD, Mills NL, Al-Abri M, et al., authors. Continuous positive airway pressure improves vascular function in obstructive sleep apnoea/hypopnoea syndrome: a randomised controlled trial. Thorax. 2008;63:578–83. [PubMed]
Coughlin SR, Mawdsley L, Mugarza JA, Wilding JP, Calverley PM, authors. Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J. 2007;29:720–7. [PubMed]
Robinson GV, Smith DM, Langford BA, Davies RJ, Stradling JR, authors. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J. 2006;27:1229–35. [PubMed]
Alonso-Fernandez A, Garcia-Rio F, Arias MA, et al., authors. Obstructive sleep apnoeahypoapnoea syndrome reversibly depresses cardiac response to exercise. Eur Heart J. 2006;27:207–15. [PubMed]
Faccenda JF, Mackay TW, Boon NA, Douglas NJ, authors. Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med. 2001;163:344–8. [PubMed]
Engleman HM, Gough K, Martin SE, Kingshott RN, Padfield PL, Douglas NJ, authors. Ambulatory blood pressure on and off continuous positive airway pressure therapy for the sleep apnea/hypopnea syndrome: effects in "non-dippers". Sleep. 1996;19:378–81. [PubMed]
Nguyen PK, Katikireddy CK, McConnell MV, Kushida C, Yang PC, authors. Nasal continuous positive airway pressure improves myocardial perfusion reserve and endothelial-dependent vasodilation in patients with obstructive sleep apnea. J Cardiovasc Magn Reson. 2010;12:50. [PubMed Central][PubMed]
Lam JC, Lam B, Yao TJ, et al., authors. A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea. Eur Respir J. 2010;35:138–45. [PubMed]
Lam B, Sam K, Mok WY, et al., authors. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax. 2007;62:354–9. [PubMed Central][PubMed]
Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, et al., authors. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest. 2006;129:1459–67. [PubMed]
Ip MS, Tse HF, Lam B, Tsang KW, Lam WK, authors. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004;169:348–53. [PubMed]
Becker HF, Jerrentrup A, Ploch T, et al., authors. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation. 2003;107:68–73. [PubMed]
Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al., authors. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet. 2002;359:204–10. [PubMed]
Monasterio C, Vidal S, Duran J, et al., authors. Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med. 2001;164:939–43. [PubMed]
Middleton S, Vermeulen W, Byth K, Sullivan CE, Middleton PG, authors. Treatment of obstructive sleep apnoea in Samoa progressively reduces daytime blood pressure over 6 months. Respirology. 2009;14:404–10. [PubMed]
Miles J, Shevlin M, authors. Applying Regression and Correlation: A Guide for Students and Researchers. London: Sage, 2001.
Green S, author. How many subjects does it take to do a regression analysis? Multivariate Behav Res. 1991;26:499–510.
Palatini P, Mormino P, Canali C, et al., authors. Factors affecting ambulatory blood pressure reproducibility. Results of the HARVEST Trial. Hypertension and Ambulatory Recording Venetia Study. Hypertension. 1994;23:211–6. [PubMed]


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Attending college is a big Financial Leap. Higher education costs have been increasing at more than the rate of inflation for years. It is no different at Alexandria Technical & Community College. As ATCC's base funding from the State of Minnesota continues to decrease, tuition rates have been rising. Even if you did extensive planning for your eventual higher education costs, you may not have considered the current realities of higher education funding. If you have done nothing to prepare financially for your higher education costs, you could be in for a real shock.
Financial aid programs never were and never will be intended to pay for all the costs associated with attending any higher education institution. That includes Alexandria Technical & Community College. The financial aid application process ( completing the FAFSA ) determines an expected family contribution (EFC). If parent's are providing data on the FAFSA, there are two components to the EFC - parent contribution and student contribution. If parents are not involved, obviously the EFC is only student contribution. Many families and students are shocked at the expectations for their contribution. If you have not applied before, you too may be shocked. Since the Federal and State governments have limited resources, the EFC formula really is a rationing formula as opposed to a real reflection of the costs of higher education. As was mentioned earlier, financial aid never was intended to pay the total cost.
At the risk of over simplifying, your contribution for higher education comes from three sources - money you saved, money you can squeeze out of current earnings or money you must borrow. Sixty percent of all financial aid provided for higher education in the US is in the form of loans. ATCC is no different. Our students borrow significantly. The long-term financial risk is borrowing more than you can reasonably repay. It will affect your finances and possibly your credit for many years.
Higher education affordability is a hot topic nationally. It is not a Minnesota phenomenon nor an Alexandria Technical & Community College phenomenon. But it is real. You must PLAN - Cost Worksheet (PDF) in order to avoid real financial problems. Following are some myths, misconceptions and suggestions that are intended to help you plan for your attendance at ATCC.

subset: commoncrawl


text: As many women who have plenty of education and training would tell you — except for Carly Fiorina, who the McCain campaign is keeping under lock and key after her comments that John McCain couldn't be a CEO — having those things is no guarantee of pay equity despite whatever crap John McCain insists on spewing. A recent study by the Chartered Management Institute in the U.K. shows that, actually, the pay disparities between male and female business executives, on the average, worse than the pay disparities in most other professions.The CMI study reports that female executives, on average, earn about 30 percent less than their male counterparts and that, at the rate at which they are achieving pay equity, it'll be a short 187 years until they catch up. Scottish women, and women in the IT industry in the U.K. also have it pretty bad, though men and women at the junior executive level in the energy industry might attain equity by 2010, after which they'll all be senior execs and the women will start earning 30 percent less. In case you're wondering, this reflects a trend in the U.S. as well, in which statistics show that women with Masters degrees actually face a slightly steeper wage disparity on the average than women with only a high school education — and that's before you account for occupational differences at both levels. Occupational surveys show that women nurses and teachers earn 10 percent less than their male counterparts despite comprising the vast majority of the work force, and professional women face a steeper wage gap with their male counterparts than women in sales and office occupations faced. A new survey shows that women at the top of the legal profession (lawyers, magistrates, and judges) make almost half what men in similar positions make — even as female paralegals make 93 percent of what their male colleagues do. Contrary to everything women have been taught about the value of higher education, while you're likely to make more money than you would otherwise, you are far less likely to make a comparable amount to that of a man. In another sad statistic, historically speaking, women's pay has been catching up to men's in he U.S. at a rate of about half a percent a year. That means, without radical changes, we might only have to wait 44 years to get paid equally for the work that we do instead of 147 — unless you're a doctor or a lawyer, in which case it's more like a century. But, hey, I'll bet that's a century's worth of really important education and training to catch up with men's skills, right John McCain? Right? McCain Dismisses Equal Pay Legislation, Says Women Need More 'Training And Education.' [Think Progress] Equal Pay For Women Is 'Several Generations Away' [The Guardian] The Wage Gap by Education: 2001 [National Committee on Pay Equity] Professional Women: Vital Statistics [AFL-CIO] Women Getting Screwed When It Comes To Pay [Above The Law] The Wage Gap Over Time: In Real Dollars, Women See a Continuing Gap [National Committee on Pay Equity]


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WASHINGTON, DC — A team of about 30 airmen and government workers jumped on their bikes and hit the streets and paths around the Washington, DC area to enjoy bicycling and raise money for various causes. They call themselves the Blue Suit Pacers.
The team has rookies and "hammers" — the more experienced cyclists. Gloria Padilla is a hammer. Five years ago, doctors diagnosed her with breast cancer. The 11th Wing human resource worker at Bolling Air Force Base, DC, beat the disease.
Joining the team one year ago was one of the best decisions she ever made, she said. Padilla said her teammates are "great people to ride with" and are always cheerful and supportive.
"They are my wingmen," she said.
The group has raised money for cancer research in the past along with money for diabetes research and the Red Cross. Recently, the team received pledges for every mile they rode and raised more than $1,000 for Air Force Hurricane Katrina survivors.
"People really connect more through their passions," said Master Sgt. B.L. Lawrence, who works in the Air Force Senior Leader Management Office at the Pentagon and is a member of the team. "Cycling is our passion, and it gets even better when we are able to help others by doing what we love."
Padilla and Lawrence proved that last October when they flew to Texas to ride with famed cyclist Lance Armstrong at his Ride for the Roses event that commemorates cancer survivors. For Sergeant Lawrence, the trip to Texas was more than another cycling event; it was a return to his cycling roots, his wife Laurie said.
"He actually started riding when we were stationed there (in Texas)," she said. "It was the [former Air Force] bike test that got him started. He had a hard time passing it, so that's when he got on the bike. Things took off from there."
While living in Texas, the sergeant began riding in charity events. When the Lawrences moved to Washington, DC, he began meeting other cyclists and decided to turn the hobby into a legitimate team open to others. Hence, the Blue Suit Pacers.
The Blue Suit Pacers is more than a team — it's family, which includes spouses and children, Laurie said. During rides, family members drive in a van behind the team to pace and keep riders on track. Though the name implies Air Force, an Army medical student is among the team's ranks, as are government civilians and retirees.


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Golden Triangle Rose Society annual Spring Rose Show on April 26
The Golden Triangle Rose Society annual Spring Rose Show will be held Saturday, April 26, at the Tyrell Park Garden Center at Tyrell Park. The show is Free to the public and invitations are heareby issued to those who would like to exhibit their home garden grown roses in our show, regardless of membership in GTRS. Those attending can not only view the roses and ask questions about them, but they can also purchase a few or a bouquet of the actual show roses for their very own at what the society says will be at bargain prices.
Doors will open at 6 a.m. for exhibitors from all over the area. Judging begins at 10 a.m. Viewing is open to the public from noon to 3 p.m. Entrance is free.
For more information, contact Master Rosarian Tommy Hebert at (409) 899-1149.
At the same day as the Rose Show, The Harbor Foundation will host its fifth annual Celebration of Life Butterfly Release from 11 a.m. to 2 p.m. The entire community of Beaumont and the surrounding areas are invited with free admission. The butterfly release will also feature food, live entertainment, music, and children's activities. Proceeds from the event will go toward continuing to help Harbor patients and their families well beyond the scope of traditional health care. Visit www.harborfoundation.com or call (409) 981-1888 for more information.


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Hello ladies and good morning! So today is gonna be a picture Monday sorta day. #1, my mom is coming over to help me take little man to his circumcision today (Sorry buddy :( ), then my grandma is coming over to meet her 1st GREAT grandchild. #2, this is my 1st day without Nick - he went back to work. Not happy about this. My only "baby blues" I've had is when it comes to Nick. I cannot stress enough how much Nicks support means to me. Every challenge we face, he is always telling me how great I'm doing and how proud of me he is. Whenever Troy get's fussy and I get up to get Troy, Nick is always asking if I need help. He is the best and I hope every husband/daddy is like he is.
Now onto the fun stuff - pics! Here is my belly pics 1st.
Monday, January 31, 2011
Pictures Galore!
Hello ladies and good morning! So today is gonna be a picture Monday sorta day. #1, my mom is coming over to help me take little man to his circumcision today (Sorry buddy :( ), then my grandma is coming over to meet her 1st GREAT grandchild. #2, this is my 1st day without Nick - he went back to work. Not happy about this. My only "baby blues" I've had is when it comes to Nick. I cannot stress enough how much Nicks support means to me. Every challenge we face, he is always telling me how great I'm doing and how proud of me he is. Whenever Troy get's fussy and I get up to get Troy, Nick is always asking if I need help. He is the best and I hope every husband/daddy is like he is.
Posted by californiadreamin at Monday, January 31, 2011 12 comments Links to this post
Labels: Troy
Sunday, January 30, 2011
Oh Lordy...
Oh my goodness. Motherhood has kept me so busy!! I promise to be back tomorrow and ill share pics of our little Troy Maximus as well as 1 day post partum tummy and 1 week post partum tummy. So every Monday you ladies can look forward to that sexy picture to start off your week. You ladies can also expect some blog changes when it comes to the layout and look. This mama needs a blog face lift! Talk to you girls tomorrow!!!
Posted by californiadreamin at Sunday, January 30, 2011 2 comments Links to this post
Tuesday, January 25, 2011
Posted by californiadreamin at Tuesday, January 25, 2011 36 comments Links to this post
Labels: birth story, Troy
Saturday, January 22, 2011
Awww Shucks
Laura over at Between the Lines, gifted me a FABULOUS blogger award. I am most def playing along with this one - so here we go!
Here are the amazingly creative rules:
1. You must proudly display the absolutely disgusting graphic that I have created for these purposes (put it in your post, you don't have to put it in your sidebar, I think that would seriously be asking too much). It's so bad that not only did I use COMIC SANS, but there's even a little jumping, celebrating kitten down there at the bottom. It's horrifying! But its presence in your award celebration is crucial to the memetastic process we're creating here. If you need a higher resolution version... I totally have one!!
2. You must list 5 things about yourself, and 4 of them must be bold-faced lies. Just make something up, we'll never know; one of them has to be true, though. Of course, nobody will ever know the difference, so we're just on the honor system here. I trust you. Except for the 4 that you lied about, you liars! But don't go crazy trying to think of stuff, you'll see by the example I've set below that we're not really interested in quality here.
3. You must pass this award on to 5 bloggers that you either like or don't like or don't really have much of an opinion about. I don't care who you pick, and nobody needs to know why. I mean, you can give a reason if you want, but I don't really care.
4. If you fail to follow any of the above rules, I will hunt you down and harass you incessantly until you either block me on Twitter or ban my IP address from visiting your blog. I don't know if you can actually do that last thing, but I will become so annoying to you that you will actually go out and hire an IT professional to train you on how to ban IP addresses just so that I'll leave you alone. I'm serious. I'm going to do these things.
1.) I have some major foods I cannot live without: Blueberries, Peaches, and Salmon. I could eat these things every day all day. My favorite meal would be a nice salmon steak and a blueberry or peach pie for dessert
2.) I shave my legs, arms and armpits every day. Nothing better than having super soft smooth skin
3.) I hate pedicures. Who wants some stranger to rub and scrub their feet? Then soak them in a mini hot tub that has been used by a bajillion people? Not me, no thank you.
4.) I can make my ears wiggle on their own. Think Alfalfa on "Little Rascals". It's one of the things Nick finds sexy about moi.
5.) I was shot in the foot (by accident) when my brother was messing around with his pellet gun. I was 12, he was 16. We were even in the paper! That's what happens when you live in the foothills :)
Gosh I feel like such a dirty liar. But which ones are the lies? Hmmmmmm, haha!
Okay, now to the gorgeous sweets I want to pass this fun award onto:
Mrs. Stethoscope over at 5K's and Chardonnay
Erin at A Real Housewife
Shannon at Philadelphia Phitness Pharmacy
Breanna at Adventures in Mommyland
And of course, The Hungry Runner Girl
Have fun cupcakes!!
Posted by californiadreamin at Saturday, January 22, 2011 5 comments Links to this post
Labels: blog awards
Friday, January 21, 2011
He gets it from his mama
Who's excited this week is coming to a close? Even though I'm not working away from home anymore, I still get super excited for Fridays - they are Nicks day off and I get the whole weekend with him. What can I say, I like kickin it with my hubbinator.
So I had my OB appointment bright and early. The results? NO PROGRESS WHAT.SO.EVER! Honestly, I am disappointed, but I'm okay with it. My induction date is still January 27th (6 days away!!), and I'm okay with waiting till then. Of course, he can always come before then, but I am highly doubting this. He likes to make people wait like his mama (according to Nick). After that, Nick and I headed over to Labor and Delivery and got my Non Stress Test. Troy passed with flying colors, WOOT WOOT! I laid there (the beds were pretty comfy btw) for 30-45 minutes and I was done. It could have gone by so slow, but luckily Nick was there to keep me company.
So that's my update ladies - I plan on getting a pedicure with Miss Jenni on Tuesday, making sure the place is still nice and tidy, and enjoying Wednesday night with my man as our last night of no kid responsibilities. Unless Mr. Troy Maximus has other plans, but I really have a feeling he's staying in there.
Posted by californiadreamin at Friday, January 21, 2011 7 comments Links to this post
41 Weeks - Stick a fork in me, I'm done!
Hello lovelies! I'm actually writing this on Thursday night rather than Friday. I have an OB appointment 1st thing in the morning followed by my 1st ever Non Stress Test. Not sure what to expect from that, but we shall see how Mr. T i doing in there.
Today's date: January 21, 2011
How far along: 41 weeks. Never thought I'd be making it this far
Total weight gain: I haven't asked these past 2 appointments, but I'm probably at about 30-32 right now.
Size and growth of the baby: A bit over 20 inches long, your baby has continued to grow and may now weigh almost 8 pounds. As cozy as he is, your baby can't stay inside you forever. {isn't that the truth?! The 27th is the final day he is allowed to stay}
What's happening to mama this week: It's hard not to be anxious when your due date comes and goes and you're still hugely pregnant (especially when well-meaning family and friends keep calling to check on your status!). But don't fret — you won't be pregnant forever. There's a good chance you'll go into labor on your own this week, and if you don't, you'll be induced by 42 weeks, or earlier if you or your baby has any problems. * I'll be induced when I am exactly 41 weeks and 6 days!
Sex: Still a baby boy
Maternity clothes: I'm living in VS yoga pants and my long tanks during the day. Both non maternity, but both stretchy
Sleep: Horrible. I am back to waking up every hour to pee and I've been having strong enough contractions to where they wake me up
Best moment(s) of the week: Losing my mucus plug :P
Movement: Lots of rolls and jabs in the ribs
Food cravings/aversions: PB&J's have been a MAJA' craving this week. With a nice big cold glass of non fat milk please
Morning sickness: Some queasiness here and there, but nothing that lasts the whole day
Symptoms: Lower back pain, groin pain, contractions, headaches, tiredness, cramps
Labor signs: Cramps and contractions and lower back pain
Belly button in or out: Its half way in and half way out. I'm gonna call it that it's never fully developed into an outie.
What I miss: my pre-pregnancy clothes/body, sleeping on my stomach. Tonight I really am missing my glass of vino
What I'm looking forward to: Troy's arrival! Any day now. If not, I am looking forward to my induction date although I know I'll be sweating bullets up until I get hooked up to the monitors and all the IV's get put in. Makes me nervous just thinking about it! I'll do 1 more "weekly update" before I get induced (if I make it that far)
Posted by californiadreamin at Friday, January 21, 2011 4 comments Links to this post
Labels: Troy
Thursday, January 20, 2011
It'll be water and salad for me
Good morning cupcakes! I've been in nesting mode for awhile now, but today I'm really doing a number on the place to make it sparkle. Maybe it just hasn't been living up to Troy's standards and he's just been waiting for a nice clean place to come home to? Or maybe he is waiting till I make a nice batch of brownies with some chocolate frosting, to make his appearance? I'll see what I can do little buddy :)
Other than cleaning, it's the same ol' day for me - took my 3 laps around the apartment complex, responding to work emails/booking travel arrangements, and I'll probably go for another walk sometime soon. I noticed something HORRIBLE last night. You girls know how hard it has been not being able to work out to my full potential. Not in an unhealthy way, it's just working out is a passion of mine and I enjoy it. Well, last night after getting out of the shower, I noticed I have...CHUB RUB! Dun Dun DUUUUUN!! Yes, my inner thighs are starting to touch, blah! I'm also rocking 2 brand spankin new stretch marks. Sexy, no? Sure their tiny, but me no likey. I ordered some Maderma the other day after reading great reviews. It says in 12 weeks they'll be unnoticeable to the naked eye. Well that's fabulous because I have a Mexico trip coming up and I REFUSE to give up bikini's with I'm only 24. Could Troy come out now and save his mother's body PUHLEASE!? I'm planning on taking some post partum pics of my belly after seeing a couple other girls doing the same. I think it's a great way to show other women what you'll look like right after birth. I'm tired of seeing these Gisele Buasduhasdashd (or however you spell her name) type girls walking around with their tight abs when supposedly they just gave birth.
I thought I'd get your opinion on another little gem - Miss Megan Fox. I used to think she was SUPER gorgeous and her face still is to me. Buuuuut, if I were a dude or lesbian, I'd prefer a little more meat on my women. What do you guys think? This is her new Armani underwear ad and below that is a pic the paparazzi got of her vacationing recently.
{Picture from here}
{Picture from here}
Another random tid bit about Ms. Fox. I guy I went to Elementary school all the way through HS was in a commercial with her. He was such a nerd in Elementary school and now look at him trading oo lala looks with a Fox (Pun intended :) )
Posted by californiadreamin at Thursday, January 20, 2011 8 comments Links to this post
Wednesday, January 19, 2011
Wee Bit of Me Wednesdays
{one} name one thing you worry about running out of.
Eggs. I eat 5-6 eggs a day. Scrambled for breakfast all egg whites except 1 yolk. Yeah yea, I waste a bunch of it
{two} what is your favorite pizza topping?
artichokes! I love all veggies, no discrimination here, but if a pizza has artichokes, I'm sold
{three} what is your favorite Harrison ford movie?
To be honest, I don't like Harrison Ford. If I had to pick, the Fugitive
{four} apple juice or orange juice?
Right now I'm having a craving for the AJ on ice with a splash of water please
{five} what's your favorite thing to do on a Sunday afternoon?
During Football season - watch football with my man while munching all day long. Non football season, I like to make us breakfast and then head to my parents house to socialize and have din din
{six} what is the wallpaper on your cellphone of?
A weird circle thingy that came with the phone
{seven} do you have a favorite tv commercial?
This Mayhem commercial for AllState insurance
and this funny little gem
{eight} what is the weirdest thing you've ever eaten?
Monkey back. It was a Brazilian restaurant in Puerto Vallarta, so who knows if it was really a monkey. It coulda been the dog I had seen in the back ally that day
{nine} what is one piece of clothing you can't live without?
sport bras. I love my girls snug and in place when I sleep, so their a must
{ten} if you were a character from "lost", who would you be?
Either Claire or Kate. Claire was so sweet and really pretty and her and Charlie were a cute couple. Kate just cause she gets to do fun stuff - like have both Jack AND Sawyer. She got on my nerves CONSTANTLY though.
To link up and participate, click here
Posted by californiadreamin at Wednesday, January 19, 2011 1 comments Links to this post
Hump Day Randoms
This chick is seriously off her rocker and when she kept crashing everyone's date and standing in bushes to eve's drop, I was about to lose it. I mean, I think we've all learned from Snooki, that unless your just kickin it, or pee'ing, you shouldn't be in bushes
I heard from a fellow co-worker that she heard that Emily is a finalist? When she told the other girls her story about what happened to her fiance, I about lost it. Since becoming pregnant, I swear my paranoia of something happening to Nick has shot through the roof! I don't know what it is, but I will come up with crazy stories that he isn't okay if he is late coming home from work (Hello Karli, I-5 during rush hour is no joke, take a chill pill!), or if he is running errands without me and he's gone for a longer time than I think he should be (which never happens, the man HATES shopping). Anyways, when I heard Emily's story, I bawled like a baby.
and this bad boy - concealer.
I was in the market for a new concealer because this blogger needs an even skin tone ASAP. Since I can't just go get a bajilion microderm abrasion sessions, I needed somethin to cover it up and make my skin look more even. Jenni recommended I try her concealer that she loves by Exuviance CoverBlend Concealer.
Posted by californiadreamin at Wednesday, January 19, 2011 2 comments Links to this post
Labels: hump day, products, random, reality tv
Monday, January 17, 2011
10 days to go
Good morning loves! Since I am blogging, you all know what that means - Troy is STILL not here. That little booger is just too comfy inside his mama's tummy. That's fine, whatev. Last night I wanted to try a couple other methods I had heard about. 1 being pineapple. I heard if you eat 2-3 WHOLE pineapples, it can induce labor contractions. Well, since I am too lazy to buy whole pineapple and cut it up, I bought 2 cups of fresh cut up pineapple. I had a couple cramps, but nothing to write home about (or to send me to L&D). Theeeeen, I had heard that pumping would help. Something about stimulating the nipples. So I hooked up my trusty Medela, and away I went. I had ZERO contractions, but when I pulled it away, I saw I had caused colostrum to come out!!! Colostrum is what the baby eats for the 1st day or two until the milk comes in and it's VERY important that the baby has it. It has all sorta of nutrients in it. After a google search (and email from my mom), I stopped due to the fact that I just might deplete my colostrum supply. Soooooo, both methods were a bust! I am outta options to try. The only thing I haven't tried (and refuse to try) is Castor Oil. I am just going to sit back and wait. I know that in 10 days at the most, he is going to be here, so he'll be here soon I guess *SIIIIIIIIIIIIIGH*. Until then, I will enjoy my pregnancy as much as I can. Your only pregnant for the 1st time once, right? Right.
So welcome to Monday ladies! I hope your weekends were filled with football happiness. Who was shocked that the Pat's lost? I was, and don't like Mr. Adulator Tom Brady, so haha, that's what you get! Mondays used to be all about the baby prep classes, but confession time - Nick and I dropped out after 2 classes, EEK! We learned the main things though - breathing and we learned about the labor process from start to finish. We are such rebels :)
Posted by californiadreamin at Monday, January 17, 2011 6 comments Links to this post
Saturday, January 15, 2011
Running like I stole something...
...or I am training for a marathon....or I just want to fit back into my sexy Express jeans that look fabulous on my ba-donk-uh-donk? Or all of the above :) So you all know how I will be training for my 1st ever MARATHON that will take place at the end of this year (Octoberish), so I'm doing some calculating on when I can start training. At the absolute latest, I can start training the week of March 7th (have to wait the 6 weeks for intense workouts for a smooth vaginal delivery). That means, I have about 7-7.5 months to train. To my runner followers: does that sound like enough time to train for my 1st marathon? I'm not looking to break records or to even get this UH-MAZING time (it'd be nice though), just be able to complete it without dying. I am wanting to do other workouts, such as lift weights, cross train, kick my butt in XBike class again. So, I have googled a butt ton of beginner marathon training schedules that would fit what I am looking for, but nothing too aggressive in a short amount of time. So....here it is - my 20 week program
On the cross training days I plan on either doing a 30 minute XBike class or weights. I am sure there are going to be days that I will opt for resting rather than the Cross training, which is to be expected - I'm gonna have a wittle baby after all! Who will be accompanying me on most of these runs in his brand new jogging stroller (thanks to his Gma and Pa-gee <--- pa-g is what my niecey poo came up with when she was a baby and was trying to say grandpa, so why change it?)
{this is the exact color and all. I LUUUURVE it!!}
Soooooo excited {and scared!} about March. I am looking forward to some crazy training. I've only ran 10K's and 5K's. Any suggestions from you seasoned runners? Can I also just thrown in, that I cannot wait to proudly display that "26.2" decal on my car? Just so I can brag to all the other cars I zoom past.
Posted by californiadreamin at Saturday, January 15, 2011 6 comments Links to this post
Labels: running


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Cedars-Sinai and Coach: Bringing the Care to the Kids
Tens of thousands of children from across Los Angeles County have received some sorely needed medical care – delivered in a special way from Cedars-Sinai.
As part of the medical center's century-long commitment to the community, the COACH for Kids and Their Families® program rolls out two fully equipped mobile medical units to schools, community agencies, homeless shelters and public housing developments. There, Cedars-Sinai experts offer quality medical care free of charge on a regular basis.
This vital medical and case management program of the Cedars-Sinai Maxine Dunitz Children's Health Center also provides youngsters and their families: dental screenings and referrals; mental health care and family service referrals; and educational and early-intervention nutrition services.
"Everyone on the COACH team is passionate and dedicated to caring for this community. Children need a healthy family to be healthy, but families have other issues besides medical ones," said Program Director Michele Rigsby Pauley, RN, MSN, CPNP. "We've seen so many kids with dental problems that weren't addressed. So in 2003 we added a dental hygienist to the COACH team. Later on, one after another child we checked was not eating properly, so we saw the need for a nutrition program. Filling the need, that's how we've grown."
The highly trained COACH team includes: a pediatrician, registered nurses, nurse practitioners, health educators, social workers and community outreach coordinators from Cedars-Sinai's staff. Heading the team are Arthur K. Cho, MD, medical director of the COACH for Kids® program and an attending physician in pediatric services at Cedars-Sinai Medical Center; and Rigsby Pauley, who handles programs and clinical operations for the full range of health services.
COACH for Kids® staff members are bilingual, which helps them provide the best care and build strong relationships with their Spanish-speaking clients.
The program, which has been serving Los Angeles neighborhoods since 1994 and brought care to more than 100,000 children, also works closely with more than 200 public and private community organizations, including Children's Health Fund, the Los Angeles Unified School District and Upward Bound House.
For children with illnesses beyond the scope of the mobile medical unit, COACH for Kids® nurse practitioners can make referrals to partner community agencies.
Because families also need referrals to an array of local agencies and resources that can improve the quality of their lives and their health, a team of COACH for Kids® experts also assists with this.
Cedars-Sinai has demonstrated a deep commitment to serving its community for more than 100 years. The COACH for Kids program is just one part of its $502.4 million Community Benefit financial contribution for 2010. It helps the medical center increase access to healthcare for vulnerable, underserved populations; assist communities to become healthier through prevention programs and services; conduct research that leads to innovative treatments for a broad spectrum of diseases; and offer education to prepare the next generation of healthcare professionals.


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photo 1 of 29
UFC®121: Press Conference Photo Gallery
October 20, 2010
29 Photos
UFC 121 Press Conference: Dana, Brock, Cain, Tito, Matt, Jake, Martin and Brock's beard answer questions about the biggest fight card of the year. (Photo by Josh Hedges/Zuffa LLC/Zuffa LLC via Getty Images)
Getty Images reserves the right to pursue unauthorized users of this image or clip. If you violate our intellectual property you may be liable for: actual damages, loss of income, and profits you derive from the use of this image or clip, and, where appropriate, the costs of collection and/or statutory damages up to $150,000 (USD).


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As you read this, 85-year-old Chiang Bei-bei's (蔣伯伯) ramshackle house in Taipei's Huaguang Community (華光社區) will have been pulverized by bulldozers sent by the central government. Like many other residents of the community, Chiang barely ekes out a living and the government's decision to raze the community to erect a glitzy neighborhood condemns him to destitution. While business tycoons and the central government pour millions of dollars into China's Sichuan Province following Saturday's earthquake, the fate of Chiang and others is ignored.
No sooner had the magnitude 6.6 quake hit Yaan City than the Executive Yuan, along with tycoons like Hon Hai chairman Terry Gou (郭台銘) and Want Want China Times Group chairman Tsai Eng-meng (蔡衍明), announced they would make donations to help with relief efforts and reconstruction. Gou and Tsai alone donated more than US$10.5 million, with actors, singers and other business leaders also making contributions.
While this outpouring of generosity is commendable, it raises serious questions about those people's priorities. Just as with the 2008 quake in Sichuan, what the Chinese government needs is emergency aid in the form of food, medicine and expert medical teams — not money, which it has plenty of.
Even more disturbing is that not a single one of those donors has bothered to say anything about, let alone provide just a fraction of the money they are sending to China, to help destitute people in Taiwan. The destruction of Huaguang, the forced relocation of its predominantly elderly residents, the lack of proper assistance from the government and the fines that this same government has imposed on those people, is just one among many examples in Taiwan of situations where desperate people should receive help.
Many of the residents, including Chiang, are not entitled to social assistance and are being forced to move into social housing in Taipei's Nangang District (南港). In most cases, their meager earnings are insufficient to cover the NT$13,000 rent, while the small businesses that they operated are now uprooted.
For the rich and powerful, the residents of Huaguang are nothing. In fact, their presence on this prime plot of land in the heart of Taipei stands in the way of further riches. Those who have extended a helping hand are mostly students, social organizations and private individuals.
While the wealthy donate to China, it is artists like film director Hou Hsiao-hsien (侯孝賢), who last week donated his NT$1 million (US$33,520) in prize money from the National Cultural Award to help finance reconstruction of the partially demolished Losheng (Happy Life) Sanatorium in New Taipei City (新北市), who man the front lines in the local war between the haves and the have-nots.
Of course, the large donations to China have a self-serving component, as it ingratiates the tycoons with the Chinese authorities and opens the door to large investments in future. Which is why the wealthy cannot be bothered with the fate of Taiwan's own poor.
This is shameful. Taiwan is, by any metric, a modern and wealthy country, and the refusal by the government and the more fortunate to help those in need flies in the face of the very values that underpin society. One-tenth — one-hundredth — of the money generously donated to Sichuan to help its people recover from a natural catastrophe would go a long way in helping people like the displaced residents of Huaguang, the victims of human agency, live their last few years in dignity rather than destitution.


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Check out Robin (played by Justin Long aka the Mac guy in those I'm a Mac commercials) get cock blocked by Batman (played by Sam Rockwell of Confessions of a Dangerous Mind fame). This video went viral this past year (first appeared at the 2005 Fantasia Film Festival) and only now I've stumbled across it!
Anyhow, it appears that they are planning a sequel to "Robin's Big Date." "We still want to do a sequel to that,†said Rockwell. "Someone wants to produce it. Somebody wants to give us some money to do it. It's under wraps and top secret but there would be a few more superheroes and super-villains involved. And some dating prospects.â€Â


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Matt Ballou to exhibit artwork at Moss-Thorns Gallery
09/24/2013 lar
Guest artist Matt Ballou will display his artwork at Fort Hays State University's Moss-Thorns Gallery of Art from Oct. 3 to Oct. 25. The opening reception will be on Thursday, Oct. 3, from 7 to 9 p.m.
Ballou, an assistant professor of painting and drawing at the University of Missouri, Columbia, has exhibited across the United States, from New York and Boston to Seattle. Ballou is also a prominent writer and educator.
"I create paintings, drawings and prints in an attempt to address -- through archetypal themes and symbols -- the fundamental questions, ideas, hopes and concerns I have about being in the world," says Ballou in the artist's statement on his website at www.eikonktizo.com.
"Eikonktizo" (pronounced ee-cone kuh-teed-zo) is a combination of two Greek words, "eikon" and "ktizo." "Eikon" is like an image of the heavenly things and "ktizo" means to create or form. Ballou explains it as "image-making from a consciousness and acknowledgement of the Divine notion."
At the Moss-Thorns Gallery of Art, Ballou will showcase his new collection, "Asevenandawonadoe," featuring 30 different paintings and prints. The exhibit "explores the reality that a vernacular of meaning is constructed through our physical, emotional, and intellectual experiences," Ballou says on his website.
Ballou's daughter invented the word "Asevenandawonadoe" when she was learning to speak, he said. While completely made up, this word is built on the structures of real words and "symbolizes the notion that abstract concepts, things that cannot be felt with our five senses, such as comfort, happiness or patriotism, are meaningful to us because of the experiences we relate to them."
For more information, contact Lee Powers, chair of the Department of Art and Design, at 785-628-4247 or firstname.lastname@example.com.


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|This article needs to be cleaned up to conform to WikiFur style and standards.
For specifics, check the edit history and talk page. Consult the Furry Book of Style for editing help.
TaniDaReal is a German furry artist and fursuiter. She works as a media and graphics designer (web and print). Since 2012 Tani is married to Richard_Nightfox.
Fandom involvement[edit]
TaniDaReal is part of the Eurofurence staff (Charity team, PawpetShow). In the Eurofurence pawpet show, DoPE, she played Mika, a tough snow-leopard girl, in 2012 Vesonia (an arctic vixen), and various other characters. In addition, she managed overall set design and backdrop creation. On the F8K radio show she was a gag author and voiced various characters for the radio sketches. Her husband Nightfox and she organized the New Year's party LaerCon (Bochum, Germany) in 2012 and 2013.
Conventions attended[edit]
- Anthrocon: 2006, 2008, 2009, 2010, 2011, 2012, 2013
- ConFuzzled: ConFuzzled 2010, ConFuzzled 2011, ConFuzzled 2012, ConFuzzled 2013
- Eurofurence: 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19
- Furnal Equinox: 2016
- Furry Connection North: 2011
- Further Confusion: 2004, 2005, 2007, 2008, 2009, 2010
- Megaplex: 2014
- MiDFur: 2012
- Painted Desert Fur Con: 2019
- RainFurrest: 2011
- Scotiacon: 2013
TaniDaReal was Guest of Honour at ConFuzzled 2010, Furry Connection North 2011, RainFurrest 2011, MiDFur 2012, ScotiaCon 2013, Megaplex XIII (2014),[1] and Furnal Equinox 2016.[2]
TaniDaReal's fursona is a grey "schnolf" (wolf / snow leopard hybrid) with a black dorsal stripe. The schnolf replaced the former grey snowleopard version.
Tani created and built four fursuits: Two of her character - old lioness form (2002) and new snow leopard (2004), one of her silverfox-wolf hybrid character Savoy (2006), and one of her new character Daiquiri, the Transilvanian Wild Dog, built together with Nightfox.
Savoy is a female silverfox-wolf character created and owned by TaniDaReal. The character was created in 2005.
Since 2006 the character also appears as a fursuit. The old fursuit version made by herself (in 2006) was retired. Since 2012 she wears the new Savoy fursuit, created by OneFurAll.
Daiquiri is a female Transilvanian Wild Dog (Lycaon pictus transilvanus), also a Vampire. The name derives from the Daiquiri cocktail, because of her sugar-like ear-tips[3].
The Character was created by TaniDaReal in 2007/2008 and built as a fursuit by herself and Nightfox. The fursuit was presented first at Cologne Furdance Edition 2 in November 2008.
- Fursuit Making (Tani's Fursuit making of website)
Tani's art is well-commented on art sites such as Fur Affinity or deviantART. She works with both traditional and digital media, but also experimented with sculptures and plushie creations. She likes to draw a mix between toony and realistic art and has a fable for extraordinary fur markings and colors (including hybrid characters).
She also creates and produces furry items / merchandise with her art on it, like t-shirts, calendars or beer coasters.
Some of the projects done by her are:
- the flippable Mood Badges, started in 2008
- the WeuUkoo Wolves (her family pack of grey wolves)
- various printed t-shirts (like the two-sided 'stuck' series)
- artwork for the Pittsburgh AnthroCon t-shirt, published in 2013
- several furry website (personal sites, conventions)
Did you know? The Tani fursuit made a cameo appearance at 1:25 in the October 15, 2008 installment of the online video game review series Zero Punctuation.[4]
- ↑ Tweet on the Megaplex account on Twitter. Dated July 28, 2013. Retrieved July 29, 2013.
- ↑ Tweet on the Furnal Equinox account on Twitter. Dated March 18, 2016. Retrieved March 21, 2016.
- ↑ http://fursuit.tanidareal.com/daiquiri/index2.htm
- ↑ Zero Punctuation review of S.T.A.L.K.E.R.: Clear Sky
External links[edit]
|This person is a WikiFur user:
- TaniDaReal on Twitter
- TaniDaReal on Tumblr
- Cleanup
- Wikifurries
- People
- Artists
- Puppeteers
- Fursuit makers
- Fursuiters
- Eurofurence staff
- ConFuzzled guests of honour
- Furnal Equinox guests of honour
- Furry Connection North guests of honor
- Megaplex guests of honor
- Painted Desert Fur Con guests of honor
- RainFurrest guests of honor
- Scotiacon guests of honour
- Wolf-hybrid characters
- Snow Leopard-hybrid characters
- DoPE
- Germany


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Socks from David and Goliath and Sock It To Me
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Keep warm in style with our novelty slipper socks and David & Goliath socks in a range of fun designs - because one fun design is never enough! Add an edge to your sock drawer and treat your feet to a new pair of hilarious socks! (warning: other socks may become jealous, so keep a close eye on your sock drawer!) No longer will you have to feel the big chill with our cute slipper socks. The soft plush fabric will keep the heat wrapped around your feet and legs so you can stay nice and toasty. These David and Goliath socks are perfect when buying as a gift, as one size fits all. So, our selections of slipper socks are suitable for all Chicks!
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Just copy and paste the code below to embed this station in your blog, website or social profile.
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Graphic artist Jillain Kristen has a good perspective on Nintendo, exchanging the gray-scaled consoles with her colourful nostalgia of playing with them as a kid.
The result is this series of prints, all delightfully colourful. She explains the inspiration to me in an email:
I wanted to design out the consoles in really child-like and friendly colours, different from the black or grayscale colours the consoles really are - these designs are what I thought they should've looked like. It was a happy part of my growing up, so I thought treating them differently and in a more friendly and approchable (and even "girly-er") way would be fun to experiment with. It just looks... happy. And that's why it fit my image of Nintendo so well.
The designs definitely evoke a more accurate portrayal of my own memories with the respective devices, so much so that I wish they'd come in these designs. There's still time, Nintendo! People like retro things, right people? We'd buy them? I'd buy them. I'd at least buy the prints of them.
Jillian elaborated on her design choice:
The years on each piece are when they came to America, which is when I was introduced to them in my life, and the textures were meant to make it look more "vintage" or as if they were printed on canvas already.
And she promises there are more designs — like the Wii! — to come.
Nintendo Series [Jillian Kristen via Moon 83]


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This is not an offer for credit and should be used for estimation purposes only based on the information you provided. You should not base your decision on this estimate alone. Title, registration, tax and other fees, and personal circumstances such as employment status and personal credit history, were not considered in the calculations.
Front - Dual Ventilated Hydraulic Disc
Rear - Single Ventilated Hydraulic Disc
Front - AT26 x 9 - 10 Radial
Rear - AT26 x 11 - 12 Radial
4WD with Locking Differential - L H N R
Final - Shaft Drive
Front Rack - 44 lb.
Rear Rack - 77 lb.
Dark Green
Bahama Blue


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Happiness, Homelessness, FOBTs & Funding: Highlights of a recent conference
Excessive gambling: Prevention and Harm Reduction, a conference held at the University of Neuchâtel, Switzerland, 15th to 17 January 2014.
Conference Highlights and Questions Arising
Should gambling prevention, treatment and research be funded directly from the National Lottery?
This was a rare European gambling conference not directly funded by the gambling industry. It was organised by the Centre du Jeu Excessif (Centre for Excessive Gambling) which is located in Lausanne and which, interestingly enough, is funded out of a 0.5% share of the profits of the Swiss national lottery. This immediately makes one wonder why such a thing doesn't happen in Britain. It would surely be appropriate if one of the 'good causes' funded by the National Lottery was problem gambling prevention, treatment and research. That also happens in some states in the USA. It was timely to hold the gambling conference in Switzerland since new Swiss gambling legislation is being drafted right now. Swiss gambling regulation is quite tight; for example, gambling machines have been confined to casinos since 2005. It will be interesting to see if their new law maintains present controls or moves in the direction of lifting some of the existing restraints.
Are FOBTs just the British variant of a global move to circumvent local laws that restrict the dangers of EGMs?
There were speakers at the conference from all over Europe as well as from Russia, Australia, Canada and the USA. Several of the keynote speakers had interesting things to say about electronic gambling machines (EGMs). Robert Williams from the USA referred to the comparatively high concentration of EGMs in Europe compared to the USA; but he thought the problems that can so easily be associated with EGMs had been kept down by severely limiting maximum sizes of stakes and prizes. Ralph Lattimore, from the Australian Productivity Committee (which has produced, in 1999 and 2010, two of the most comprehensive reviews of the costs and benefits of gambling), used the expression 'high powered' to refer to EGMs that get round such limits in one way or another, for example the 'pokie' machines in Australia which allow multi-line, multi-credit staking, which accounts for the problems EGMs have caused there. The Productivity Committee in its 2010 report recommended mandatory pre-commitment, but the social clubs, where many of the pokies are situated, spent 20 million Australian dollars lobbying against the proposal and it has not happened. A prominent German gambling researcher, Gerhard Meyer, told me that in his country the stake and prize limits are circumvented by allowing winnings to be 'paid' in the form of points exchangeable for money. This helps put the British experience of Fixed Odds Betting Terminals (FOBTs) into wider international context. It makes it clear that the FOBTs are just the British variant of a global move to circumvent local laws that restrict the dangers of EGMs. Neither multi-line, multi-credit staking nor exchange of points for money are allowed under British regulations, but casino-style machine gambling with high stakes was allowed to creep in via a loophole in British regulations.
Jörg Häfeli, a Swiss contributor to the conference, addressed the important question of whether some forms of gambling are more dangerous than others. It is odd that, although everyone recognises that some forms of gambling such as the National Lottery are less dangerous, and other forms such as casino table games more so, we have nothing for gambling similar to the Class A, B, C system which is central to British regulation of drug supply and consumption. Or perhaps we do. Jörg reviewed three systems that have been proposed for suggesting how dangerous a form of gambling might be – the Veikkaus Ray, GAM-GARD, and ASTERIG models. They have a lot in common, each including stake and prize sizes, speed of play, and 'near misses' as signs of danger. FOBTs would clearly have been identified as dangerous if, 10 to 15 years ago, such a warning system had been in place.
Analysis of the 'happiness question' in the 2010 British Gambling Prevalence Survey suggests 1) that people with gambling problems are as unhappy as those suffering from a serious illness such as cancer, and 2) that the threshold for defining a gambling problem is being set too high.
Professor David Forrest from the University of Salford gave a fascinating run down of results he has produced by analysing the single 'happiness question' included in the 2010 British Gambling Prevalence Survey. Such a question, asking people to rate how happy they would say they were 'these days' on a scale from 1 to 10, has become very popular for inclusion in population surveys, so there is a lot of comparative data. I admit I was sceptical about such an apparently simple question, but David's results convinced me there may be something in it. What he finds is that scoring as having a gambling problem on the PGSI (Problem Gambling Severity Index) was associated with the same degree of unhappiness as suffering from a serious illness such as cancer. This was the case even after allowing for a number of socio-demographic factors and alcohol and tobacco consumption.
Furthermore, having a somewhat lower PGSI score, but one which suggested that gambling was at a 'moderate risk' level, was also associated with significant unhappiness, roughly equivalent to being unemployed. The latter finding led him to suggest that the threshold for defining a gambling problem on the PGSI is currently being set too high (at 8 plus). If it was reduced (to 5 plus) to include the 'moderate risk' group, as he and others, such as Robert Williams from the USA, believe it should, this would immediately double the estimate of adults experiencing problems with their gambling according to the results of the 2010 British Gambling Prevalence Survey.
In addition to the above, those who said Yes to the question asking whether any close relative or partner had had a gambling problem in the last 12 months also indicated significant unhappiness.
It is only fair to add that those who said they had gambled, but who scored zero on the PGSI, the largest group in the survey, indicated that they were happier than non-gamblers. That was significantly so for men gamblers in general and specifically for women bingo players. Assuming of course that happiness is the goal we should all be striving for, and that Government should be using policy to promote it, these findings, if valid and replicable, do focus our minds on whether gambling policy should be favouring moderate happiness for some at the expense of much unhappiness for others.
The first study of the prevalence of gambling problems among homeless people in Britain suggests that more than one in ten homeless people may have gambling problems
Steve Sharman spoke about his research on the prevalence of gambling problems among homeless people in one area of London. This is the first such study to be carried out in Britain and only, he believed, the fourth to have been conducted anywhere. Over 400 people using services for homeless people in the Westminster Council area were interviewed about gambling by their keyworkers. Problem gambling prevalence was found to be 11.4%. This is a very high figure, and it was higher still amongst rough sleepers compared to those living in hostel accommodation.If more than one in ten homeless people have gambling as a problem, additional to their homelessness, this represents a large group who would have been completely missed by the British Gambling Prevalence and English and Scottish Health Surveys, and whose gambling problems are probably being missed by homelessness services most of the time.
People in this conversation
Comments (3)
Dear Jim
Thank you for your report! I could'nt attend this conference so I am pleased to read you! (too bas, I could have had, for once, the pleasure to present in French! )
Gambling problem among homeless people is mostly interesting, I plan to investigate that topic. One of the challenge of such a research is that, here in Québec, after what we call the de-institutionalization, people who have mental health problems are over represented among homeless people.
Thanks for your website, I will share with my "community of practice" on gambling!
Elisabeth Papineau
I myself am a passionate gambler who dabbles in poker (for a long term online profit) and the odd horse race where I go to have fun. Not win money. Although whether I've lost money or not would be debatable, there are no online statistics to measure it.
But when I go in the bookies and see these folk pouring their money into these FOBT's I feel sick to the stomach. The only people on these machines are people that are clearly hard up on cash or are getting so high and absorbed in their fixed roulette that they can't stand still. With my local bookies closest to the cheap high rise flats and emergency housing it is the more deprived customers who generally come in and I gather most vulnerable.
The FOBT's cost many in there lots but so too the virtual horses, all of these things should be outlawed.
Britain is a disgrace now ,, bombarded with gambling adverts on tv all the time, bookies opening everywhere taking over our once nice high streets. These machines have created a monster amount of people men and women addicts . The government knows there's a huge problem , but they are not interested in you or I . We are creating a future of gambling addictions , it's disgusting .


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LOS ANGELES - Hollywood is known for snatching up best-selling books and turning them into big-screen blockbusters: "Twilight," `'Harry Potter," `'The Hunger Games," `'The Help" and countless others.
But the adaptations hitting theaters this week didn't need a novel's characters or built-in narrative, just a well-known brand name.
The must-read pregnancy manual "What to Expect When You're Expecting" has become an all-star comedy romp about the pitfalls of new parenthood. The book is full of helpful advice, "but it's almost like a medical manual," said Shauna Cross, who co-wrote the screenplay. "That's not that entertaining to go and watch."
So the cinematic version, opening Friday, stars Jennifer Lopez, Cameron Diaz, Chris Rock, Elizabeth Banks, Dennis Quaid and others in intertwining tales about various experiences of pregnancy, from infertility and miscarriage to trouble-free twins.
Also opening Friday is "Battleship," an action flick inspired by the 45-year-old board game starring Taylor Kitsch, Liam Neeson, Brooklyn Decker and Rihanna. Based on finding a hidden enemy by searching coordinates on a grid, the classic game may be best known to some readers by an old TV commercial in which an exasperated player proclaims, "You sank my battleship!" The film, set during a war games exercise on the Pacific Ocean, shows how the U.S. Navy might respond to an alien attack at sea.
"There are certain elements from the board game that lent themselves well to the DNA of a movie," said director Pete Berg. "Two enemies trying to locate and kill each other violently is, good god, a movie... The rest is classic creative endeavor."
Coming up with characters and narratives around popular brands that intrinsically have neither one has become business as usual in Hollywood.
"With movies costing so much, studios are looking for any kind of a hook that would ring a bell with an audience," said veteran film critic Kenneth Turan, who writes for the Los Angeles Times. "It's the same reason why they have all the sequels and things from TV shows and remakes: They're desperate to ring that bell."
Still, seizing on a popular brand doesn't guarantee a successful film.
The 1985 film version of the board game "Clue" flopped (though it later gained a cult following). But "Transformers," based on Hasbro's shape-shifting robot toys, became a multi-billion-dollar global franchise.
Berg said turning "Battleship" into a movie "was one of the great and really fun creative challenges of my career." The film has collected $215 million so far overseas, where it has been open for nearly five weeks.
As with "Battleship," adapting advice books such as "What to Expect When You're Expecting" and Steve Harvey's 2009 dating guide, "Act Like a Lady, Think Like a Man," requires writers to develop characters and story lines that aren't in the books.
"Think Like a Man," which topped the box office for two weeks when it was released last month, successfully spun Harvey's book into a romantic comedy following five couples navigating their relationship issues.
"One of the main challenges of an adaptation like this is the book already has a loyal following," said producer Will Packer. "All you can really do is mess it up. It's very tough to elevate it and take it beyond."
The appeal of tapping such a successful book as source material is, of course, that it "potentially has a built-in audience," Packer said. "It helps you cut through the clutter in a very, very crowded marketplace in terms of the outlets and mediums trying to get attention from consumers."
Still, those who relied on "What to Expect" during their pregnancies won't really find the book's advice on screen.
"It's the source material we wanted to include, but there's so little there that was actually used," said Heather Hach, who co-wrote the screenplay. "It's not an adaptation in the truest sense, but without this wonderful pregnancy bible that countless women have consulted, the germ wouldn't have been there."
Director Kirk Jones said that while some have called adapting the pregnancy handbook "desperate," anticipating a baby is a naturally funny experience.
"Just stop and look beyond the manual and think about pregnancy and that nine-month period: It affects guys and it affects girls in the most extraordinary ways," he said. "It was really just taking the essence of the book... You're basically enhancing the brand, because people are already familiar with the title."
The book's author, Heidi Murkoff, is one of the film's executive producers. Hasbro's president and chief executive, Brian Goldner, is a producer of "Battleship."
Hach said guidebooks are great for adapting into movies: "What's interesting about advice books is there are so many ways to tackle a problem. There are so many ways to think about a situation, and that's what our characters are doing."
Turan, the film critic, expects the trend to continue, whether or not the results are worthy.
"This is not about making good movies. It's about getting people into theaters... Everything else is secondary," he said. "They might make a movie out of Scrabble."


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Morehead City Mayor Jerry Jones was disappointed to see that the first reaction to a proposed wood pellet-handling facility at the state port in Morehead City was a negative one.
MOREHEAD CITY � Morehead City Mayor Jerry Jones was disappointed to see that the first reaction to a proposed wood pellet-handling facility at the state port in Morehead City was a negative one.
�It is our community and we have to be careful how we develop it, but that doesn�t mean we have to shut the door on all proposals,� Jones said.
The N.C. State Ports Authority has proposed to build facilities to handle wood pellets made from Eastern North Carolina timber resources and shipped to Europe, where utility companies are moving away from burning coal. The ports authority board has approved $5 million for the design of the Morehead City facility, which they want to see operational by January 2014.
Public protest scuttled plans for a sulfur smelter proposed for the port a year ago due to concerns about health and safety hazards and impacts on local tourism.
That project wasn�t a compatible one with the town.
Jones sees the wood pellet project in a different light.
�Our port is not a manufacturing port. It is a shipping and receiving port and I think the wood pellet facility fits in that category,� he said.
The town council adopted a resolution at its Nov. 13 meeting that notes the potential benefits of the project but goes beyond that to express overall support for the port at Morehead City.
Jones said the town was founded around the port and the railroad and the state port in Morehead City has been a vital part of the local, state and regional economy for more than 150 years.
�I don�t think people realize the role the port plays, not only in our local economy, but the state economy as well,� he said.
Outside of shipping activity that supports jobs and benefits partner industries, Jones said having the port provides a deep dredged channel that supports fishing and tourism industries as well as port shipping.
�The Town of Morehead City supports the efforts of the North Carolina State Ports Authority to maintain and expand a dynamic port and its efforts to increase the positive economic benefits for eastern North Carolina and its efforts to do so in an environmentally sustainable fashion,� the resolution states.
The town sent copies of the resolution to the county and other municipalities in the area, including Swansboro and Havelock, which are part of the Crystal Coast Mayors Association. Jones said they�ve made the resolution available if there are others who would like to adopt ones like it.
Swansboro commissioners adopted the resolution at their November board meeting.
Contact Daily News reporter Jannette Pippin at 910-382-2557 or email@example.com.